Health and Adult Social Care Reform

Baroness Merron Excerpts

Tuesday 7th January 2025 Lords Chamber

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

I thank both Front Benches for their welcomes, in varying degrees and to varying aspects, for the two plans: one to deal with social care into the very far future—something that I would want to emphasise—and the other on electives. I, too, pay tribute to NHS and social care staff, not just for the work that they did through Christmas and the new year but for the work they do and the commitment they show in some very difficult circumstances all year round. That is exactly why we have come to your Lordships’ House and the other place with this Statement.

To start with social care, the noble Lord, Lord Kamall, talked about the agreement that was around in respect of the social care cap, but that really dealt with only one aspect of social care; what we seek to do is something that actually has not happened before, which is a very comprehensive and long-lasting approach that will transcend politics and last, no matter who the Government are, and that is perhaps what has been lacking. Certainly, I would agree that there has been no shortage of ideas in the past 15 years—some good and some, as I am sure some people would say, less good—but what there has been a lack in is a different way of doing things and a different approach, and that is what the independent review led by the noble Baroness, Lady Casey, will seek to provide.

I am glad that both opposition parties have accepted the challenge or invitation from the Secretary of State to participate in a cross-party solution, and I am most grateful to party leaders and spokespersons for that. I want to put on record that the noble Baroness, Lady Casey, is regarded as Whitehall’s number one doer; she is a leading social reformer, and she has served Governments of all political stripes, which equips her very well to talk about building a national care service.

I understand the concerns raised about the amount of time that is being taken. The noble Lord, Lord Scriven, referred to that. Perhaps I can reassure your Lordships’ House that the first report will be published next year, with recommendations that can be implemented as soon as possible. The final report will be later in the Parliament.

I should also say that we have not actually waited. It is important to say that there are a number of things happening right now, because I do not want your Lordships’ House to believe that everything is waiting for the conclusion of the report. I shall run through some of them because I think they are helpful in terms of social care. Legislation has happened for the first ever fair-pay agreement, which will tackle the 131,000 vacancies that social care is currently carrying and is a real problem in providing service. On the budget, I was very glad that your Lordships’ House welcomed the biggest increase in carer’s allowance since the 1970s. There has been an extra £3.7 billion for local authorities and, last week, the immediate release of £86 million for the disabled facilities grant, which will enable some 7,800 home adaptations before April. There has been a whole range of reforms, including the current introduction of new standards.

The noble Lord, Lord Kamall, asked about digitisation. Joining together medical and care records is so important. I know from the report of the House of Lords committee chaired by my noble friend Lady Pitkeathley that the most concerning aspect for those who care for those who need that support is that they constantly have to say what is wrong and what the issues are. Always having to repeat things was the number one issue that that report identified. We are also training care workers to perform more health interventions. I would say that there has been a lot done but that there is an awful lot more to do, which is why I am very glad about this approach. I do not regard this, by the way, as kicking the can down the road; I regard this as realistic for the situation that we are now in. I must emphasise that we really want a cross-government approach that will outlast any Government, no matter who they are, into the future.

On electives, the noble Lord, Lord Scriven, asked about measuring outcomes and ensuring that, in meeting one target, other matters are not overlooked. He makes an extremely fair point, and we will, as part of the ongoing work, look at how we measure and how we avoid the unintended consequences that both noble Lords have referred to. I am grateful for the reminder on that point. It is important, and noble Lords will have heard it said by the Secretary of State, that we take the best to the rest—I think that is crucial. There is some excellent work that goes on across the country, but it is not universal or serving everybody.

On reducing waiting times, the noble Lord, Lord Scriven, used the word ecosystem, which I would absolutely share. For example, the failure of social care currently puts enormous pressure on the NHS. It is an ecosystem, and not always a positive one, I might add. If we go back to November, some 12,400 people every day were well enough to leave hospital but could not do so because it was not possible to discharge them. That is a failure of social care very much linked to the NHS, but we also have an ageing society. By 2050, we will have 4 million more people aged 65 and over than we have now and if we do nothing, for example, on social care, the costs will double over the next two decades. Neither exists in isolation. Social care and the NHS come together.

I say to the noble Lord, Lord Kamall, that this is absolutely a cross-government problem which will require a cross-government solution. Of course, it will be very much part of the 10-year plan and part of our three immediate pillars of change, which are sickness to prevention, hospital to community and analogue to digital.

This is about major reform, not kicking the can down the road on social care and the NHS. I know the noble Lord was not suggesting that of the NHS. On workforce, we are currently making plans which are different from those of the last Government, so we must carefully look at not just numbers but the range of skills and professions needed. This reform requires change. It is not about standing still.

The noble Lord, Lord Kamall, asked how we will keep centres open for more hours. It was one of our manifesto commitments, and we have held many discussions with workforce representatives to seek a wide range of solutions. One proposal, which has been extremely well received, is to offer to pay people overtime to do the work. We are already reducing waiting lists through this. We all know that the current working hours of the NHS do not reflect the reality of people’s lives.

This is a really big opportunity to make a major change and grasp the many nettles. I wish all of it could happen immediately—particularly on social care, as we know that it has taken a long time and many have failed along the way—but it will take time. However, we have the plan and a commitment to support, guide and resource not just the NHS that we need now, but that we will need in the many years ahead.

[Lord Laming (CB)]

My Lords, the Statement is most welcome, not least the attention given to social care services. I congratulate the Minister and the Government on striking that proper balance between health and social care. The issues are hugely challenging, very expensive and important for the whole of society, especially if the National Health Service is to survive and prosper, for reasons that the Minister has touched on. The issues in social care range from recognition of the very important contribution of unpaid carers to the fact that a large number of local authorities face financial problems which place their future in a degree of jeopardy. The commission to be chaired by the noble Baroness, Lady Casey, will tackle these and many other issues, but we have to get through the immediate situation. Can the Minister assure the House that, in taking the social care agenda forward, from today these matters will be kept in sharp focus and handled with great vigour and determination?

[Baroness Merron (Lab)]

I am pleased to give that assurance and thank the noble Lord for his welcome for these measures. As I mentioned earlier in response to opposition Front-Benchers, we have not waited. In the last six months, we have made a number of immediate changes. He mentioned carers, and it is worth emphasising that, as I said, the increase in carer’s allowance is the largest since the 1970s. It will mean roughly an extra £2,300 a year for family carers. That is extremely significant. This House rightly presses me on the need to recognise carers, in particular unpaid carers, which we have done. The whole range of measures I described earlier will show our direction. I look forward to the noble Baroness, Lady Casey, publishing her first report next year. Those recommendations will also be there straightaway. We are doing this on all timescales.

[Baroness Pitkeathley (Lab)]

My Lords, it is indeed gratifying, as the Minister has mentioned, that many of the health proposals take into account the report of the Committee of your Lordships’ House on integrated care, which I had the privilege of chairing. I am going to take it for granted that the issue of unpaid carers will be the focus of the commission’s report, since the whole edifice of social care depends on unpaid carers.

Does the Minister agree that social care and health care work best when you cannot see the join between them? Therefore, are we able to look at employing people across both disciplines—and indeed across the voluntary sector as well, which provides many of these workers—in order that the focus can be on the patient or the user, and not on the institution?

[Baroness Merron (Lab)]

As the House knows, my noble friend is a great campaigner on this issue. I can certainly assure her that the review will include exploring the needs of the 4.7 million unpaid carers who effectively hold the adult social care system together. On the point about the care workforce, we are already improving career pathways by expanding the national career structure, including new role categories. The suggestions my noble friend makes about a seamless service are quite right. We are a long way from that, but I hope we will be able to get to it, and the workforce will be key in that.

[Lord Lansley (Con)]

My Lords, may I tell the Minister that the Statement is not an accurate representation of what happened in 2009-10? More importantly, it is now over 13 years since Andrew Dilnot produced his report, and there have been many promises to implement it that have not been kept. There should be no further delay. The Minister should acknowledge that if there is further delay in implementing a social care cap on costs, many thousands more people will face the catastrophic loss of their life savings and earnings as a consequence of meeting those costs. Until we implement the cap on social care costs, we will not know whether it will deliver a market in providing insurance against long-term care costs, which in itself would make a significant contribution towards meeting some of the costs of social care in the future.

[Baroness Merron (Lab)]

I understand the wish of many, myself included, for more urgent action. However, the reality is that acting in haste will not solve the problem, not least because of the depth of the difficulties we are looking at. The noble Lord is right that many promises have been made—a number by his own Government—but not fulfilled regarding what should happen on the cap. I reiterate the point I made earlier: while I appreciate that there are Members of your Lordships’ House who believe that Dilnot is the answer, it deals with just one aspect, and that is not what we need. As my noble friend just said, we need a comprehensive look at creating a more joined-up service that will work around people, rather than focusing on institutions or one particular problem.

[The Lord Bishop of St Albans]

My Lords, I am grateful to His Majesty’s Government for trying to get cross-party agreement on this really important issue; it is important that it does not get lost in party politics. It is good to hear about the improvements to the NHS app, which is working quite well in some areas already. However, some people are digitally excluded, and there is a lack of connectivity in rural areas. How are we going to ensure that these groups are not excluded as we go forward with this important work?

[Baroness Merron (Lab)]

The right reverend Prelate is correct to mention—I have raised it myself—not just the digital exclusion of individuals but connectivity. It is one of the reasons that we will approach this in a cross-government fashion. However, on our move from analogue to digital—the noble Lord, Lord Kamall, rightly mentioned the capacity of the NHS—our view is that it can do so much more than it is doing currently. The Secretary of State said in the other place that restaurants, for example, have been texting customers for many years, have they not? They remind customers about their booking and give them a chance to cancel or change it. That is the kind of connectivity and service that we need from the NHS. I assure the right reverend Prelate that, where people are unable to use whatever the digital solution might be, they will be able to deal with it person-to-person or on paper. We will be flexible enough and actively seek out those who are not, as he described, immediately connected.

[Baroness Tyler of Enfield (LD)]

My Lords, the Darzi review estimated the impact of delayed discharges at some 13% of total hospital beds. Given this, can the Minister say how confident she is that the immediate steps to improve the rate of discharge from hospital into social care, which she has already outlined, will happen? How quickly will that happen and over what timescale, and what accountability measures will be established at both national and local levels to ensure that those delayed discharges start to come down, and quickly?

[Baroness Merron (Lab)]

The independent review by the noble Baroness, Lady Casey—in addition, as I mentioned, to producing recommendations that can be implemented straight away next year—is focusing on completing its final report later in this Parliament, so we are looking at the longer term. I cannot give an exact timetable, although I am hopeful that we will be able to update your Lordships’ House with further information, as the noble Baroness quite rightly asked. The matter of discharge requires there being suitable facilities in the community, but we are not in that place, so this will take some time. But I am very hopeful that all of the measures here, and the measures we have taken already, take us further to that point. We will continue to strive on the matter of discharge, because it is a problem not only for the NHS but for patients and their carers and for social care. We are carrying, as we know, a lot of vacancies and a social care system that is creaking at the seams: we must be honest about that.

