HIV Action Plan

Baroness Merron Excerpts

Monday 18th October 2021 Lords Chamber

[Lord Kamall (Con)]

As noble Lords will have seen, there is agreement with the noble Lord’s point. As part of the Government’s commitment to reaching zero new HIV transmissions in England by 2030, the department is currently developing a new sexual and reproductive health strategy and an HIV action plan. Officials will continue to engage in discussions with the Department for Education during the development of these publications to relate them to how HIV is covered in the statutory curriculum in schools and as part of the intimate and sexual relationships lessons under personal health and social education.

[Baroness Merron (Lab)]

My Lords, HIV can affect anyone, as we know. Despite the success in combating it, further reducing the number of people who remain undiagnosed with HIV will become very challenging unless testing uptake is improved, as my noble friend Lord Cashman said. This is particularly the case for heterosexuals who do not consider themselves at risk of HIV. What assessment has the Minister made of why people who visit a sexual health clinic may leave without testing for HIV? Will he make it a priority to ensure that all those attending sexual health clinics are offered, and encouraged to accept, an HIV test?

Virginity Testing

Baroness Merron Excerpts

Tuesday 12th October 2021 Lords Chamber

[Lord Kamall (Con)]

I thank my noble friend for that question. I think we all agree, as he said, that conversion therapy is an awful practice and should be outlawed. The Government have made a commitment to outlaw it. There is an interesting thing, when we talk about the history of various commitments from the Front Bench and whether they were implemented: around Christmas time, we often see advertisements saying, “A dog—or a puppy—is for life, not just for Christmas”. As we know, with ministerial life, it is the opposite: a ministerial portfolio is for Christmas, not for life. However, when I look back at my time, I would ask people to judge me on my actions.

[Baroness Merron (Lab)]

My Lords, I welcome the Minister to his place and wish him well. In addition to private examinations performed by gynaecologists and other medical professionals, campaigners report that victims are often subject to extremely crude examinations performed at home by family members, involving such means as inserting fingers into the vagina to check if the hymen is intact. What steps are the Government taking to tackle such hidden forms of abuse?

[Lord Kamall (Con)]

One issue we have to think about whenever we bring in any new law or ban is the unintended consequences. One unintended consequence that has been raised is that doing so might drive this practice not only into the home but underground. If we make it illegal, it is illegal; we must make sure that, when someone subjects a woman or girl to that awful experience, everyone knows it is illegal and that they will face the full force of the law.

Health: Type 2 Diabetes

Baroness Merron Excerpts

Tuesday 12th October 2021 Lords Chamber

[Lord Kamall (Con)]

I thank my noble friend. I have done my homework and I have read a little about what has been happening up to now, especially about the NHS diabetes prevention programme, which identifies those most at high risk of developing diabetes and refers them on to behavioural change programmes and personalised education to reduce their risk of developing diabetes, including things such as bespoke exercise programmes and learning about healthy eating and lifestyle. The programme achieved full national rollout in 2018 and 2019, with services available to patients in every system in England.

As we know, tackling diabetes is multifactorial. Nevertheless, the NHS long-term plan sets out plans for increased action on diabetes and related issues. I shall mention just a few, including the healthy weight strategy launched in July 2020 to help adults and children maintain a healthy weight, and the restrictions on the promotion and advertising of foods high in fat, sugar and salt, as was mentioned earlier. It is really important with programmes such as this that we look at these studies on a longitudinal basis and look at the evidence. Some of these programmes will work, and some will not. That is just the way the world is. We have to make sure that we tackle unintended consequences first of all, and that any future policy is very heavily based on evidence rather than a wish. That will be the most effective way of tackling diabetes.

[Baroness Merron (Lab)]

My Lords, the rise in diabetes means that millions of people are at risk of devastating complications, including heart attacks. In 2009, to improve heart health, checks were introduced for the over-40s. However, by 2019, only half of those invited actually received those checks, and the checks were paused during the pandemic. Does the Minister agree that it is vital that these preventive checks are relaunched, and will he commit to putting in place a plan to ensure that people are able and willing to attend them?

