Health and Care Bill

Baroness Merron Excerpts

Committee stage
Wednesday 9th February 2022 Lords Chamber

[Baroness Walmsley (LD)]

My Lords, I hope the Government Chief Whip will send the memo round.

Last Tuesday, my noble friend Lady Barker introduced a Question for Short Debate about ambulance response times. In introducing the debate, she looked behind the distressing headlines about people with life-threatening illnesses waiting too long, sometimes fatally, for an ambulance. She outlined the underlying factors important in identifying the problems and solutions for our ambulance services.

The NHS has set out national targets for a seven-minute average response time for life-threatening incidents. However, the average has been rising and was over nine minutes in December 2021. Targets for less serious incidents have also been rising. This amendment would put in place just one of the potential solutions to the ambulance crisis, which my noble friends Lady Barker, Lady Brinton and Lord Scriven referred to in that debate. It would set up a system for ambulance trusts to collect data about ambulance response times by integrated care system and by postcode. They would also have to publish information about where response targets were missed. In any situation that requires corrective action, it is vital that we know where we are starting from, and transparent and detailed data collection and publication does exactly that.

During the debate, my noble friend Lord Scriven suggested that in order to understand why ambulance services are so hard-pressed, we need to look up the line to primary care services. He was, of course, correct: many urgent cases occur because patients have been unable to get a GP appointment, despite the fact that GPs tell us they are now carrying out more consultations than ever through triage telephone consultations.

The problem is caused by the shortage of GPs, particularly in some areas. We have been promised 5,000 more GPs but that has not been achieved. My noble friend also mentioned the lack of community mental health services, and in some cases the almost complete absence of child and adolescent mental health services that often lead to a mental health crisis resulting in the patient calling an ambulance.

Another major issue is caused by problems downstream. Paramedics have to wait outside hospitals to hand over their patients to A&E staff, meaning that they cannot go out to another case. It is incredibly frustrating and demoralising for them. Sometimes paramedics have to leave a serious case in the hands of a family member in order to go to an even more serious case elsewhere. It is well known why ambulances are piling up outside A&E: there are no free beds because the patients already inside cannot be transferred to a bed in the main hospital or discharged. The main hospital cannot discharge patients because of the lack of social care elsewhere, and so it rolls on. These delayed transfers of care are the result of serial underfunding of social care and poor workforce planning. The problems are both upstream and downstream, but we cannot solve all those with one amendment. However, I hope the Minister will accept that collecting and publishing data on a very detailed basis will at least help.

The detail is important. During the debate my noble friends referred to the fact that there is enormous regional variation in ambulance response times. My honourable friend Helen Morgan, MP for Shropshire North, collected a worrying set of data in her very rural area, where four ambulance hubs have recently been closed. Her constituents are rightly horrified about this. Ambulance services in Cornwall have also recently shown unacceptably long waiting times, even for category 1 cases where lives are at stake.

Collecting the data referred to in this amendment would certainly help to identify the specific issues in areas such as these so that action can be taken. It may be harder to serve very rural areas, but residents in those areas deserve as good a service as anyone else. Better data plus better workforce planning, which we are dealing with under another amendment, would ensure that the resources available are adequate to take account of geography and other factors. I beg to move.

[Baroness Merron (Lab)]

My Lords, I thank the noble Baroness, Lady Walmsley, for presenting this amendment. I too take the view that ambulance services play a significant role in our National Health Service, particularly in the redesign of care pathways to reduce pressure on hospitals and provide better care to patients. If that can be at the right time, in the right place, that produces the greatest benefits.

The amendment in the name of the noble Baroness, Lady Walmsley, sets out the case for a more rigorous and accessible reporting system for ambulance services on response times. As your Lordships’ House debated just last week, and as the Minister acknowledged, at present performance is below what is acceptable. I am pleased that under the amendment, the method for introducing regulations would be subject to proper review by Parliament. On the specifics, it is welcome that there is a requirement of the use of data already captured by ambulance control and dispatch systems, specifically requiring analysis by integrated care system area and by postcode. This would provide a valuable source of further evidence about inequalities in care provisions which would mean that it was possible to identify and address them.

On the proposed requirement for the recording of explanations for all incidents where the relevant response time target was missed, it would of course be important to ensure that any extra recording of data in an emergency care environment did not add to existing pressures. I look forward to the Minister’s response.

