NHS England Update

Baroness Merron Excerpts

Wednesday 19th March 2025 Lords Chamber

[Lord Scriven (LD)]

My Lords, the Government, with their sovereign right, propose the abolition of NHS England. Although the method of delivery is a matter for the Secretary of State to propose, governance changes in themselves will not achieve better outcomes. These Benches will continue to point out that chronic operational issues in the NHS cannot and will not be dealt with effectively until the Government show the same speed and determination to deal with the social care crisis. The Minister must know that you cannot have 13,000 hospital beds full of people medically fit for discharge and pretend that a change of who sits in what chairs in the governance of the NHS will solve that issue. When will the Government commit to a timetable to restart the cross-party talks to deal with this important issue?

The paramount—indeed, the sole—objective of any organisational change to the NHS must be demonstrable improvement of patient experience and outcomes. The Government assert that this change will improve efficiency and streamline services. However, assertions alone are insufficient. We require rigorous evidence, not mere conjecture.

Therefore, I am going to ask the Minister five questions. First, and most importantly, what detailed analysis has been conducted on the projected impact of this abolition on patient outcomes? We require more than abstract pronouncements. For instance, how will it improve cancer treatment? What will these changes do to improve access to GP services? How will they improve local integration, particularly when 50% of funding for ICBs will be reduced across the board?

Secondly, what specific legislative changes are required to abolish NHS England and redistribute its functions? I note that the Secretary of State pointed out that the Government could predominantly go ahead with these changes but that legislation is required, so will the Minister explain to the House exactly what legislation will be required to bring about this change? Will she give a commitment that no redundancies will take place until legislation has been passed and these changes have been given the go-ahead by this House and the other House?

Talking of redundancies, my third question is: what are the estimated costs of redundancies associated with the abolition of NHS England, including not only financial implications but the potential loss of expertise and institutional knowledge? Furthermore, will the Minister indicate whether any departing executive has been offered a severance package exceeding statutory redundancy limits and, if so, how many? What justifications are there if such arrangements have been made?

Fourthly, how will the Government ensure continuity of service during the transition period? Any disruption to patient care is unacceptable, so when will there be a robust plan that outlines how essential services will be maintained, how staff will be supported and how the public will be kept informed?

Finally, in line with what the noble Lord, Lord Kamall, said, what mechanisms will be put in place to ensure ongoing accountability and transparency in the newly restructured healthcare system? How will the Government measure success—not just of the times in which people are seen but that these changes have contributed to improvements in patient care? The Government are the custodians of this vital public service and have a duty to ensure that any changes to NHS structures are driven by evidence, guided by principle and focused relentlessly on improving the lives of the people it serves. They must proceed not blindly but with clarity, so I look forward to the Minister’s answers.

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

My Lords, I am grateful to both Front Benches for their reflections and their support for the direction of travel, in certain areas. I am pleased to see the noble Lord, Lord Scriven, in his place and I wish him a full recovery. I note that the noble Lord, Lord Kamall, welcomed the moves on value for money, freeing up from bureaucracy and the need to put the patient at the centre. I am glad that he did that, because that is exactly what this is about: better services and cutting duplication.

It is probably worth my reflecting on the sentiments expressed in the other place by my right honourable friend the Secretary of State for Health and Social Care when he referred to the question of why we are doing this. The independent investigation by the noble Lord, Lord Darzi, was called for by this Secretary of State not long after we came into government and discovered a situation beyond what I think anyone had anticipated. The noble Lord, Lord Darzi—this relates to the point that the noble Lord, Lord Scriven, made about evidence—traced the current crisis back to the 2012 top-down reorganisation of the NHS and the establishment of NHSE. He stated that it had

“imprisoned more than a million NHS staff in a broken system”.

There are twice as many staff working in NHS England and the Department of Health and Social Care today as there were in 2010. In 2010, the NHS was delivering the shortest waiting times and the highest patient satisfaction in history. When we came into government last year, it was the exact opposite: the longest waiting times and the lowest patient satisfaction in history.

You can add that up: taxpayers pay more, and they get less. We have been left with two very large organisations. I see that there are some former Ministers from the department in the Chamber today, which I am glad about. I will not speak for them, but they might also reflect that they will have noticed duplication and layers of bureaucracy that have stifled the progress and the patient treatment, patient focus and patient experience that we all seek to improve. The noble Lord, Lord Kamall, talked about the need for us all to coalesce around the interests of the patient, with which I certainly agree. Over the next two years, the intention is to bring NHS England into the department entirely. That will make significant savings of millions of pounds a year. To noble Lords who have raised some questions about whether the money will flow down to the front line, I say that it will cut waiting times faster and deliver our plan for change.

The matter of staff came up, and I will come back to that. I acknowledge that there are talented, committed public servants who work at every single level of the NHS and the Department of Health and Social Care, including NHS England, with whom I have had the privilege of working over the past eight months under this Government. I was previously a Minister in the department in the last Labour Government. This is about the system, not the people. I say that to reassure those who are employed both at the department and in NHS England.

The noble Lord, Lord Scriven, asked some important questions about staff reductions and when redundancies would potentially take place. There are currently 19,000 staff across NHS England and DHSC; across both, we are looking to reduce the overall headcount by 50%. Conversations have already begun with the trade unions on this change, and we will of course continue to engage with them throughout the process. As the noble Lord, Lord Scriven, rightly observes, abolishing NHSE—a non-departmental public body—will require primary legislation, so we are working with the usual channels to ensure that we have an appropriate legislative timetable to allow us to do things in a timely way, while safeguarding what is an ambitious legislative programme that has already been set out. We are already getting on with the job immediately, which also answers the point raised by the noble Lord, Lord Scriven, about bringing NHSE back into the department.

The noble Lord, Lord Kamall, raised a very good point about the need for better understanding, clear lines and transparency. One of my learnings since we announced the abolition of NHSE was that, unfortunately, some members of the public thought that meant we were abolishing the NHS. I would like to reassure anybody in this Chamber or outside it that we are not doing that at all: we are committed to the National Health Service, as we have always been throughout our history as a party, and we will continue to strengthen it. However, what that said to me relates to the point the noble Lord made. People do not care about structures, and why should they? What they are interested in—and I completely endorse this—is what it does for them. Can they get that appointment? Can they get that treatment? Can their child get access to dentistry, or whatever it is? That is what people want.

Actually, this is a tremendous opportunity to be clearer and more straightforward about what those lines are, and I certainly look forward to doing so. The noble Lord, Lord Kamall, is right about the need for a change in culture, and I think that applies to a whole range of issues.

This measure has been considered and, as I explained, was born through experience and evidence. It will fit as part of the 10-year plan, to which the noble Lord, Lord Kamall, referred, and I thank him for that. On when that will be published, I will say only that I hope the noble Lord will not feel he is kept waiting for much longer. I am very grateful to everybody who gave input to the consultation—the biggest one ever in the history of the NHS.

The noble Lord, Lord Scriven, rightly asked for a number of details about impact; there will, of course, be a full impact assessment with the legislation. He asked particularly about improvements overall, which is what we seek. Currently we have two organisations, many layers and duplication. I cannot think of one organisation that can boast all that—I do not say boast in a positive way—and say it is at its most efficient in delivering for whoever the service users are.

All of it will translate to improvements on the front line, which is what we are talking about. As I mentioned, as I often do, earlier in Questions, we believe that decision-making locally—done in the interests of the local population, with their involvement and reflecting their nature—is crucial. Noble Lords will be aware that, on the advice of the report by the noble Lord, Lord Darzi, we reduced the numbers of targets in the planning guidance from 32 to 18, to free up local areas to better meet the local requirements. Again, we see the direction of travel.

The noble Lord, Lord Scriven, asked about senior management and severance packages. Of course, I cannot comment on individuals, but I emphasise that, in the cases of those who announced their resignation, it was just that, so all the normal arrangements would apply.

I hope we can continue to work together to improve the structure, support the staff and, most importantly, keep patients at the centre, so that they see improvements from this change and the recognition that two organisations are duplication and this needs to change.

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[Baroness Thornton (Lab)]

I am just asking the question. What is the likely timescale for when investment might be released? I am thinking particularly about technology and investment in infrastructure, as a non-executive director of a hospital, a large part of which is still a Victorian build.

[Baroness Merron (Lab)]

I thank my noble friend for her reflections on what has gone before and her welcome that the opposition parties can work with us to put this into a better place now. With respect to change and productivity, and a further extension to the point raised by the noble Lord, Lord Kamall, about culture, I can say straightaway that the Government have a 2% productivity growth target in 2025-26. That is immediate. We are not waiting to make this change, because if we do not improve NHS productivity and efficiency, we will not be able to deliver the three shifts needed to future-proof the NHS and support the Government’s growth mission.

We have already invested more than £2 billion in NHS technology and digital in 2025-26, which will help with essential services and drive productivity in hospitals, such as the one that I know my noble friend serves very well. That will free up staff time, ensure that all trusts have electronic patient records, improve cybersecurity and enhance patient access through the NHS app. That is before we even make this change.

We have already achieved a lot in the past eight months, but that is why we have to continue with this reform. We have delivered the 2 million extra appointments that we promised, months ahead of schedule, we have cut waiting lists by 193,000, and, as I said earlier, we have committed to 700,000 extra urgent dental appointments, just to name some. We know about the importance of change, which the noble Lord, Lord Scriven, asked me about, and that my noble friend calls for. That is why we will always continue to take bold steps where we have to, and not shy away.