[Lord Kamall (Con)]

I do not think anyone will disagree on the importance of making sure that these checks are reinitiated, or on what is being put in place to make sure either that patients are able to continue with or that new patients can start some of these programmes. Also, as noble Lords can imagine, there has been better use of technology in all fields during the Covid lockdown. For example, the NHS used Facebook to reach millions of men aged 40 or over who were at risk of developing type 2 diabetes. We also know that, in some cases, there are online consultations between patients and medical experts. Of course, with better tools, such as remote monitoring and flash blood readers, it is important that information can reach clinicians and be reviewed remotely. But there is no substitute for face-to-face meetings, and we hope very much that many of these can be resumed as soon as possible.

Calorie Labelling (Out of Home Sector) (England) Regulations 2021

Baroness Merron Excerpts

Thursday 22nd July 2021 Lords Chamber

[Baroness Merron (Lab)]

My Lords, the need to tackle obesity and to support people in so doing is crucial to the health and well-being of individuals as well as the health and well-being of the nation. Excess weight directly impacts how well—and how long a life—we live, carrying a higher risk of heart disease, diabetes and cancer. It places limits on us at work, at home and in our social lives. It is a growing challenge that exacerbates inequalities. There are nearly three times as many hospital admissions due to obesity in the poorest communities as in the better-off.

It is demonstrably not the case that everyone knows how to manage their weight or that it is simply a matter of exercising a choice as to whether we do so or not. The challenge of maintaining a healthy weight and lifestyle requires information, knowledge and support, as well as personal effort, as was illustrated by the noble Baroness, Lady Jenkin of Kennington.

The Department of Health and Social Care cites evidence that one in four children and adults is now obese and that restaurant or takeaway meals contribute to the overconsumption of calories because they contain, on average, twice as many calories as the equivalent retailer own-brand or manufacturer-branded products. We know that voluntary compliance on labelling has not worked, and the pandemic has certainly been no friend to healthy weight levels, making this an ever more pressing situation to address.

This statutory instrument offers one step along the way, with many more steps needed, matched by proper investment and a strategic approach. As the display of calorie information and the recommended daily calorie intake is required only of larger businesses—those with 250 or more employees—does the Minister agree that there is greater value to be gained from this measure through the reformulation of products and portion sizes? The sight of a 2,000-calorie meal on a menu may well drive a provider to address that. Can the Minister explain what plan is in place to lever this opportunity for a bigger prize of change?

As we heard, the Government’s impact assessment gives a best estimate of net benefits amounting to over £5.5 billion over the next 25 years. The impact assessment makes it clear that most of the benefits come from a change in personal decision-making, but it seems that the evidence base on reformulation is stronger. It is particularly important that an evidence base around personal choices is acquired, so that we can have full, informed conversations as we look forwards. I hope the Minister will take note of this.

As we have heard in this debate, calories are a very crude measure of what we put into our bodies. It is crucial that we understand the nutritional content of what we consume. Will the Minister explain what consideration was given to a model much closer to what we see on packets in supermarkets? That does not seem to have been considered in the options appraised in the impact assessment. Is extending the scope of these measures being considered and, if so, on what sort of timeline? Will the research base be grown before action is taken?

The amendment in the name of my noble friend Lord Brooke of Alverthorpe rightly highlights that obesity is also impacted by alcohol consumption. It is right that the noble Baroness, Lady Finlay, and my noble friend Lord Berkeley laid down a challenge to the food and drink industry to step up to the mark. We on these Benches will return to this during consideration of the Health and Care Bill.

I am very grateful to the noble Baroness, Lady Bull, for bringing real insight to this debate and to the noble Baronesses, Lady Parminter, Lady Wheatcroft and Lady Greengross, who all spoke movingly and personally about the reality for those living with eating disorders. To follow this through, before implementation, will the Minister continue to engage with those who have legitimate, very real concerns about the draft regulations and seek to address them?

We know that eating disorders in the UK have increased during the pandemic, while services are simply not good enough, particularly failing children and adolescents. Will the Minister commit to a national strategy, matched by proper investment? Improving access to treatment and support is crucial. We will further press this home through amendments to the Health and Care Bill.

