Unpaid Carers: Patient Hospital Discharge

Lord Kamall Excerpts

Thursday 19th March 2026 Lords Chamber

[Baroness Merron (Lab)]

My noble friend makes exactly the right points. We certainly recognise the vital role that unpaid carers play in supporting those who are to be discharged. Decisions about staffing and the approach—I emphasise that a multidisciplinary approach is clearly needed here—are a matter for local areas, but I can say in addition that there is a regular cross-government meeting, which is really important when it comes to joining up the approach, that looks at providing unpaid carers with the recognition and support that they need, as my noble friend said. We are also working towards publishing a cross-government action plan later this year. So in this area, including the LGA work, the kind of approach that my noble friend talks about will certainly be considered.

[Lord Kamall (Con)]

My Lords, I thank the noble Baroness, Lady Pitkeathley, for being a tireless champion of unpaid carers over many years and successive Governments. She quite rightly pointed out that Carers UK found that only 14% of unpaid carers were asked about their ability and willingness to provide care before hospital discharge. I want to follow up on the previous question from the noble Baroness, Lady Andrews. One of the problems faced by successive Governments is that trusts and what were previously CCGs and are now ICBs are very bad at learning from other parts of the system that do things well. For example, Northumbria has been known to have a really good discharge system: it embeds co-ordinators and works out how to get that discharge going. How can the Minister’s department improve learning across the system where there is good practice, take that best practice and appropriately transplant it into other areas so that we can really tackle this problem once and for all?

[Baroness Merron (Lab)]

The whole system needs to do better, as the noble Lord outlines. It will be helpful that we are also looking at commissioning research in this area to look at best practice, as well as barriers and solutions, regarding the involvement of unpaid carers—I think that has been somewhat overlooked, if I am to be honest with your Lordships’ House. We have regional teams that have issued very practical toolkits to help hospitals implement their legal duties; we should remember that there are legal duties in this response. In addition, that is why we are involving the LGA’s better care fund support programme, as I said, as well as seeking to publish a cross-government action plan. These will be steps in the right direction, but I very much acknowledge that we do not start in a good place.

GP Contract

Lord Kamall Excerpts

Tuesday 17th March 2026 Lords Chamber

These ideas were not cooked up by someone sat behind a desk in Whitehall. What is happening is that we are taking the best of the NHS to the rest of the NHS, working with pioneering practices that have been doing these things for a long time. Today we can see that our policies are working, and after years of decline in general practice, we are getting the front door back on its hinges. Patient satisfaction with general practice is finally moving in the right direction. According to the Office for National Statistics, almost 77% of people described contacting their GP as easy in January this year, up from just 60%, where it was languishing in July 2024. I know that when he gets up, the honourable Member for Hinckley and Bosworth, Dr Evans, will hugely welcome, as will his honourable friends, the progress that we are making”.

[Lord Kamall (Con)]

My Lords, I am grateful to the Government for this repeat. The Minister in the other place pointed to 1.3 million referrals being diverted through something called “advice and guidance”. This means that GPs must seek input from a specialist before making a referral, but some professional bodies have warned that this mandatory approach will risk creating barriers to patients accessing specialist care and may compromise patients’ safety if they are not referred in a timely manner. To address these concerns, can the Minister set out what clinical safeguards are in place where a GP believes a patient needs to be referred directly to a specialist but is instead referred to go through this advice and guidance process? If a patient comes to harm as a result of any delay due to not being referred directly to a specialist, who will bear responsibility for that decision and how will accountability be determined?

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

As the noble Lord said, we have seen 1.3 million people diverted since April 2025. Otherwise, they would have been added to the electives waiting list, in clinical terms, unnecessarily. The main thing I can say to the noble Lord on advice and guidance is that I think the figures speak for themselves. That is why we are embedding it into the core contract. We are recognising it as routine practice. It provides more predictable funding and removes annual sign-ups. More generally, I must emphasise to the noble Lord that it does not take away a GP’s right to refer. That remains a matter of clinical judgment and, as in all things, clinical judgment will rule the day.

NHS: In-house Software Capabilities

Lord Kamall Excerpts

Monday 16th March 2026 Lords Chamber

[Baroness Merron (Lab)]

Cyber attacks across our whole government are extremely concerning, and that is why we have built resilience. On health and social care specifically, I can assure the noble Lord that, in 2025-26, we invested £75 million across health and social care; that built on the £375 million invested since 2017. When I had responsibility for the blood transfusion service, my own experience was that, where there was a cyber attack, we had the systems in place.

