HIV Care: Access

Baroness Merron Excerpts

Wednesday 11th September 2024 Lords Chamber

[Lord Black of Brentwood (Con)]

My Lords, I beg leave to ask the Question standing in my name on the Order Paper and declare my interest as a patron of the Terrence Higgins Trust.

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

My Lords, in 2022 England exceeded the joint United Nations programme on HIV and AIDS targets, with 98% of people diagnosed with HIV receiving treatment. The UK Health Security Agency estimates that between 6% and 15% of people living with diagnosed HIV in England did not access HIV care that year. Re-engaging people into HIV care is a priority for the current HIV plan for England and for the new plan that is in development.

[Lord Black of Brentwood (Con)]

My Lords, we know from the opt-out testing programme in A&Es introduced by the last Government that up to 15,000 people in England who are aware that they have HIV are not accessing life-saving care, with devastating personal consequences for them and profound ramifications for public health, because if you are not on medication, you can pass on the virus. Is the Minister aware of the case of a 45 year-old man, out of care for several years, who went to hospital with a headache and was found to have a CD4 count of just four. He was diagnosed with cryptococcal meningitis, an AIDS-related illness. He went blind and died three months later, one of a growing number of tragic preventable deaths. Can the Minister ensure that we get an HIV action plan as soon as possible and that this issue—with funding, if necessary—will be a key part of it, to ensure that we get those lost to care back into it?

[Baroness Merron (Lab)]

My Lords, Ministers have already commissioned officials for advice on how to progress the development of a new HIV action plan. On the very tragic case that the noble Lord refers to, he will be aware that since April 2022, NHS England has funded emergency departments in London, and in areas of very high diagnosed HIV prevalence, to provide routine blood-borne virus testing for HIV as well as for hepatitis B and hepatitis C in everyone aged over 16. That attention at the point of contact is crucial in this area.

[Lord Fowler (CB)]

My Lords, I declare an interest as an ambassador for UNAIDS. Is it not a fact that we have been extremely successful in developing the means to combat HIV and AIDS, but we still face the obstacle of stigma around the whole subject, which is a serious deterrent for treatment and continuing treatment, as the noble Lord, Lord Black, suggested? Will the Government make the fighting of stigma around HIV a priority, so that we can become one of the first countries to be absolutely AIDS free?

[Baroness Merron (Lab)]

The noble Lord’s campaign in this area is very well regarded, and for good reason; I certainly agree with him. The fact is that engagement in care is strongly affected by a number of factors, including a person’s well-being and quality of life, discrimination and, as the noble Lord says, stigma. That, alongside accessibility of service, will define how successful we are. I am keen that our new plan will absolutely take account of stigma.

[Baroness Thornton (Lab)]

My Lords, the crisis of people lost to HIV care is of course underpinned by serious health inequalities. Are the Government taking account of the pilot work by the Elton John AIDS Foundation in south London, which has successfully returned people to care through case-finding, focus follow-up and wraparound support for people when they return to clinics, thus saving the local NHS millions in the care that would be necessary if they were not receiving it?

[Baroness Merron (Lab)]

I can confirm to my noble friend that we are, and say how grateful we are to a number of charities, including the Terrence Higgins Trust and the Elton John AIDS Foundation. As she says, there have been pilots for emergency department HIV opt-out testing since 2018. A pilot that began in April has expanded that to 47 additional sites, and we will be looking closely at the impact of that.

[Baroness Barker (LD)]

My Lords, if that pilot in the 47 areas shows, as it did in London with the Elton John work, that such testing finds people who not only do not know their status but are lost to care, will that form a basis of the national plan the Government are working on? Will there be a particular emphasis on extending services to people in rural areas, who do not have the access to clinics that people in metropolitan areas do?

[Baroness Merron (Lab)]

Yes, and I thank the noble Baroness for making those points, which I certainly agree with. The challenge for us now is to reduce the number of people who live with undiagnosed HIV, but also to reduce the number not seeking care and treatment. For the first time, the latter has exceeded the former, which suggests that we have a challenge we must focus on in the new plan, and we will do so.

[Lord Kamall (Con)]

My Lords, I pay tribute to my noble friend Lord Black for his consistent campaigning on this issue, and especially for helping those with HIV. What has been learned from previous initiatives? We know that in recent years, the NHS and the previous Government looked at ways to address issues such as vaccine hesitancy, and the reluctance of some to seek tests and treatment at any time. What lessons have been learned from these previous initiatives for the HIV action plan—for example, by working with local communities and the charities that a number of noble Lords have mentioned to encourage more patients with HIV to seek treatment, especially in communities such as black and Asian communities, where there may also be a stigma, as the noble Lord, Lord Fowler, mentioned, around admitting that they have HIV?

[Baroness Merron (Lab)]

There is what I call a three-pronged approach to interventions to reduce the number of people not being seen for care, which is so important, as I know the noble Lord is aware: identifying people who have not been seen for care; contacting them and re-engaging them; and addressing the barriers to engagement, which a number of noble Lords have referred to. This means sustaining engagement with care in the long term and supporting people with HIV.

We will review what lessons we are learning from the HIV action plan for England, which runs to 2025, and that means we will be able properly to inform the development of the new plan. I look forward to updating your Lordships’ House on this.

[Lord Cashman (Non-Afl)]

My Lords, we have come a long way since the dark days of the 1980s and 1990s, when many lives were lost. Progress has been made primarily through the work of activists, NGOs, the commitment of Governments and, indeed, the commitment and leadership shown by the noble Lord, Lord Fowler, to whom I pay tribute. But we are seeing greater numbers of people disengaging from HIV care for many reasons, including stigma, mental health issues, poverty, discrimination, and the terrifying fear of isolation within families and communities. Will the Government therefore look at the projects carried out across the country, including in Greater Manchester, and, indeed, as has been mentioned, the NHS South East London Integrated Care Board project, which focused primarily on these issues and groups and successfully reintegrated people back into HIV care? Arguably, this approach must be in any national HIV action plan.

[Baroness Merron (Lab)]

Yes, we will be looking at all the work currently going on and at the successes—and there are many. I believe that my noble friend is referring to Fast-Track Cities, an international initiative involving cities tackling HIV through a multidisciplinary, multi- sectoral approach. There are 13 signatory cities in the UK, and all are beacons of good practice that we must learn from, including in order to find out what is not working. I also want to emphasise peer support, which has been shown to reduce self-stigma, but also to improve engagement in care and the taking of treatment, and to having low levels of virus. This area will obviously very much feature in the new strategy.

[Baroness Sugg (Con)]

My Lords, looking at HIV internationally, the UK has long been a proud supporter of the Global Fund. In 2022 alone the Global Fund reached over 15 million people with HIV prevention services, including 710,000 HIV-positive mothers, who received medication to keep themselves alive and to prevent transmission of HIV to their babies. Will the Government commit to continuing to support the Global Fund?

--- Later in debate ---

[Baroness Merron (Lab)]

Certainly, as the noble Baroness says, the Global Fund is crucial in HIV care. The UK remains a world leader in efforts to end the global AIDS pandemic and funds all the key partners in the global AIDS response. I confirm to your Lordships’ House that some £1 billion was recently pledged to the Global Fund. That will save more than 1 million lives, including by providing antiretrovirals for 1.8 million people, and provide HIV counselling and testing for 48 million people. It will also reach 3 million members of key affected populations with prevention programmes. We will continue to have discussions with the FCDO about the support this Government give.

Bread and Flour Regulations 1998

Baroness Merron Excerpts

Wednesday 11th September 2024 Lords Chamber

[Lord Rooker]

To ask His Majesty’s Government what plans they have to update the Bread and Flour Regulations 1998.

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

My Lords, although work on reviewing the Bread and Flour Regulations was paused due to the general election, I can assure my noble friend that I have picked this up as a personal priority. We have spoken to the devolved Governments about laying legislation later this year and I will update noble Lords on progress in the very near future.

[Lord Rooker (Lab)]

I thank my noble friend the Minister for her Answer. On 16 May, the previous Government said that the regulations for England would come forward in July, on the basis of an agreement with the four nations and the four Chief Medical Officers. There really should be no delay; this could be picked up, like other Bills are being picked up, and be done quite quickly. Is my noble friend aware of the Written Answer I received on 23 July, when I asked about the reform of the Bread and Flour Regulations? It said that it “could include” folic fortification. I want my noble friend to be more specific now than in that Written Answer and give a specific commitment that this Government will do the folic fortification of flour, as agreed by all the consultations and the previous Governments.

[Baroness Merron (Lab)]

My noble friend has been a tremendous campaigner. Indeed, he reminded me that this is, I believe, his 22nd Question on this matter, so I do not wish to test his patience. I absolutely assure him that, as he said, the policy is being taken forward as a UK-wide measure and all the necessary preliminary legislative steps have been taken, including the public consultations he mentioned, which were reported on earlier this year. Subject to renewed collective agreement in England, Defra will lay legislation later in 2024.