Will the Minister also commit, as a starting point for local authorities, to reinstate the resources already lost to the improvement of public health? The evidence favours interventions that promote a life of healthy choices, while cuts to public health over the past decade have put pressure on local authorities and worked in the opposite direction. I hope these regulations can offer a step forward.

Covid-19: Aligning UK and Foreign Entry and Return Requirements

Baroness Merron Excerpts

Monday 19th July 2021 Lords Chamber

[Lord Bethell (Con) [V]]

My Lords, I do look at the costs and have regular meetings with the team to look at this. I pay tribute both to officials and to the industry for standing up an enormous number of tests. I believe that, between 30 June and 7 July, 182,137 tests of people quarantining at home were registered and processed, and 18,946 by those who manage quarantine. That is an enormous number and pays tribute to the industry. A variety of costs reflects a variety of different services and in itself is not a problem—but we are driving the costs down and the industry is responding accordingly.

[Baroness Merron (Lab)]

My Lords, regrettably, we see the Covid border restrictions descend into further chaos with the last-minute U-turn on self-isolation requirements for fully vaccinated people returning from France. Once again, we see the travel industry and the British people paying the price. Will the Minister agree to publish the full data behind the traffic light system, and could he give his views on the stance of the World Health Organization, which has reaffirmed that it believes that proof of vaccination should not be required for international travel?

[Lord Bethell (Con) [V]]

My Lords, we are working with our partners to try to open up borders. There is a growing consensus that vaccination is an important component in opening up borders, and the Government generally support that. The virus itself chops and changes; we have to adapt in response to the growth of variants. I cannot promise that we will not act promptly and emphatically when the health of the nation is threatened.

Elderly Social Care (Insurance) Bill [HL]

Baroness Merron Excerpts

2nd reading
Friday 16th July 2021 Lords Chamber

[Baroness Merron (Lab)]

My Lords, I pay tribute to the noble Lord, Lord Lilley, for his efforts through this Private Member’s Bill to find a way forward to improve the provision of social care which is so desperately needed. There has been a theme throughout this debate which has heard many thoughtful contributions by noble Lords. It is a determination to see the right quality of social care at the point in people’s lives when they are at their most vulnerable. This debate has made clear the need to meet both duty of care and duty of dignity.

I start by paying tribute to the extraordinary work and commitment of social care staff over the past year, in both the independent sector and the local authority sector. They have been at the front line of this pandemic, going beyond the call of duty and helping hundreds of thousands of people through an extremely difficult time.

However, as my noble friend Lord Davies of Brixton and the noble Baroness, Lady Wheatcroft, reminded the House, it is some two years since the Prime Minister stood at the steps of No. 10 Downing Street promising to fix this challenge, yet nothing has changed. We can remind ourselves that there were high hopes of a Bill in the Queen’s Speech, but they were roundly dashed. Instead, today, as we read in the media, we have rumours that Downing Street is

“comfortable with some sort of tax”

to pay for social care. I wonder whether the Minister is in a position to flesh out details of this tax plan, which has clearly been some years in the making.

I should at this point acknowledge that while this Bill refers to the older members of our society, social care extends far beyond them. Half the budget for social care is for working-age adults with disabilities, who comprise a third of the users. Furthermore, there is a misconception, as has been pointed out several times today, that social care is all about care homes, when in fact there are more people getting care and support in their own homes, something we should aim and hope to expand, as advocated by the noble Lord, Lord Best.

Social care is as much a part of our infrastructure as are the transport, telecoms and energy systems we rely on. A neglect of the country’s physical infrastructure results in the lights going off and trains grinding to a halt. Well, the same is true if there is a failure to invest in social care infrastructure. As the noble Baroness, Lady Watkins of Tavistock, identified, if we do not have a properly paid and trained care workforce, we see vacancy and turnover rates soaring, fewer people getting the support they need and families—and, overwhelmingly, women—ending up taking the strain.

Covid-19 has brutally exposed existing failures, as described by my noble friend Lady Chakrabarti. Throughout the pandemic, we have seen that care is still not funded or treated as equally important as the NHS. We know that front-line care workers are chronically undervalued and underpaid, as my noble friend Lord Hendy set out. Families get too little support in return and an already fragile care market has been made even more susceptible to failure, with all the human consequences this brings.