[Lord Kamall (Con)]

My Lords, there is always a very difficult balance between keeping something in-house or outsourcing it, and we should not forget the national programme for IT in the NHS in the early 2000s, which ended up costing between £10 billion and £20 billion. My question is on the company Palantir. The Minister will be aware that there are a range of views on Palantir. Some say that it is the best software available and that no one can match it; others say that they are worried that it will lock the NHS in long-term and scrape data for other uses. What specific measures have NHS England and the department put in place so that, in the event that the Palantir contract is not renewed, the healthcare system will be able to move seamlessly to another supplier?

[Baroness Merron (Lab)]

That seamless movement is an important point generally, but the federated data platform does not centralise or sell patient data. Data remains firmly under NHS control, and access is strictly governed. It is fully auditable and used only for approved patient benefit and NHS benefit. Palantir operates strictly under the instruction of NHS England and it does not, as I said, own or control NHS data. That access is tightly governed. In response to the earlier question, I note that the federated data platform to which the noble Lord refers is cyber resilient and subject to rigorous contractual, legal and information governance controls.

NHS: Heart Valve Disease

Lord Kamall Excerpts

Thursday 12th March 2026 Lords Chamber

[Baroness Merron (Lab)]

The noble Lord is right to make the point that innovation research is one part of it, but it is actually its implementation that matters. However, the faster and more frequent detection of cardiovascular conditions is the key thing and training is certainly a part of that.

[Lord Kamall (Con)]

My Lords, I am grateful to the Minister for giving me time for this question. She will be aware that studies analysed in around 155,000 diagnoses of aortic stenosis in England have found that women were significantly less likely to be referred to specialists and far less likely to receive valve replacement. This also applies to patients from deprived areas and in some ethnic minority groups. What assessment have the Government made of these disparities and what action are the noble Baroness’s department and NHS England taking to ensure that patients have access to heart valve treatment regardless of their gender, ethnicity or where they live?

[Baroness Merron (Lab)]

The noble Lord is quite right: women are underdiagnosed, they are undertreated and some ethnic minority groups face poorer access. That is why I very much welcome the fact that, in the framework to which I referred, dealing with inequalities will be absolutely key. Research, in which we are partnering with the British Heart Foundation, will focus on tackling inequalities in higher-risk groups as well as unequal cardiovascular disease outcomes. Inequalities and tackling them will be at the heart of all our acceleration of progress as well as our research.

Tobacco and Vapes Bill

Lord Kamall Excerpts

3rd reading
Monday 9th March 2026 Lords Chamber

[Baroness Merron (Lab)]

My Lords, it has been a privilege to take this landmark Bill through your Lordships’ House. Smoking is the number one preventable cause of death, disability and ill health and tobacco claims around 80,000 lives every year. While tobacco remains the greatest threat, this legislation is about protecting future generations from the harms of not only tobacco but nicotine addiction.

I extend my thanks to noble Lords who have contributed from right across the House: in particular, on the Front Benches, the noble Lord, Lord Kamall, the noble Earls, Lord Howe and Lord Russell, and the noble Baroness, Lady Walmsley. My thanks go also to the Secretary of State for his leadership and support and to former Minister Ashley Dalton MP, who advanced this Bill to your Lordships’ House.

I also want to pay tribute, as many of us do, to former Prime Minister the right honourable Rishi Sunak for his ambition for a smoke-free generation. I also thank the Chief Medical Officer, Sir Chris Whitty, for his expertise and unwavering focus, and all the officials who have played a crucial role, including the Bill team, policy teams, analysts, the Bill’s senior responsible owners, my private office and the Government Legal Department and the Office of the Parliamentary Counsel for their invaluable contributions.

Finally, I pay tribute to Ministers and officials from the devolved Governments for their collaborative approach. This is genuinely a four-nations Bill which will ensure that we create a smoke-free generation and tackle youth vaping in every corner of our country. I beg to move.

[Lord Kamall (Con)]

My Lords, we have now reached the conclusion of what many will see as a landmark Bill. I thank all noble Lords who have contributed throughout the various stages of its journey through your Lordships’ House, which began with its introduction as long ago as March last year. From these and other Benches, we heard a range of views on its various proposals and on the Bill itself. For some, it goes too far. For others, it does not go far enough. However, among all the disagreements, there were three points that I think noble Lords can agree on. First, smoking is bad for your health. Secondly, current evidence shows that vaping is less harmful than smoking tobacco. Thirdly, not vaping is healthier than vaping.