[Lord Patel (CB)]

My Lords, I welcome the Statement and many of the proposals in it. We have learned from past experience that all reforms to, and any proposal to change things in, the NHS—and, for that matter, social care, but more so with the NHS—lead to increased bureaucracy but not the benefits that we thought they might deliver. One of the waiting list initiatives is that GPs will have a consultation with hospital staff to try to reduce waiting times and avoid unnecessary duplication. There is some financial incentive attached to that, but it certainly will increase bureaucracy. What modelling has been done to find out whether it will work, whether it will increase bureaucracy and by how much it will increase costs?

[Baroness Merron (Lab)]

I am grateful to the noble Lord for welcoming many of the measures in this announcement. He referred to the £20 fee that will be paid to GPs to call the consultant where necessary. I understand the concern about increasing bureaucracy, but all these reforms are intended to work the other way. We will very closely monitor them and have very carefully considered them with all those who will be dealing with them. I am actually more than hopeful, because the intention is that allowing the GP, for example, to get further advice, and making sure that people are being seen in the right place, will save money. It will mean that people are not taking up a referral place and that they will be referred for the necessary tests, scans, et cetera without the middle bit, which is a very backward-facing way of dealing with things. We will continue to monitor that to ensure that we are reducing what is currently wasted clinical time, while also preventing unnecessary out-patient appointments. The monitoring should show all of that and I will be very happy to update the House on that. The fee is to ensure that it can happen and is an incentive to do so. Of course, the greatest prize is an increased and speedier service for patients.

[Lord Turnberg (Lab)]

My Lords, it is pleasing to welcome the proposals from the Government. It is also very pleasing to hear of the immediate things that can be done for social care, because we should not be waiting for the final report.

There are some more suggestions that we could make that do not require any money—that should be music to the Minister’s ear. We do not need more money to reduce the bureaucracy that people in the community are required to go through to gain admission to a care home. It is horrendous. They have a means test and a needs test serially, which can be very bureaucratic and time-consuming, and there are waiting lists. We must reduce that bureaucracy.

The second thing, which the Minister has already referred to, is the value that we place on care home workers. It is good to hear that they will get a rise in their money and that ideas will be put about on their careers, but, unless they have a recognised national qualification and registration of that qualification, career prospects will be limited. We must do more for them to allow them to see themselves in a career that could go on to nursing in the NHS. We must do more in that field if we are to retain these enormously valuable people.

[Baroness Merron (Lab)]

My noble friend, as always, makes very practical observations. I totally agree with the point about bureaucracy in terms of care homes. I have experienced that as I have power of attorney for an elderly friend, and I constantly wonder: if I am struggling with it, what would it be like for somebody who perhaps is not as used as I am to dealing with forms, organisations and, indeed, bureaucracy? It is extremely troubling. Yes, that will be part of what we will be looking at to improve social care—and also the discharge ability that we were talking about earlier. Valuing care workers, professionalising the service and recognising them are all key. I agree that it should be a natural move from being a care worker into a clinical setting, but we also need to recruit people to be care workers, retain them and upskill them, which is so important.

[Lord Bellingham (Con)]

My Lords, on the vexed subject of delayed discharge of very elderly patients who have been admitted from care homes, quite often with ailments such as flu, medicine management, wound-dressing management, et cetera, surely the key is to ensure that many of these patients are not admitted in the first place. This follows on from the last question about the training of care workers. Is there an argument for enhancing their training so they become better carers in terms of dealing with these problems? Can the Minister say something about what I know has been tried in a number of care homes: having intermediate NHS beds in care homes?

[Baroness Merron (Lab)]

Both the points that the noble Lord makes are very welcome and shine a light on the need to be more flexible in the range of services and care provided. It should not be just an either/or. People have intermediate stages. Some of the issues about discharge are about having a position in the middle, which is more about rehabilitation, and having the things in place to allow people perhaps to return home or to some other setting.

There is also the point about having a range of settings. Currently, the offer is perhaps too restrictive, although not in all places, as there are some excellent examples. We must be much more creative in the kind of offer that is available and in the training of care workers, not just for the service that they offer to patients, which is important, but for their professionalisation and their morale in their jobs.

[Baroness Hollins (CB)]

My Lords, why is there no mention of mental health in the Statement? What happened to parity, I wonder? For example, 12,400 hospital patients a day are well enough to be discharged. I presume that this does not include the 1,500 or so autistic people and people with learning disabilities who are waiting to be discharged from psychiatric hospitals but for whom there is no social care? Community diagnostic centres are mentioned but there is nothing about the need for 24-hour community drop-in centres for citizens who have mental health problems. Social care costs for elderly people may be expected to double, but what about the increasing costs of care for disabled adults of working age?

[Baroness Merron (Lab)]

The noble Baroness makes very real and important points. Some of the points in the Statement cover mental and physical health but, if I might be honest about the situation, this is only one of the things that we are putting forward. As I said at the beginning of this Statement, how I wish that we could deal with everything immediately. It is not possible. This is just the first stage in the journey that we are on. I hope that the noble Baroness is reassured by the direction that we are taking, the commitments and the work that we have already done on mental health. The Committee stage of the Mental Health Bill next week will also be a very significant step forward. I absolutely accept that there is so much more to do, and we will be getting through that.

Hospice Funding

Baroness Merron Excerpts

Monday 6th January 2025 Lords Chamber

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

I thank the noble Lord for his good wishes and extend my new year wishes to everybody in your Lordships’ House.

To clarify the situation, this is the biggest boost for hospice funding in a generation. It is £100 million in capital, and there is no intention, as the noble Lord asked, to have any less engagement with the third sector—in this case, the hospice sector. The £100 million in capital is for adult and children’s hospices, and £26 million is confirmed for children and young people’s hospices. This has been widely welcomed. The decision in respect of national insurance perhaps would not have had to be made had the financial situation inherited by this Government been somewhat different.

[Baroness Brinton (LD)]

My Lords, I am grateful to the noble Baroness for explaining about the capital grant, but can she get the Government to commit to a long-term revenue funding formula for hospices for those services that are equivalent to those provided in the NHS, so that they are rewarded financially on the same basis as the NHS fairer funding formula?

[Baroness Merron (Lab)]

I understand the point the noble Baroness is making, because planning ahead and certainty are key. I can confirm that my ministerial colleague, Minister Kinnock, will soon meet all major stakeholders to discuss long-term sustainability of funding. We are very aware of the difficulties that have been caused thus far and seeking a way forward.

[Lord Forsyth of Drumlean (Con)]

My Lords, I commend to the Minister a scheme that I introduced when I was Secretary of State for Scotland, at the suggestion of the broadcaster Martyn Lewis, who wrote a book on the hospice movement in tribute to Dame Cicely Saunders. That scheme introduced pound-for-pound funding: every pound raised was matched by the Government, which had the effect of greatly increasing funding and the incentive for people to support the hospice movement. Will she consider introducing such a scheme, which, alas, did not survive the introduction of the Scottish Parliament?

[Baroness Merron (Lab)]

The noble Lord makes a very interesting point. Of course, the introduction of gift aid supported charitable funding, including to hospices, and I know was very warmly welcomed. These are all important ways of looking at funding and we will consider the best way forward, but I note from discussions with the hospice movement that hospices very much value their autonomy in terms of funding; the more linked it is to government funding, the less autonomy they have. We want dignified and appropriate care for patients and families, and to find the best way to deliver that.

[Baroness Finlay of Llandaff (CB)]

My Lords, I pay tribute to Lady Randerson, who was a great supporter of hospice and palliative care services in Wales, as well as a dear friend. I declare that I am vice-president of Hospice UK and have been involved in setting up the palliative care commission, which will be chaired by Professor Sir Mike Richards and will start to take evidence this week. Can the Minister inform us of the department’s work to look at different funding formulae, such as the one we developed in Wales, which respects the individual autonomy of the voluntary sector while ensuring that some of the black holes of provision can be filled? Will the Government collaborate with the commission by providing as much evidence as possible so that Professor Sir Mike can come up with some really firm recommendations for the future?

[Baroness Merron (Lab)]

I associate myself with the tributes paid to the great contribution that the late Lady Randerson made to this House. She will be sorely missed. In addition to Minister Kinnock meeting major stakeholders, including Macmillan, Together for Short Lives and a number of other organisations and charities to discuss sustainability of funding, Ministers will continue to have discussions with NHS England, because the other area is about getting the money promptly, which has not happened to date. Again, that has caused huge difficulties. We very much look forward to seeing the commission’s findings and recommendations and will look at how we can work to support it.

[Lord Scriven (LD)]

My Lords, I add my tributes to Lady Randerson and wish the Minister a happy new year. As welcome as the £100 million in capital is, it will not pay for staff, drugs, heating, lighting, meals or day-to-day services. What are the Minister and the Government going to do to add extra revenue funding to deal with the costs that the hospices are dealing with now?

[Baroness Merron (Lab)]

As I mentioned, it has been confirmed that there will be funding for children and young people’s hospices for the forthcoming year, which I know had been hoped for but not actually delivered. I am very glad that the Secretary of State was able to confirm that. On long-term sustainability, Minister Kinnock is very much looking forward to meeting major stakeholders and is working with NHS England to find the best funding mechanism, in respect of the £100 million capital grant and more generally.

[Baroness Winterton of Doncaster (Lab)]

My Lords, it is very good news that the commission is in the safe hands of Sir Mike Richards, who I worked very closely with when I was a Health Minister. Could my noble friend set out the ways in which the Government might assist the hospice sector with training, because there must be a crossover in the different tasks undertaken? In particular, could some of the changes announced for social care workers be transferred to the hospice movement?

[Baroness Merron (Lab)]

My noble friend makes a very helpful point that I will certainly follow up. The fact that the majority of hospice care is provided through the NHS suggests that there is room for further co-operation between the independent hospice sector and the NHS. I am grateful for her comments and will follow that up.

[Lord Balfe (Con)]

My Lords, I remind the House that I am joint chair of Together for Short Lives, the hospice movement for babies and young persons. We greatly welcome the decision and announcement by the Government. Our only hope, as has been alluded to, is that there will be a development to get some forward perspective. One of the problems I addressed in my meeting with Minister Kinnock was the short-termism there has been. Can we use this gap to try to get a longer-term perspective for funding?

[Baroness Merron (Lab)]

We would certainly like to do that. As I mentioned, we will talk with Together for Short Lives and others to achieve that. It is very important to make sure that there are no delays to funding and that it promptly gets to where it needs to be. That is the other area we will attend to.