Dealing with such a virulent and dangerous virus was always going to be difficult but, when the pandemic struck, our care system was more vulnerable than it should ever have been. We have a welfare state in the 2020s built on the life expectancy of the 1940s. One in four babies born today is set to live to 100 years old. As the noble Baroness, Lady Altmann, and other noble Lords set out, our health and care system has struggled to keep pace with these changes, with social care developing—as far as it has—in a piecemeal and fragmented way. As my noble friend Lord Foulkes of Cumnock said, we face a major and growing crisis in social care that cannot wait.

Fundamentally, as we have heard throughout this debate, social care services need to be fully joined up with, but not run by, the National Health Service. Noble Lords will be only too familiar with distressing tales of people having to battle their way around various services, repeatedly telling the same story. This is not good for them and is wasteful and inefficient. We need one care system built around the needs of users and families, with proper links to other services, including housing.

The Private Member’s Bill before us seeks to address the very real problem of older people being forced to sell their home to pay for care. However, as the noble Baroness, Lady Greengross, and other noble Lords identified, regrettably the Bill falls short of a comprehensive approach—not least because it does not address the situation of those who do not own their own homes or have the requisite level of resources.

In addition, nearly a fifth of pensioners live in poverty and may not have the assets required to finance insurance. They need care just as much. The latest figures are that 8% of pensioners would not even be able to pay an unexpected bill, as expressed by my noble friend Lady Bryan of Partick. I am sure that the noble Lord, Lord Lilley, will bear this in mind, because it certainly begs the question of whether those in poverty would consider using their assets for insurance that they might not need.

The issue of eligibility thresholds and how they would be determined is also to be resolved. According to Age UK, 2 million people have had requests for support turned down in the last two years, while local authority budget cuts have led to eligibility thresholds being tightened, as my noble friend Lord Sikka highlighted.

Although we are unable to support the Bill, I am grateful to the noble Lord, Lord Lilley, for seeking to address a challenge that hitherto remains unaddressed, while impacting on so many of us. I am grateful to him for providing more than the Government have so far managed to do. In the century of ageing, everyone should be able to look forward to getting older with confidence and without fear. I hope that the debate today will make its contribution.

Folic Acid

Baroness Merron Excerpts

Tuesday 13th July 2021 Lords Chamber

[Lord Bethell (Con)]

My Lords, I share the sense of urgency expressed by the noble Baroness in her articulation of those statistics. They are both worrying and entirely accurate. We very engaged with the devolved assemblies. Welsh and Scottish Ministers have expressed their support, but with Northern Ireland it is important that we consider all the implications of the Northern Ireland protocol. I am therefore not able to lay out the precise timetable now, but I reassure the noble Baroness that we are moving as quickly as we can.

[Baroness Merron (Lab)]

My noble friend Lord Rooker continues to press to protect newborn babies while, sadly, the Government have over a number of years continued to drag their feet. In preparation for the Minister’s forthcoming update, which he has promised the House today, what assessment have the Government made of the impact of the Covid-19 pandemic on the financial and practical ability of women to access prenatal vitamins, including folic acid? How has the pandemic affected awareness-raising to ensure that women are not missing out on vital nutrients in the early stages of their pregnancy?

[Lord Bethell (Con)]

I am sorry, I cannot answer the noble Baroness’s question directly. I am not sure whether an assessment has been made of the impact of the pandemic on the consumption of folic acid, but it has undoubtedly raised the importance of these kinds of preventive measures. We have never been more acutely aware of the importance of improving the health of the nation, and this is an important step in that direction.

Health Security (EU Exit) Regulations 2021

Baroness Merron Excerpts

Monday 5th July 2021 Grand Committee

[Baroness Merron (Lab)]

My Lords, we debate these regulations today on the 73rd anniversary of the National Health Service. I am sure that all noble Lords take great pleasure in seeing the George Cross awarded to recognise NHS staff past and present across all disciplines and all four nations; it is indeed a worthy honour.