[Baroness Bottomley of Nettlestone (Con)]

My Lords, the point is well made about duplication, bureaucracy and excessive cost. Can the Minister give us an assurance, though, that we will not move from excessive bureaucratic centralisation to political centralisation? There are few politicians who are clinicians, sophisticated managers or financiers. This is the largest employer in the world, with extraordinarily dedicated and talented individuals concerned. They will not be happy to think that they will be organised on the whim of whoever is the latest Minister.

The right reverend Prelate the Bishop of London used to be the Chief Nursing Officer—there are many people who have worked at high levels in the NHS. We need to be confident that there will be an evidence-based, rational system at some distance from party-political considerations, because the viciousness of health debates about hospital closures, boundaries and other matters knows no bounds. We do not want by-elections to become involved in non-party-political matters.

The noble Lord, Lord Waldegrave, and even the noble Lord, Lord Clarke, and I, were very happy with an NHS executive which was part of the department. However, the role of the chief executive was not the same as the role of the Secretary of State. I hope the Minister can give us some assurance.

[Baroness Merron (Lab)]

I am very pleased to give the reassurance that the noble Baroness seeks. When we reflect, the disastrous 2012 top-down reorganisation certainly did not depoliticise the NHS—it made it less efficient and less able to treat patients on time.

This is not about politicisation; this is about responsible government. I add—without embarrassing anybody—that a number of former Conservative Health Ministers have said to me, and to my colleague Ministers and the Secretary of State, how much they welcome this and how they wish that they had taken this step. That, for me, as well as the tone of the contributions from the Front Benches today, provides the reassurance the noble Baroness seeks.

[Lord Kakkar (CB)]

My Lords, I draw the House’s attention to my registered interest as chairman of King’s Health Partners. In the announcement made by the right honourable Secretary of State for Health in the other place, there was particular emphasis on identifying that in this period of transition, NHS England will focus on ensuring that local providers are better able to cut waiting times and to organise their finances appropriately. But NHS England has many other functions beyond those two important ones, and they will need to be delivered in what is a substantial transformation in reabsorbing NHS England into the Department of Health and Social Care. What reassurance can the Minister give your Lordships’ House that functions such as the recently integrated Health Education England function into NHS England, the NHS Digital function and many others, are going to be properly supervised and delivered during this period? They are as essential, in many ways, as delivering on waiting times and organising finances.

[Baroness Merron (Lab)]

The noble Lord is right to talk about NHS England in all its functions. Bringing it together with the department will not diminish those functions but will allow them to be delivered rather more effectively than they are currently. At the head of the transformation team is Sir James Mackey, the new chief executive of NHS England, working with Dr Penny Dash as chair. Both individuals are well respected across the sector for their outstanding track records, not least on turning round NHS organisations, in Jim’s case, but also on balancing the books, driving up productivity and driving down waiting times—exactly what is needed. But I agree totally with the noble Lord, and we are going to ensure that the necessary functions are continued; it is the way they are delivered that we are changing.

[The Lord Bishop of London]

My Lords, I declare my interest as indicated by the noble Baroness, in that I am a former government Chief Nursing Officer. Following on from the noble Lord’s point, this is a very significant change not just to the NHS but to its workforce. We know from looking back that when there is a reorganisation of the NHS, attention and funds are distracted away from the front line and patient care. The announcement came on the same day as the publication of the NHS staff survey results, which highlighted that only 31% felt that there were enough staff to enable them to do their job, and that 45% felt unwell due to work-related stress. What action will the Government take to make sure that there is not a management distraction, through this reorganisation, away from the front line and patient care in particular? How will staff be supported during this transition, not least those who, I suspect, fear that their jobs are now under threat?

[Baroness Merron (Lab)]

I recognise what the right reverend Prelate is saying. I myself have experienced change in large organisations, and change is never easy. We are talking about job losses; we cannot shy away from that. But it is appropriate that I re-emphasise the reassurance of our respect for and thanks to all those talented and hard-working staff in both the department and NHSE. We will, as I said, work with trade unions on this change in order to be fair and transparent and to deal with it properly. Of course it is uncomfortable, and people naturally find it difficult.

It is also important to look at the benefits. Currently, we have rather too much micromanagement, which frustrates progress and staff. Reducing that is one of the liberations that this will provide, so we can innovate and get on with caring for patients.

On maintaining people’s morale, this is a big challenge for us because morale has not been good at all, so we will pay particular attention to this as we publish the workforce plan later in the summer. This work continues. Senior managers and transformation team are very alive to the points the right reverend Prelate has made, and they will continue in that regard.

[Baroness in Waiting/Government Whip (Baroness Blake of Leeds) (Lab)]

My Lords, I am very conscious that a number of noble Lords want to get in. Can all keep their questions brief? I will take the Liberal Democrat contribution first and then Labour.

[Baroness Tyler of Enfield (LD)]

My Lords, I will be brief. With such a strong emphasis in the Statement on reducing duplication and bureaucracy, can the Minister say what consideration is being given to fusing NHS England’s regional offices with the remaining ICBs that come within their geographical area? It strikes me that there is scope for savings there.

[Baroness Merron (Lab)]

All of this will be looked at by the transformation team, because it is a considerable change. I thank the noble Baroness for that contribution, and I will ensure that it is heard.

[Baroness Rafferty (Lab)]

My Lords, can my noble friend the Minister kindly confirm that the role of the Chief Nursing Officer for England will migrate to DHSC?

[Baroness Merron (Lab)]

My noble friend will know—as I am sure the right reverend Prelate knows—that the Chief Nursing Officer has always played a role in advising Ministers; that the case was long before the establishment of NHS England and will continue long afterwards. The chief executive, Sir James, has announced his new transformation team, and that includes NHS England’s Chief Nursing Officer.

[Lord Markham (Con)]

As a former Health Minister, I too welcome this move, but the devil is in the detail. The point made about the NHS regions is completely right: that is another layer which will stop hospitals being freed up in the way the Secretary of State said he wants to happen. There is the question of whether lots of merged entities will be demerged again. As we all know, it is the uncertainty which hits productivity in the meantime, when people are naturally worried about their jobs.

I would really like to press the Minister on when we will see the detail behind the plan. When will it be produced, and when can we give the staff the information they need, so they know their position? Until that happens, the uncertainty will, unfortunately, hinder productivity and stop the changes we all want to see happening.

[Baroness Merron (Lab)]

I understand that point and the noble Lord’s wish for dates, which I am not able to give him, as I am sure he will appreciate. These reforms are not about front-line staff losing their jobs; we are talking about people employed directly by the department and the NHS. The noble Lord referred to the Secretary of State, and I would add that other arm’s-length bodies also need to be leaner than they are today.

I understand the problem, and we are going to work very closely with staff organisations, but it is not a neutral situation. Staff are suffering from box-ticking, duplication and red tape, which prevents them doing their job properly. Their morale is not good in this case—in any case. We do not want to add to that, but we do want to give them hope for the future.

[Baroness Butler-Sloss (CB)]

After the transformation team has completed its work, who will take over the duties that the noble Lord, Lord Kakkar, referred to in his question?

[Baroness Merron (Lab)]

That will be declared in due course, once the work has been completed.

[Baroness Sugg (Con)]

My Lords, I spent yesterday morning at the women’s health department in Mile End hospital—I know the Minister is a great champion, and I highly recommend a visit. What will the NHS England update mean for the women’s health strategy, and, specifically, for NHS England’s commitment to eliminating cervical cancer by 2040?

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[Baroness Merron (Lab)]

It will not affect commitments to women’s health. As we have said, women’s health remains a priority. The noble Baroness will know that there are some 600,000 women already on the gynaecology waiting list; that is far too long for women to wait. Women’s health hubs are part of the solution, and I continue to champion those with the integrated care boards.

[Lord Turnberg (Lab)]

My Lords, I am delighted to support the direction of travel towards patients first. I wonder if there are savings to be made. We can concentrate on the gap in social care, where I suspect much of the NHS is so interdependent. Social care is so badly funded, and we need to do something there.

[Baroness Merron (Lab)]

As we discussed earlier, the provision of social care and housing has a huge impact on quality of life and discharge from hospital. As my noble friend will be aware, the noble Baroness, Lady Casey, will be commencing her look into social care, to report to us all on the immediate and long-term changes that are needed and to build cross-party consensus.

[Baroness Freeman of Steventon (CB)]

My Lords, since NHS Digital was merged with NHS England, NHS England staff have been running absolutely critical data and digital infrastructure. During this period of uncertainty, we are bound to be in danger of losing some staff with expertise that is difficult to replace. What are the Government doing to make sure that these jobs are absolutely safeguarded and that this expertise is not lost?

[Baroness Merron (Lab)]

Nobody should worry about data or their privacy. Our job is to improve our ability on data, and this change will not affect that. Indeed, part of the 10-year plan will include a move from analogue to digital, because we recognise the importance of data and digital change in improving healthcare. This change will give us a better opportunity to implement that.

[Baroness Fox of Buckley (Non-Afl)]

My Lords, I congratulate the Government on removing a powerful and unelected body—the world’s largest quango. What the Government have done is so important democratically, given that the Secretary of State says, “The buck stops here”. However, it is not a silver bullet. There is no NHS England in Wales—my neck of the woods—and the buck stops with the Senedd, but the Welsh health service is in a terrible state, with wastage of money, red tape, bureaucracy, and smoke and mirrors about where money is being spent. Does the Minister agree that that can happen even when the buck, apparently, stops with the politicians?