Puberty-suppressing Hormones

Baroness Merron Excerpts

Monday 16th December 2024 Lords Chamber

[Baroness Walmsley (LD)]

My Lords, on these Benches we welcome the tone of the Secretary of State’s Statement. I have often said that there are many ways of being human. Growing up can often be a very trying time for teenagers. How much more difficult, then, for those young people with gender distress who are struggling with finding out who they are while being different from their peers, and all without adequate support? It is high time that proper services were put in place for young people struggling alone with these issues. Their families too need help to support them at this difficult time. For too long, children and young people who are struggling with their gender identity have been badly let down by a low standard of care, exceptionally long waiting lists, even by the standard of mental health waiting lists, and an increasingly toxic debate.

We always want to see policy based on the evidence. With any medical treatment, especially for children and young people, the most important thing is to follow the evidence on safety and effectiveness. It is crucial that these sorts of decisions are made by expert clinicians, based on the best possible evidence. It is also important that the results of the consultation and the advice of the Commission on Human Medicines are made public.

Some might wonder why the treatment is deemed not safe for gender dysphoria patients but safe enough for children with early-onset puberty. More transparency might clear up the confusion and give more confidence to patients and their families. However, the Secretary of State himself admits that he does not know what effect the sudden withdrawal of this treatment for young people already embarked on a course of puberty blockers will have. These are the young people with the most urgent need for other types of care in the current situation, so what clinical advice have the Government taken about the effect of withdrawing these drugs on the physical and mental state of young sufferers of gender incongruence already on the drugs, and what physical and psychological support will be offered to them?

In the current circumstances, plans for a clinical trial are welcome, but we would like to know the criteria for those eligible to participate. What assessment have the Government made of the recent Council of Europe report, which raises the ethical and rights implications of offering participation in the trial to only a small group of patients? If the only way to continue access to these drugs is through participation in the clinical trial, whose scope, length and start date have yet to be announced, this lays the Government open to accusations of coercion and breaches of human rights.

We welcome the plans for additional treatment centres in Manchester and Bristol as well as London, but can the Minister say why they will not be up and running for two years? Is it lack of funding, lack of premises or lack of sufficient therapists with the appropriate specialist training? This is a very sensitive area, so the wrong people could do more harm than good. If that is the reason, is there a plan for training up more qualified therapists in time for the opening of the regional treatment centres? I very much look forward to the Minister’s replies to these questions.

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

My Lords, I start by thanking the noble Baroness, Lady Cass, for her work in this very important area. I also refer to the actions taken by the previous Government, which set in train the action we are continuing. As both the noble Lord, Lord Kamall, and the noble Baroness, Lady Walmsley, rightly said, this is about keeping children safe. There is nothing more important than evidence-based action—which is what we have before us—and taking the necessary steps.

The Cass review made it clear that there is not enough evidence about the long-term effects of using puberty blockers to treat gender incongruence to know whether they are, first, safe and, secondly, beneficial. It is important to bear both in mind. The Commission on Human Medicines independently found that clear evidence of unsafe prescribing exists and recommended that there should be a ban until there can be a safe prescribing environment. That is where we start, and last week’s laying of legislation stops that unsafe prescribing to children and allows time to develop the necessary safeguards, as recommended by the commission. I should just clarify that the legislation is indefinite, not permanent. There will be a full review in 2027 so this continues to be a very live issue.

The clinical trials, referred to by both the noble Lord, Lord Kamall, and the noble Baroness, Lady Walmsley, will be a world first. It is important to pay tribute to that. In addition to the work currently being undertaken to respond to the recommendations of the Commission on Human Medicines, the trial is presently undergoing development and approvals. The aim is to begin recruitment early in the new year. I am sure there will be an opportunity to update the House on that detail.

In answer to the point from the noble Baroness, Lady Walmsley, the numbers will be uncapped, which is important. I am sure we all agree that better-quality evidence is critical. The development of the clinical trial between the National Institute for Health and Care Research and NHS England will provide the better-quality evidence that we are all looking for.

The noble Baroness, Lady Walmsley, spoke about new services. To make the situation clear, NHS England has already opened three new services in the north-west, London and Bristol. The fourth will be in the east of England and will open its doors in spring next year. The noble Baroness also asked about the timetable; we are on course to have a service in every region of England by 2026. I cannot always confirm developments of that nature, so I am glad to do so because it will help reduce the waiting list, which noble Lords are rightly concerned about. It will also bring services closer to home, which is crucial too.

Furthermore, this is a very specialist area, so recruitment and training are key. This is part of the reason for the—I would not call it a delay—realistic timetable. There is also the need to work with local trusts and take into account all the various operational considerations, so realism rather than delay is how I would put it to the noble Baroness.

I agree with the points made by noble Lords on the Front Bench about tone and discourse. I am very grateful to the noble Baroness, Lady Walmsley, and the noble Lord, Lord Kamall, for welcoming the way the Secretary of State made the announcement and what the announcement refers to. We have a real responsibility in this House—and outside it—to handle conversations on this topic extremely sensitively. This is about people’s lives. I absolutely agree with the point just made: the public debate has been frighteningly toxic. Irresponsible statements made recently have put young people at risk of serious harm and that has to stop. That is one of the many reasons I welcome the Statement—and the tone and discourse this evening.

On the point made by the noble Lord, Lord Kamall, about alternatives to puberty blockers, no exact alternatives are being offered. However, within the new services there will be an emphasis on, for example, psychosocial support.

In response to the point made by the noble Baroness, Lady Walmsley, about the—she did not use this word, but perhaps I might—transparency of evidence, all the commission’s recommendations have been published in full as part of the Government’s response to the consultation. The full advice, as I hope the noble Baroness will understand, was prepared solely for Ministers, but we are considering whether it should be published. I know the noble Baroness will understand that, as with all advice prepared for Ministers, there are legal and other matters that must be considered before it can happen.

I will say a word on mental health support, which is so important for children and young people. An offer of an appointment with a mental health professional has been made to everyone on the national waiting list for children and young people’s gender identity services. Those who joined the waiting list on or after 1 September will have an appointment with a mental health professional or paediatrician before being referred to specialist gender services. Those who are not on the waiting list and are directly affected by the restrictions can access NHS mental health services through a dedicated single point of contact, supported by clinical nursing.

I hope that is helpful, and if there are any points I have missed—

[Baroness Walmsley (LD)]

Can the Minister address the issue of the children who are part-way through a course of treatment? Will they get mental health support as a priority?

[Baroness Merron (Lab)]

For those who are already on puberty blockers, there is an immediate withdrawal. But I hope that what I have outlined on mental health support covers all the areas the noble Baroness, and indeed all of us, are concerned about. The approach is as compressive as possible, and the new gender services I described should make it even easier to provide the service. It is not a matter of waiting until 2026; we absolutely understand the need to provide that support now, and we are making that available.

[Baroness Cass (CB)]

My Lords, I echo the thanks given to the Secretary of State for his careful and scientific approach to this issue and for his very sensitive Statement in the other place.

It might be helpful to elaborate on just one or two of the points that have been raised, particularly the use of puberty blockers for precocious puberty—that is, for children who enter puberty too early—which is a licensed use of these drugs. We are confident about that use because we have many years of experience, and because it is a very different situation from prescribing for young people with gender dysphoria. The difference is that children with precocious puberty have an abnormal hormone environment, which we normalise, whereas in young people with gender dysphoria we are taking a normal surge in pubertal hormones and disrupting it. That is why it is much less clear what the long-term impact of that intervention is, and why we need careful clinical trials.

The second thing it would be helpful to clarify is the appropriate question, asked by the noble Baroness, Lady Walmsley, about children and young people who are already on puberty blockers from private or overseas sources. In addition to the comments made by the Minister, it is important to know that NHS England has set up a telephone number that young people and families can ring to receive a mental health triage. Young people’s mental health services have been forewarned and are on hand to provide that triage for that small group of young people who may be in significant distress because of fear of interruption of their supply of puberty blockers. There is provision that, in those circumstances, and where the clinician thinks it is in the best interests of that young person to continue on puberty blockers, an NHS prescriber is allowed to continue the prescription. We hope that those in distress will come forward and contact NHS England and therefore be supported through the system.

One of the other misunderstandings about puberty blockers is that they have become totemic as the main treatment or entry-point treatment for young people who want to transition, or who may in the longer term be trans but may not go on to a medical pathway. Young adults have said to us that they wish they had known when they were younger that there were more options for them than a binary medical transition, and that there were many more ways of being trans—that they could remain gender fluid, continue to be non-binary, or in the longer term continue to be a cis adult, as some do, and not go through any medical interventions at all.

Having a multidisciplinary team that can support young people in that decision-making without necessarily rushing them into a medical pathway is crucial, and that is what the new services have now embarked on doing.

[Baroness Merron (Lab)]

I thank the noble Baroness for bringing her expertise directly into the Chamber. We are very glad that she is in the House to do so, and she has actually answered a number of the points better than I ever could.

I will emphasise one point that I am particularly interested in, because I know it has been raised a lot, about why the legislation is being laid in respect of the use of medicines just for gender dysphoria. The noble Baroness, Lady Cass, referred to this. It is really important to emphasise that the medicine might be the same, but the fact is that it is not licensed for gender incongruence or dysphoria—that is the key point. These medicines have not undergone that process, which means that safety and risk implications have not yet been considered. It is true that there are licensed uses of the medicines for much younger children or for older adults, but the issue here is about adolescents, and it is an entirely different situation.

[Lord Winston (Lab)]

My Lords, perhaps I might return to the conventional asking of a question to the Minister—a very quick question. There are a number of practitioners who are considering, if not giving, sex steroids to patients who are requesting gender reassignment; either oestrogen or progesterone, or the equivalent male hormone. Have the Government yet considered how patients will be treated in this situation? There are certain, clear dangers involved.

[Baroness Merron (Lab)]

I understand the point my noble friend rightly raises, and I emphasise again that what matters here are safety considerations—particularly when we are talking about children and young people—but also the evidence in respect of treatments, that there should be the prescription only of medication which is safe and appropriate to the actual patient and situation.

[Baroness Jenkin of Kennington (Con)]

My Lords, given that puberty blockers almost invariably lead to cross-sex hormones, can the Minister explain why the proposed trial cannot study those who have already used or are using puberty blockers, rather than starting with a new cohort of children? Given that the trial will look at the long-term effects on health, does she have any indication of how long that trial will need to continue, and is it right that it might be for up to 30 years?

[Baroness Merron (Lab)]

I do not recognise the last point that the noble Baroness made about the time. The aim is to start recruiting participants in spring next year and, as I mentioned, the National Institute for Health and Care Research is working with NHS England to develop the clinical trials. They are the first in the world and I will be very pleased to provide further information as and when it is available.

[Baroness Fox of Buckley (Non-Afl)]

My Lords, I commend the Secretary of State—and, indeed, the Minister. I commend the Secretary of State for his very clear Statement and for his courage, because he has had to stand his ground. He kept his cool, despite receiving unpleasant smears and abuse not only online, but even, to a certain extent, from the Back Benches in the other place.