[Baroness Penn (Con)]

I thank the noble Baroness, Lady Walmsley, for bringing this short but important debate before the Committee.

The Government fully recognise the importance of ambulance response times and of patients receiving the help they need when they need it. Like other emergency care services in the NHS during the pandemic, ambulance trusts have come under significant pressure, answering almost a million 999 calls in December alone —an increase of 22% on the year before. That is why we have put significant support in place to help ambulance trusts at this time. I will not go into the detail, which we covered in the debate last week. Instead, I will respond to the specifics of the amendment.

It is the Government’s view that it is right that reporting happens at the level of ambulance trust region. Trusts are commissioned to meet response time targets at a regional level, not at a more granular part of their operating area such as postcode or integrated care board area. It is inevitable that there will be variations in response times within regional footprints from month to month. However, the existing ambulance response time standards already include a mechanism to performance-manage significant variation or long waits for ambulances. All ambulance response time categories include a 90th centile response time standard to measure the “tail” of ambulance response times. This means that trusts are measured on the response to every call they receive and cannot favour some parts of their region over others to game response time targets. Reporting response times down to a postcode level would require a massive expansion to existing reporting that would not be reasonably deliverable.

I also reassure noble Lords that the service transparently provides clinical outcomes data. These indicators were introduced in 2011 and provide detailed information on clinical outcomes for cardiac arrest, heart attack, sepsis and stroke patients. While the Government acknowledge the challenges to ambulance response times and are working hard to address them, for the reasons I set out, I hope the noble Baroness feels able to withdraw her amendment.

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The amendments in this group have been laid not to damage the objective of the HSSIB but to enable and protect it. I hope the Minister will be able to accept that and give us some reassurance in his response.

[Baroness Merron (Lab)]

My Lords, this has been a very detailed debate and has explored what is at the heart of the subject before us. It has focused very much on what it is to have a safe space—something to which I will return briefly. I want to thank my noble friend Lord Hunt for leading this group of amendments and I will not repeat the points he made so ably in setting them out. As the noble Baroness, Lady Walmsley, said, I hope the Minister will take these amendments in the spirit they are intended. Clearly, they have been very carefully crafted and debated in order to improve this section of the Bill, and I believe that they are very worthy of merit.

We on these Benches also support the development of a culture where staff feel able to speak up about mistakes without a presumption of blame. Since its creation, the work of the HSIB has placed an important focus on learning and improvement when things have gone wrong. However, there must be a balance with the need for appropriate accountability and redress, for the public to be protected from unsafe practices and practitioners, and for public confidence in the system to be maintained.

This debate has been rightly supportive of the HSSIB, its mission and the concept of safe spaces—on that I think there is agreement. There is also agreement that it must be independent to be effective and trusted. However, following this debate, it seems that there is much work to be done by the Government on reviewing where, and to whom, disclosure of information can be made. Although the debate has expressed agreement that it is not appropriate for coroners, with their adversarial role, to have such access—and I share this view—there is a finely balanced debate about the issue of the ombudsman. As the noble Lord, Lord Kakkar, said, this is complex—which I think is something of an understatement. The debate reflects the reality of the world in which the HSSIB seeks to improve the delivery of service.

The noble Baroness, Lady Neuberger, and the noble and learned Lord, Lord Etherton, have put forward their view that the ombudsman needs to be able to investigate robustly. I am sure there is agreement on that. I am sure the difficulty that the Minister will want to unpick as she takes away the views of your Lordships’ Committee today is how it will be possible to allow the ombudsman to do its job and yet retain safe spaces. As the noble Lord, Lord Patel, said, it is so important to give confidence to professionals that they can contribute to the investigations into systems failure.

I say to the Minister that I hope there will be a close examination of all the points put forward in today’s debate. I feel that by further investigation into and thought about the points that noble Lords have made, this part of the Bill can certainly be strengthened.

[Baroness Penn (Con)]

My Lords, I thank all noble Lords for this debate and reassure them not only that I have listened carefully to it but that the Government will of course again look carefully at the arguments made. As the Committee has heard, HSSIB is no ordinary investigatory body. It will look at systemic risks and focus on learning lessons. It is not about blame; it is about improving patient safety incidents across the system and making a real difference to patient safety.

The Government agree that the integrity of the safe space is paramount. Safe space conditions will encourage patients, families, NHS staff and other investigation participants to speak freely and candidly. Without guarantees that this information will not be shared, except in very limited circumstances, we risk eroding the confidence of all those participating in an investigation, potentially leading to information being withheld and reducing the effectiveness of the investigation.