I thank the Minister for outlining the focus and intent of these regulations, which are certainly welcomed. We welcome the focus on co-ordinating data-sharing, epidemiological surveillance and a four-nations approach to the prevention and control of serious cross-border health threats. It is certainly important to see the devolved nations’ public health agencies working in a close, collaborative relationship, which is what we hope to see following the adoption of these regulations. It is worth noting that, throughout the course of the pandemic, we have seen considerable regulatory divergence and differing communication issues between the devolved Administrations and the UK Government, particularly at a political level. As we well know, and as has been referenced in this debate, global health—in fact all—threats do not recognise borders. They do not fit that neatly.

The First Minister for Wales, Mark Drakeford, has consistently asked for a “regular, reliable rhythm” to meetings between the devolved Governments and the UK Government. Can the Minister assure us that this will become the norm? I noted his complimentary comments about the collaborative nature of his recent discussions, and I certainly wish to be assured that that will continue.

According to the Government, the UK Health Security Agency will undertake functions in five core areas in relation to future infectious disease threats. It will also

“act to strengthen health protection capability from top to bottom”

and place a “strong focus” on reducing inequalities in the way that different communities experience, and are impacted by, infectious diseases or environmental hazards. However, there is still very little information about how this will work, and it remains unclear how it will address the wider socioeconomic determinants of health. Perhaps the Minister can help us here.

To be more specific, the UK lost its elimination status for measles in 2016 and that was not about an external threat. That was about the internal competence—or otherwise—of the Government in handling public health issues. Does the Minister share my concern that the decision to subsume Public Health England into a security-focused agency may result in large areas of public health being neglected amid a focus on future pandemics?

What emphasis will be given to tackling the wider determinants of health, which have had a huge impact on the UK’s very poor outcome with Covid? Does the Minister agree that the Government cannot afford to ignore non-communicable diseases, including cancer, the wider health of the UK and those social inequalities, such as cramped housing and unequal access to care, which have exacerbated the experiences of many throughout the pandemic?

One of the big problems as we went into the pandemic was that the health of the population was poor at the outset, and in many cases getting worse. The improvement in life expectancy had stalled from 2012 onwards. Can the Minister confirm whether the agency will deal with this? One of the major failures of the UK’s response to Covid has been the inability of people to isolate. How will the agency address people in precarious occupations in the informal economy—those who do not have access to paid leave in order to self-isolate—and people who live in multigenerational homes?

We welcome the investment in tackling future infectious diseases but remain concerned that at the same time there has been disinvestment in UK Research and Innovation research funding. UKRI has warned of a £120 million hole in its budget following recent cuts. Does the Minister share my concern that this shortfall threatens to undermine overseas scientific projects seeking to understand how we can better mitigate against zoonotic diseases such as Covid-19? Will the Government commit to bringing forward their commitment to increase research and development spending to 2.4% of GDP by 2027?

Like my noble friend Lord Hunt of Kings Heath, I refer the Minister to the comments of the Secondary Legislation Scrutiny Committee on the Explanatory Memorandum, which, it said

“does perhaps overestimate the average reader’s knowledge of the UK’s plans.”

I hope the Minister will be able to assure the Committee that the department will ensure that the Explanatory Memorandum will be explicitly clear on what Parliament is being asked to agree going forward.

Coronavirus Act 2020 (Early Expiry) Regulations 2021

Baroness Merron Excerpts

Monday 5th July 2021 Grand Committee

[Baroness Merron (Lab)]

I thank the Minister for introducing the regulations and explaining the reasons for them. We certainly welcome this statutory instrument, which removes provisions that enabled local authorities to divert resources to care and support from other duties as stipulated in the Care Act 2014.

As has been acknowledged in the debate, the pandemic has been exceptionally difficult for everybody, while the most vulnerable have seen disproportionately high death rates and a profound impact on the level and quality of their care. With regard to that, I join my noble friend Lord Hunt of Kings Heath in paying tribute to those in the care sector, both paid and unpaid.

According to the guidance issued to local authorities, the easements were meant to be activated only when they were necessary to ensure safety. They were intended to be temporary, kept under review and used as narrowly as possible. An open letter of 19 March 2021, signed by at least 27 disabled people’s organisations, highlighted concerns. It said:

“At such a strained and worrying time for everyone, this unnecessary power that no Council is even using hangs over the heads of disabled people, causing only anxiety.”