I am slightly confused about something. I think we can see now that puberty blockers are a medicalised euphemism for chemical castration. The same kinds of drugs, when given to Alan Turing, were used as punishment for being gay. I am still not convinced, and do not really understand why the Government still think it is appropriate to conduct a clinical trial on children with these drugs. The Minister emphasised “uncapped” as though that was positive, whereas I thought that was scary.

As this medical scandal unravels, more and more young people are de-transitioning, but the NHS has no services to deal with this. I wonder whether the Minister would agree, perhaps, to meet some of the charities that are doing this kind of thing—there is Genspect’s Beyond Trans and its special service providers—just to discuss what the NHS might need to look at, moving forward in a different way.

[Baroness Merron (Lab)]

I very much welcome the generous and supportive comments of the noble Baroness, Lady Fox, in respect of the Secretary of State’s Statement. I am grateful for those. I note that she finds the reference to “uncapped” scary. I presented it as the way to gather the widest amount of relevant evidence, because that is a clinical trial; that is what is so important. The reason it is being done is that there is insufficient evidence and there has not been such a trial, and we need to do one for this particular situation.

In respect of meeting charities and others, the Secretary of State has been very keen to—what I would call—reset the relationship with various groups which all have different sets of thoughts on this. I have joined him in those meetings. He has also been meeting those with lived experience. We continue to do so. We have wanted to detoxify the debate, and those meetings have helped immensely. We will continue to have that listening ear.

[Baroness Morgan of Drefelin (Lab)]

My Lords, I too welcome the Statement. The tone, as we have already heard, has been absolutely right. Thinking about the clinical trial, I would like to know a little more about the timing. If we are intending to run a clinical trial that is going to be looking at efficacy and safety, it will not be an easy trial to run and it is going to take some time. It would be really welcome if the Minister could keep the House informed, which she has already promised to do.

I am particularly interested in hearing the Minister’s view on the following point. It is really important to get this clinical trial on the puberty blockers going, but we also need to understand the value and the evidence supporting all the other interventions too—the psychosocial support, the psychological support, and all the other interventions—so that it is not just this clinical trial but a broad understanding of what really helps these young people. `

[Baroness Merron (Lab)]

My noble friend is right to raise the second point. It is a whole range of interventions, and that is certainly something that we have very much in mind for consideration, for the reasons that we have heard in the Chamber this evening and the points that my noble friend makes. In respect of timings, it is a planned pathway study and that includes a clinical trial component. It is, as I said, to build evidence. I am glad to say that it remains on track to commence recruitment early in 2025, but only after there has been ethical approval. When that is granted, that is when the final study protocol will be ready, and I know that noble Lords will have a lot of interest in that. We will be issuing further updates in early 2025, and if there are any particular questions, noble Lords are very welcome to raise them with me.

[Baroness Bennett of Manor Castle (GP)]

My Lords, my question follows on from that of the noble Baroness, Lady Walmsley, about the scale of the trial. I also note the report from the experts at the Council of Europe, which the noble Baroness referenced. In the other place, the Secretary of State said in response to my honourable friend Carla Denyer that the clinical trial would be “uncapped”, and the Minister repeated that word this evening. However, an article published yesterday in the Metro, arising from various freedom of information requests and headlined, “Trans Youth ‘Languishing’ While Waiting Six Years For Gender Healthcare”, said:

“If a trans young person joined the waiting list for gender-affirming healthcare on the NHS today, they would have to wait 308 weeks for a first appointment”.


In that context, I am struggling to understand where the Government will secure the resources from to run a trial to provide the resources needed to have this uncapped clinical trial allowing access to puberty blockers.

[Baroness Merron (Lab)]

In view of what the noble Baroness said, it is quite important to consider that the children and young people’s gender services waiting list currently has 6,237 people on it. I certainly agree that waiting lists for these services are too long. We are committed to changing that, which is why I outlined the timetable for the new gender services and the opening of the new centres. They will increase clinical capacity and reduce waiting times for sure. On the point the noble Baroness raised, there is a commitment to the clinical trial, and I am glad there is. As we have brought forward this legislation in an absence of evidence, it is incumbent on us, as a Government, to follow through on what the previous Government started in train, which is to use a clinical trial to provide the evidence. Otherwise, the debate would remain uninformed and not evidence-based, and that cannot be helpful.

[Lord Jackson of Peterborough (Con)]

My Lords, I welcome the Statement and congratulate the Secretary of State on the moral clarity and leadership that he has shown in balancing the evidence base with compassion. Perhaps I may press the Minister on a few points. An indefinite ban is not the same as a permanent ban. Is there a chance that the indefinite ban, which goes to 2027, may segue into a permanent ban as more information and evidence arise over the next few years?

Given that it is pretty well understood that puberty blockers have given rise to fertility problems, bone health issues and psychological health issues, I cannot understand the inconsistent policy of keeping children currently on puberty blockers in the system, when we know that there is no positive evidence base and only a negative one. I think that will affect many children.

My final point is about the eight new regional centres that will be set up. Will we be certain that the ideologically-driven zealots—clinicians who misuse their position and have prescribed unsafe puberty blockers for children and young people—will not find themselves in these new facilities? That is an important issue as we wait for the clinical trial and ruminate on the issues that the noble Baroness, Lady Cass, mentioned. We need to start again on this and to understand that there are more treatments available for the most vulnerable children, who we need to protect, than merely puberty blockers.

[Baroness Merron (Lab)]

I certainly agree with the noble Lord about the vulnerability of children and young people in this regard, which is why we are taking this action. His last point gives me the opportunity to say that we are committed to implementing the recommendations of the Cass review in full. That is a very useful guideline and tool for us to use.

I have no expectation that the situation that the noble Lord described in his third point will happen. Recruitment is subject to all the usual provisions, and I know that the gender services will seek to recruit very positively. If the noble Lord finds out anything else, I am sure he will raise it with me.

On whether the ban could become permanent, the review—at the risk of repeating myself—will report in 2027, as the noble Lord said. I believe that we should wait for that.

[Baroness Grey-Thompson (CB)]

My Lords, like other noble Lords, I welcome the tone of the Statement. In today’s society, there is huge pressure on young people, through social media and more widely. I would really not want to be a teenager right now.

There is also huge pressure on the NHS, with multiple calls on its services. Can the Minister elaborate a bit more on how His Majesty’s Government are going to increase the number of staff and make sure they are trained to support young people? How can we support those staff? This is a tough area for them to work in. We also need to protect them from malicious complaints to make sure that they can do their job.

[Baroness Merron (Lab)]

I am glad that the noble Baroness has raised the issue of staff. It is vital that people are allowed to go about their work—as the noble Baroness, Lady Cass, should have been too—without fear of physical, verbal, online or direct abuse. I am sure that we all agree that the abuse has been an absolute disgrace. I agree about protecting those who are doing this. On the point about service, as has been said, this is about a group of vulnerable children and young people. It is our duty to provide the services to support them and to make them evidence based.

NHS: Patients with Allergies

Baroness Merron Excerpts

Thursday 12th December 2024 Grand Committee

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

My Lords, I start by congratulating my noble friend Lady Ramsey not only on securing this highly relevant debate but on shining a light on this important matter. I thank all noble Lords for their considered contributions, which were given through experience and with empathy.

As noble Lords have observed, there has been a significant rise in hospital admissions for anaphylaxis over the last two decades and it is clear how increasingly significant this matter is. That means that it is incumbent on us to lift our commitment to improving outcomes.

Anyone with an allergy, and anyone close to somebody with an allergy, knows only too well the considerable challenges and risks in everyday life, as we have heard. Very sadly, there are tragic cases of those who die from severe allergic reactions that could have been prevented. On behalf of all noble Lords, I give my heartfelt condolences to those who have lost a loved one because of a severe and sudden allergic reaction.

I thank my noble friends Lady Ramsey and Lord Mendelsohn for speaking about their children’s allergies and their experiences as parents. I also thank my noble friend Lady Keeley for making reference to her own experience. Noble Lords understand just how serious allergies can be, and the worry and anxiety, rooted in reality, that parents and loved ones feel. I too want to pay tribute to then outstanding charities that support people living with allergies in the UK, including Allergy UK, Anaphylaxis UK and the Natasha Allergy Research Foundation. They all do vital work in raising awareness, providing information and support, and funding research.

Work is ongoing across government, the NHS, voluntary organisations and patient representative groups to consider how allergy care and support could be improved. Noble Lords made reference to the Expert Advisory Group for Allergy, which was established last year, met again just last week and continues to bring together all key stakeholders in order to inform where we go next. I am most grateful to that group.

In addition, last year the MHRA launched a safety campaign to raise awareness of anaphylaxis and provide advice on the use of adrenaline autoinjectors, which have also been mentioned in the debate. A toolkit of resources for professionals to support the safe and effective use of AAIs has also been produced, along with new guidance on their use. The guidance clearly states that prescribers should prescribe two AAIs to ensure that patients always have a second dose available.

I am very pleased that Palforzia, a new treatment for peanut allergy, was approved by NICE in 2022 for those up to 17 years old to help reduce the severity of allergic reactions. The NHS is now legally required to fund this medication for eligible patients, in line with the recommendations of NICE. That means it is opening up a way for thousands of children and young people to access the medication through the NHS.

This Government are committed to improving care for people with allergies and ensuring that they get the care and support they need at the right time and access to the latest treatments. I am aware of the inequalities that my noble friend Lady Ramsey referred to in accessing allergy services. I very much acknowledge the points raised by noble Lords, particularly in respect of the workforce, delays to treatment and care, and lack of information and support that some patients have unfortunately experienced. I consider that to be a situation that cannot continue.

Noble Lords have referred today to the 10-year health plan to reform the NHS, and I am glad that noble Lords, including the noble Lord, Lord Scriven, spoke about the move from treatment to prevention. It is also about moving healthcare from hospital to the community, as well as analogue to digital. A core and central part of our 10-year plan will be the workforce, as referenced correctly by my noble friend Lady Keeley and the noble Lord, Lord Scriven, among others. In our work to prepare for the workforce that we need now and in future, it is vital that we train and get the right staff, technology and infrastructure in place. In acknowledging the points made, I absolutely recognise the need for a multidisciplinary-team approach in this area. That will be part of our considerations.

I remind the Committee that this Government have made a commitment that 92% of patients should wait no longer than 18 weeks from referral to treatment within the first term of this Government. That includes those waiting for allergy treatments. As a first step towards this, following the Budget, we will be delivering an additional 40,000 appointments this week to cover operations and scans and appointments themselves.

With regard to the point about the national lead on allergy services, I understand that there is a need to do more, as raised by the noble Lord, Lord Scriven, my noble friends Lord Mendelsohn and Lady Keeley, and the noble Lord, Lord Kamall. I am absolutely aware that there is no national lead with overall responsibility for allergy services, and of the reasons why noble Lords have raised it. My colleague Minister Gwynne is putting this under active consideration and I will certainly ensure that I raise not just this point, which has been made so regularly to him, but the other points raised in this debate. I will also raise with him the reference made by the noble Lord, Lord Scriven, to rolling out a pilot.