I turn to Amendments 311, 311A and 312A. We have sought to strike a fine balance between protecting safe space and acknowledging the need for very limited exceptions. We have allowed senior coroners to have access to information from the HSSIB, but only when it is appropriate and necessary for them to fulfil their judicial functions, and not to disclose onwards without further protections in place. Where the HSSIB has information about a death which the coroner is investigating, we need to ensure that the coroner’s judicial role is not undermined and that they have accurate and clear information. It does not mean that the coroner will have complete access to safe space information—far from it—nor that they will be able to automatically share this information. We have drafted provisions so that this does not happen. It is an intentionally limited and contained exemption.

Regarding Amendment 311, the Bill’s provisions are likely to have a very limited impact on the Parliamentary and Health Service Ombudsman’s ability to fulfil its important independent role of investigating complaints, given that it will still be able to use its existing powers to obtain material directly from the same primary sources. It will often not be investigating the same incidents as the HSSIB, as we have heard in Committee. If the PHSO felt it needed to access protected material held by the HSSIB, it could apply to the High Court. We do not envisage this being a common occurrence, as the HSSIB’s purpose will be very different from that of the PHSO. However, it means that the PHSO does have a way to gain access to protected information in certain circumstances.

We are committed to monitoring the impact that the safe space provisions may have on the PHSO’s ability to carry out its functions. We shall report to the House of Commons Public Administration and Constitutional Affairs Committee on this issue within 12 months of the HSSIB being fully operational, which we expect to be 12 months after the Bill gains Royal Assent.

A number of amendments relate to the role of the Secretary of State in relation to the HSSIB. We believe it is appropriate that the Secretary of State can direct the HSSIB to investigate particular qualifying incidents. This is an important tool available to the Secretary of State, which enables him and the HSSIB to respond to emerging or ongoing patient safety issues, which may arise at any time. It would therefore not be appropriate or prudent to limit the Secretary of State’s ability to direct the HSSIB to the first 18 months of its operation.

More importantly, the Secretary of State would not be able to direct the HSSIB on how to conduct a particular investigation. Clause 115 rightly allows the Secretary of State to intervene if

“the HSSIB is failing or has failed to exercise any of its functions, and … the failure is significant.”

The Secretary of State is accountable to Parliament for the HSSIB’s performance, and it is in the public’s best interests that the HSSIB functions effectively.

I turn to Amendments 310A and 310B. Given the broad scope of the HSSIB’s investigation function, some flexibility is needed so that the Secretary of State can set out additional circumstances when the prohibition on disclosure—safe space—does not apply. It is vital that the HSSIB can adapt as clinical and record-keeping practices change on the front line and practice evolves. This power is about future-proofing and continuous improvement, not eroding safe space.

On Amendments 308A and 309, I understand the importance of the HSSIB having predictable budgets for planning, but requiring a three-year budget would cut across the established processes of spending reviews and put it out of step with the confirmation and allocation of budgets across government and other arm’s- length bodies.

Turning to Amendment 310, I reassure noble Lords that the HSSIB’s reports will be published. Organisations will generally be required to respond to the HSSIB’s recommendations and it may publish these responses. In some cases—for example, an investigation into a private provider—it would not be appropriate for the Secretary of State to publish an additional report.

I turn to Amendment 308. In line with the Cabinet Office’s Governance Code on Public Appointments, the chair of the HSSIB will undergo pre-appointment scrutiny by the Health and Social Care Committee. However, the appointment of the chief investigator, which is not a public appointment, will be undertaken directly by the non-executive members of the HSSIB, including the chair, with the consent of the Secretary of State. We believe that this strikes the right balance between scrutiny, accountability and operational independence, without compromising the effectiveness of the board.

Finally, I turn to Amendment 309A. Whistleblowing is a distinct legal concept, with an existing legislative framework to ensure that whistleblowers are protected. The purpose of the HSSIB’s investigations is to identify risks to the safety of patients and address them by facilitating the improvement of systems and practices in the provision of healthcare services in England. A disclosure to the HSSIB concerning patient safety is complementary to but distinct from whistleblowing, so it is right that it should sit outside that legal framework.