[Baroness Walmsley (LD)]

My Lords, I am hearing that, unfortunately, the Government are not being very ambitious in the level of fortification that they will propose. They are considering a level that will reduce neural defects by only about 20%, whereas 1 milligram of folic acid in 100 grams of flour could reduce neural tube defects by 80%, which is a massive amount. Can the Minister at least reassure me that the appropriate committees will look at the level of fortification being proposed, so that it is appropriate and safe?

[Baroness Merron (Lab)]

I assure the noble Baroness that that has already happened. As I am sure your Lordships’ House is aware, the proposal is to add 250 micrograms of folic acid per 100 grams of non-wholemeal wheat flour. I emphasise that this fortification would be in addition to the foods that are already voluntarily fortified, such as a wide variety of breakfast cereals, so we are not talking about just bread. The feeling among the experts, to whom we listen, and the committees to which the noble Baroness referred is that this is the right level at which we can provide reassurance, and so this is where we are focusing our efforts.

[Lord Krebs (CB)]

My Lords, I am delighted to hear that the Minister has confirmed that folate fortification of bread flour will proceed. However, I want to ask her about members of our population who do not eat white bread flour because, for example, they are coeliacs or gluten intolerant, or because they come from ethnic groups who get their main carbohydrate intake from other sources such as rice. In the United States, rice, maize and flour are all fortified with folate and have been since 1998.

[Baroness Merron (Lab)]

The noble Lord raises an extremely good point. Before we speak about the groups to which the noble Lord referred, I want to point out that fortification will not be enough in any case. We need to continue our encouragement for women to take daily folic acid supplements before conception and in the first 12 weeks of pregnancy, because doing so can prevent up to seven out of 10 cases of neural tube defects—I want to emphasise that. I will take on board the noble Lord’s very important point and ensure that it is part of our considerations.

[Lord Kamall (Con)]

My Lords, I start by paying tribute to the noble Lord, Lord Rooker, for his persistence in this matter. When I was a Minister, I found it rather frustrating to be told that the consultation process could not be speeded up, so I pay tribute to the Minister for the progress she has made. However, I want to ask about a possible unintended consequence. The NHS website says that folic acid is not suitable for some people: those who are allergic to folic acid, obviously; those who have low vitamin B12 levels; those who have cancer, unless they have folate deficiency anaemia; and to those who are having a course of haemodialysis or who have a stent in their heart. Given these warnings on the NHS website, can the Minister assure the House that she is confident that those who suffer from those conditions will not be harmed unintentionally by increasing the volume of folic acid in our bread and flour?

[Baroness Merron (Lab)]

I thank the noble Lord for his support in this area; I know that he also worked hard to make progress in it. I can give the assurance he asked for, and I would say to people that if they are concerned, they should seek expert advice about their own personal circumstances. All of the expert advice and relevant committees are content that this is the right way forward.

[Lord Dodds of Duncairn (DUP)]

I thank the Minister for her personal commitment to this issue. Can she give a categorical assurance that the regulations will be amended across the entirety of the United Kingdom at the same time? She will know that in Northern Ireland we have a different regulatory regime for some of these matters due to the Windsor Framework. Can she also assure the House that there will be a common approach across the United Kingdom in both timing and content?

[Baroness Merron (Lab)]

I know that the noble Lord takes a great personal interest in these matters and has also campaigned very strongly. The area he refers to is being pursued because we want collective agreement on this across the whole of the UK, so that we can confirm that it is government policy with absolutely no qualifications, and that everyone is moving on the same timescale. I can confirm that we have notified the EU Commission and the WTO in order to fulfil international obligations and have thus far received no responses; that is why we are able to proceed with the next legislative steps.

[Lord Jackson of Peterborough (Con)]

My Lords, the Minister is a great asset to the Front Bench. This is a bipartisan issue, and I pay tribute to the noble Lord, Lord Rooker, for his excellent work over the years. When I was a Member of Parliament in the other place, Shine—formerly known as ASBAH—the charity for hydrocephalus and spina bifida, was located in my constituency. I say gently to the Minister that we have been campaigning on this issue for almost 20 years, and to my own Front Bench that there is no demonstrable, empirical scientific evidence of any substantial side-effects of putting folic acid into basic foodstuffs, and that it should happen. Finally, more than 30 countries have pursued this policy; they have tackled the enduring tragedy of spina bifida and hydrocephalus, and the impact they have on families. Therefore, can we please do this as soon as possible?

[Baroness Merron (Lab)]

I certainly hear the very welcome points that the noble Lord makes. As we progress, this will make us the first European country to mandate folic acid fortification of non-wholemeal flour. While some European countries, including Ireland, have voluntary fortification, mandatory fortification is not the case. I and my ministerial colleagues are keen to be in this position.

[Baroness Finlay of Llandaff (CB)]

I am grateful to and congratulate the Minister on her perseverance on this issue and on decreasing neural tube defects. Can she also ensure that products are appropriately labelled with warnings that they are not fortified and that any woman who might become pregnant should take additional folic acid supplementation? Without that, we will not tackle the ongoing problem of neural tube defects. I do have a concern that there is inappropriate fear over toxicity, given that in 1991 there was a very good randomised controlled study. People were divided into groups, given fairly high doses, including with multiple vitamins, and compared with those on a placebo. There were no adverse neurological or other effects.

[Baroness Merron (Lab)]

I am grateful for the noble Baroness’s contribution and can reassure your Lordships’ House, and anyone else who may be concerned, that, as noble Lords have said, this has been gone through over many decades. Safety is paramount. On products that are non-fortified, I will have to look into this, but for those that are fortified, there will be a transition period for industry because the equivalent of some 11 million loaves of bread are sold in the UK every day but only 65% of the flour used in their manufacture is produced in the UK. We have to look at this huge diversity of food products, including biscuits and cakes, and where it is a food ingredient in ready meals and soups. It is quite an undertaking, but your Lordships’ House can be assured that we are on it.

Government Policy on Health

Baroness Merron Excerpts

Tuesday 10th September 2024 Lords Chamber

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

Before the Minister responds, I make it clear that these should be questions, not speeches.

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

My Lords, to set out some key points in respect of the right honourable Alan Milburn, he has no formal role in the department. Therefore, the conflicts of interest the noble Lord referred to do not even arise. The main thing I would like to set out is that it is very important to make a distinction between the areas of business and meetings in the department about generating ideas and policy discussion—it is those in which Mr Milburn has been involved, at the request of the Secretary of State—and the very different meetings about taking government decisions. If I might summarise it for your Lordships’ House: Ministers decide, advisers advise.

[Lord Wallace of Saltaire (LD)]

My Lords, I declare a certain puzzlement at this Question. I recall, when the Conservatives were in office, reading regularly on the front page of the Times that donors had been talking to the Prime Minister or various Cabinet Ministers about government policy and expressing strong views on which direction they should take in various areas. As an academic, I am also well aware of the extent to which expertise comes into government through informal channels.

On one now famous occasion, which was not reported at the time, a number of experts on the Soviet Union whom I knew well were invited by Margaret Thatcher to an informal seminar in No. 10 to advise on whether the Foreign Office or Margaret Thatcher’s advisers were correct in their attitude to the Soviet Union. A number of the academics suggested that the Third Secretary of the Communist Party, then a man called Gorbachev, was a good person to get to know. Mrs Thatcher took their advice rather than that of her advisers and it had a remarkably positive impact on British foreign policy. Do the Government accept that all informal contact with outside experts is desirable and that it is a good thing, where possible, that it should be reported?

[Baroness Merron (Lab)]

It is right that people from outside government come into departments to lend their expertise and share their views and that Ministers make decisions without those people involved. That was the line I was trying to draw. The Secretary of State for Health is very fortunate to be able to turn to every living former Labour Health Secretary, from the right honourable Alan Milburn through to my noble friend Lord Reid, Andy Burnham and many others, because all of them have offered to roll their sleeves up and assist us. Perhaps I could remind your Lordships’ House that, between them, they delivered the shortest waiting times and highest patient satisfaction in the history of the National Health Service. I hope that we will be able to do justice to their experience.

[Lord Foulkes of Cumnock (Lab Co-op)]

My Lords, does the Minister agree that this is very different, because the Minister is taking advice from people with huge experience, and it is open and above board? This is unlike when Boris Johnson was Prime Minister, and his wife Carrie Johnson apparently made a number of decisions, including the appointment of Ministers. Was that not something we ought to be worried about, rather than this open and sensible arrangement we have now?

[Baroness Merron (Lab)]

My noble friend makes an important distinction, and I would certainly share that view. It is worth reminding your Lordships’ House that ministerial meetings that are attended by third parties are declared in a quarterly transparency publication in the established way. Of course, this will be done. I can tell your Lordships’ House that I had a meeting with the right honourable Alan Milburn, and it was very useful.