On the point about a meeting, raised by my noble friend Lady Ramsey, I am glad to say that Minister Gwynne met the Natasha Allergy Research Foundation just last week to discuss how care and support can be improved. The department is obviously working closely with Professor Sir Stephen Powis, the national medical director at NHS England, and, as I said, there is active consideration of the point about a national lead. I will alert my honourable friend Minister Gwynne to the point about further meetings.

Once diagnosed, and with a management strategy in place—my noble friend Lady Healy spoke to this point —patients with allergies may be able to be cared for through routine access to primary and secondary care. The Royal College of GPs has added allergy training to the new curriculum and, to support existing GPs, it has developed an allergy e-learning resource. As noble Lords will know, this Government seek to bring back the family doctor, especially for those who would benefit from seeing the same clinician regularly; obviously, that includes those with allergies.

On the transition from paediatric to adult services, which was raised by a number of noble Lords, including my noble friend Lord Mendelsohn, I absolutely acknowledge the challenge there. NICE has published guidance on the transition that we are speaking about, including recommendations on transition planning, support both before and after the transfer, and the development of transition infrastructure.

I turn to some of the additional points made in the debate; I will be pleased to write to noble Lords on the ones that I do not answer. My noble friend Lady Ramsey mentioned research. Research into allergies is funded through NICE—no, it is not. It is funded through the NIHR; I am on it. It always welcomes funding applications. We have also invested in research infrastructure; for example, Southampton Hospital is participating in a three-year trial funded by the Natasha Allergy Research Foundation.

My noble friends Lady Ramsey and Lady Healy, as well as the noble Lord, Lord Kamall, referred to a strategy on allergies. Let me clarify the situation: the National Allergy Strategy Group is developing a strategy, which will come to the department. We will consider it, and its recommendations, carefully.

The noble Baroness, Lady Burt, mentioned appropriate provision in schools in order to protect children with allergies. The Department for Education recently reminded schools of their legal duties and highlighted the Schools Allergy Code. Regulations now allow schools to obtain and hold spare adrenaline autoinjectors, and there is guidance on that.

On the important matter of prevention, as noble Lords will know, we are committed to moving from treatment to prevention. Some research shows that feeding the most common allergy-causing foods to babies and infants before the age of 12 months may prevent or reduce the chance of them developing food allergies. We will continue to look at that.

I am most grateful for this debate, which has shone an important light on this issue. I can commit to us continuing to work on this matter to improve things for those who suffer from allergies and those who are near to them.

Anti-depressants: Cost, Risks and Ramifications

Baroness Merron Excerpts

Wednesday 11th December 2024 Lords Chamber

[Lord Kennedy of Southwark (Lab Co-op)]

My noble friend Lady Merron is now here.

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

I apologise to your Lordships’ House and am grateful to my noble friend the Chief Whip, as ever.

In 2023-24, 8.7 million identified patients were prescribed anti-depressants at a cost of £220 million, compared with 2015-16, when the cost was £270 million for prescriptions to 6.88 million people. The NHS Business Services Authority reports patient prescribing data on an annual basis rather than a running total. All licensed anti-depressants meet robust standards of safety, quality and efficacy, constantly reviewed by the MHRA.

[Lord Alton of Liverpool (CB)]

My Lords, I thank the noble Baroness, Lady Merron, for her reply and for facilitating and attending our meeting with the Medicines and Healthcare products Regulatory Agency. Has she had the chance to read the correspondence I shared with her from the bereaved family of Thomas Kingston, who, like Olivia Russell, committed suicide while using anti-depressants? Has she noted that the coroner intends to issue a prevention of future death report to the MHRA? In the light of this tragedy, what can the Minister do to create a more rigorous approval regime, including greater definition of risk? Given that hundreds of millions of these drugs are issued, at a cost of hundreds of millions of pounds, will the Government establish a longer-term inquiry to ask searching questions about root causes—what is leading to endless repeat prescriptions and driving such widespread reliance on anti-depressants?

[Baroness Merron (Lab)]

I extend my deepest sympathies to the family of Thomas Kingston after his very tragic death earlier this year. We await the findings of the inquest and will act on any recommendations by the coroner as appropriate. While there has been an increase in prescribing, as the noble Lord observes, anti-depressants, for example, are often prescribed for a wide range of reasons—not just for the treatment of depression but for migraine, chronic pain, and ME, among other conditions. The other possible reason for the increase is because of the stigma associated with seeking mental health treatment, but prescribing anti-depressants is never the first port of call—it is just one of the tools in the box to assist people. There are no current plans to conduct a review.

[Lord Patel (CB)]

My Lords, the noble Lord, Lord Alton, did not mention whether we were discussing specific anti-depressants, but the case he mentioned does refer to a group of anti-depressants called selective serotonin reuptake inhibitors. They treat the patient by increasing serotonin levels, but they run the risk of patients having suicidal ideation—the feeling of wanting to commit suicide. In a meta-analysis carried out using 29 research reports, it was found that they are beneficial in the early phase of the treatment of depression, but in later phases the data is less reliable. Are the MHRA and the NIHR working together to look at the evidence available and to produce the appropriate guidance? To avoid a high risk of suicide in people using this group of drugs, it is important to have proper monitoring, which means controlled visits to appropriate health specialists.

[Baroness Merron (Lab)]

I assure the noble Lord that NICE keeps all its clinical guidance under active surveillance to ensure that it can respond to any new evidence that is relevant, including relevant clinically related literature, that could possibly impact on its recommendations. More broadly, guidance recommends that suicidal ideation should be monitored in people with depression who are receiving treatment, particularly in the early weeks of treatment. That includes specific recommendations on medication for people at risk of suicide.

[Baroness Pidgeon (LD)]

My Lords, a study in 2019 found that a third of women were prescribed anti-depressants by their GP to combat symptoms of the menopause. What are the Government’s current assessment of this situation and of adherence to NICE guidance in this area? If the Minister does not have full details to hand, perhaps she can write to me.

[Baroness Merron (Lab)]

I would be very pleased to write further to the noble Baroness. This is a very important point about support for women during the menopause. However, a prescription is made only after discussion with the patient about it and other alternatives, and the clinician has to follow and comply with the guidelines. Patient choice is absolutely key here. Every individual is an individual, and only what is appropriate should be prescribed—if needed.

[Baroness Blackwood of North Oxford (Con)]

My Lords, as the Minister pointed out, SSRIs can be the right choice for some patients, but for there to be patient choice, there has to be the capacity for those therapeutic options. In April 2024, around 1 million people were recorded as waiting for mental health services, 340,000 of whom were children, and over 100,000 had waited for more than a year. The Government have pledged to provide an additional 8,500 mental health staff. Can the Minister say what she will do to increase patient choice and build that capacity?

[Baroness Merron (Lab)]

We have already made a number of commitments, but the noble Baroness is quite right to observe the excessive numbers on the waiting list. We are deeply aware of the distress and continuing difficulty that this causes for many. The noble Lord, Lord Darzi, in his independent investigation, confirmed that about 1 million people are waiting for mental health support as of April 2024. Moving to the 10-year plan will be an opportunity to put mental health services in a different place. In addition to the commitments that the noble Baroness has mentioned, we are providing access to a specialist mental health professional in every school and providing open-access Young Futures hubs.

[Lord Kamall (Con)]

My Lords, I am grateful to the noble Lord, Lord Alton, for organising a recent meeting with the Minister, the MHRA and some psychiatrists, who raised the issue of SSRIs and their side-effects. One concern was that patients need to be aware that one side-effect of SSRIs is to have suicidal thoughts. Therefore, I was surprised to see on the NHS website’s page on the side-effects of anti-depressants that you have to scroll down four or five pages before seeing the warning signs about suicidal thoughts. While we await the review from the MHRA which it discussed with us, will the Government and the NHS look at the advice on the website so that those who are prescribed SSRIs are clearer about the risk of suicidal thoughts?

[Baroness Merron (Lab)]

I would be happy to look at that. However, there have been warnings on the leaflets accompanying medication for some 20 years. It is always a cause to review to ensure that it is most effective. There are at least two sides to this. One is the clinician doing their job to discuss side-effects, including on withdrawal from the medication, but it is important that patients understand it as well.

[Lord Hacking (Lab)]

Is my noble friend the Minister aware of the work of the Charlie Waller Trust, whose directive is to apply awareness among teachers, tutors and so forth of the danger of suicide in the work that they perform?

[Baroness Merron (Lab)]

I am not specifically aware, but I will be glad to look into this.

[Lord Crisp (CB)]

My Lords, I want to raise the issue of dependency on anti-depressants. As the Minister will know, a lot of people have great difficulty coming off these anti-depressants. It is striking that for those using drugs illegally or with substance abuse, there are many services, but there are no services in the NHS for those seeking to withdraw from anti-depressants. This is a major problem. With that in mind, I ask two questions. First, will the Government consider the delivery of a helpline, which has been called for in a number of reviews, so that people can have some access to help? Secondly, will they support an NHS project designed to introduce withdrawal services within the NHS?

[Baroness Merron (Lab)]

The noble Lord makes an important point about the effects of withdrawal from any medication. I am not sure that this is an exact answer but there is the 111 helpline, which has been expanded to refer to mental health services, so people can ring and ask those questions. However, I take his point about withdrawal. We may wish to consider this as we go towards the 10-year plan.

Bread and Flour Regulations 1998

Baroness Merron Excerpts

Wednesday 11th December 2024 Lords Chamber

[Lord Rooker]

To ask His Majesty’s Government, further to the answer by Baroness Merron on 11 September (HL Deb col 1562), whether it remains their intention to lay regulations before Parliament to amend the Bread and Flour Regulations 1998 in 2024.

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

My Lords, I am delighted to be able to say that, a month ago, this Government laid the legislation to introduce the mandatory fortification of non-wholemeal wheat flour with folic acid. We are the first European country to do so, providing pregnant women with protection for their unborn babies from neural tube defects and the devastating impact on families. I pay great tribute to my noble friend and many others in this House who have championed this momentous intervention over a number of years.

[Lord Rooker (Lab)]

My Lords, I thank my noble friend for that Answer. Will she formally thank the Opposition, who spent six years saying no and five years organising the consultations that have led to this decision—just a few minutes ago, I was looking at four Ministers who had answered Questions on this? I do not want to be too negative but, in the department’s extensive press release on the day it published the regulations, why was there not a single reference, even in footnotes, to the Medical Research Council’s work of 1991, which over 80 countries have already followed? Has the Secretary of State picked up the phone to talk to Nicholas Wald, the research scientist who led that work in 1991, which has been followed by so many countries and now, belatedly but welcomely, by his own country, the United Kingdom?