[Baroness Merron (Lab)]

I am not sure if that was a question about politicians or Wales. We work very closely with the devolved Governments, as the noble Baroness will be aware. On her point about politicians, we take our responsibilities very seriously. That is why we have recognised the problem and are acting.

Soft Drinks Industry Levy

Baroness Merron Excerpts

Tuesday 18th March 2025 Lords Chamber

[Lord Rennard]

To ask His Majesty’s Government what assessment they have made of the success of the Soft Drinks Industry Levy in comparison to voluntary sugar, salt and calorie reduction and reformulation measures.

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

My Lords, the soft drinks industry levy has nearly halved the sugar in soft drinks. By uprating the levy, as was announced in the Budget, we will ensure it remains fit for purpose and drives further restrictions. The voluntary programme has delivered meaningful product change and learning on what more is possible. We continue to drive reformulation through promotion and advertising restrictions, which are showing promising results. We will continue this momentum to create a healthier generation.

[Lord Rennard (LD)]

My Lords, the levy has reduced considerably the number of children who would otherwise have been admitted to hospital for dental extractions. Two-thirds of the public support an expansion of the principle of this levy to other high-sugar foods, with revenue raised funding children’s health programmes. Will the Minister commit to supporting the Recipe for Change campaign, which is backed by over 50 health charities and medical colleges, given that if the proposed sugar and salt levy in Henry Dimbleby’s National Food Strategy was implemented it could avoid more than 320,000 cases of type 2 diabetes over the next 25 years?

[Baroness Merron (Lab)]

I understand why the noble Lord raises this: he, like me, wishes to reduce obesity rates. Although the soft drinks industry levy is showing success, it is much harder, as he will be aware, to apply the same in respect of food, simply because of its formulation: there is no other sugar in soft drinks beforehand, whereas there is in food. Although I understand the pressure to do this, and we continue to do more, it is not quite as straightforward to draw the direct comparisons, as I know he understands.

[Lord Rooker (Lab)]

I remind my noble friend that the voluntary system for the reduction of salt, which was organised by the Food Standards Agency before I joined it, was so successful that the World Health Organization held its international conference in London in 2010 because it had been so successful on a voluntary basis. Of course, this was before the noble Lord, Lord Lansley, removed nutrition from the Food Standards Agency. The voluntary system can work substantially.

[Baroness Merron (Lab)]

My noble friend is right: voluntary schemes can indeed work well. In addition to crediting my noble friend for his work with the Food Standards Agency, I can tell your Lordships’ House that voluntary reformulation has encouraged sugar reduction by around 15% in cereals, 13% in yoghurts and 29% in milk-based drinks, and contributed to a reduction in salt intake. Of course more can be done to improve everyday food and drink, and we continue to work by whatever means necessary and within all sectors of industry to do just that.

[Baroness Manzoor (Con)]

My Lords, the Minister will know that sugar has been substituted with glycerol in slushy drinks—these are iced drinks that are particularly for children. This is having an adverse health impact, particularly on young children. According to recent press announcements, a number have been admitted to hospital. Can the Minister say what the Government are doing to educate parents and to address this issue?

[Baroness Merron (Lab)]

I thank the noble Baroness for raising this very important point. The Food Standards Agency is considering very carefully the findings of the review mentioned in the media, to which she referred. In the meantime, parents are strongly encouraged to follow the advice that slushy drinks should not be given to children under four years old. Retailers are also advised to make adults fully aware of this guidance if they seek to buy them for children. In addition, although the symptoms of intake are usually mild, it is important that parents are aware of the risks, particularly at high levels of consumption. I thank the noble Baroness for shining a light on this matter.

[Baroness Bennett of Manor Castle (GP)]

My Lords, research by the First Steps Nutrition Trust shows that parents believe that baby foods are strongly regulated. In fact, there is no legal threshold for the amount of sugar in baby foods in the UK; there is only a threshold for the amount of added sugar. If a large quantity of concentrated fruit juice is added, we end up with baby foods that have implicit labels on them suggesting that they are healthy but they contain more sugar than Coca-Cola. In the UK, 61% of two to five year-olds’ energy comes from ultra-processed foods. Will the Government look to get significant, important regulation for baby foods?

[Baroness Merron (Lab)]

I understand the point that the noble Baroness raises. This is one of the areas that we are looking at. She also raised ultra-processed foods. As she may be aware, the Scientific Advisory Committee on Nutrition has reviewed evidence and stated that further research is needed as to whether ultra-processed foods are unhealthy due to processing or to an unhealthy nutrient content. We have discovered that we need to separate the two. That will also assist on the point that she raised about baby foods.

[Lord Kamall (Con)]

My Lords, although sugar taxes and levies are examples of top-down state solutions to tackle obesity, I will ask the Minister about grass-roots, bottom-up solutions. She will know of non-state local civil society projects that work in communities to encourage healthier lifestyles, such as BRITE Box in south London, which offers recipes, ingredients and budgeting advice to help low-income families cook and eat more healthily. Can she tell your Lordships how the department works with such local projects to tackle obesity and how that best practice has spread to other communities? Could she also write to me with a list of some of the projects that her department is aware of, so that all noble Lords could learn a bit more?

[Baroness Merron (Lab)]

I would be very pleased to write further to the noble Lord on this matter. I pay tribute to all of those community third sector organisations that work in line with government direction to reduce obesity. There are many aspects to this: it is not just about what community organisations can do but, for example, about implementing TV and online advertising restrictions for less healthy food. In all these ways, we will be able to make progress to reduce obesity.

[The Lord Bishop of London]

My Lords, we know well that diet and nutrition, and the infrastructure from which we can access the food that we eat, determine our health. These things continue to be unequal. The proportion of household income required to afford to follow the Eatwell Guide is 11% in the least deprived areas and 45% in the most deprived areas. What consideration will be given in the NHS plan to these wider issues—including the merits of reformulation policies—to improve the critical determinants of health?

[Baroness Merron (Lab)]

The right reverend Prelate is right to speak about the additional levels of ill health and obesity; a child of 11 in the most deprived areas is twice as likely to be obese as those in the least deprived areas. I can certainly assure her that the 10-year plan, which is soon to be made available, will take account of inequalities in all their aspects, including nutrition and food.

[Lord Bird (CB)]

Is the Minister aware that, according to the BMA, 50% of people who suffer from cardiac arrest actually suffer from food poverty in the first instance?

[Baroness Merron (Lab)]

I thank the noble Lord for that point. He will know that the Defra-led food strategy will assist us across government in tackling this.

[Baroness Walmsley (LD)]

My Lords, I will follow up on the question from the noble Baroness, Lady Bennett of Manor Castle, about the regulation of foods for babies and toddlers. Is the Minister aware that some of the fruit and vegetable pouches marketed for babies from four months onwards—despite the advice that they should not be weaned until they are six months old—contain more sugar per 100 millilitres than Coca-Cola? Some toddlers’ teeth are being rotted as they emerge from their gums. When will the Minister take action on this?

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[Baroness Merron (Lab)]

The noble Baroness reminds us that one of the major causes of children having to report to A&E is dental decay. That is why I am glad that we have announced plans for over 700,000 urgent dental appointments, as well as for supervised tooth-brushing. To the specific point that the noble Baroness makes, she is indeed right about the progress that needs to be made. We have recently responded to the House of Lords Select Committee inquiry into food, diet and obesity, as I know she is well aware. We will have a debate on that formal response on 28 March.

Primary Healthcare Facilities

Baroness Merron Excerpts

Monday 17th March 2025 Lords Chamber

[Baroness Pitkeathley]

To ask His Majesty’s Government what steps they are taking to accelerate the construction of primary health care facilities to facilitate patients moving from hospital to community care.

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

My Lords, the Government are committed to fixing the front door of the National Health Service. This includes working with providers to deliver the primary care infrastructure required to enable a neighbourhood health service. We have already taken steps, including providing over £100 million of capital funding in 2025-26 to upgrade GP buildings—the first dedicated national capital fund for primary care since 2020. Spending plans for future years will be confirmed later this year.

[Baroness Pitkeathley (Lab)]

I thank my noble friend the Minister for that helpful answer. The limited capacity of GP premises, as highlighted in the Darzi report, is hindering the service’s ability to meet growing patient demand for face-to-face contact with the general practitioner and the primary care team, as well as obstructing the move to community care. Therefore, I have two specific questions for the Minister. First, will the Government make primary care infrastructure a priority when the very welcome new housing developments are being planned? Secondly, will the Government encourage the use of existing community premises, such as community centres and village halls, which could be temporarily adapted for primary care purposes until sufficient, purpose-built centres are available?

[Baroness Merron (Lab)]

I can assure my noble friend that we are working closely with the Ministry of Housing, Communities and Local Government to raise the importance of primary care provision in the planning process, as my noble friend has highlighted. That is to influence the direction of local plans, as well as maximise contributions from developers. We very much support using existing community spaces, which is a creative solution to deliver primary healthcare services, and we are exploring through the 10-year health plan how to further support the integration of services into the wider public estate to improve access. Indeed, we will consider all solutions, including the ones that my noble friend highlights.

[Lord Kakkar (CB)]

My Lords, I draw noble Lords’ attention to my registered interests. The Minister will, I am sure, agree that, beyond physical infrastructure, one of the most important impediments to ensuring that there is effective integrated care between secondary and primary care settings is the question of regulation—professional and institutional regulation—which is quite different across those institutional boundaries. What plans do His Majesty’s Government have to look at the question of regulation to improve integrated care as part of their broader review of the delivery of healthcare in our country?