[Baroness Finlay of Llandaff (CB)]

My Lords, I should declare an interest because I was on the Times Health Commission. We took evidence from a wide range of people, including the person mentioned. Can the Minister provide assurances that, whenever people are consulted, they are routinely asked to declare their interests; that any declaration of interest is repeated not only at the first meeting but whenever other people are present so that it is well known; that the consultation goes widely; and that there is no overreliance on a small number of people? We at the Times Health Commission found that, by consulting widely, we were able to hear very conflicting views, which was helpful and formative.

[Baroness Merron (Lab)]

I thank the noble Baroness for sharing her experience of consulting widely. It is certainly entirely legitimate for government departments to do just that. However, those who do not have a formal role are not required to declare interests; it is different for those who have a formal role. Requiring them to do so would mean, for example, us sending forms in advance to Cancer Research UK before it comes in to talk to us about cancer and to assist us. Would we want that? We would not. Of course, where there is a formal role, we absolutely do that.

It is probably worth saying that a particularly high-profile invitation went from the Secretary of State to the noble Lord, Lord Darzi. He will report shortly on the true state of the National Health Service. He does not have a specific role in the department but he has been invited by the Secretary of State to assist; I believe that he will assist both your Lordships’ House and the other place.

[Baroness Bennett of Manor Castle (GP)]

My Lords, when the Green Party consults on health policy, among the organisations it consults are the Socialist Health Association, Keep Our NHS Public and 999 Call for the NHS—all organisations that are greatly concerned about the continuing privatisation of the NHS. Can the Minister tell me whether the Secretary of State or she herself have had meetings with any of those three organisations since coming into government?

[Baroness Merron (Lab)]

I cannot answer that, I am afraid. I would be very happy to look at it for the noble Baroness.

[Lord Markham (Con)]

Although I understand completely the role of advisers—obviously Alan Milburn is a very reputable adviser—where is the line? My concern is that, when an adviser has a pass, has been in meetings without Ministers present and has perhaps directed civil servants in those meetings, a line has perhaps been crossed. I would welcome assurances from the Minister that this has not occurred and that there have not been any meetings where Alan Milburn has been there without Ministers—in effect, directing policy with no formal role.

[Baroness Merron (Lab)]

The right honourable Alan Milburn has not been directing policy; he also has no pass. I hope that is helpful to the noble Lord.

Pharmacies: Rural Areas

Baroness Merron Excerpts

Tuesday 10th September 2024 Lords Chamber

[The Lord Bishop of St Albans]

To ask His Majesty’s Government what plans they have to ensure that pharmacies are accessible to those living in rural areas.

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

My Lords, pharmacies are key to our plans to make healthcare fit for the future, as we shift healthcare out of hospitals and into the community. We will expand the role of pharmacies, including the introduction of prescribing services. People’s experiences of accessing pharmacies differ across the country; we will look closely at this. There are dispensing doctors in areas where pharmacies are not viable, and online pharmacies delivering medicines free of charge to patients.

[The Lord Bishop of St Albans]

I thank the noble Baroness for her response. However, analysis by the Independent Pharmacies Association has identified a £1.2 billion funding gap in this sector, which is leaving, in particular, pharmacies in rural and deprived areas very vulnerable indeed, at the very point when, as she said, we are looking for them to deliver more services. Given that 90% of their income comes from the NHS contracts and that most are unable to fill the funding gap through a retail outlet, what else can His Majesty’s Government do to ensure that we have adequate coverage in rural areas?

[Baroness Merron (Lab)]

I take on board the point that the right reverend Prelate makes. The analysis to which he refers shines a light on the fact that funding for community pharmacies was either cut or held flat over the last eight years, which amounted to a funding cut in real terms of some 28%. We are seeing the result of that. It is also worth saying that the consultation with Community Pharmacy England on the national funding and contractual framework arrangements for 2024-25 was not concluded by the previous Government, so I can say to your Lordships’ House that we are looking at this as a matter of urgency. We look forward, through my colleague Minister Kinnock, to how community pharmacy can be best set to deliver on the ambitions that I have already outlined.

[Baroness McIntosh of Pickering (Con)]

My Lords, I refer to my role with the Dispensing Doctors’ Association; I am grateful to the Minister for paying tribute to it. The right reverend Prelate identified the problem of having equal funding in urban and rural areas, where the dispensing doctors she identified fulfil such a crucial role. Can she give the House a commitment that sufficient funds will be made available in the negotiation of the GP contract so that all the services that are available in urban areas will also be available in rural areas?

[Baroness Merron (Lab)]

I know that the noble Baroness understands that there are some services which cannot be provided—for example, online services do an excellent job, as do dispensing doctors, but although I regard the online option as a very creative one that I would like to see expanded further, there are some things that require in-person attention and that will not be possible. We of course take account of situations across the country, in all the discussions, and that includes rural areas.

[The Earl of Devon (CB)]

My Lords, I am chair of the Plunkett Foundation’s inquiry into the state of rural retail, in particular the loss of wholesale supply chains essential to the survival of rural communities. Will the Government please undertake to review this highly discriminatory circumstance, which hits the rural poor the hardest?

[Baroness Merron (Lab)]

I will be very happy to look at the work that the noble Earl refers to. If he would like to meet me to discuss it, I am sure that would be of great assistance as we look to the future.

[Lord Scriven (LD)]

My Lords, there is a crisis in community pharmacies, as the Minister will know. Two weeks ago, the industry brought out a report that predicted that one in six community pharmacies could close within the next year. What urgent action will the Government take to ensure that that does not happen?

[Baroness Merron (Lab)]

On the point that the noble Lord correctly raises, it is worth reflecting that there has already been a reduction in the number of pharmacies since 2017. There are now some 1,200 fewer pharmacies than we had in 2017 and 600 fewer than there were two years ago. This is a trajectory that we would rather was not the case. Support is available—for example, through the Pharmacy Access Scheme, which provides financial support to pharmacies in areas where there are fewer pharmacies. I can say that we are monitoring access to pharmacies. While it is the case that four in five people live within a 20-minute walk from a community pharmacy, we absolutely recognise that the experiences of patients differ. If we are to see pharmacies as key to future plans for the health services, we will have to address that.

[Lord Kamall (Con)]

My Lords, we recognise that the current access to healthcare is based on an outdated model, where far too many patients are unable to book GP appointments online or by telephone in advance. They have to join the 8 am lottery to try to get an appointment by phone, only to be referred later to a pharmacist or hospital. The Pharmacy First reforms introduced by the last Government attempt to unblock the GP surgery bottleneck by allowing patients to access treatment for common health conditions without the need for a GP appointment. To ensure that patients in rural communities equally benefit from the Pharmacy First initiative, is the Minister able to give the House a firm commitment that the Government will continue the Pharmacy First approach and look at how this could be accessed by more patients in rural areas?

[Baroness Merron (Lab)]

I am pleased to say that, as I am sure the noble Lord is aware, prescribing pilots are going on in NHS England. These will look at what more pharmacies could do in this regard, in particular asking whether more minor illnesses could be dealt with, and whether the long-term management of conditions could be better managed through pharmacies. We will be very interested in what those pilots come up with. They are across the entire country, so will of course include rural areas. This is something that we will want to ensure is available in rural and urban environments.

[Baroness Blackwood of North Oxford (Con)]

My Lords, the Commons Health and Social Care Select Committee pharmacy inquiry found that, while most medicines are in good supply, medicines shortages have doubled since 2021. This means that pharmacists spend time dealing with medicines shortages every day—some as much as four and a half hours. The committee recommended an independent review into how to improve resilience of the medicines supply chain, including looking at pharmacists’ prescribing. Will the Minister commit to this, and if not, what will she do to improve the situation?

[Baroness Merron (Lab)]

The noble Baroness makes a good point about the shortage of medicines; this has been raised many times in your Lordships’ House. I will ensure that my colleague Ministers are aware of the points raised today, to build these into our consideration of how we support pharmacists and pharmacies to continue to do a good job and, indeed, expand their remit.

[Lord Foulkes of Cumnock (Lab Co-op)]

Does the Minister agree that part of the problem around access to rural pharmacies is the massive deterioration of bus services under the previous Government? Since our Government are going to give powers to local councils to run bus services more efficiently and effectively, will that not improve access to local rural pharmacies? Can the Minister ensure that that is done as quickly as possible?

[Baroness Merron (Lab)]

I welcome the announcement by the Secretary of State for Transport about ensuring that bus services can be more readily available, which will assist access to pharmacies. However, there are other options that we need to continue to look at. For example, there are 400 distance-selling pharmacies that deliver medicines which they dispense free of charge to patients, and provide other pharmaceutical services remotely, and, as we know, GP practices can dispense medicines to their patients. I mention those as examples of more creative ways in which we can support people in rural areas.