However, I reassure the noble Baroness, Lady Kramer, that information shared with the HSSIB to alert it to a patient safety issue will be protected by the safe space provisions if it fulfils the definition of protected material. If, as mentioned in the amendment, a concern is raised that conduct is illegal, we would expect it to be raised with an appropriate person. Similarly, concerns relating to unethical conduct would not be best dealt with solely by the HSSIB. This amendment would risk blurring the lines with other organisations which may be better placed to deal with such matters.

I suspect that I have not given noble Lords as much reassurance as they would like in order not to return to this issue, but I hope I have given them enough that they feel able withdraw or not move their amendments at this time.

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[Baroness Walmsley (LD)]

My Lords, I added my name to Amendments 229 and 230 from the noble Lord, Lord Patel, to limit the Secretary of State’s powers in Part 3 of the Bill to transfer or delegate functions. Part 3 as it stands would give the Secretary of State a wide range of powers to abolish or modify the functions of a body without primary legislation. That goes to the heart of the matter. I share the concerns of the Constitution Committee. In the absence of proper parliamentary scrutiny, it is necessary to narrow the scope of these powers. To this end, the two amendments would remove from scope the power to abolish a function of the body, the power to change the purpose or objective of a body and the power to change the conditions under which the body works.

The amendments go to the heart of what the Government are trying to do in Part 3. We will come to the wholesale removal of Part 3 in the next group but, for now, will the Minister explain why these powers are needed, why they need to be so broad in scope and why the Government are so frightened of Parliament that they do not want to give Peers and MPs an opportunity to make a judgment on their justification? It would be helpful if the Minister could say how it is anticipated these powers will be used. Give us some examples, please.

I also support Amendment 318 in the name of the noble Lord, Lord Warner. The Minister may recall that at Second Reading and at the beginning of Committee stage, five exhausting weeks ago, I expressed similar concerns about the ability of the NHS to cope with this wholesale reorganisation at this time. The NHS has been in crisis for the last two years and the noble Lord, Lord Warner, has laid out clearly the extent of the backlog—as far as any of us know about it. There is a big difference between 30% and 80%. The Secretary of State himself makes it clear that he knows that the backlog will go up before it comes down again. We have what we call “the dark backlog”; we do not know how many people are going to come forward.

There is also the issue of the pre-emption of Parliament, as the noble Lord, Lord Warner, suggested. A lot of these bodies have been set up and we do not know whether Treasury rules have been broken by the expenditure of money in their setting up. Perhaps questions will be asked about that. I hope that the Minister will bear in mind what the noble Lord, Lord Warner, said in conclusion. The amendment is not intended to destroy the Bill, but to delay it to a point when the NHS can cope with it, without damage to patients.

[Baroness Merron (Lab)]

My Lords, this is a mixed group of amendments and it has been extremely helpful to hear from noble Lords about the various aspects. I thank the noble Lord, Lord Clement-Jones, for introducing the group.

Amendment 227 is about the powers to merge NHS Digital and NHSX into the new transformation directorate of NHS England. It would also allow the health and social care information centre to be swept up in the changes. This amounts to the abolition of the health and social care information centre and I look forward to hearing from the Minister about the implications for the integrity of patient data and what safeguards might be applied.

I draw the Minister’s attention to the article in the Health Service Journal on 8 February entitled “Revealed: How NHSE’s New Transformation Directorate Will Operate”. It sets out how this new transformation directorate will function and how all the appointments have already been made despite Parliament having not yet completed its deliberations. It would be helpful to hear from the Minister on this point.

Amendment 228 modifies the power to transfer functions. It has already been argued that this power function should not be given so lightly. The amendment emphasises that point.

In the previous debate, we heard some excellent contributions about patient data and the need for safeguards but also about the need for public confidence in the systems, process and governance. It is far from clear that the changes to allow the Secretary of State to take powers in this complex and contested territory are at all wise.

I thank the noble Lord, Lord Patel, for Amendments 229 and 230, which seek to limit the scope of the powers of the Secretary of State. Since we continue to oppose these additional powers of the Secretary of State altogether, we certainly acknowledge the need to limit that scope, as defined within the amendments.