[Baroness Merron (Lab)]

The noble Lord is right to highlight regulation. Of course, there are many other aspects beyond physical infrastructure: for example, the use of technology, which also supports the subject on which we are speaking. All these matters are being considered as part of the 10-year plan and I am sure we all look forward to that reporting.

[Baroness McIntosh of Pickering (Con)]

My Lords, is the Minister aware that there is a network of community hospitals which survives? Will she therefore use some of the funds to ensure that these community hospitals remain in place, so that, after a stroke or treatment, patients will be made fit to enable them to return home?

--- Later in debate ---

[Baroness Merron (Lab)]

There are indeed many aspects of community care, as the noble Baroness refers to in terms of community hospitals. I emphasise that we are moving towards a neighbourhood health service, with more care delivered locally to create healthier communities, to spot problems earlier and to help people stay healthier for longer. It is of course up to local health systems to decide how best to serve their local communities, and services will vary according to where they are across the country.

[Baroness Tyler of Enfield (LD)]

My Lords, as part of the shift from hospital to community, what specific plans do the Government have to set up more walk-in diagnostic centres and polyclinics as a way of allowing quicker and easier access to joined-up healthcare for patients, giving them greater control and reducing current pressures on GP surgeries and hospitals?

[Baroness Merron (Lab)]

We will be providing further details in the national implementation programme, but I can say that neighbourhood health guidelines have already been published to help ICBs, local authorities and health and care providers to continue to progress neighbourhood health. We will trial neighbourhood health centres to bring together a range of services, and others that the noble Baroness refers to, to ensure that healthcare is closer to home and that patients receive the care they deserve when and how they need it.

[Lord Kamall (Con)]

My Lords, we know that the Government are keen to encourage more investment into our national infrastructure—which these Benches welcome. Given that, what conversations are the Department of Health and Social Care and the Treasury having with pension funds and other funds on investing in neighbourhood primary health and care facilities, and indeed in other parts of our system of health and social care?

[Baroness Merron (Lab)]

Although I cannot give a specific answer to the noble Lord on that point, I will be happy to look into it. As I mentioned earlier, in our discussions with the Ministry of Housing, Communities and Local Government we are, for example, looking at how we can lever greater contributions from developers who are working on new developments, where they will be providing much-needed health services and infrastructure. So we are taking a creative approach because we recognise the need to do more.

[Baroness Winterton of Doncaster (Lab)]

My Lords, my noble friend referred to creativity and the noble Baroness on the Lib Dem Benches talked about facilities in the community. Well, in Doncaster, we are already ahead of the game, as Mayor Ros Jones has worked with the local health community to provide a “health on the high street” facility, which will not only reduce pressure on the hospital but make it easier for patients to access services and, crucially, help regenerate the city centre. Will my noble friend join me in congratulating Mayor Ros Jones on this initiative, but also work with the local community to address the issue of urgent repairs that are still needed at the hospital?

[Baroness Merron (Lab)]

I am very pleased to congratulate Mayor Ros Jones on this initiative, as I would be pleased to congratulate such initiatives up and down the country. My noble friend is right to talk about the great benefits to local communities, which I myself remember, as will my noble friend, from the previous Government, in terms of walk-in health centres, which made a huge difference. To the point about repairs to the local hospital, it is vital, if we are to create the right NHS going forward through the 10-year plan, that we repair and rebuild the healthcare estate, which has a very considerable backlog maintenance bill after years of underinvestment. That is why the Chancellor confirmed extra investment for the backlog of critical NHS maintenance and repair upgrades.

[Lord Laming (CB)]

Does the Minister agree that success depends on quite sophisticated co-ordination of different services employed in different organisations? That includes not just community nurses but home helps, specialist hospital-type equipment, the whole range of adaptions to property, and the like. Can the Minister assure the House that these things will be properly considered as we go forward to try to improve the movement from hospital to the community?

[Baroness Merron (Lab)]

I certainly agree and can reassure the noble Lord that this is the case. I know that your Lordships’ House will have heard me speak previously about the very considerable investment that the Chancellor committed to in the Budget to provide adaptions for people’s houses in order that they could be cared for at home. I also say to the noble Lord that integrated care systems infrastructure strategies have been developed, which will create a long-term plan for future estate requirements and investment, while community health services also provide for planned and urgent care close to home, including clinics, care homes and, to the point raised by a previous noble Baroness, community hospitals.

[Lord Turnberg (Lab)]

My Lords, the biggest problem is the shortage of GPs. We are losing them faster than we are recruiting them. What plans do the Government have to increase the number of general practitioners?

[Baroness Merron (Lab)]

I am glad to say that recently, as my noble friend will be aware, we concluded the annual consultation on the GP contract and the committee voted in favour of the contract for the first time in four years. That will provide a way forward in terms of strengthening provision, prevention and the integration of services, which I hope will lift morale and the attraction to being a GP. We want to see consistent growth. There are now over 1,000 more full-time equivalent doctors working in general practice compared with January 2024. We have committed to training thousands more GPs across the country and recruiting over 1,000 newly qualified GPs through an £82 million boost to the additional roles reimbursement scheme.

Mental Health Bill [HL]

Baroness Merron Excerpts

Monday 17th March 2025 Lords Chamber

Moved by

[Baroness Merron]

That the Bill be considered on Report in the following order: Clauses 1 to 3, Schedule 1, Clauses 4 to 23, Schedule 2, Clauses 24 to 39, Schedule 3, Clause 40 to 56, Title.

Motion agreed.

Apricity Fertility Closure

Baroness Merron Excerpts

Wednesday 12th March 2025 Lords Chamber

[Baroness Owen of Alderley Edge]

To ask His Majesty’s Government what assessment they have made of the effect of the closure of Apricity Fertility on 1 January on the patients who were undertaking treatment with them.

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

My Lords, the Human Fertilisation and Embryology Authority advised the department about the closure of Apricity in December. Apricity did not fall under the HFEA’s regulatory remit, as it was only a digital service. I urge anyone seeking fertility treatment to check that the clinic they are using is HFEA licensed. I advise affected patients in this case to check their consumer rights and engage with trading standards, if needed. More broadly, the HFEA is helpfully providing advice.

[Baroness Owen of Alderley Edge (Con)]

My Lords, Apricity Fertility advertised itself as:

“The UK’s Top Virtual IVF Clinic”.


As the Minister pointed out, it was not regulated by the Human Fertilisation and Embryology Authority, which by law can regulate only UK-licensed fertility clinics, which are the premises where treatments take place. Will the Minister commit to a review of the HFEA’s powers to ensure they are appropriate for digital services?

[Baroness Merron (Lab)]

As the noble Baroness will be aware, in November 2023 the HFEA published Modernising Fertility Law, in which it made a number of recommendations for urgent change, including around its regulatory powers. I will meet the HFEA chair and CEO tomorrow, and we will further discuss the regulatory challenges that the HFEA faces. I assure the noble Baroness that the Government are currently considering the HFEA’s priorities, including its role with digital clinics such as the one referred to, should an opportunity for legislative reform arise.

[Lord Winston (Lab)]

My Lords, the noble Baroness, Lady Owen, asks a most important Question, and I am grateful to my noble friend the Minister for answering it at least partially. I argue that much more of an answer is needed. Apricity advertised a success rate that was literally impossible; indeed, it was more than double the national success rate. Again and again, patients are being sucked into in vitro fertilisation—which may not always be the best treatment for them, just because they are infertile—because they think they will have a better chance of success than they actually have. It is time to be much more rigorous. As my noble friend the Minister is seeing the HFEA chair tomorrow, will she ask her how well the HFEA feels it is auditing the results it gets from clinics? In my view, many clinics are exaggerating, in all sorts of ways, what the success rate is.

[Baroness Merron (Lab)]

My noble friend raises an extremely important point, which I will of course cover in my meeting tomorrow. It may be of interest to know that the Advertising Standards Authority and the HFEA issued a joint enforcement notice in 2021 to ensure that fertility clinics and others were aware of the advertising rules and were treating consumers fairly. That remains in place. The ASA periodically reviews compliance with its rules. Its recent review in the fertility sector found far fewer absolute claims than it had found previously and that the level of compliance is good. That is not to say that it is good in all cases, and I agree with my noble friend’s point.

[Baroness Barker (LD)]

My Lords, the law governing human fertilisation and embryology in this country built on the outstanding work of Baroness Warnock. It was carefully crafted so that it rests on principles that endure, but it was designed in such a way that it could be regularly updated to deal with advances in scientific knowledge and changes in society. Does the Minister agree that this is an indication that we have come to a point where that legislation needs to be reviewed? In order to do that, will the Government commit to beginning the process of consultation that must take place before any legislative review comes to this Chamber?

[Baroness Merron (Lab)]

I agree with the noble Baroness’s observations. The legislation goes back to 1990. We are in 2025, and there has been an advent of many new technologies, techniques and business models—for example, the noble Baroness, Lady Owen, referred to Apricity—that were never imagined just a few years ago, let alone in 1990.

The majority of clinics are privately owned. Many are part of large groups with external finance. Elements of fertility care and associated treatments are increasingly offered online or outside HFEA regulation. There is a huge challenge here. That is why we are in discussion with the HFEA, and we will be in discussion tomorrow.

[Lord Kamall (Con)]

My Lords, the Minister will recall that in 2022 the previous Government published the 10-year Women’s Health Strategy for England. During the consultation process, it came out that access to fertility services differs greatly across the country—possibly one of the reasons that many women went to Apricity in the first place. Part of the solution that was proposed to tackle these disparities was a target to establish women’s health hubs. I understand that the current Government have decided not to go ahead with these women’s health hubs. My question is not why, but how the Government envisage tackling these disparities without women’s health hubs. What is the strategy for doing that?