[Lord Swire (Con)]

Another creative way is to locate some of these pharmacies where we still have community or cottage hospitals up and down the country, which has been done successfully. Will the Minister therefore undertake to look at where this is common practice to see if it can be expanded?

[Baroness Merron (Lab)]

All these creative approaches will be considered as we look at what we will be doing to ensure that pharmacies are key to delivering on improved healthcare across the entire country.

Support for Infants and Parents etc (Information) Bill [HL]

Baroness Merron Excerpts

2nd reading
Friday 6th September 2024 Lords Chamber

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

My Lords, I thank the noble Lord, Lord Farmer, for his thoughtful introduction of the Bill, and I pay tribute to him for his work not just on the welfare and well-being of children but on prison reform over many years. It is also a pleasure to see the right honourable Dame Andrea Leadsom on the steps of the Throne today.

I am grateful for the many contributions to this debate, and I have listened closely to them. This debate shows just how passionately your Lordships’ House feels about early childhood development, and I very much welcome that, because nothing says more about us as a nation than the health and well-being of our children —the noble Lords, Lord Evans and Lord Addington, were good enough to thoughtfully acknowledge that.

I assure your Lordships’ House that the Government absolutely recognise the importance of the earliest days of an infant’s life and that we are committed to raising the healthiest generation of children in our country’s history. In general answer to the noble Lord, Lord Evans, we will be going beyond simply the provisions of a Bill such as this, and I very much look forward to being able to update your Lordships’ House when I am able to do so.

However, as regards this Bill, I absolutely recognise the good intentions in the Bill, and I also want to acknowledge the importance of information and guidance which it shines a light on. However, as the noble Lords, Lord Farmer and Lord Evans, are aware, the Government have reservations about the detail in the Bill itself, which I explained in discussion to the noble Lord, Lord Farmer, when we met earlier this week. I was most grateful to him for his time but also for the manner of our discussion.

This Government need to do things differently from the last Government, and will indeed do so in order that we can improve the lives of all our children through our health and opportunities missions and by driving long-lasting and sustainable change for children, both now and in the future. We need the time and we need to be able to roll out our own cross-government package of support for infants, children and families, as noble Lords have today asked us to do. This needs to be comprehensive, rather than piecemeal. Unfortunately —and I do not like to disappoint the noble Lord, Lord Farmer—while the intent of the Bill is certainly to make a contribution in the right direction, it does not align with how this Government intend to deliver the comprehensive change that our children need, not least because we do not wish to limit ourselves in how we deliver on our commitment to raise the healthiest generation of children ever.

The need for change is compelling. England compares poorly with other nations on a range of child health outcomes, while children in the most deprived areas suffer far worse health outcomes than those in better-off areas, and we have an absolute duty to close that gap. The noble Lord, Lord Hannan, the noble Baroness, Lady Miller, and other noble Lords referred to the situation in regard to local authorities and the fiscal state in which they find themselves and how the Bill would manage any additional strain on them. I agree with noble Lords that we exist in a very challenging fiscal environment, which is exactly why we must consider our child health action plan in the round, ensuring it is sufficiently considered and funded. We are very conscious of introducing new burdens, no matter how small they might appear, given the reductions to local authority budgets and the constrained finances—a situation that has been the case for many years.

Over 4 million children are growing up in low-income households and, last year, a million children experienced destitution. This cannot go on. It not only harms children’s lives now but damages their future prospects and holds back our economic potential as a country. The noble Lord, Lord Bird, was very energetic on this point—and rightly so. I hope he will be pleased to know that we have set up a cross-government child poverty task force to develop an ambitious strategy to reduce child poverty, and its work is under way.

I was proud to serve in the Government who did not just pioneer Sure Start, to which my noble friend Lord Blunkett led the way, but brought in the indoor smoking ban in 2007. Through the Tobacco and Vapes Bill, we will continue the task of improving life chances for children. We will continue to tackle the harms of smoking, break the cycle of addiction, and pave the way for a smoke-free UK.

I know from the debate today that your Lordships’ House is well aware that this Government were elected on a mandate to deliver change. As the Prime Minister said just last week, this will not happen overnight. We will not cover up the problems; we will lay the foundations. We will do that ensure that we raise the healthiest generation of children ever through our work to tackle childhood obesity, improve mental health and ensure that children have good oral hygiene. I very much look forward to debating these important topics and others over the coming months.

To the points raised on alcohol and drugs by the noble Baroness, Lady Finlay, it is right to acknowledge the growing problem of alcohol and drug use among parents and carers, which affects their capacity to parent well. The Government are absolutely committed to addressing that. This year, we will make over £300 million of additional investment in this regard. I thank the noble Lord, Lord Meston, for bringing the matter of the family drug and alcohol courts to my attention, and I would be very pleased to meet him to discuss it. Furthermore, I can assure the noble Lord that the Government are aware of the work of Pause, which indeed met officials at the Department for Education just this week. We will continue to work with Pause to ensure that a better system is built for all children and parents in future.

The noble Baroness, Lady Uddin, raised a crucial point about inequalities in maternity care. I thank her for her powerful contribution in this regard. She is right to describe the ongoing inequalities as truly shocking. I can assure her that I have already met officials and asked for urgent advice on immediate action to tackle inequalities for women and for babies, addressing racism in maternity services and determining what ambitions are needed and how we might get there. To the noble Baroness, Lady Miller, I am pleased to share that we will publish the infant feeding survey in summer 2025. To the right reverend Prelate, I want to acknowledge the contribution that not just churches but synagogues, mosques and other faith institutions make to supporting the well-being and development of children and infants.

In conclusion, while we are not supporting this Bill, I am very grateful to the noble Lord, Lord Farmer, and to noble Lords who have taken such an interest today in how we might seek to raise the healthiest generation of children ever—which is, I believe, however noble Lords regard this Bill, exactly what we all want.

Vaginal Mesh Implants: Compensation

Baroness Merron Excerpts

Thursday 5th September 2024 Lords Chamber

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

My Lords, I congratulate the noble Baroness, Lady Cumberlege, on securing this important debate. I compliment her on getting it early in the time of a new Government, which will help me to do the job that I will need to do. I also thank noble Lords for their powerful words on this important topic. To borrow some of the words used, anybody sitting here will understand that we are talking about something so harrowing, so shocking and so distressing that it would be hard not to be moved by what has been heard both today in the Chamber and, as the noble Baroness, Lady Wyld, said, when one reflects back on the report.

I give the assurance that after the debate I will reflect closely on all the points raised, and I will seek to cover a number of them as best I can now. The noble Lord, Lord Evans, obviously and rightly invites me to set out a timetable—as have many other noble Lords. I know that your Lordships’ House understands the newness of the Government and the need to get it right. While saying that, I also hope that noble Lords will appreciate that I understand that this has been going on for a very long time under the previous Government and that many individuals, and their families and friends, are looking for resolution.

As we have heard, lives have been irrevocably changed by vaginal mesh implants, and we have to ensure that lessons are learned. This Government will endeavour to build a system that listens—particularly, I might add, to women, whose voices have not been heard, which is why we find ourselves in many of the situations we are considering—and a system that hears properly and will act with speed, compassion and proportionality.

The noble Lord, Lord Mancroft, brought into the Chamber a very specific case, about which I was sorry to hear. I am sure that we are all sorry to know that the woman to whom the noble Lord referred is far from alone. I repeat to all those who have been affected that, as the report said,

“it was not your fault”.

We deliberately will put patient safety at the heart of improving our health and social care system. I convey my sympathy to everyone who has suffered complications following vaginal mesh implants. I am committed to ensuring that we learn from these tragic incidents. The Independent Medicines and Medical Devices Safety Review’s report, which was published in 2020 and chaired by the noble Baroness, Lady Cumberlege, was pioneering in its impact. The stories and realities are as deeply affecting today as they were when the noble Baroness commenced her work. I thank her, as many other noble Lords have done, for her work. She has been and is a key advocate for women’s health, but particularly for those who are experiencing complications and after-effects that they should not be enduring.

The Patient Safety Commissioner has continued this work. I thank her for the work she did on the Hughes report, published in February. Having met with Dr Hughes soon after my appointment, I very much look forward to working closely with her on a number of issues, including this one, to improve patient safety.

I hope that noble Lords will appreciate that in my comments I am reflecting on the situation as it stands. As we have heard, when used for pelvic organ prolapse and for stress urinary incontinence, vaginal mesh can be incredibly damaging for those suffering from complications, which is why it has been paused in these instances. NHS England has now established nine specialist mesh centres across England. The aim is to ensure that women in every region who have complications can get the right support and care. Each mesh centre is led by a multidisciplinary team to ensure that patients get access to the specialist care and treatment that they need, including pain management and psychological support as well as mesh removal surgery where that is appropriate.