Amendment 318 is in the name of the noble Lord, Lord Warner, who has set out the scale and the reality of the challenge of waiting lists and how that affects the wisdom or otherwise of the Bill and its timing. I emphasise that we are now talking about reducing numbers on a waiting list to below 1 million, but that is not only due to Covid. The NHS went into the pandemic crisis of waiting lists with a pre-existing crisis of its own. It is important that the Minister addresses the fact that this has been going on for some time. Just how long it will really take for the recent recovery plan to reduce the length of the waiting lists for hospital treatment below 1 million is far from clear. As we have heard, this amendment rightly highlights the points about the pre-emption of Parliament and the fact, which we have raised on several occasions, in the Chamber and in meetings, that appointments have already been made ahead of Parliament coming to a conclusion. That remains a matter of concern, as the Minister is well aware.

The remaining amendments in this miscellaneous group are those from the Government, which are consequential on obligations and relations with the devolved Administrations. We were advised by the Minister that these would be forthcoming, somewhat late on in consideration of the Bill. We thank the Minister for advising us, but we cannot support these amendments as our position relates to the original clauses to which they relate, as they are not ones with which we find favour. I hope that the Minister will reflect and respond on the points raised in this debate.

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This is part of a group that would remove part 3 from the Bill. It would prevent the following bodies being abolished: Health Education England, Health and Social Care Information Centre, Health Research Authority, Human Fertilisation and Embryology Authority, Human Tissue Authority.

[Baroness Merron (Lab)]

My Lords, Part 3 of the Bill has seven clauses: Clauses 88 to 94. This group of amendments seeks to oppose each of them and has been tabled in the name of my noble friend Lady Thornton. The title of Part 3 is:

“Secretary of State’s Powers to Transfer or Delegate Functions”.


It puts into legislation what is proposed in the Integration and Innovation White Paper, which was justified by reference to the need to be able to respond rapidly and —once again, we see this word—flexibly.

It is a fair observation that the existence of multiple arm’s-length bodies is a side-effect of the more modern NHS, as we see more distancing from government. Some of them have worked better than others and, of course, some are listed specifically in the Bill. So the question for the Minister is: why does the Secretary of State need the broad powers outlined in the Bill to intervene in the running of these arm’s-length bodies, and why now? In the White Paper, in Committee in the other place and since, nothing has come forward to explain why giving even more powers in this way can be justified, so it would be most helpful if the Minister could illustrate what would happen were these powers not granted to the Secretary of State.

Of course, there is a danger here. If the arm’s-length bodies know that they are subject to these powers, they will inevitably become a lot less arm’s-length and less able to fulfil the functions for which they have been established. I venture to suggest that this is about consolidation of power at the top while pushing accountability down or further away, and I would welcome the Minister’s observations on this.

Throughout the deliberations of this Committee and the Committee in the other place, numerous concerns have been expressed about giving greater powers to the Secretary of State. Unless a compelling case is made and appropriate safeguards built in, I believe it is right that we oppose these clauses standing part of the Bill. I beg to move.

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[Lord Kamall (Con)]

I thank both noble Baronesses for bringing this debate before the Committee. The proposal is to remove Part 3 of the Bill entirely. I understand that the noble Baronesses are principally concerned to prevent Health Education England, NHS Digital, the Health Research Authority and the Human Fertilisation and Embryology Authority from being abolished as a consequence of this power.

I clearly understand the concerns in this debate, but I stress that this is not a power to take away services currently being performed by arm’s-length bodies. The power is to enable the transfer of functions between arm’s-length bodies, and the delegation of the Secretary of State’s functions to arm’s-length bodies, to improve consistency and coherence in the arm’s-length body landscape. There is no free-standing power simply to abolish an arm’s-length body contained in this clause, and it is not the Government’s primary intention to use this power to abolish bodies. The only circumstances where a body may be abolished under this power is where it is, as the result of transfers of its functions to other bodies, effectively rendered redundant. To not have the power to abolish such bodies in these circumstances would effectively leave shell arm’s-length bodies with no significant functions, which would weaken the efficiencies we are seeking to create.

I reassure the noble Baronesses that all proposals will be considered through a full and extensive engagement and consultation process. Regulations providing for transfers under this power will be subject to the affirmative procedure. This ensures that Parliament can scrutinise the use of this power, including any necessary amendments made to primary legislation. This would follow on from a consultation with the relevant parties.

The Secretary of State must, at a minimum, consult the arm’s-length bodies and devolved Governments to which the transfer relates. Additional stakeholders whom it may be appropriate to consult will vary depending on the nature of the transfer of functions contemplated. The Bill therefore provides that such other persons as the Secretary of State considers appropriate should also be consulted, which is in line with the department’s and the Government’s commitment to engaging with stakeholders.