[Baroness Merron (Lab)]

Women’s health hubs—which are a huge success and we continue to support and promote them, without any shadow of a doubt—do not deal with fertility treatment in the way this Question is discussing. I gently point out to the noble Lord that, as he rightly said, commitments were made to improve access to fertility services, which is very variable across the country. They were made under the last Government’s women’s health strategy but, regrettably, were not delivered. It now falls to us to look at how we can improve both availability and quality, and to equalise what is available, which is a huge challenge. This continues to concern me.

[Baroness Deech (CB)]

My Lords, I declare an interest as a former chair of the HFEA. The problem the Minister has referred to is increasing commercialisation. Vulnerable patients are more or less captured by clinics—for example, by being charged ever-increasing amounts for the storage of their embryos. How can the Government get to grips with the market element in an area that is largely private? Can they encourage the NHS? I know the difficulty of taking on more. What legislation can there be to control this commercialisation and the huge amount earned by the private doctors?

[Baroness Merron (Lab)]

The noble Baroness and other noble Lords are quite right in what they are reporting on the change. Fertility treatment is now overwhelmingly obtained through private means. It is in a very different place from the rest of healthcare in our country.

On the point the noble Baroness made—I am grateful for her contribution in view of her previous service in this area—there are many claims made, for example, about egg freezing. It is crucial that anyone considering freezing their eggs understands that there is an optimum age for freezing, that it is a serious medical procedure and that the risks should be taken into account. That chimes with the point made by my noble friend Lord Winston.

The market has changed—it has very much become a market. The demand is huge and has multiplied many times over the decades. We are not in a situation where we have either the regulation or the NHS provision to deal with that. I assure your Lordships’ House that we are working with NHS England, particularly on the variability up and down the country.

[Baroness Manzoor (Con)]

My Lords, the Minister is right that the market has changed, but the legislation has not been kept up to date; nor has it kept up to date with patient expectations, developments and the way those services are being provided for some of these women. Often, some of these women are vulnerable. Can the Minister say exactly what the Government will do to update not only the regulations but the law?

[Baroness Merron (Lab)]

In my discussions, I will consider the publication Modernising Fertility Law, which, as I said, the HFEA put forward in November 2023. In it there are a number of recommendations for urgent change, which I am taking extremely seriously. Most patients are funding their own treatment, which is why we have to make a shift. In 2022, 27% of IVF cycles were funded by the NHS; that figure fell from 40% in 2012. That gives some idea of the scale of the challenge. I consider it unacceptable that access to NHS-funded fertility services is so variable across the country.

Food and Feed (Regulated Products) (Amendment, Revocation, Consequential and Transitional Provision) Regulations 2025

Baroness Merron Excerpts

Wednesday 12th March 2025 Lords Chamber

Moved by

[Baroness Merron]

That the draft Regulations laid before the House on 29 January be approved.

Relevant document: 17th Report from the Secondary Legislation Scrutiny Committee (special attention drawn to the instrument). Considered in Grand Committee on 10 March

Motion agreed.

Autism and Learning Disabilities: Hospital Detention

Baroness Merron Excerpts

Tuesday 11th March 2025 Lords Chamber

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

My Lords, this Question refers to a very sad and concerning story. This Government want more people with a learning disability and autistic people to be supported in the community, not detained in mental health hospitals. That is why we are proposing reforms to the Mental Health Act, which this House is currently scrutinising. Through this, we want to help ensure that people get the support they need in the community, improving care and keeping people out of hospitals.

[Baroness Tyler of Enfield (LD)]

I thank the Minister, and I am sure the whole House was appalled by this shocking case, which came to light only due to a BBC investigation. Does the Minister agree that to prevent such a terrible situation arising again, we cannot just wait for the Mental Health Bill to get on the statute book with its current five- to 10-year implementation period? What immediate plans do the Government have to set up a system to review long-term detentions? Does the Minister agree with me that a mental health commissioner, currently under debate in the Bill, could take on this role?

[Baroness Merron (Lab)]

I am grateful to the noble Baroness for tempting me to agree with her comments about a mental health commissioner. We have debated that, and the noble Baroness is aware that we do not feel that this is the right way forward. However, I am sure we will return to that on Report.

With regard to not waiting for the Mental Health Bill to become an Act, of course I agree. The number of people with a learning disability and autistic people who are in mental health hospitals is unacceptable, and there are still too many detained who could be supported in their communities. We have taken immediate action in allocating funding to local areas: £124 million for learning disability and autism services. We are making sure that the workforce has the right skills and knowledge through work such as the HOPE(S) model. We are providing for the CQC to deliver independent care (education) and treatment reviews. NHS planning guidance provides a continued focus on improving mental health and learning disability care, with an objective to deliver a minimum—I emphasise minimum— 10% reduction in the use of in-patient care.

[Baroness Hollins (CB)]

My Lords, for 25 years, this woman’s detention was in long-term segregation. My review of this practice, which was commissioned by the previous Government, recommended that people in LTS must have an independent review, should have national support to reduce confinement, and be allocated an independent project manager to co-ordinate their timely discharge. But despite the unequivocal success of the ICETR programme, the HOPE(S) intervention and senior intervenors’ support, funding has been cut at the end of this year. Will the Government commit to funding these vital initiatives to end this rights-depriving restrictive practice?

[Baroness Merron (Lab)]

I am most grateful to the noble Baroness for her contribution and expertise in this area, which I know we all look to in your Lordships’ House, as well as outside it. The points she makes are quite right and important. On this particular case, which is very sad and concerning, I understand that the person is now living in the community with 24/7 care and has been since 2022. I saw at Rampton how people were being supported out into the community with the right support. On the example the noble Baroness gave, we are very keen to improve the uptake of advocacy services, and she will know that all these matters are being addressed in our discussions on the Mental Health Bill.

[Baroness Ramsey of Wall Heath (Lab)]

My Lords, I refer to my particular interest in this subject as the younger sister of a woman with severe learning difficulties who was detained in a hospital for many years. Is my noble friend the Minister confident that this sort of tragic lengthy detention of a non-verbal woman with both autism and learning disabilities will be prevented in future by the register proposed in the Mental Health Bill to be established and maintained by integrated care boards?

[Baroness Merron (Lab)]

Yes, because we are, as my noble friend knows, updating an Act that is over 40 years old, to keep pace with demands and changes, and to meet our expectations of providing care through a compassionate and appropriate service. There were particular circumstances in this case, which I do not seek to excuse, but it is not appropriate for me to go into them. It is important to look at specific cases.

[Baroness Monckton of Dallington Forest (Con)]

My Lords, there are over 2,000 people with autism and learning disabilities locked up in these facilities at huge cost. Putting them into the community does not necessarily work because the infrastructure is not there. Will the Minister commit to funding the necessary care and housing for this cohort?

[Baroness Merron (Lab)]

The noble Baroness is quite right to raise the fact that at the end of January 2025 there were some 2,065 people with a learning disability, autism, or both, in mental health in-patient settings. The population I referred to is not a static one; there are new admissions every month. We know, for example, that in January 2024, some 10,000 discharges to the community had been undertaken since 2015. So it is not necessarily the same group of people. She will know that funding decisions are made at the appropriate point. Again, this is a matter of great importance to the Mental Health Bill, and we will continue to take that through the House to get it into the best place possible.

[Lord Kamall (Con)]

My Lords, during the 45 years that this poor autistic lady with learning disabilities was detained and the 25 years she was in segregation, we have had Governments of all political colours, so this is clearly not a political issue. Indeed, I remember the Minister challenging me on such detentions when I was in her place. Given that, are the Government any closer to understanding the barriers that prevent such patients from being released into the community? Rather than assuming that the state always has a solution, have the Government and the NHS had conversations with local community civil society organisations so that they can support these patients once they are released into the community?

[Baroness Merron (Lab)]

This matter is one of concern on all sides and yes, indeed, we continually have those discussions, because this is not just something for the NHS and social care—the third sector is absolutely key. I have already outlined the measures we are currently taking and the way in which we continue to monitor.

On the question about obstacles, it is about having the right community provision in place and also about having the right pathway and treating people as individuals. Increasingly, that is the case, and a revised Mental Health Act will be a tremendous support in this area.

[Lord Laming (CB)]

My Lords, I hope the Minister will agree that the use of the Mental Health Act in these circumstances should be a last resort and a minimal experience. What happened to this lady is no credit to our society as a whole. Can the Minister say what steps have been taken since this lady’s experience came to light to ensure that other people are not subject to the same experience? We really need to learn from this experience.

[Baroness Merron (Lab)]

Regrettably, that person’s experience is not a lone example. That is why, for example, the Mental Health Bill will limit the scope to detain people with a learning disability and autistic people, so that they can be detained under Section 2(3) only if they have a co-occurring mental disorder that requires hospital treatment. That is key because, in the times that we are talking about, people were detained just because of autism or a learning disability. That is not acceptable.

[Baroness Ritchie of Downpatrick (Lab)]

My Lords, I welcome my noble friend the Minister and advise her that your Lordships’ House has a specialist committee that is dealing with the review of the Autism Act 2009. I encourage my noble friend and her ministerial colleagues, both in health and social care and in education, to undertake a review of that Act to ensure that it is fit for purpose, for the needs of autistic people.