Many of the people most vulnerable to the virus simultaneously faced a reduction in essential care and support. By the middle of 2020, seven in 10 people with learning disabilities had had their social care cut or significantly reduced, and 79% of family members were forced to take on further unpaid caring duties in the face of cuts. Just eight of the 151 English councils with social services responsibility made use of the easements during the first wave, and only two of these—Derbyshire and Solihull—used it to cease meeting needs that they were required to meet. According to the CQC, by July, all had stopped.

We continue to know of the loss and long-term closure of day care centres, group activities, travel training and at-home support. There is also little clarity on how local authorities will catch up on reduced assessments or deal with retroactive demands for payment. The catch-all phrase “cancelled because of Covid” remains, and there are concerns that this so-called explanation will continue to linger. Does the Minister accept that the social care easements do not appear to have eased the burden for anybody?

Of course, there is a much bigger issue here: the chronic underfunding and devaluing of the social care sector, of which the fleeting emergence of the social care easements was but a symptom. We have been waiting almost two years to see the clear plan for social care that the Prime Minister claimed to have prepared, and all we heard in the Queen’s Speech was just nine words. Does the Minister agree that a better future for our country cannot be built after Covid-19 without transforming social care? We need the Government to make a firm commitment to reforming and presenting plans to Parliament as soon as possible.

Looking forward, the emergency Coronavirus Act gave Ministers sweeping powers, many of which have yet to be used. The priority must be to use the Act and other regulations related to health protection to bring us out of restrictions safely, support the NHS in recovering from the crisis, ensure that there are measures in place to restart the economy effectively, and enable those who need to self-isolate in future to do so. Nobody wants these regulations in place for any longer than is needed but we have to make sure that this is the last lockdown.

It seems that guidance and reliance on personal choice are set to be the order of the day, with the final stage of the four-step plan out of lockdown imminent. This is despite coronavirus cases rising to their highest level since January. Does the Minister share my concern that letting cases rise with no corresponding actions means further pressure on the NHS, more sickness and more disruption to education, and risks a new variant emerging with a selection advantage?

The new Health Secretary used the weekend press to emphasise that we must learn to live with the virus as we have done with flu. Can the Minister advise the Committee what level of mortality and cases of long Covid he considers acceptable? Will he outline the measures that the Government will introduce, such as ventilation support for buildings and sick pay for isolation, to push cases down? As we know, coronavirus does not impact people and communities equally. What support will be in place for the most deprived areas, where cases are highest and vaccination rates lowest?

Covid-19: Wuhan Institute of Virology

Baroness Merron Excerpts

Wednesday 30th June 2021 Lords Chamber

[Lord Bethell (Con)]

My Lords, I agree with the noble Lord’s appeal for more data—but, candidly, as I know he knows, it is not just quantity of data that we need; it is the right data. Where we are struggling is in getting genomic sequencing of new mutations from the furthest reaches of the virus’s spread. We need a systematic programme around the world that shares the sequences of new mutations with academics who can study and assess them. Without such a systematic programme we are flying blind. That is why we are working on the new variant assessment platform and other pandemic preparedness projects.

[Baroness Merron (Lab)]

My Lords, scientists are warning that we are in an era of pandemics, and that viruses more deadly, contagious or resistant to antibodies than Covid-19 could emerge. What steps are the Government taking to prepare themselves and the country for the next potential pandemic, and will the Minister commit to ensuring that future pandemic preparedness plans are independently assessed and reported to Parliament?

[Lord Bethell (Con)]

My Lords, I pay tribute to the Chief Scientific Adviser, Sir Patrick Vallance, who is leading the pandemic preparedness work. He is doing an enormous amount both on the international treaties through our G7 chairmanship, and on the internal domestic re-envisaging of our healthcare system. We need to invest more in public health, and we also need the data, the diagnostics and the patient behaviours that support really rigorous tracking down of diseases when they arrive. The noble Baroness is entirely right: pandemics will come, sooner rather than later.