The noble Baroness, Lady Sugg, and other noble Lords rightly raised the powerful Sling The Mesh campaign for an improved database. I associate myself with the comments of appreciation for that campaign group and many others who have campaigned in an area where others have feared to tread. I certainly share the desire of the noble Baroness, Lady Sugg, to ensure that there is proper data collection on device safety, which is why mesh centres will improve recording and monitoring of patient outcomes and experience by submitting procedural data to the pelvic floor registry. In this vein, through the National Institute for Health and Care Research a £1.56 million study has been commissioned to develop the patient-reported outcome measure for prolapse, incontinence and mesh complication surgery. In the longer term, this measure will be integrated into the pelvic floor registry.

The review by the noble Baroness, Lady Cumberlege, also looked into the matter of sodium valproate, and rightly so. I am glad to report that since then a number of actions have been taken or are under way to ensure that valproate is prescribed only when absolutely clinically appropriate. Alongside that, I am encouraged that the number of women who are still being prescribed it has reduced significantly following the MHRA’s introduction of the pregnancy prevention programme.

While significant progress may have been made in the areas I have outlined, the core question posed by this debate is about progress in ensuring that those suffering complications receive financial compensation for their suffering. This is an absolutely key question. This and the sodium valproate issue, which was reviewed in the Hughes report, are extremely complex and sensitive, as I know noble Lords appreciate. I want to reassure your Lordships’ House that I am considering this and the recommendations of the Hughes report.

As I mentioned at the outset, as a new Government, we need to carefully consider the report before coming to a decision. The recommendations will be discussed with colleagues across government, and lessons will be learned from other instances where patient safety has been impacted, as noble Lords have asked of me. As part of this, and in answer to some of the questions by the noble Baroness, Lady Bennett, and others, I will ensure that the number of those affected is reflected correctly. While I hope that noble Lords will understand, if not be happy, that I cannot provide a decision today, I commit to providing an update to the Patient Safety Commissioner’s report at the earliest opportunity and look forward to being able to update noble Lords further.

I have taken on board a point made by the noble Baroness, Lady Sugg, and throughout the debate, about the importance of transparency, trust and confidence. The department has worked with NHS England and healthcare providers to understand systems already in place for the collection and publication of information on doctors’ conflicts of interest and the work needed to implement updated guidance. That guidance will be published by NHS England. Again, I look forward to providing an update to your Lordships’ House on this. Furthermore, the department has held a public consultation on the disclosure of industry payments to the healthcare sector, and we will respond to that one shortly.

The noble Baroness, Lady Cumberlege, and other noble Lords raised the topic of imposing rules on manufacturers to pay compensation. This is a complex area and would potentially affect how products were developed, so it will need careful thought. Again, I will do that in conjunction with colleagues across government. Where a product causes injury, while it may be possible for an individual to pursue a claim for compensation directly against the manufacturer under existing legislation, I absolutely take the points made in the Chamber today that legal costs, practicalities, stress and the further distress that obviously goes alongside it often make this totally unrealistic.

I turn to some of the additional specific questions from noble Lords. The noble Baroness, Lady Bennett, was one of the noble Baronesses who raised the question on stopping manufacturers putting a 10-year time limit on redress. I will certainly raise this in discussions with colleagues at the Ministry of Justice, and I am happy to write to noble Lords further to update them on any progress. The noble Baroness, Lady Berridge, made a powerful and illustrative point that errors are not cost-free in any sense. I definitely echo her concerns about the extensive cost of this failure: some is seen and some unseen, but the costs are there. I will consider it such an exercise when I reflect on how we take this forward. The noble Baroness, Lady Wyld, also raised the point on maternity services, which, as she will be well aware, the Government recognise has serious issues. We are determined to improve this, and I assure noble Lords that my work is under way. Those areas failing in maternity care will be supported to make rapid improvements. The noble Baroness, Lady Brinton, clearly shares my appreciation, as do others, for the work of the Patient Safety Commissioner. I will ensure that she has the resources and support that she needs.

This subject rightly evokes great sympathy, but it also needs action. I must and will return to this again.

Palliative and End-of-life Care: Funding

Baroness Merron Excerpts

Wednesday 4th September 2024 Lords Chamber

[The Lord Bishop of London]

To ask His Majesty’s Government what assessment they have made of the adequacy of funding arrangements for accessible and equitable palliative and end of life care.

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

My Lords, we want a society where every person receives high-quality, compassionate care, including at the end of their life. Integrated care boards are responsible for the commissioning of palliative and end-of-life care services to meet the needs of their local populations. This is to promote a more consistent national approach and supports commissioners in prioritising palliative and end-of-life care. We will be considering the next steps, including funding, more widely in the coming months.

[The Lord Bishop of London]

I thank the Minister for her reply. We know that the hospice sector depends on charitable giving because of the low level of statutory funding at present. This means that the wealth and resilience of a community define the level of hospice services. This entrenches inequalities of place and means that access to hospice services is extremely unequal. Can the Minister outline what the Government are doing to look at the funding settlement, and particularly the wider hospice funding model, to ensure that this is not just another service that has poorer access for those in more deprived areas?

[Baroness Merron (Lab)]

I certainly take on board the point that the right reverend Prelate makes. It is the case that the amount of funding that charitable hospices receive varies by ICB area. That, in part, is dependent on the breadth of a range of palliative and end-of-life care provision within the ICB area. I can assure your Lordships’ House that my colleague, Minister Kinnock, the Minister of State for Care, has recently met with NHS England, and discussions have started on how to reduce inequalities and variation in access to services and their quality.

[Baroness Pitkeathley (Lab)]

My Lords, does my noble friend agree that when end-of-life or palliative care is delivered at home, the principal deliverers are usually the family—the unpaid carers—of the patient? Does she agree, therefore, that they must be considered in this equation to get them as much support as possible, and that they ought to be given as much information as possible about the patient’s prognosis and the treatment plan, bearing in mind the sensitivities associated with such information?

--- Later in debate ---

[Baroness Merron (Lab)]

My noble friend is absolutely right, and I certainly agree with the points she has made. Those who care for their loved ones are absolutely crucial to ensuring that the right care is provided in the right place and the right way for that person. Everybody is individual, and we want a society where everybody receives the right kind of care at the end of their life. That should be a time of dignity, and we want to provide that.

[Baroness Fraser of Craigmaddie (Con)]

My Lords, people with neurological conditions face many barriers to accessing palliative care, even though it could do them a huge amount of good. The answers to this are better identification of individual needs and better collaboration between palliative and neurological services. Can the Minister assure me that she will look at this? There is a great inequity in access to palliative care. I declare my interest as a chair of the Scottish Government’s neurological advisory committee.

[Baroness Merron (Lab)]

The noble Baroness is quite right to raise this, and I can give her that assurance. She raises the point about identification of people with specific needs. I am interested to see that there are some very good examples of local good practice—for example, in Dorset, where they have proactively gone out to identify who needs palliative and end-of-life care. By so doing, they have raised the percentage of the local population who should be receiving it. That is a model we will want to look at. With regard to those who have particular needs, as the noble Baroness describes, I think that model will be helpful too.

[Baroness Hollins (CB)]

My Lords, the Minister has rightly pointed to the growing need for excellent palliative care close to home, and I am glad of that, but I wonder whether she is aware of the Hospice UK report pointing to the number of redundancies occurring across the sector. In the context of the 2022 Act, which required the NHS to commission adequate NHS care, this seems to be rather urgent, not just to provide good care for people but to reduce the impact on the acute hospital sector of not providing palliative care.

[Baroness Merron (Lab)]

The noble Baroness is right in her observations, and we certainly recognise that times are difficult, particularly for many voluntary and charitable organisations including hospices, for example, due to the increased cost of living. We are working alongside key partners and NHS England to proactively engage with stakeholders, including the voluntary sector and independent hospices, because we want to understand the issues they face and to seek solutions to them.

[Baroness Brinton (LD)]

My Lords, the charity Together for Short Lives has found that the NHS local funding for children’s hospices has dropped by 31% in the last three years. Worse, the previous Government’s £25 million children’s hospices grant has been given to local integrated care boards, many of which have delayed distributing it. As a result, the children’s hospice movement is in real crisis. Please will the Government urgently review the funding that government has in the past put aside for children’s hospices, to make sure that they receive it?

[Baroness Merron (Lab)]

As the noble Baroness said, in 2024-25 the £25 million in funding from NHS England was distributed, for the first time, via integrated care boards. As I understand it from the previous Government, that was in line with NHS devolution. We will carefully consider the next steps on palliative and end-of-life care funding much more widely in the coming months and will take on board the comments of the noble Baroness and other noble Lords.