[Baroness Merron (Lab)]

I am very grateful to the committee for its work and I am certainly looking forward to its report. The Government will respond to that report within two months. It is indeed vital work that is being undertaken.

Food and Feed (Regulated Products) (Amendment, Revocation, Consequential and Transitional Provision) Regulations 2025

Baroness Merron Excerpts

Monday 10th March 2025 Grand Committee

Moved by

[Baroness Merron]

That the Grand Committee do consider the Food and Feed (Regulated Products) (Amendment, Revocation, Consequential and Transitional Provision) Regulations 2025.

Relevant document: 17th Report from the Secondary Legislation Scrutiny Committee (special attention drawn to the instrument).

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

My Lords, these regulations were laid before the House on 29 January. This draft SI uses powers conferred by the Retained EU Law (Revocation and Reform) Act 2023 to propose two reforms to the market authorisation process for regulated food and feed products in Great Britain. The first is the removal of the requirement for certain products to be reauthorised every 10 years, and the second is to allow authorisations to come into effect following ministerial decisions and to then be published in a public register, rather than prescribed by statutory instrument. The reforms are very much related to process.

These reforms are part of this Government’s mission to kick-start economic growth by increasing investment, driving up productivity and tackling regulatory barriers—something that I know noble Lords are concerned with. The UK food industry is worth some £245 billion in consumer spending annually. It is driving innovation, particularly as the UK’s growing engineering biology sector harnesses emerging technology to produce novel foods.

Regulated products are food and feed products that require safety assessment before they can lawfully be sold. The Food Standards Agency and Food Standards Scotland carry out this assessment and provide recommendations to Ministers across Great Britain on the authorisation of products. Innovation and growth across the food sector is increasing demand for authorisations. We need proportionate regulation to support investment, while maintaining safety and consumer trust. This statutory instrument removes requirements that are unnecessary for food safety without compromising it.

On renewals, certain authorised products must currently be reauthorised every 10 years. This SI removes that requirement. Instead, safety reviews will be carried out when necessary. The service will be more efficient if regulators focus on detailed reviews of products that potentially pose risk, instead of reassessing products that have many years of safe use.

The FSA and the FSS have earned public trust through rigorous risk analysis. These reforms build upon regulators’ existing powers to request safety information. They enable an efficient approach, where the regulators respond effectively to emerging risks. I emphasise that, where necessary, approvals can be modified, suspended or revoked. Food safety will continue to be the priority.

Although steady progress is being made, it is fair to say that the FSA and the FSS are not processing as many applications as are coming in. This is causing an increasing backlog, which is of concern. There are 481 current applications; although 97 applications have been completed since 2021, the caseload is growing, not reducing. Of those 481, about 100 are renewals, with almost 500 additional renewals expected in the next three years. This has to be dealt with. While the FSA and the FSS have implemented measures to improve the service within current legislation, it is essential that the service and the system are modernised. Removing automatic assessment for renewal allows a more targeted approach.

I turn to the removal of SIs. The second part of these reforms allows authorisations to come into force following ministerial decisions and to be published in a public register, rather than being prescribed by an SI. This will enable new products to be brought to market more quickly, without, I emphasise, compromising safety. Publishing authorisations together in online registers, rather than in complex legislation, will make finding information on authorised products more accessible than currently. This aligns with other UK regulators’ authorisation processes, such as for veterinary medicines and pesticides.

The FSA and the FSS provide scientific scrutiny through expert staff and independent scientific advisory committees. They provide safety assessments, risk management advice and recommendations for ministerial decisions. This process aligns with internationally recognised principles. The FSA and the FSS will publish risk assessments and authorisations, in line with their commitments to transparency. The statutory obligation to consult will not change, and authorisations will continue to be subject to public scrutiny.

I assure noble Lords that there has been extensive engagement with industry and consumer groups, including through public consultation. The reforms have received substantial support. The Secondary Legislation Scrutiny Committee was reassured by the FSA’s responses to questions raised during scrutiny. I have responded to those primary areas of focus in this opening speech.

These reforms prioritise efficiency and safety, focusing resources on innovative products. I hope noble Lords will feel able to support these reforms, which will create a service which manages risk in a proportionate fashion, without compromising our high food and feed safety standards. I beg to move.

[Baroness Coffey (Con)]

My Lords, I welcome these regulations, on several grounds. First, as the Minister mentioned, this is a deregulatory approach. There cannot be many regulations deemed to be deregulatory that have 104 pages, but 70 of those pages deal with revocations of existing legislation. That is to be welcomed.

I completely support that this will be a risk-based approach. I am conscious that consultations are ongoing on products being considered by the FSA under this approach. I am conscious that some may be concerned about removing the need for separate secondary legislation, which is a hangover from our days in the European Union, but this is perfectly routine.

I have a couple of questions for the Minister. First, I am conscious that the Food Standards Agency is a non-ministerial department, with the DHSC leading on this in government and in Parliament. Can she confirm whether DHSC Ministers will be making these decisions or whether it will be open to Defra Ministers?

Secondly, an issue that arose during the passage of what is now the precision breeding Act was concern that the devolved Administrations would be reluctant to have any GMO in products sold in their countries. The purpose of the United Kingdom Internal Market Act and the non-discrimination principle was to make sure that, where something had been given the go-ahead in England, say, it could be sold anywhere across the United Kingdom, respectful of the devolved Administrations but nevertheless giving consumers that choice. Will the UK Government fully assert the non-discrimination principle in the sale of future products? As I said, I support these regulations.

--- Later in debate ---

[Lord Kamall (Con)]

My Lords, I welcome the noble Lord, Lord Moraes, to his place. We served together in the European Parliament, of which he was a well-respected member. I thank the Government for sending out so many big guns—I think I count six on the Front Bench in this Room. I will not flatter myself that they are here for me, but I am impressed by how seriously the Government are taking this statutory instrument.

I thank the Government for addressing the concerns of the Secondary Legislation Scrutiny Committee. The noble Baroness, Lady Walmsley, rightly said that questions were not answered, but it is good that the Government were able to address those concerns, and we are grateful for that. Like my noble friends Lady Coffey and Lady McIntosh of Pickering, I think that these Benches generally welcome measures to streamline processes, but I understand potential concerns over the safety and oversight of regulated products. As the saying goes, one person’s safety standards may be another’s red tape. That was something that the noble Baroness, Lady Bennett, alluded to.

We welcome that there was a consultation between April and June 2024. I understand that, while there was broad agreement in principle, there were some concerns and disagreements, which I would like to ask the Minister about today. Before I do that, I shall pick up on the issue of GMOs. Let me clear—I have nothing in principle against GMOs, but for consumers it is important that there is labelling, so that they can make that choice in an informed way. When we were in the European Parliament and negotiating the Transatlantic Trade and Investment Partnership with the US and made the point about labelling GMOs, what was interesting was that the US negotiators would say, “That’s a non-tariff barrier”. If the Government intend to label GMOs, is that an issue that will be brought up in future trade negotiations? The Minister may not be able to answer that immediately, but perhaps she can write to us about it, or ask her colleague who is taking through trade issues at the moment.

The Government claim that these changes will provide businesses with quicker approval times, increasing the return on investment and stimulating innovation. That is of course to be welcomed, but we should always be aware of two things. What happens in the case of negative unintended consequences, and what happens if new evidence comes to light that shows that a product authorised under these terms presents previously unforeseen risks to public health or the environment? That is something that other noble Lords referred to. In a situation where regular renewals are no longer required, can the Minister assure your Lordships if and how products covered by this regulation will be reassessed, if any new data emerges that suggests that they are not as safe as originally thought, especially if these products are already on the market?

I understand that the Food Standards Agency and Food Standards Scotland have the power to conduct evidence-based reviews if new information surfaces, but can the Minister assure us that a less regular review mechanism will not compromise safety? I think that she mentioned the phrase “where necessary”. Can she put more meat on the bone and explain a bit more what that means? What mechanisms are in place to ensure that products remain compliant with safety standards over time? We know that regulation is often outpaced by innovation, so how do the FSA and the FSS plan to stay ahead of new risks or scientific developments with less regular oversight than these renewals once provided?

The second potential concern is that the Government do not appear to have conducted a formal impact assessment of these proposals. Given that these regulations will affect a significant number of products and legislative instruments, could the Minister tell noble Lords whether it is correct that no formal impact assessment was conducted and, if not, why not? Was there an informal impact assessment of any kind, and why was it decided that no formal impact assessment would be needed? Can the Minister assure the public that the full range of potential risks and benefits has been properly assessed?

Finally, as noble Lords may know, I spent 14 years in the European Parliament—not as long as my friend, the noble Lord, Lord Moraes. I was often frustrated by EU regulations, because they were more often than not based on the precautionary principle, or the over-precautionary principle, rather than the innovation principle. It is important that we get the balance between innovation and precaution right—I welcome that. I am not necessarily against divergence between UK and EU regulations, especially when it allows innovation, but could the Minister tell your Lordships what conversations the Government have had with EU counterparts and colleagues in Northern Ireland about the potential impact of these regulations on the Windsor Framework?

Overall, while these Benches welcome the regulations, I hope that the concerns expressed during the consultation, and today by other noble Lords, can be addressed by the Minister.

[Baroness Merron (Lab)]

My Lords, I thank noble Lords for their valuable and considered contributions to the debate today. I re-emphasise the main point I made in my opening comments: removing automatic renewal processes and statutory instrument requirements will not lower food safety or standards. I am grateful for the support from the noble Baroness, Lady Coffey, and for her bringing to bear her experience across relevant departments, as well as from the noble Baroness, Lady McIntosh, and the noble Lord, Lord Kamall.