[Baroness Merron (Lab)]

I am glad my noble friend welcomes the announcement that I am making today. With respect to any phone calls made by the Secretary of State, I will gladly find out; I certainly cannot comment at this Dispatch Box. I thank previous Ministers and officials who, over the years, have contributed to where we are. In respect of the delay, all I can say is that I am very glad to be the Minister announcing it today.

[Baroness Manzoor (Con)]

My Lords, I welcome the announcement; I think it is very good news. I also welcome the tenacity of the noble Lord, Lord Rooker. He has done an amazing job, so well done to him. For me, it is important to have a widespread strategy to include folic acid in flour and to look at previous programmes to, say, reduce rickets, to ensure that we do not increase inequalities by not thinking about the outcomes—for instance, ensuring that folic acid is included in chapatti flour.

[Baroness Merron (Lab)]

The addition of folic acid is to non-wholemeal products. Flour is not just used in baking but is in all sorts of other products. That is part of the reason for it being a 24-month transition, and of course industry can act quicker than that. The reason that it is in non-wholemeal flour is that wholemeal is already a higher source of folate. In respect of chapattis, all products will be considered. I should add that some of the transition time is due to the labelling changes that will be required. We are not stopping industry acting quicker, but we are being realistic about how long it will take.

[Lord Krebs (CB)]

My Lords, I congratulate the Government on introducing this legislation and the noble Lord, Lord Rooker, on his tenacity. However, I would like to ask about another vitamin. We know that between one in five and one in six people in the country have low vitamin D levels; the previous Government had a consultation on this back in 2022. Will the Minister update us on what the Government’s policies will be to try to address the issue of low vitamin D levels?

[Baroness Merron (Lab)]

I will be glad to look into that and to update the noble Lord and your Lordships’ House on the matter.

[Baroness Walmsley (LD)]

My Lords, I congratulate the noble Lord, Lord Rooker, on his persistence; these Benches have always supported him. I welcome that more NTDs will be prevented. However, given that we have to wait yet another two years and that the Government’s guidance for women who wish to become pregnant or who are pregnant is to continue taking folic acid supplements, are the Government looking at creative ways of making it easier for them to do that —for example, having them available for free in antenatal clinics or at family hubs?

[Baroness Merron (Lab)]

As I mentioned earlier, while 24 months is a realistic transition, not everything will wait that long. It is the case, as the noble Baroness says, that there is still advice to women who could become pregnant to take folic acid supplements, and it is important that we keep that message going. However, 50% of pregnancies are not planned, so it is not possible to prepare by taking supplements. We are looking at all ways of effectively getting the message across.

[Lord Kamall (Con)]

My Lords, I congratulate the Government on publishing the regulation. I pay my own tribute to the noble Lord, Lord Rooker—although he may not welcome it—for his tenacity on this particular issue. One of my frustrations when I was a Minister on this was how long the processes and consultations took. For future reference, if other supplements are to be introduced into our food, I wonder whether the department has looked at ways in which it could possibly shorten the process without compromising patient safety.

[Baroness Merron (Lab)]

Patient safety is at the forefront of this. I do not want to look backwards, but I gently suggest that there are all sorts of reasons for delays. Still, we are where we are now, and what is important is moving ahead. We are working closely with the Chief Medical Officers across the UK. We are very much in lockstep with the devolved Governments, and I think that will also assist.

[Lord Winston (Lab)]

Given the Government’s excellent initiative to reduce the serious risk of neural tube defects, which cause such despair to so many people, will they tell us where we have got to with fluoride addition to the water supply to prevent dental disease?

[Baroness Merron (Lab)]

My noble friend is right, and we anticipate that this policy will reduce the number of neural tube defects in pregnancy by around 200 a year. Those are life-changing brain and spinal defects, such as spina bifida. The question about fluoridation goes a little wider than I had anticipated.

[Lord Winston (Lab)]

I am sorry.

--- Later in debate ---

[Baroness Merron (Lab)]

Please do not apologise. We are seeing through all the measures that are possible to reduce dental decay as part of our prevention policies, and that includes introducing supervised toothbrushing for young children. I know that a number of noble Lords are interested in the matter of fluoridation—they have raised it with me in discussions about dentistry—and I will be pleased to write to my noble friend.

[Lord Patel (CB)]

My Lords, the noble Lord, Lord Rooker, is right to mention Nick Wald; he pioneered the study that I was part of when I was on the steering committee of the MRC. The important point I want to make is that it is before pregnancy starts and in its early phases that folic acid is most important; it is not about prescribing it once the pregnancy is established. I speak as someone who had to look after many mothers who had neural tube defects, such as anencephaly.

[Baroness Merron (Lab)]

The noble Lord’s observation is, obviously, right. Folic acid contributes, for example, to tissue growth during pregnancy, as well as to the normal function of the immune system and to reducing tiredness and fatigue. As for the point I made earlier, one of the strong reasons for this policy is that 50% of pregnancies are not planned. Therefore, it is about ensuring that folic acid is available in a diet before pregnancy, whether or not that pregnancy is planned. That is vital.

[Lord Dodds of Duncairn (DUP)]

My Lords—

--- Later in debate ---

[Lord Dodds of Duncairn (DUP)]

I warmly welcome what the Minister has said. I thank the noble Lord, Lord Rooker, for his work on this, as well as those who worked with me when I had the honour to co-chair the all-party group on this in the other place. On working in partnership with the devolved Governments, can the Minister commit to continue that work of implementation and enforcement through to 2026, so that families will be spared the pain of having babies born with neural tube defects, which is a particular issue in Northern Ireland?

[Baroness Merron (Lab)]

I am grateful for the comments of the noble Lord, who himself has brought much to this campaign. I am glad that, in Northern Ireland, the legislation was laid a few days later, on 20 November. I assure him that we will continue to work with the devolved Governments on this matter; it is crucial that we do. I finish by thanking again all noble Lords, including my noble friend Lord Rooker, who has led from the front on this to ensure that we could announce it today.

Health: Quad-demic

Baroness Merron Excerpts

Tuesday 10th December 2024 Lords Chamber

[Baroness Morgan of Drefelin]

To ask His Majesty’s Government what steps they are taking to reduce the impact of a potential “quad-demic”, involving high prevalence of influenza, respiratory syncytial virus, COVID-19 and norovirus, following the warning of Professor Sir Stephen Powis, the NHS national medical director.

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

My Lords, levels of hospital admissions due to flu and norovirus are higher, while Covid hospitalisation rates are lower and RSV hospitalisation rates are about the same as the same time last year. The impact of these infectious diseases can be reduced through our annual vaccination programmes for flu and Covid-19, as well as the new year-round vaccination programme for RSV, and by observing good hygiene measures. Some 16.6 million flu vaccinations, 9.3 million Covid-19 vaccinations and 1.2 million RSV vaccinations have been delivered so far this winter.

[Baroness Morgan of Drefelin (Lab)]

My Lords, I thank my noble friend the Minister for that comprehensive Answer. I have to say that “quad-demic” was a new phrase for me and so I was very keen to understand what the Minister made of the announcements from the NHS national medical director, Sir Stephen Powis. From my point of view, it is vital that we learn the lessons of the last pandemic and I know a huge amount of work is being done to understand the implications of the recommendations from Module 1 of the inquiry. But, as I understand it from Sir Stephen’s announcement, the uptake of NHS vaccine programmes is much lower than last year, so I am concerned for us to be reassured that if uptake does not improve in the run-up to Christmas, we are ready and we have learned the lessons from last time and we will not panic and start making foolish decisions about PPE acquisition, for example.

[Baroness Merron (Lab)]

We are absolutely committed to learning the lessons from Covid in order to build resilience. The recommendations of the independent review of procurement by Nigel Boardman have already been implemented and a Covid Counter-Fraud Commissioner has already been appointed to scrutinise contracts to learn the lessons and recover money for taxpayers. Professor Sir Stephen Powis, who I have spoken to about this, was not suggesting that there is a pandemic but more that four infectious diseases are coalescing to create a situation and that vaccination is crucial. His comments were a call to the public to get vaccinated, which I also endorse.

[Lord Patel (CB)]

My Lords, currently the RSV vaccination is available to the older age group of 75 to 79 year-olds—of course, it is available to a younger age group for vulnerable people—unlike in the CDC advice, which is that over-75s should get the immunisation. Older people are more susceptible to RSV and end up with more severe disease and hospitalisation, so why is the advice in the United Kingdom that the over-80s should not get immunisation? It has been suggested that the trials had insufficient evidence. The two trials for Moderna and Pfizer showed that efficacy was maintained in the older age group and therefore the JCVI’s interpretation is rather narrow in scientific terms —or is it to save money?

[Baroness Merron (Lab)]

I listened carefully to the noble Lord. The JCVI considered that there was less certainty about how well the RSV vaccine works in people aged 80 and over when the programme was introduced in 2023, and that is because, as the noble Lord said, there were insufficient people aged 80 and older in the clinical trials. The JCVI continues to keep this under review, including looking at data from clinical trials and evidence in other countries, and there will shortly be an update to your Lordships’ House in respect of research and clinical trials.

[Lord Bethell (Con)]

The Minister says that we are determined to learn the lessons of Covid. During Covid we had vaccination rates of 90% but, as she said, only 16 million—just 25%—of our citizens have had the flu jab and vaccination rates among children are also deteriorating at a rate. I say this with some personal interest because there was an outbreak of the quad-demic in my own household at 2 am today. There are three times as many people in hospital today with flu than in this week last year. Can the Minister please explain what she is doing to increase vaccination rates, particularly among children?

--- Later in debate ---

[Baroness Merron (Lab)]

We are aiming communications —I know the noble Lord will be familiar with this from his previous role—particularly at groups that are less represented in terms of vaccinations. From my discussions with the national medical director, I do not recognise the reference that the noble Lord made to hospitalisations; they are as I set out in the Answer to my noble friend. However, we are far from complacent and continue to push vaccination. We will get vaccination rates up because they are the best line of defence against infectious diseases.

[Lord Scriven (LD)]

My Lords, the chief medical officer at the UK Health Security Agency stated last week that NHS staff should get the flu vaccination. The Government’s own statistics show that last week, in the largest trust in the country, only 7.9% of those eligible had had flu jabs, and on average the number is in the lower 20%. Why has this happened? What are the Government doing urgently to improve the take-up of the flu vaccine by NHS staff?

[Baroness Merron (Lab)]

I must be honest: I cannot explain here the exact reasons why NHS staff are not taking it up, but I assure the noble Lord, as I have assured other noble Lords, that our focus is on getting vaccination rates up. That is why the national medical director made the comments that he did, as well as assuring me that we are not nearing a pandemic.

[Baroness Ritchie of Downpatrick (Lab)]

My Lords, undoubtedly the vaccination programme has had an important influence and impact on our National Health Service as well as our economy. What further vaccines and vaccination programmes will be accelerated on to the national immunisation programme this year and in further financial years?