[Lord Evans of Rainow (Con)]

My Lords, everyone should be able to access quality palliative and end-of-life care and patient care in their local area. Under the Conservatives, we made integrated care boards legally responsible for commissioning palliative care services to meet the needs of the local population. What assessment has the Minister made of access to palliative and end-of-life care across the country? What steps will the Government take to ensure that everyone, especially those living in rural areas, can access quality end-of-life care?

[Baroness Merron (Lab)]

As the noble Lord will be aware, statutory guidance and service specifications are provided to support commissioners in ICBs to meet their duty. As I am sure the noble Lord is also aware, NHS England has developed a palliative and end-of-life care dashboard that brings all the relevant local data together and helps commissioners to understand the situation so that they can provide for their local populations. This is part of ongoing work for this new Government to see how we meet requirements to provide dignity, compassion and service at the end of life and just prior to the end of life.

[Baroness Hayter of Kentish Town (Lab)]

My Lords, although I pay enormous tribute to the hospice movement, there will be some people for whom end-of-life care means assisted dying. We will have the Second Reading of the Bill in November. I hope that my noble friend will be able to give strong government time, if not government support, to enable that Bill to make good progress.

[Baroness Merron (Lab)]

The Prime Minister has already reiterated his commitment to allow time for a Private Member’s Bill and a free vote. I recognise that this is an extremely sensitive issue with deeply held views on the various sides of the debate. Our commitment is to ensure that any debate on assisted dying in Parliament will take place in a broader context of access to high-quality palliative and end-of-life care and that we will have robust safeguards to protect vulnerable groups, if the will of Parliament is that the law should change.

[Lord Patel (CB)]

My Lords, the Minister mentioned funding—I am glad that the Government will look at funding—as well as the NHS England dashboard. Both are processes that do not deliver care, particularly for children who require hospice and end-of-life care. I will give an example that the noble Baroness, Lady Brinton, briefly referred to. Because NHS England has devolved funding to ICBs, average funding for ICBs supporting hospices for children is £149, with a range from £18 to £376 per case. ICBs are legally bound to deliver hospice care, but the accountability to do so is not there—and that is what NHS England needs to focus on.

[Baroness Merron (Lab)]

I am grateful to the noble Lord. I will ensure that my colleague, the Minister of State for Care, is fully aware of the comments that he and other noble Lords have made today. They will form part of our looking at the situation to make sure that services—not just processes—are provided.

Covid-19 Inquiry

Baroness Merron Excerpts

Tuesday 3rd September 2024 Lords Chamber

Moved by

[Baroness Merron]

That this House takes note of the first report from the Covid-19 Inquiry.

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

My Lords, the noble and learned Baroness, Lady Hallett, published her report from the first module of the UK Covid-19 Inquiry in July. I thank her and her team for the work that they have done to this point, and for putting the bereaved at the heart of this inquiry.

I also thank everyone who has provided evidence to the Covid-19 inquiry thus far, which has made it possible for it to carry out its important work. There are clearly vital lessons emerging from before and during the pandemic that this Government will consider in strengthening preparations for future emergencies, and that will include increasing the resilience of our public services.

Module 1 of the Covid-19 inquiry is focused entirely on whether the UK was adequately prepared and had built the necessary resilience to deal with a pandemic between 2009 and early 2020. I know that your Lordships’ House will welcome this chance to debate the findings today.

Today, my thoughts, and I am sure those of all noble Lords across the House, are with the families and communities who lost loved ones because of the pandemic. Their grief is harrowing, and they lost loved ones too soon. It is heartbreaking to recall that many goodbyes were said through a screen, and many could not say goodbye at all. Many could not attend loved ones’ funerals, and everyone had their lives turned upside down by Covid.

I can only imagine the distress and disappointment that are felt as a result of this report confirming what many suspected—that this country was not properly prepared. The noble and learned Baroness, Lady Hallett, was clear that

“the UK was ill prepared for dealing with a catastrophic emergency, let alone the coronavirus … pandemic”.

She found that “processes, planning and policy” across the entire country let our people down and that there were major failings in state services, while existing health and social inequalities made us more vulnerable.

Before the pandemic hit, our public services were already badly stretched. NHS waiting lists were already too high; too little attention had been paid to our infrastructure, and workers delivering public services were already under significant pressure. The status of the health and care system at the onset of the pandemic was its “starting point”, and a more resilient system could have reduced the impact of the pandemic on the system.

The report concludes:

“The UK prepared for the wrong pandemic”,


focusing too much on influenza and too little on other pathogens. The noble and learned Baroness, Lady Hallett, also noted that there was a lack of leadership, oversight and challenge from Ministers and officials, which weakened resilience. This report does not make pretty reading.

Reference is also made to “fatal strategic flaws” in assessing risks and a failure to learn from prior emergencies and outbreaks of disease. The report concludes that a positive analysis of the UK’s preparedness sowed complacency among Ministers and officials and that too little attention was paid to how government could mitigate the most harmful consequences of a pandemic; for example, by setting up a test, trace and isolate system.

The report highlights the disproportionate impact on the most vulnerable in our society, including the elderly and those with existing health conditions. The Government asked many to shield for months, some families were stuck in overcrowded accommodation and workers in the gig economy and those on low incomes missed out on much support. We witnessed a shocking increase in domestic abuse during lockdowns, and young people’s education was severely disrupted. Those with access to online learning and IT could manage to a degree, but this was not the reality for far too many children. The lessons for the future are clear: resilience has to be for our entire society and everyone in it.

The report also tells us about the state of our public services. A nation’s resilience depends on the strength of its infrastructure and public services. These were simply not strong enough before the pandemic and they are not strong enough today. The NHS waiting list currently stands at more than 8 million, prisons are overcrowded, too many councils have been pushed to the brink and the Government have inherited a £22 billion black hole in the public finances which cannot be ignored.

We have already taken difficult decisions that will start to turn the situation around, but it will take time and it will take focus. It will be a long process and it is crucial that we get it right, because, as the noble and learned Baroness, Lady Hallett, says, it is not a question of if another pandemic will strike, but when. We are committed to learning the lessons of the pandemic and upholding our first responsibility: that of keeping our people safe.

I understand that the department was learning continuously throughout the pandemic, seeking to adjust its response with each lesson learned. Officials have identified five key lessons that can inform the approach to pandemic preparation, which are now being combined with the lessons we will be learning from the inquiry. I will now set out the five key lessons, which have already been shared with the noble and learned Baroness, Lady Hallett.

The first is that responding to a range of threats needs flexible and scalable capabilities alongside plans. The evidence in module 1 has been clear that, given the unpredictability and range of possible future pandemics, it is unrealistic to try to create a specific plan for each possible new threat. Instead, there is a recognition of the need for future pandemic preparations to focus on developing a toolkit of capabilities which can flexibly pivot to address different emerging threats, and that will be backed up by sufficient resources so that they can be scaled up quickly.

Secondly, the underlying resilience of the system is essential to pandemic preparedness. High resilience means that the NHS, adult social care and public health will be more likely to cope effectively and respond to shocks of any kind, including pandemics. At the time the pandemic struck, the NHS had very little spare flexibility in the system, as it was already operating at high capacity. Waiting times for elective care had been steadily increasing even before the pandemic, and the adult social care sector had structural challenges which significantly impaired its resilience. The Government are looking at how we ensure built-in capacity in order to respond to emergencies.

Thirdly, there must be an ability to scale up quickly. This includes ensuring that there are plans quickly to increase levels of staff, medicines and equipment. All of that is needed to mitigate and control the spread of a disease. It will mean thinking carefully about the resources that can be put aside as investment against a future emergency.

Fourthly, diagnostics and data are crucial in a pandemic response. As my noble friend Lord Vallance put it, the UK was “flying blind” at the start of the pandemic and officials were taking difficult decisions based on stark scarcity of data. Finally, pandemic plans must consider all possible modes of transmission of communicable diseases. Respiratory pathogens remain the most likely to cause future pandemics. However, changes in our environment such as those caused by climate change mean that the risks of outbreaks through some other modes of transmission are increasing. Planning must prepare for the range of transmission modes, including oral routes such as contaminated food and water; sexual and blood routes—which include diseases such as HIV, syphilis and, more recently, mpox—contact routes in diseases such as Ebola; and vector routes such as insects, which include diseases such as malaria and bubonic plague.

It is helpful to look now at recent events. The World Health Organization has declared a public health emergency of international concern because of the rapid spread of the mpox virus strain clade 1. Although currently the risk to the UK population is low, planning is under way across government, the health and care system and with our local partners to prepare for this. The spread of mpox demonstrates that issues can escalate quickly, and it is important that we are ready as a country to respond to any national emergency that arises. To do this, we must prepare for all future threats, not just for pandemics.