I have heard a number of concerns, including from the noble Baronesses, Lady Bennett and Lady Walmsley. I understand the points made, and I hope that I can reassure them further from my opening comments. I am very happy to follow up where I have not got the ability, time or wherewithal to answer the questions.

The noble Baroness, Lady Coffey, asked about ministerial decision-making and the assertion of the non-discrimination principle. These reforms do not change what is in place to maintain the functioning of the internal market Act. Differences in approach will continue to be managed through the relevant common frameworks. I reassure not only the noble Baroness but other noble Lords that the FSA and the FSS are strongly committed to achieving a four-nation consensus, in line with our commitment to the food and feed safety and hygiene common framework. Decisions by Ministers in England—which will be from the Department of Health and Social Care, to the point brought up by the noble Baroness—as well as Scotland and Wales, will still be required for authorisations in their respective nations.

The noble Baroness, Lady McIntosh, asked about processes that will be followed with the removal of the renewals process. This SI does not change current GMO labelling requirements, which I know was another matter of concern to other noble Lords. Products that contain or consist of GMOs must be clearly labelled as defined in current legislation. Nothing will change in that regard. Following the reforms, businesses will continue to be required to notify the FSA and the FSS, if they have any new information which might affect the suitability of a validated laboratory-based method for the identification, detection and qualification of GMOs, something that the noble Baroness, Lady Bennett, was also concerned with.

To the point about the SLSC, it is suggested that the House may wish to consider the steps proposed to maintain parliamentary oversight. However, proportionate processes are in place for sufficient scrutiny of authorisation decisions, such as public consultation and the publication of safety assessments and authorisations. It is an important point that the authorisation process remains open and transparent. The SLSC recognised that this aligned with the processes used by other UK regulators.

[Baroness McIntosh of Pickering (Con)]

I do not wish to labour the point too much, but when a statutory instrument is presented to this Committee, we have the opportunity as parliamentarians to look at it. How will we be informed of the renewals if they are on a register? Do we have to ask someone to notify us? How do we know? At the moment, it is automatic; in future, it will not be.

[Baroness Merron (Lab)]

I understand the point the noble Baroness is making. I will turn to the point about the availability of information, which was also the point that the noble Baroness, Lady Walmsley, made. However, details of applications and authorisations will actually be more publicly available than they are currently. I hope that will be helpful. Of course, as we know, Ministers must provide reasoning if they disagree with FSA and FSS advice when they are making their decisions. In order for the public and anybody—including Parliament—to scrutinise regulated product applications and authorisations, all those tools and resources will be available.

The noble Baroness, Lady Walmsley, suggested a reporting mechanism. I am happy to look at that and will take into account what she said. But I say to noble Lords—and I know they know this—that statutory instruments are not the only way in which to hold matters to account, nor are they always the best way to ensure transparency and openness. We are seeking to be more transparent and ensure that we make this an easier place for industry, the public and others to work in—which most noble Lords welcomed.

--- Later in debate ---

[Baroness Bennett of Manor Castle (GP)]

There may be a legal obligation on companies to act, but we have seen again and again that, with the profits versus the costs of them identifying a problem and being prepared to go public and go to the Government about it, the legal requirement is not much of a safeguard.

[Baroness Merron (Lab)]

I understand that. It is why these reforms build on existing powers, whereby the FSA and FSS can request information for the review. It is of course in the interests of businesses to proactively provide it. As I mentioned in my opening remarks, where necessary, approvals can be modified, suspended or even revoked if a safety concern has been identified. That will not change.

To return to the point I was making previously, when, or if, new safety evidence emerges, it will inform whether authorised products are safe to remain on the market at any time, instead of—this is the reason for this statutory instrument—working to arbitrarily fixed renewal timetables, which burden industry and the public sector with comprehensive reviews for all products, whether they are needed or not, even when there is no evidence to suggest that one is needed. The evidence shows that this move is generally in the desired direction to be working.

The noble Baroness, Lady Walmsley, asked whether more should have been done in the Explanatory Memorandum to point out issues. As I listened to her, I wished that we could all predict what needs to be answered. Importantly, the FSA responded to all the questions raised by the SLSC, which was reassured by the responses. I hope that noble Lords agree that the FSA has been most helpful there.

On the question asked by the noble Baroness about sufficient resources and systems, it is anticipated that a relatively small number of authorisations will require a review on the basis of safety, as compared to the large number of renewals currently processed. I would expect that to be very manageable.

The noble Baroness also asked whether reports are always sent, whether they are always complete and whether that would give confidence. An evidence-based review system will ensure that already-authorised products are reviewed based on risk and new evidence rather than, as I said, on a fixed timetable. Reports are indeed provided and completed, but this change will make that even more doable and meaningful, and that is the reason for the change.

As I said earlier to the noble Baroness, Lady Walmsley, who made a suggestion about Written Statements being made, I will certainly take that away and reflect on it—as I will do for all of the points that were raised. With that, I thank noble Lords for their interest in and scrutiny of this SI.

Motion agreed.

Prostate Cancer: National Screening Programme

Baroness Merron Excerpts

Thursday 27th February 2025 Lords Chamber

[The Lord Bishop of St Albans]

To ask His Majesty’s Government what plans they have to introduce a national screening programme for prostate cancer.

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

My Lords, we are investing £16 million in the Prostate Cancer UK-led TRANSFORM trial to look for better tests than we have currently. Evidence shows that the current best test available, the PSA test, is not accurate enough to use in men without symptoms. As noble Lords will appreciate, policies must be evidence-based, so the UK National Screening Committee is actively reviewing the evidence for prostate screening programmes and will complete its review this year, to be followed by consultation.

[The Lord Bishop of St Albans]

My Lords, I declare an interest, in that just a year ago I was unexpectedly and rapidly diagnosed with prostate cancer and received wonderful treatment from the NHS, to which I pay tribute today. Some 12,000 men die each year, many needlessly, because of late diagnosis. It is a postcode lottery. It is quite clear that in areas of socioeconomic deprivation, and among black men between the ages of 45 and 70, there is a much higher incidence. When can we expect to hear news about a national screening programme? What assessment is being made of the new tests that are being reported at the moment, which are much more successful in diagnosis?

[Baroness Merron (Lab)]

My Lords, I am glad to hear that the right reverend Prelate had such good care in the NHS. His comments are appreciated, and we are very pleased that things have out turned so well for him. The issue, as I know he will he understand, is that we cannot offer an inaccurate test to high-risk groups, not least because that increases the risk of adverse effects, unnecessary treatment and misdiagnosis. We are not yet in a scientifically and evidence-based position to offer the national screening programme, and that is why we are taking the action that I outlined in my Answer.

[Baroness Walmsley (LD)]

My Lords, while we wait for a more reliable screening tool, what are the Government doing to inform men about the very clear risk factors that are known about? To that I would add that maintaining a healthy weight reduces the risk. Additionally, what can the Minister do to reassure men that, if they are in any way worried about any symptom, they are not wasting their GP’s time if they go along and get it checked out?

[Baroness Merron (Lab)]

The noble Baroness is absolutely right. I encourage everyone, men and women, to be aware of any changes in their bodies. They are not wasting the time of their GP. That is exactly what they should do. As she says, men are disproportionately affected by a number of health conditions, including some cancers, heart disease and type 2 diabetes. As part of addressing this, the Secretary of State has announced that we are developing a men’s health strategy, not least because we know that men are less likely to come forward to deal with health matters.

[Baroness Manzoor (Con)]

My Lords, in the absence of a national screening programme and given the difficulty in getting access to GPs, particularly in deprived areas, how are the Government improving access to GPs? In some areas, it is two to three weeks before people can get an appointment.

[Baroness Merron (Lab)]

Again, I am sure that the noble Baroness would agree that the important thing is that people ensure that they do not ignore the situation. I agree that the situation that we inherited was hugely difficult, particularly in some areas, around GPs. In the 10-year plan, which will be published in the coming months, there will be a big focus on the move from sickness to prevention, from analogue to digital, and from hospital to community. In all three pillars, greater access to GP appointments will be included.

[Baroness Finlay of Llandaff (CB)]

My Lords, as the Minister rightly highlighted, there are detection gaps, and one in 50 people have aggressive disease at the time of diagnosis. When this proves to be hormone-therapy or chemotherapy resistant, how many centres can offer strontium, which can be very effective for metastatic bone pain, as that is how some people present?

[Baroness Merron (Lab)]

I was glad to have the opportunity to discuss this with the noble Baroness. Having looked into it, we do not currently hold this data. However, where strontium therapy is appropriate and preferred to improve patient outcomes, it will be offered. This is, of course, a clinical decision.

[Lord Kamall (Con)]

My Lords, when I worked in Belgium, a urologist told me that men over 45 years old should seek a test every year for this. When I came back and asked my GP, he was dismissive of that, saying that I should seek a PSA test. When I asked a nurse at my next blood test for a PSA test, she said, “Are you sure? They’re not very reliable”. Given that the last Government introduced trials, and that one of the tests seems to be 96% accurate, can the Minister say any more about that trial and its evaluation, and whether we are any closer to a definitive test? If not, what guidance is available to medical practitioners for the PSA test?

--- Later in debate ---

[Baroness Merron (Lab)]

The advice and guidance is that GPs should counsel asymptomatic men about the potential benefits and harms of PSA testing, so that they can make an informed decision. However, the guidance is that GPs should not proactively offer a PSA test, for the reasons that we have covered. That is why we are investing in this trial, to find a better test so that we can address this. This is a complex area, as often it is, but we are making progress, as I have already outlined.