Beyond that, our debates covered a number of issues, from the evidence base to how to make vapes an attractive alternative to adults who wish to quit smoking while not appealing to children, as well as matters of individual liberty. We also debated the illicit sale of tobacco, the treatment of specialist retailers, cigarette filters, the compatibility of the Bill with the Windsor Framework and the enforcement of a regulatory regime of considerable complexity. We also probed the Government on the evidence behind some of the proposals, for example on the relative harm of heated tobacco compared with combustible tobacco for smokers who have tried vapes but did not like them, so reverted to cigarettes.

While we did not always agree, I thank the Minister and her officials for meeting my noble friend Lord Howe and me throughout the passage of the Bill. I particularly thank her for the concessions made: we particularly welcome the amendment permitting vape vending machines in secure mental health settings. These are vulnerable people in restricted environments for whom access to cessation aids is not a luxury but a genuine health need and it was right that the Bill was amended accordingly.

Independent Commission on Adult Social Care

Lord Kamall Excerpts

Monday 9th March 2026 Lords Chamber

[Baroness Merron (Lab)]

Yes, indeed. We have three core foundations in place in our government objectives for adult social care, one of which is—to the point made by the noble Lord—strengthening the join-up between health services and social care services, because people need to experience more integrated, person-centred care. I am glad that the noble Lord welcomes the immediate actions, set out by the noble Baroness, Lady Casey, that the Government must take on adult safeguarding, dementia and motor neurone disease. We are not wasting any time in taking those recommendations forward.

[Lord Kamall (Con)]

My Lords, picking up on the points made by the noble Baroness, Lady Pitkeathley, and the noble Lords, Lord Young and Lord Laming, when we were in government, we published a White Paper on an integrated national health and care service, to be available for patients from birth to their later years. When the new Government were elected, as was their prerogative, the Secretary of State talked about creating a separate national care service, but we have heard little since. Can the Minister tell your Lordships’ House whether we will have to wait until the next stage of the Casey commission, in 2028, to get any further details at all, especially on how it will work in tandem with our healthcare system, or can we expect any clues or hints before then?

[Baroness Merron (Lab)]

The noble Lord does not have to wait because, in addition to the work by the noble Baroness, Lady Casey, which, as I have said, is independent, she has set out immediate recommendations, which we are working on. We have already made commitments on the disabled facilities grant for housing, so that people can stay in their own homes. We have announced a £500 million investment in the first ever fair pay agreement, and we are uplifting social care allowances to support disabled people more than they ever have been. Those are just some examples, and I would be very happy to direct the noble Lord to other ways in which we are already taking action.

Tobacco and Vapes Bill

Lord Kamall Excerpts

Report stage
Tuesday 3rd March 2026 Lords Chamber

[Lord Lansley (Con)]

I say a big thank you to the Minister for listening; as she rightly said, she has listened and taken on board the comments made in Committee. Amendment 78, which I tabled in Committee, is in fact in the same terms as the Minister’s Amendment 64, which she introduced earlier this afternoon. My purpose was to ensure that local authorities would be able to enforce, more effectively and more substantially, the provisions of the Bill and their trading standards responsibilities generally. I am very glad that the Minister listened so positively to our Committee debate.

[Lord Kamall (Con)]

My Lords, I was very happy to give way to my noble friend to allow him to heap more praise on to the Minister. Sometimes Government Ministers cannot always be assured of receiving praise from other Benches.

My noble friend Lord Howe and I welcome these government amendments and are grateful to the Minister and Department of Health and Social Care officials for reflecting constructively on our debate in Committee on fixed penalties.

On Amendments 66 and 68 in the name of the noble Baroness, Lady Walmsley, while I do not disagree with the sentiment, which is admirable—since in theory hypothecation of taxes, public fines and penalties would lead to more transparency on how taxpayers’ money is spent—there is also a strong argument in favour of more fiscal devolution to local authorities, and whether we should use legislation to tell local authorities what they should be doing with the funds they are responsible for. Nevertheless, I would be interested to hear the Minister’s reaction to those amendments, and I thank her and the Government once again for their amendments.