[Baroness Merron (Lab)]

My noble friend has campaigned tirelessly for the vaccine rollout in respect of RSV, for which I thank her, and I know that many others would wish to thank her for that too. With regard to the other vaccines about which my noble friend asked, we will continue to work with the JCVI and, as there are further developments, I will update your Lordships’ House.

[Lord Kamall (Con)]

If the spread of any of the four viruses listed by the noble Baroness, Lady Morgan, were to turn into a pandemic, hospital capacity would be an issue of concern. Hospital capacity is already an issue in most winters. With that in mind, figures released last week show that NHS hospitals are operating at 95% capacity. Therefore, what discussions are the Government and the NHS having with the independent healthcare sector to utilise its spare capacity to help to alleviate the pressures, both this coming winter and in the face of future pandemics?

[Baroness Merron (Lab)]

The noble Lord will be aware that being prepared for winter is crucial. It has felt for too long as though winter crises have almost become normalised. Certainly, our move towards a 10-year plan will ensure that we have an NHS that can provide all year round. To give one statistic on Covid, in the week beginning 1 December there were 1,390 hospital beds occupied by confirmed Covid-19 patients per day, which was 41% lower than in the same week last winter. However, we are absolutely aware of this issue and we are not expecting a difficulty in respect of beds.

[Baroness Finlay of Llandaff (CB)]

My Lords, in her original Answer the Minister spoke about hygiene measures. I wonder whether she could expand on the advice that will be given to the public about considering washable face masks that can be recycled; about improving handwashing because of norovirus; and, particularly as we go into the Christmas season, about not washing poultry, which causes the droplet spread of campylobacter in kitchens and can lead to severe gastrointestinal infections. These will all increase the workload on the NHS if combined with the other infections that we have spoken about.

[Baroness Merron (Lab)]

Prevention is key, rather than just focusing on cure. Communications thus far are focusing on handwashing; I will discuss the other points the noble Baroness raises with the department.

Physician and Anaesthetist Associate Roles: Review

Baroness Merron Excerpts

Thursday 5th December 2024 Lords Chamber

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

My Lords, I congratulate the noble Baroness, Lady Bennett, on securing this debate. This is an important issue, as we have heard today. I thank all noble Lords for their invaluable and varied contributions.

I shall start with the toxicity of the debate. I emphasise this Government’s support of and gratitude to all staff. That absolutely includes physician and anaesthetist associates who work hard to treat and care for patients in the NHS. As the noble Lord, Lord Kamall, said, the debate has been not just toxic but polarised. As the noble Lord, Lord Scriven, acknowledged, we have seen bullying, which is unacceptable; as the noble Lord, Lord Kamall, said, we need to look at the toxic culture as well as the toxic debate. I absolutely associate myself with the comments made by the noble Lords from their respective Front Benches. At times, not just the debate but the activity around the subject has been deeply abusive, not just in words or on social media, and has been aimed at PAs and AAs. There is no excuse for this and it will not be tolerated. They are valued team members, as is everybody who works in the National Health Service, and deserve our respect and support.

Let me assure noble Lords that this review—I am glad that it has been welcomed—will be an independent, end-to-end review. It will cover training, recruitment, day-to-day work, oversight, supervision and professional regulation. It will assess the safety of the PA and AA roles relative to existing professions, the contribution that the roles can make to more productive use of professional time in multidisciplinary teams and whether the roles deliver good-quality and efficient patient care in a range of settings. All these matters, among others that noble Lords have rightly flagged today, will be considered.

The noble Baroness, Lady Bennett, asked about resources, support and co-operation for the review. I can assure her that this review is properly resourced and, importantly, that stakeholders across the health and social care system have already indicated that they will actively support its work. I agree that this is vital to Professor Leng’s work. As the noble Lord, Lord Kamall, identified, Professor Leng is a champion for patient safety who brings a thorough understanding of healthcare in this country. She is one of the UK’s most experienced leaders in it and I am most grateful to her for her work. I will draw key points from this debate to her attention, including the matter that the right reverend Prelate and the noble Lord, Lord Scriven, raised about getting information to the public. I take that point and will draw these aspects of the debate to the attention of my ministerial colleagues and Professor Leng.

As the Secretary of State highlighted when he announced it on 20 November, the review will gather available evidence and data on the PA and AA professions. It will also engage with relevant professions, the public, employers and researchers. In response to a number of questions raised today, I am committed to ensuring that noble Lords are kept informed as the review progresses. As has been identified, it will report in spring 2025 and we will publish our findings and update your Lordships’ House on the next steps.

I will address the concerns of the noble Baroness, Lady Bennett, and other noble Lords on interim action. NHS guidance remains in place on PA and AA deployment while the review is ongoing. Furthermore, NHS England continues to engage with NHS organisations to ensure that this guidance is adhered to. On the pace of the review, we are committed to it moving quickly to provide clarity, while ensuring that it has sufficient time to consider all available evidence.

The right reverend Prelate spoke of the value of a skills mix and the need for it in providing the kind of healthcare that we need into the future. My belief is that it is recognised—the noble Lord, Lord Scriven, also spoke to this—that the mix of professions required to deliver the right kind of care has evolved continually since the birth of the NHS. As the right reverend Prelate said, on previous occasions there have been many other criticisms and concerns; it is the nature of change. However, I want to be clear that the premise behind the use of PAs and AAs as part of the multidisciplinary team is absolutely sound. To give some context, PAs and AAs have been practising in the NHS for over 20 years, as the noble Lord, Lord Scriven, said. It is not a recent development.

The numbers we are speaking about are small. I will give some context to your Lordships’ House. There are 14,000 full-time equivalent doctors in anaesthetics in England and 170 AAs in the whole of the UK. There are 146,000 full-time equivalent doctors in England and 1,600 PAs. There are 38,420 full-time equivalent GPs and 2,105 PAs. I would not want your Lordships’ House to labour under any misunderstandings.

PAs support doctors to diagnose and manage patients —“support” is the operative word. They are not and should never be used to replace doctors. Similarly, AAs are qualified to administer anaesthesia but only under the supervision of a medically qualified anaesthetist. These roles always have to work under the right supervision. Concerns have been raised by medical professionals about blurred lines of responsibility and whether, in some cases, PAs and AAs are being used to replace doctors. So I understand the need for a comprehensive view of how these roles are being deployed and how effectively. I am confident that the review will address this.

I am acutely aware of the rare but deeply tragic incidences where patients have lost their lives following treatment by an associate. I offer sincere condolences—I know other noble Lords will too—to family and friends. They deserve answers and the assurance that we are listening—and indeed we are. My noble friend Lady Keeley spoke so movingly about the cases of Emily Chesterton and Susan Pollitt, which are deeply tragic. As the noble Lord, Lord Scriven, said, it is so important not to lump every PA and AA together, just as it is not right to do that for any other group. The noble Lord, Lord Kamall, rightly observed that tragic death happens when care is provided by other health professionals. Our job is to reduce that as far as we possibly can, which is what we are working to do.

The noble Baroness, Lady Bennett, highlighted a reference to legal action and redundancies, as well as the systematic impact that uncertainty has created for employers, GP practices, NHS services and individuals. That is why this review is so vital. It enables us to take stock of the evidence, establish the facts and provide absolute clarity for patients, professionals and employers.

As the noble Baroness, Lady Bennett, acknowledged, there has been significant debate on the scope of practice, especially for PAs. The review will cover all aspects of PA and AA roles, including their deployment and scope of practice. The issue will therefore be considered as part of the review, and I will not pre-empt its outcome on this or any other aspect. Many questions were rightly asked about what happens in the meantime. NHS England’s guidance on the deployment of PAs and AAs should continue to be followed.

On the important points about patient confusion, the GMC has published interim standards for AAs and PAs in advance of regulation. That will make clear that professionals should always introduce their roles to patients and set out their responsibilities in the team. The Faculty of Physician Associates has produced guidance, which includes an example of what a good initial introduction should look like. The review will also consider the professional regulation of these roles, which, as was set out, the GMC will commence next week.

The noble Lord, Lord Kamall, and the noble Baroness, Lady Bennett, asked about the action that will be taken in advance of the review concluding. It is important to note, as the noble Lord, Lord Scriven, did, that regulation by the GMC will begin in a very short while. As the noble Baroness, Lady Bennett, set out, I am aware that concerns have been raised about the GMC as the regulatory body for the roles. But we can be assured of the benefit of statutory regulation in helping to ensure that all PAs and AAs meet the very high standards expected of—and I emphasise this—every healthcare professional. Where these standards are not met, action can be taken.

This has been a challenging period for the PA and AA workforce, and it is vital that, like all NHS staff, they are treated with respect. It is therefore incumbent on all to do this. I look forward to the review, and I wish Professor Leng well. I thank noble Lords for their valued contributions to this debate. I look forward to PAs and AAs playing their part in providing improved healthcare in this country.

Fracture Liaison Services

Baroness Merron Excerpts

Wednesday 4th December 2024 Lords Chamber

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

My Lords, I congratulate the noble Lord, Lord Black, on securing this important debate and pay tribute to his very effective campaigning over many years. I am always touched when he refers to his mother; personally, I always feel that his campaigning shows great respect to his mother, and I am sure that the whole House appreciates that. I also enjoyed, as I am sure the noble Lord, Lord Kamall, did, his reminder to me and the now Opposition Front Bench of what we said when we were on the other side, and we are suitably—not chastened exactly—brought to book by his comments.

I thank other noble Lords for their many insightful and accurate contributions. As I am sure noble Lords will be aware, I have much sympathy with many of the points that have been made. I know this is an issue close to many, either because of their own experience or that of those to whom they are close.

As we have heard, including from the right reverend Prelate the Bishop of London, inequalities in access to and the quality of fracture liaison services have a significant impact on so many people across the country. Over half a million people in England alone suffer a fragility fracture every year. More than 40% of those will suffer another fracture within a decade. As the noble Lord, Lord Black, so powerfully illustrated, fracture liaison services can play a vital role in reducing the risk of refracture, improving quality of life and, importantly, increasing the number of years that can be lived in good health.

Many noble Lords referred to the postcode lottery, including my noble friend Lady Quin and the noble Lord, Lord Rennard. Noble Lords spoke of the difference in access coming at a substantial cost. I agree; it is not only a cost for the NHS and social care, but there are also many personal costs of life-changing injury and increased mortality and morbidity. This cannot continue.

Today’s debate refers to the progress towards universal provision by 2030. The noble Lord, Lord Black, and other noble Lords powerfully advanced the case for moving swiftly and the potential consequences of not doing so. It was suggested that there was funding from the previous Government for the expansion of fracture liaison services. All investigations show that no funding was ever confirmed or announced, including as part of the Major Conditions Strategy. I remind your Lordships’ House that the 2030 ambition for the rollout of fracture liaison services was first announced by the previous Government on the day after the election was called. On that point, I am very grateful for the understanding of a number of noble Lords, including the noble Lord, Lord Kamall, and my noble friend Lady Quin, that these are early days for the Government, but I will attempt to be helpful.