We have set out the principles of engagement and consultation with the devolved Governments through a memorandum of understanding, which has been negotiated and is close to agreement. This will sit along- side the legislation and provide the opportunity for the devolved Governments to be involved at a formative stage of policy development. In addition, the principle of Amendment 231C, which we have just discussed, is a requirement for the relevant devolved Governments’ consent to be given to transfer any functions that are within their legislative competence or that modify functions exercised by the devolved Government.

Although the majority of the arm’s-length bodies and functions within the scope of the power relate to reserved matters or apply in England only, certain bodies have functions that meet the criteria laid out above. We all know that the arm’s-length body landscape is complex, and this power will ensure that there is a transparent process throughout, including formal consultation, so that any relevant arm’s-length bodies and devolved Governments, and Parliament, will have the opportunity to scrutinise any plans for its use. I hope that that has given some assurance, and for these reasons I ask the noble Baroness to withdraw her opposition to the clause standing part.

[Baroness Merron (Lab)]

I thank the Minister for his reply and the reference to parliamentary scrutiny. He will know that, in discussions in this Committee, the call for transparency and scrutiny has often been repeated. I am interested in the reassurances that the Minister has given and will consider his points further. I am sure that he understands that there is a feeling that these powers are still not necessary—not now—but I will certainly consider his points. With that, I beg leave to withdraw my opposition to Clause 88 standing part.

Clause 88, as amended, agreed.

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[Baroness Barker (LD)]

My Lords, very briefly in view of the early hour, I wish to join others in welcoming this amendment and thanking the Minister for taking notice of what the noble Baroness, Lady Sugg, chair of All-Party Parliamentary Group on Population, Development and Reproductive Health, has done with other actors.

I want to make two points. First, the people who have brought the work to this point recognise that this practice, although rare, happens disproportionately within particular cultural and religious groups. I therefore ask the Minister whether the religious element of this will feature in the materials that are to be prepared.

Secondly, will FCDO staff learn lessons from the forced marriage legislation on how we spot young girls who are particularly vulnerable to this and particularly at risk of being taken abroad? Can I make the assumption that, were any medical practitioner registered in the United Kingdom to be found performing these operations abroad, they would still be dealt with by the medical authorities in this country when that came to light?

[Baroness Merron (Lab)]

My Lords, I am very glad that the Government have heeded the calls of victims and experts alike to make hymenoplasty a criminal offence, along with virginity testing. As we have heard repeatedly both this evening and in the course of campaigning for this, the two practices are inextricably linked. It is right that those who carry out or facilitate these practices should face justice and that no woman or girl should have to suffer these abusive, intrusive and medically unsound practices. This legislation will send the strongest of messages and I am very glad that education will underpin it.

Of course, the fight to end violence against women and girls is not over, but it has taken a step forward in this measure. I add my thanks to all those who have campaigned tirelessly on this, as outlined by the noble Baroness, Lady Sugg. I thank the noble Baroness, the noble Lord, Lord Patel, and others for all they have done in your Lordships’ House to bring this forward. This is a positive point on which to bring our deliberations in Committee to a close. I very much welcome this move.

[Baroness Penn (Con)]

My Lords, I thank noble Lords for the short but constructive debate on these amendments. I add my thanks to the noble Lord, Lord Patel, for his support on this issue.

My noble friend Lady Sugg asked about the other recommendations in the panel’s report. Of course, the amendments brought forward today satisfy many of the recommendations made in the final report, including: prohibiting the advertising of hymenoplasty; the inclusion of extraterritorial jurisdiction; ensuring that women will not be criminalised for undergoing hymenoplasty; and that there should be no defence or exemption for a healthcare professional or anyone to carry out hymenoplasty. The Government are carefully considering the panel’s remaining recommendations and will provide an update on this in due course.

There were also a number of questions about implementation. Guidance will be produced alongside these offences coming into force. It will make clear that hymenoplasty is a form of violence against women and girls and lay the framework for how it can be prevented and, when it has taken place, reported. While the details of the guidance are being carefully considered, I can say that it will focus on how the Government, local authorities, social services, the police, education providers and third-sector organisations and community groups can work together to effectively safeguard women and girls.

A number of other specific points were raised, such as whether the FCDO can learn from legislation relating to forced marriage and measures to spot girls who are at risk, the religious element which may feature within this, and UK-registered practitioners conducting these practices abroad. I suggest I write to noble Lords with further detail in response to those questions.