The Covid-19 inquiry modules present a wide range of areas to assess and identify learning in order to inform the Government’s approach. This includes the impact of the pandemic on healthcare systems, patients and healthcare workers across the entire country; the development of the Covid-19 vaccine; the implementation of the vaccine rollout programme and vaccine safety; the procurement and distribution of key healthcare equipment and supplies, including PPE, ventilators and oxygen; the approach to test, trace and isolate; the impact of the pandemic on children and young people; and the economic response to the pandemic. There will be much to learn from these future modules.

It is important in all this that we recognise what more can be done to deal with health inequalities and to tackle and reduce socioeconomic health inequalities. Prior to the Covid-19 pandemic, planning had a focus on clinical health inequalities rather than the broader socioeconomic inequalities. The work done on identifying and addressing clinical inequalities in pandemic planning was vital to the Covid-19 response, and the department is committed to continuing with this. However, many of these clinical inequalities—for example, for those with heart disease, diabetes et cetera—are disproportionately more prevalent in some socioeconomic groups than others, and it is accepted that there was insufficient focus on these groups in the UK’s pandemic planning.

Pandemic planning must take account of all health inequalities. They must be tackled outside of emergencies so that when a pandemic emerges, the whole population is as resilient as possible and better prepared to withstand the consequences. The need to tackle heath inequalities in non-pandemic times is further necessary, given that it is impossible to predict and plan for what the unequal impact of a future pandemic might be.

It is also important to take a co-operative approach to resilience. To strengthen our national resilience in the long term, the Chancellor of the Duchy of Lancaster is leading a comprehensive review of our national resilience against the full range of risks that the UK faces. He will also be chairing a dedicated Cabinet Committee on resilience to oversee that work.

Building resilience is a responsibility shared with the devolved Administrations, regional mayors, local leaders and local authorities. This is key to understanding the challenges that all parts of our society face and to delivering effective change to communities across the country. This is why the Prime Minister has already reset the relationships with these crucial partners to help achieve this. As we consider the recommendations from the noble and learned Baroness, Lady Hallett, we will work closely with all our partners to make our country safer and more secure. Resilience cannot be built through division—it will demand careful co-operation.

Following the pandemic, the previous Administration did seek to take steps to improve pandemic preparedness, including changes to how government accesses, analyses and shares data, including with the public. There was also a change to the risk assessment processes and how the centre of government prepares for and responds to crises. As a new Government, we will review these changes, because good practices need to be built on and inadequate ones changed.

The noble and learned Baroness, Lady Hallett, proposed 10 recommendations as part of the Covid-19 Inquiry’s first report. These include improving how cross-cutting risks are managed by government and the devolved Administrations, as well as strengthening the leadership of Ministers and improving the oversight that they provide. The Government are carefully considering these recommendations and the associated findings, as well as recommendations from the Grenfell inquiry that impact on resilience planning. We will respond in full within six months, as requested by the noble and learned Baroness, Lady Hallett.

We know that, as Covid-19 exposed, pandemics never respect borders. Outbreaks of epidemic diseases are more likely to arise in and have greater impacts in lower-resourced countries. This makes global health security a bedrock that is essential to our own domestic health security, which is why the Government will get behind international drives to improve global health and pandemic preparedness. These international efforts will focus on strengthening health and surveillance systems, deploying resources to places in need and ensuring that the global health architecture is effective and responsive, while also ensuring there is sustained investment in research and development. For example, the UK has signed up to the 100 Days Mission, which is a global mission to have safe and effective diagnostics, therapeutics and vaccines in the first 100 days of a pandemic. Contributing to this commitment is our UK aid investment through the UK Vaccine Network, which supports the development of vaccines to prevent and respond to epidemics in low and middle-income countries. The UK certainly has a lot to offer to the world, and we should also remember that it is in our national interest to step up to the plate.

The pandemic was a tragedy. Throughout it we witnessed remarkable service and sacrifice from front-line workers, not least those in the NHS and adult social care services, taking care of the most vulnerable in society. Volunteers repeatedly put their communities ahead of themselves, and we cannot thank the British people enough for coming together in extraordinary ways amid the tragedy of the pandemic. This Government are determined to learn the lessons from the inquiry so that we are better prepared for the future. It is our responsibility to the people who we serve, and it is a responsibility that we will meet.

Smoking: Public Places

Baroness Merron Excerpts

Tuesday 3rd September 2024 Lords Chamber

[Lord Foulkes of Cumnock]

To ask His Majesty’s Government what plans they have, and on what timescale, to introduce legislation to extend the ban on smoking in public places; and what additional measures such legislation will contain.

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

My Lords, the Government are soon to introduce the tobacco and vapes Bill, which stands to be the most significant public health intervention in a generation and will put us on track to become a smoke-free UK. The Prime Minister fully supports measures that will create a smoke-free environment, helping to reduce 80,000 preventable deaths, reduce the burden on the NHS and reduce the burden on the taxpayer. We will set out more details very soon.

[Lord Foulkes of Cumnock (Lab Co-op)]

I am really grateful to the Minister, but can she give a clear indication as to when the legislation will be introduced, to start to reduce these premature deaths? There is overwhelming public support for a smoking ban in children’s parks, in beer gardens, on beaches and in front of hospitals. I have seen people coming out of hospitals and lighting up, when their lungs and heart are affected by that smoking. We need action as quickly as possible. I exceptionally thank the Conservatives for setting this in motion when they were in government.

[Noble Lords]

Oh!

[Baroness Merron (Lab)]

I am sure that the whole House has noted and welcomes the last point made by my noble friend. He has been a doughty campaigner in this area over many decades, and I thank him for that. As I will reiterate, more details and the introduction of the Bill will come very soon—I will not say “in the summer” or “in due course” but only “soon”. My noble friend is right to make his observations about outdoor places, details of which will be forthcoming. On the public’s attitude, what he said certainly is the case. It is interesting that polling published just last week shows that almost six in 10 adults would support banning smoking in pub gardens and outdoor restaurants. The truth is that public opinion has shifted over the decades. It is important to work with that, as well as to bear in mind that there is no good impact of smoking, including passive smoking, which is why the Prime Minister has indicated his support for the direction of travel. More details will follow.

[Lord Geddes (Con)]

My Lords—

--- Later in debate ---

[Lord Geddes (Con)]

My Lords, I thank the Government Chief Whip most sincerely. I declare an interest as a member of the pipe and cigar smokers’ club, although I indulge in neither. When His Majesty’s Government come out with the details, will they make a full assessment of the effect of such a ban on the hospitality industry? It will have significant effects on employment, let alone the enjoyment of those who indulge. Does the Minister not agree that this is a case of the nanny state multiplied by an indefinite number?

[Baroness Merron (Lab)]

On the last point, I do not agree with the noble Lord that this is the nanny state gone to a new level. It is about protecting people’s health, and in this Question, we are talking about passive smoking in particular, where people do not have choices in certain areas. On the point about hospitability, it is important to note that, after implementing the indoor smoking ban in 2007, 40% of businesses reported a positive impact on their company. Let us not forget that Office for National Statistics data showed that 69% of respondents visited pubs about the same as before, and, interestingly, 17% visited them more. However, I assure the noble Lord that we will work with the hospitality sector should this be a direction that we specifically take. As always, there will be an impact assessment, close working across government and consultation with relevant stakeholders, as there always is when we look at new legislation.

[Baroness Northover (LD)]

My Lords, I urge the Government—it sounds like the door is open—to resist the siren voices which so often have accompanied efforts to protect the public from tobacco smoke, including the theoretical risk to pubs, as we have just heard. It is a joy to be in public places which are now smoke-free. Does the Minister agree that, now that restaurants and pubs have pavement licences, those areas too should, like the interiors, be smoke-free?

[Baroness Merron (Lab)]

I am glad that the noble Baroness welcomes the direction of travel. As regards the specifics that she seeks, those will be forthcoming in the very near future. However, it is important to remind ourselves that the tobacco industry, for example, was very vociferous in its opposition to indoor smoke-free legislation and argued that it would be disastrous for hospitality, but, as I mentioned, it had almost no impact, and in some sectors it had a positive impact. As my noble friend said earlier, the response of the public, the way they approach this matter and their understanding are also crucial.

[Lord Patel (CB)]

My Lords, the noble Lord, Lord Geddes, tempted me to get up. In wishing him a happy birthday, I suggest that his longevity might not be related to his cigar and cigarette smoking. The statistics are quite clear: smoking causes immense harm to those who indulge in it, with not only 10,000 lung cancers a year but tens of thousands of chronic lung diseases. It is right that we have a policy that eliminates cigarette smoking altogether.

[Baroness Merron (Lab)]

I am glad that the noble Lord welcomes the Bill, and I hope that he will bring his expertise and support when it is before the House. This will be a matter of great debate but also one of consultation.