[Lord Brennan of Canton (Lab)]

My Lords, it is very welcome that new diagnostic tests are being investigated. However, can we be careful not to give out the wrong message? I was diagnosed with prostate cancer—and I was completely symptomless—thanks to the PSA test. In giving out that message, can we make it clear that GPs should not stop men getting a PSA test, even when they are symptomless, if they are at the right age and in the right bracket?

[Baroness Merron (Lab)]

I certainly agree with my noble friend. As he knows from his experience, tests are available. The point is that they should be used in the right situation. As he knows, one of the issues is people being asymptomatic, which is why it is very important that men take note of their health and report any change or concerns that they have.

[Lord Grayling (Con)]

My Lords, I am also here thanks to early diagnosis. I understand what the Minister is saying about the PSA test, but very many people are here today because they had such a test. It worries me that the message is that, because it is not reliable, it should not be at the forefront. I ask the Minister not to rule out using PSA tests more widely. If it is the best we have got, it may be the only thing we have got.

[Baroness Merron (Lab)]

I thank the noble Lord for sharing his personal experience. I am not suggesting that the PSA test should not be used, but we are talking about extending it and using it in a screening program. I thank him for giving me the opportunity to reassure your Lordships’ House that that is why we have the trial, which will report later this year, to find a better answer; the answer we have currently is not where we need it to be. Yes, there is a role for it, but we must strive for better than we have got currently.

[Lord Sentamu (CB)]

My Lords, 13 years ago, a PSA test saved my life. I had an operation in Leeds hospital and I now have no sign of that, and every year they test me by the same method. I encourage the Minister not to give mixed messages. We need a very clear message that, at the moment, the PSA test saves a lot of lives.

[Baroness Merron (Lab)]

I agree about the need for clear messages, and I hope the noble and right reverend Lord will agree on the need for striving to do rather better.

[Lord Bailey of Paddington (Con)]

My Lords, in many deprived communities, and in the black community in particular, there is a very high incidence of prostate cancer. Before they get to the PSA test, what work is being done to educate communities even to be involved with seeking out that test in order to protect their health?

[Baroness Merron (Lab)]

The noble Lord is quite right to raise this. I am glad to say that the TRANSFORM trial I referred to will help to address this by ensuring that a significant proportion of participants are black men, who suffer disproportionately in this regard. That is really important, because previous trials have not included enough black men. The trial will address those disparities, and therefore the results that we get from that will be really important. It is always the case that working with specific communities to get the right message out is key to what we do.

Musculoskeletal Health: Chiropractors

Baroness Merron Excerpts

Wednesday 26th February 2025 Lords Chamber

[Baroness Ritchie of Downpatrick]

To ask His Majesty’s Government whether they plan to incorporate a role for chiropractors in national musculoskeletal health prevention strategies.

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

My Lords, improving health outcomes for over 17 million people in England with musculoskeletal conditions forms a key part of this Government’s commitment to build an NHS for the future. Healthcare professionals play a vital prevention role in supporting people to self-manage their conditions. NHS England does not commission chiropractic care nationally. However, ICBs have their own clinical or commissioning policies and so may commission a limited amount of such treatment, based on the needs of the local population.

[Baroness Ritchie of Downpatrick (Lab)]

I thank my noble friend for her Answer. I say initially that I am someone who avails periodically of chiropractic services. Will my noble friend the Minister, along with her ministerial colleagues in the Department of Health and Social Care, review the allied health professions list to include chiropractors working within the NHS to deal with musculoskeletal conditions, which in turn could alleviate the burdens on an already overburdened NHS? Could this also be included in the national health plan, which I hope will be published shortly?

[Baroness Merron (Lab)]

I recognise the importance of mitigating the long-term burdens of MSK conditions, which are considerable, and the role that healthcare professionals, including allied healthcare professionals, can play in supporting not just prevention but early detection and the management of conditions. I know that chiropractic care is appreciated in a number of cases, including that of my noble friend. However, clinical evidence from systemic reviews does not support national commissioning of chiropractic treatment, as I mentioned, although ICBs can commission these services. To the point on the 10-year plan—a report on that is expected in the spring, as my noble friend referred to—I place on record that I am grateful to the British Chiropractic Association, the Arthritis and Musculoskeletal Alliance, Versus Arthritis and the Royal Osteoporosis Society for ensuring that the voices of the MSK community have been well heard in the consultation.

[Baroness Burt of Solihull (LD)]

My Lords, 30% of GP consultations are for people with musculoskeletal problems. As a previous back sufferer who has made use of chiropractors in the past, I know personally the transformation that chiropractic treatment can achieve. I can afford that treatment, but many NHS patients cannot, so why can chiropractors not practise across the NHS, when waiting lists for treatment on the NHS are causing the loss of over 6 million working days every year?

[Baroness Merron (Lab)]

The noble Baroness is absolutely right to highlight the extent of the impact of MSK conditions not just on individuals but on our economy and our health service. However, to extend my earlier comments, chiropractic care is regarded as being in the category of complementary and alternative medicines. Some treatments have an evidence base that is not recognised by the majority of independent scientists, whereas others have been proven to work for a limited number of conditions. I appreciate the point that the noble Baroness is making, but probably the simplest way I would wrap it up is in talking of sufficient and reliable evidence, because that is what NHS commissioning at a national level is based upon.

[Lord Lexden (Con)]

My Lords, is it not the case that chiropractic treatment is included in the World Health Organization’s guidance on MSK conditions? Will the Government keep that guidance clearly in mind as they work, as I am sure they will be working, to develop a better approach to helping people with these painful conditions?

[Baroness Merron (Lab)]

I am glad that the noble Lord acknowledges the ongoing work, because we are indeed exploring how best to support dealing with MSK conditions—not least to encourage and provide greater parity in the support that is given. That will be alongside the 10-year plan and the long-term workforce plan. Of course, we keep all evidence continually under review.

[Baroness Winterton of Doncaster (Lab)]

My Lords, I take the point my noble friend the Minister makes about national commissioning and the ability of integrated care boards to do some commissioning, but would not the answer be for the integrated care boards to get all preventative healthcare practitioners to sit down together and work out local strategies? It may well be that one condition can have an effect on another, and perhaps that would make the commissioning of chiropractors easier and fit in with a local preventative healthcare strategy.

[Baroness Merron (Lab)]

My noble friend helpfully emphasises the point about the need to provide for local populations, and ICBs are in the pole position to do that. I am sure that noble Lords will recall that we recently announced changes in the NHS operating model to move power from the centre to local leaders. I particularly refer to the NHS planning guidance, whereby we follow the recommendations of the noble Lord, Lord Darzi, to take a whole new approach and reduce the number of national targets from 32 to 18. The reason for that is to give the local systems my noble friend refers to greater control and flexibility on how local funding is deployed. Indeed, one such model could be the one my noble friend referred to.

[Lord Rogan (UUP)]

My Lords, an estimated 30% of the population of the UK are burdened with a painful and debilitating MSK condition. That is over 20 million people in the United Kingdom. Given the Government’s priority of shifting treatment into communities in the 10-year health plan, will the Minister meet again with representatives from the chiropractic profession to hear how they can increase capacity for community MSK treatments?

[Baroness Merron (Lab)]

I am certainly happy to have such discussions. Perhaps I could use this opportunity to say to noble Lords that part of the recently published elective reform plan sets out funding to boost bone density scanning—or DEXA—capacity, to provide an estimated 29,000 extra scans per year. The work goes on also to support workforce health. For example, we are commencing training so that over 200 doctors and nurses can undertake occupational health training and qualifications. The numbers of physios and OTs are increasing. This is very much work in progress. I certainly agree with what the noble Lord said about the impact and extent of this; it really does affect so many.

[The Lord Bishop of London]

My Lords, according to the Arthritis and Musculoskeletal Alliance report on health inequalities and deprivation, an important way to reduce health inequalities in these conditions, particularly in those groups of people who are underserved, is to help them to manage their own conditions. Often it is much harder because they often have more than one complex condition; often they are much more complex and are picked up much later. One of the recommendations was around moving NHS care into the community. Could the Minister tell us what the Government are doing to encourage the NHS to build partnerships with community groups, including faith groups, to seek to reduce inequalities in these conditions and communities?

[Baroness Merron (Lab)]

Working with community-based organisations, including faith communities, has come up a number of times in the 10-year plan consultation, as I am sure the right reverend Prelate will find. I would certainly associate myself with the comments about the importance of getting healthcare provided in the community.

[Lord Kamall (Con)]

I thank the Minister for giving me the time to ask a question. Following the tragic death of Joanna Kowalczyk in October 2021, the coroner has recently raised concerns over the fact that chiropractors are not required to request their patients’ medical records before they begin treatment. While I recognise that there is scepticism from many in the NHS, and in fact physiotherapists, towards osteopaths and chiropractors, will the Government take on board the recommendations of the coroner to look at changing guidance to ensure that all healthcare treatments require consideration of a patient’s medical history, especially as we move toward a digital single patient record that could be shared across our system of health and care?

[Baroness Merron (Lab)]

The noble Lord raises an important point about what is required before healthcare is provided. I can certainly assure the noble Lord that, as I know he is aware, where there is a coroner’s report, we look at all of the lessons to be learned to consider how we might make it a safer and more effective environment for people. Certainly in the case to which he refers, that will happen.