This mission-led Government will expand access to fracture liaison services, alongside, importantly, delivering 40,000 more appointments each week and increasing diagnostic capacity to meet the demand for diagnostic services. Why? It is because fracture liaison services play a vital role in the mission to build an NHS for the future, where waiting times are reduced and more care is moved to the community, closer to where people need it. We have to be honest about the scale of the action needed, as noble Lords will know that this Government have been. I will make some points about the background and the challenges ahead. As the Chamber will understand, it will not be solvable overnight.

My right honourable friend the Secretary of State commissioned an independent investigation into the NHS as one of his first actions in government. The findings by the noble Lord, Lord Darzi, laid bare the fact that the NHS currently has the longest waiting lists, the lowest patient satisfaction and a deterioration in the nation’s underlying health, with widespread problems for people accessing services. This includes fracture liaison services.

In response, the Government announced the 10-year plan, which will be published next spring. The plan will be shaped by input from the public, patients and health and care staff through an engagement exercise—on which noble Lords heard me answer a Question from the right reverend Prelate earlier this week, who was good enough to raise it again today. The exercise was launched as:

“The biggest national conversation about the future of the NHS”.


It will include consideration of the three fundamental long-term shifts for health reform, as emphasised by my noble friend Lady Quin and the right reverend Prelate: hospital to community, analogue to digital and changing from sickness to prevention. I agree with noble Lords that fracture liaison services encapsulate all three. This is a long-term challenge and will take time to deliver, so the plan will consider what immediate actions are needed to get the NHS back on its feet and get waiting lists down, as well as long-term changes.

We are continuing our close working relationship with NHS England to tackle issues related to provision of fracture liaison services, which are a crucial prevention service. The noble Lord, Lord Black, my noble friend Lady Donaghy and the noble Baroness, Lady Bull, along with other noble Lords, suggested a number of potential solutions. We are considering a wide range of options as we seek to identify the most effective ways of improving the quality of and access to the fracture liaison service model and the interventions it provides. I look forward to continuing work with noble Lords and being able to bring more information to this House.

My noble friend Lady Ritchie referred to the role of ICBs, and this point was raised several times helpfully in the debate. As noble Lords are well aware, fracture liaison services are commissioned by ICBs and are making decisions according to local need. National expectations of ICBs and trusts for the next financial year will be set out in the 2025-26 NHS planning guidance. I know that the matter of finance has been raised a number of times, including by the right reverend Prelate.

Along with many noble Lords here, we have benefitted from continuing engagement with the Royal Osteoporosis Society and a number of partners. The noble Lord, Lord Brownlow, rightly paid tribute to the role of Her Majesty the Queen. I felt that was an extremely important recognition with which I want to associate myself. In our engagement with our stakeholders, we are looking at the best ways to support the systems that work.

The noble Lord, Lord Shinkwin, raised matters relating to those of working age. It is the case that osteoporosis and the risk of repeated fragility fractures remain significant contributors to economic inactivity. I was pleased to hear the noble Lords, Lord Black and Lord Shinkwin, recognise the significance of musculo- skeletal conditions as drivers of long-term sickness absence. It is absolutely the case that those conditions are the second leading cause of sickness absence and the leading cause of a reduction of years lived in good health and employment.

There is much joint working going on between DWP, DHSC and NHS England under the Getting It Right First Time teams to deliver a programme, working with ICBs to reduce waiting times and improve data and referral pathways. The recent Get Britain Working White Paper included an announcement of £3.5 million in funding for this year to provide a model for musculo- skeletal community services to kick-start economic growth.

The noble Baroness, Lady Bull, and the right reverend Prelate raised women’s health. The noble Lord, Lord Black, was kind enough to draw attention to my previous interest in the issue of fracture liaison services. That now chimes in very well with one of my responsibilities, as I am the Minister for women’s health. I am dismayed at how often women’s health needs are not considered when designing services, and even worse are the additional stark inequalities referred to by the right reverend Prelate. I assure your Lordships’ House that it is a priority for us to ensure that all women receive the high-quality care that they deserve.

I close by restating our commitment to expanding access to these vital fracture liaison services. The work continues, and I look forward to updating noble Lords a number of times as we make progress together.

NHS Plan: Consultation

Baroness Merron Excerpts

Monday 2nd December 2024 Lords Chamber

[The Lord Bishop of London]

To ask His Majesty’s Government what steps they are taking to ensure the consultation for the NHS 10 Year Plan reaches all communities, including those who have least interaction with the health service.

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

My Lords, we want to ensure that the voices and experiences of patients are at the heart of our plans to make the NHS fit for the future, especially those voices that often go unheard. We are working with charities, faith groups, health and care providers, local government and others to ensure that we hear from those that national government often fails to reach. We will monitor this closely and target underrepresented groups before the engagement exercise concludes in spring 2025.

[The Lord Bishop of London]

I thank the Minister for her reply, and I am encouraged by the Government’s consultation on the NHS 10-year plan. However, does she agree with me that, if we are to move from sickness to prevention, any engagement ICBs have with their communities has to be long term and systematic? If so, what are the Government doing to resource ICBs to make sure that their engagement with communities is long term and systematic?

[Baroness Merron (Lab)]

I agree with the right reverend Prelate. Integrated care systems, which are responsible for reflecting the needs of the community and its spending, must follow guidance, and it is important that we identify the seldom-heard groups. We have built into the consultation plans a “workshop in a box”—a toolkit to support discussion in local communities, which ICBs are rolling out. It is a good way of encouraging ICBs to talk directly to local communities.

[Baroness Coussins (CB)]

My Lords, will the consultation be published in languages other than English, with proactive efforts to encourage responses from people whose first language is not English? Secondly, will the department make sure that it consults with public service interpreters working in NHS settings?

[Baroness Merron (Lab)]

I can confirm that both the online portal and the “workshop in a box” to which I just referred will be available in easy read and British Sign Language versions, and in other languages. Attention has been given to those for whom English is not their first language; in-person events can be tailored to their needs—for example, by having smaller groups. The staff to whom the noble Baroness refers are a major group being asked to provide input; indeed, they are taking part in online workshops and can respond online.

[Baroness Pitkeathley (Lab)]

My Lords, does my noble friend the Minister agree that one of the groups that sometimes finds it difficult to interact with health service professionals is unpaid carers? Despite the huge contribution that they make, they often have their needs ignored by those providing services. Does she therefore agree that it is very important that the voice of the unpaid carer is heard in the consultation process?

[Baroness Merron (Lab)]

I agree with my noble friend: we have to hear from unpaid carers, because that will strengthen the exercise. We are constantly monitoring which groups are responding and which are not, and that allows us to tailor our approach to the underrepresented groups who are not coming forward. If that includes unpaid carers, the consultation absolutely will make special, tailored efforts to reach them.

[Lord Scriven (LD)]

My Lords, the life expectancy of people with learning disabilities is, on average, 20 years less than the general population’s. Research has shown that a major contributor to this is a lack of access to appropriate healthcare. What will the Minister do to ensure that this group of people will be not only consulted but listened to, and that the 10-year plan will provide appropriate services tailored to them?

[Baroness Merron (Lab)]

This is indeed one of the groups for whom we need to ensure absolute inclusion. As I mentioned, the work with integrated care systems will be particularly helpful in running the workshop. We train organisations to work with it, and it is designed so that it is easy to use. It can be used in events to reach the seldom-heard voices in communities, including those with learning disabilities. It is vital that we hear from them as we design an NHS fit for everybody for the future.

[Lord Turnberg (Lab)]

My Lords, one of the biggest causes of inequality is where you live in the country. If you live in the north-east or north-west, you live two, three or four years less than if you live in the south-west or south-east. Far fewer resources are available for people in those deprived areas: there are fewer doctors, nurses, physios, dentists and so on. What can the Government do to redress this gross imbalance?

[Baroness Merron (Lab)]

My noble friend allows me to say—and I hope your Lordships’ House will agree with this—that our approach will of course focus on addressing the social determinants of health. The goal will be to halve the gap in healthy life expectancy between the richest and the poorest regions. We are not just going to be moving from sickness to prevention as one of our three pillars, important though that is; we are also seeking, across government, to address the root causes of health inequalities. Again, that is being highlighted as part of the consultation.

[Lord Bailey of Paddington (Con)]

What special efforts will be made to speak to young people, who are often very far away from the health system—those leaving care, those who have just left prison and those from very poor communities? What effort will be made to hear their voices? They are often far away from the NHS because they do not need it yet, but they will in the future.

[Baroness Merron (Lab)]

I thank the noble Lord. Yesterday, I was at an in-person event in Folkestone, and as with all such events up and down the country, it had used systems to find a wide range of people, including young people, who, as he rightly says, are often unlinked with the health service. I emphasise our continued monitoring and our efforts to reach the groups he speaks of. So far, we know that men, those aged under 35, and black Asian and black British people have engaged least with Change NHS. We are now stepping up our efforts.

[Baroness Winterton of Doncaster (Lab)]

My Lords, will my noble friend the Minister look at the role that pharmacists might play in any consultation? While they may not be an obvious source of reaching out, they are embedded in communities and talk to patients and users frequently. If they could be harnessed, it would much improve the consultation.

[Baroness Merron (Lab)]

I am very grateful to all those, including pharmacists, who have used all their networks and contacts to spread the word. That is why we have had over 60,000 responses and more than 1 million visits in what is the largest ever consultation in the history of the NHS. I call on all groups to continue their efforts to ensure that voices across all communities are heard loud and clear.

[Lord Kamall (Con)]

During the vaccine programmes for Covid, the NHS and the last Government put a lot of effort into looking at ways to reach people who are vaccine hesitant—often from some black and Asian communities and other excluded communities. What lessons have been learned by the Government and the NHS to ensure that the consultation on the 10-year plan reaches as many people as possible from these communities, so that their voices are heard?

[Baroness Merron (Lab)]

The lessons that have been learned are that there has to be a whole range of ways of consulting: in person around the country; online, where people can access the website; and through toolkits such as the “workshop in a box”. As I mentioned in an earlier answer, the consultation also needs to be tailored to the needs of those who need to speak up. We are asking the public, staff and organisations what is important, and we want, as the Prime Minister said, their fingerprints all over the 10-year plan.

[Baroness Bull (CB)]

My Lords, people living with homelessness often have chronic and multiple health needs which go untreated, and they are also more vulnerable to substance misuse. Appreciating the difficulty, what are the Government doing to ensure that the needs of people living with homelessness are addressed and heard through this consultation?

[Baroness Merron (Lab)]

We have identified those who are homeless as one of the specific seldom-heard groups, and that is why we are working so closely with integrated care systems: to ensure that we reach them on their territory. The other groups include, for example, sex workers, young people, those with learning disabilities and some ethnic minorities.