[Lord Sikka (Lab)]

My Lords, if I set up a market stall with products guaranteed to disable, maim or kill the consumer, I would not be allowed to sell, irrespective of any economic gains. I would probably be arrested and forced to bear the cost of restitution. Can the Minister explain why tobacco companies are allowed to do the same and do not bear the full cost of restitution?

[Baroness Merron (Lab)]

I am sure my noble friend will be pleased to know that the tobacco and vapes Bill will not just introduce a progressive smoking ban, which I know the previous Government wished to do, but will stop vapes and other consumer nicotine products such as nicotine pouches being deliberately branded and advertised to appeal to children. Together—this is important—the measures will stop the next generation becoming hooked on nicotine, and this will be the furthest step that we have taken so far. However, the focus of the Bill is on what is legal to do, and that is one of the many reasons that I refute the accusation of this being the action of some kind of nanny state. It is not. It is about giving people the environment and the support that they need to protect their own health and create a healthy environment.

[Lord Parkinson of Whitley Bay (Con)]

My Lords, the Prime Minister promised us a Government who would “tread more lightly” on our lives, but in this area, they seem to have marched ahead in a rather heavy and flat-footed manner. Many businesses in our hospitality industry, and indeed in our cultural sector, such as live music venues, are still recovering from the pandemic and its aftermath. During that pandemic and indeed in the light of the 2007 ban, many of them invested, in good faith, considerable sums in adapting their premises to be suitable. As the noble Lord, Lord Foulkes, knows, when the last reforming Government acted, they did so on the basis of evidence. The Minister says that there will be an impact assessment and a consultation. Why was that not done before these plans were briefed to the press, and when will it be conducted?

[Baroness Merron (Lab)]

I can tell the noble Lord that it was not briefed to the press. It gives me the opportunity to tell your Lordships’ House that it was a leak and, as the noble Lord will remember, it is not usual for Ministers to comment on leaks. I suggest that what we are doing here is acting on evidence. Passive smoking has a negative impact on people’s lives—both the quality of their health and their longevity. We have a responsibility in this Parliament and this Government to look at measures to improve that. I hope that the noble Lord will recall that it was his Government who started this Bill, and we welcomed it.

NHS: Breast Screening Programme

Baroness Merron Excerpts

Tuesday 3rd September 2024 Lords Chamber

[Baroness Morgan of Drefelin]

To ask His Majesty’s Government what assessment they have made of the take-up of the NHS breast screening programme.

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

Breast cancer survival rates have improved by 41% since the mid-1970s and 86% of women survive their cancer beyond five years. I pay tribute to NHS staff and to my noble friend Lady Morgan for making such a contribution to these improvements. Take-up of breast screening is just below 70%, and NHS England has developed a national uptake improvement plan, including expanding access to screening, reducing inequalities, improving IT systems and ensuring that communications are inclusive and accessible to all.

[Baroness Morgan of Drefelin (Lab)]

I thank my noble friend for that very kind and generous Answer. As we know, screening uptake has been in decline for more than 10 years now. There is no NHS region that has met its 70% minimum standards since 2019-20. Importantly, uptake for women on their first invite is really worrying. Will the Minister commit to keep feet to the fire on this issue, and work closely with the department and NHS England to press down on any potential complacency because breast cancer outcomes have improved so much? Screening is a simple way to stop women dying of breast cancer, and it is not rocket science. Please can we do all we can to improve uptake?

[Baroness Merron (Lab)]

My noble friend makes a very clear and definite point about the link between breast screening and outcomes. I certainly can give her the assurance that we will continue to seek to drive up rates of breast cancer screening. It is important to say that the reason for the take-up not improving as one might have hoped since Covid is multifactored and complex, as I am sure she understands. We all know that research shows that women are more likely to attend breast screening if it is in a unit that is easy to get to, if it is convenient, and if we can help women to get over the problems of fear of the test, awkwardness or embarrassment. I give my noble friend the assurance that the NHS is working on understanding all that, and all that will be in collaboration with charities and key stakeholders.

[Baroness Bloomfield of Hinton Waldrist (Con)]

I also begin by paying tribute to the noble Baroness, Lady Morgan, for her excellent work with Breakthrough Breast Cancer and more recently with Breast Cancer Now. Can the Minister reassure me that the Government will look again at the ceasing of breast cancer screening after the age of 70, when the incidence of disease occurring in that age group is still high, and would be higher were it not for the success of earlier breast cancer screening? This cohort of women should not be ignored.

[Baroness Merron (Lab)]

If a woman in the age group to which the noble Baroness refers has concerns, she may request follow-up and investigation. But it is the case that we follow the scientific advice, which is that going beyond that age as a matter of course will not give the rewards that we would hope. I can certainly reassure any woman in that age group that she will be seen should she have concerns, and she should present herself as soon as possible.

[Baroness Walmsley (LD)]

My Lords, artificial intelligence has been very efficient in helping to interpret breast imaging, reducing false positives and false negatives, and significantly reducing the workload of the second reader. We know that early detection is key to reducing mortality, and I understand that AI can be used to identify patients with high risk so that they can be screened more frequently and proactively. What work is being done to use AI to identify high-risk individuals, so they can be screened more frequently?

[Baroness Merron (Lab)]

It is important to ensure that the service is there for those who are at greater risk. The noble Baroness is right to refer to the growing interest in and potential use of AI, which is indeed very exciting. The National Screening Committee is very aware of this point. The committee is working with the National Institute for Health and Care Research and NHS England, and has designed a research project to see whether AI can be safely used to read mammograms in the breast screening programme, and whether that is acceptable both to women and to clinicians. That work will continue.

[Lord Patel (CB)]

My Lords, I join others in commending the work that Breast Cancer Now has done in improving outcomes for women through breast screening and improving breast cancer outcomes. However, the problem remains when it comes to wider issues about care of patients with cancers. We know that early diagnosis achieves the best results for all cancers, yet we are woefully low in the percentage of people who are picked up with early cancers. There is another more serious issue, which is unwarranted variations in the care of all cancer patients. Unwarranted variation is when care that is clearly demonstrated to be effective in reducing death rates is not given to cancer patients. That has to be absolutely unacceptable. Eliminating unwarranted variation in cancer care ought to be one of the performance measures that integrated care boards are measured on—I hope that the noble Lord, Lord Darzi, is listening.

--- Later in debate ---

[Baroness Merron (Lab)]

I am sure that the noble Lord, Lord Darzi, is listening, but if he is not I will ensure that the noble Lord’s comments are drawn to his attention. I can say to your Lordships’ House that this Government intend to transform the NHS from a late-diagnosis, late-treatment health service to one that catches illness earlier and also prevents it in the first place. It is that shift that will make the greatest change. I have been interested to see that, across all the screening programmes, something like 15 million people are invited for screening and 10 million take it up. That still leaves us with 5 million people to work on. It is important to note that the 10 million take-up figure for screening saves a considerable number of lives. We need to continue to drive up the take-up on screening, across the various cancers and not just breast cancer. As noble Lords will know, there are programmes in respect of cervical and bowel cancer, and there will be a lung cancer screening programme as well.

[Lord Evans of Rainow (Con)]

My Lords, I begin by paying tribute to the noble Baroness, Lady Morgan, for her excellent work with Breakthrough Breast Cancer and more recently with Breast Cancer Now. We are very lucky to have her in your Lordships’ House. We know that the NHS wants to shift the emphasis from cure to prevention and screening, which, whether for breast cancer or other conditions, is a vital part of prevention. The previous Conservative Government took action to drive up breast cancer screening, with new breast cancer screening units and our community diagnostic centre programme. What steps will the Government take to further increase the uptake of breast cancer screening?

[Baroness Merron (Lab)]

The measures that the noble Lord refers to did indeed assist, but as I mentioned earlier we have a stubborn problem in returning to pre-Covid rates. The improvement plan that exists sets out the priorities and the interventions, but also the monitoring of what is working and what is not. The kinds of things that are being tested and introduced now include, for example, new IT systems to enable communication with women in 30 different languages, and new IT systems that mean people know when their appointment is and are reminded of it. All these things sound quite straightforward, but they have not been in place across the country and it is important that they are. I mentioned the importance of addressing fears and embarrassment, improving information and reassurance to women, as well as more convenient times and booking systems. It is very important that we make better use of mobile screening units, so that screening is near to where women are.

[Baroness Ritchie of Downpatrick (Lab)]

My Lords, undoubtedly breast screening is vital—I know that from a personal perspective—but I ask my noble friend whether consideration could be given to lowering the breast cancer screening age to 40, to include for diagnosis those with triple-negative breast cancer, because many in the younger cohort are diagnosed with it.

[Baroness Merron (Lab)]

As my noble friend will be aware, we keep a very close eye on the science and the advice, and we will continue to follow that. I emphasise, and it was raised in an earlier question as well, that the NHS has been proactively writing to those women at very high risk of breast cancer who may not have been referred. I give an assurance that women who are at greater risk are not forgotten.