[Baroness Merron (Lab)]

My Lords, I am most grateful for the contributions to this debate. I can assure the noble Lord, Lord Kamall, that there are no limits to the amount of praise that can be received by Ministers on this Front Bench, and noble Lords should feel free, at any time, to heap praise. We will always be grateful.

I am grateful for the welcome from the noble Lord, Lord Lansley, the noble Baroness, Lady Walmsley—we are very pleased to see her back in her place in good health—and the noble Lord, Lord Kamall. On the noble Baroness’s Amendments 66 and 68, I have heard the call for, as she described, a broad approach. We recognise the importance of local smoking cessation services, which is the very reason we are investing an additional £260 million pounds over the next three years within the public health grant. This will mean that at least £150 million is ring-fenced for stop smoking services every year. The funding is protected, as the noble Baroness seeks, and cannot be used for other public health initiatives. It provides assurance and stability for these essential services.

In addition, we have extended the national smoke-free pregnancy incentive scheme for a further three years from 2026-27 to 2028-29, with funding worth up to £15 million—£5 million per annum. We are also committed to integrating opt-out smoking cessation services into routine care within all hospitals, as set out in the 10-year health plan.

I hope that this reassures the noble Baroness, Lady Walmsley, about how committed we are to providing support for smokers to quit without the need to fund services using proceeds from fixed penalty notices. Instead, as your Lordships’ House has heard, we believe that proceeds can be better used by local authorities on the enforcement of the Bill and other tobacco and vape legislation. It is important that local authorities are able to retain the proceeds to cover their costs in issuing fixed penalty notices and reinvest any remaining funds in enforcement. Strong enforcement of the measures in the Bill and other tobacco and vape legislation will help ensure that we deliver our ambition to achieve a smoke-free UK and to protect future generations from the risk of nicotine addiction. In other words, on the very important points that the noble Baroness is pursuing through her amendments, that ultimately is the best way of reducing smoking.

Government amendments 64, 65, 67, 69 and 74 will support this by allowing local authorities to retain all the proceeds from the £2,500 licensing offence fixed penalty notices as well as the £200 fixed penalty notices in the Bill, which goes further than noble Lords were originally requesting. With that, I hope that noble Lords will support these important amendments.

--- Later in debate ---

[Lord Kamall (Con)]

My Lords, before I respond to the specific amendments, I will touch on two things that the noble Earl, Lord Russell, said. First, I was previously in the European Parliament and worked on a number of technology regulations, and we can never be absolutely certain that we have legislated for the future or completely future-proofed anything. The only way to do that is to ban everything, frankly. We therefore often find regulation having to keep up with technology when it is far behind it, but we can put certain provisions in place. We can predict certain things but we cannot predict all innovation completely. Secondly, I hope the noble Earl will not mind me gently reminding him that not all vape companies are connected to big tobacco. A number of vape companies have nothing to do with big tobacco, and it is important that we understand that distinction.

My noble friend Lord Howe and I welcome the amendments from my noble friend Lord Lansley. Before the Minister speaks to them, we also very much welcome the two government amendments in this group, which we think respond very helpfully to the issues raised in Committee by my noble friend Lord Lansley. We believe that adding these provisions is a good way of future-proofing the Bill, as much as any Bill can be future-proofed, without necessarily compromising any decisions that Ministers may wish to make in the short term—but also without committing the Government or a future Government to any specific technology solution or to one company’s specific solution. With that in mind, I look forward to what the Minister has to say.

[Baroness Merron (Lab)]

My Lords, government Amendments 130 and 132 provide a power that would allow the Government to regulate the technological features of vaping products and tobacco-related devices, and the software associated with those features, to address emerging risks and to protect children. While the Bill already provides powers to regulate various device features, such as colour, size and shape, I listened carefully to the points raised in Committee about vape technology and the need to future-proof the Bill in order to respond quickly to new risks. I appreciate the support of both Front Benches on this point, particularly the comments of the noble Lord, Lord Kamall, about how far one can ever go when future-proofing. I can assure him that we are not planning to ban everything, but I thank him for the interesting suggestion.

The noble Earl, Lord Russell, spoke to concerning examples of the emergence of technology being used to make vapes more enticing to young people. As he said, some can now come with gaming functionality and others can be linked to what are called puff leaderboards and reward systems, so the more you inhale, the more credits you build up. Emerging evidence suggests—and it is worrying—that these interactive and gamified vaping features may heighten their appeal to children. This raises serious public health concerns around their potential to escalate dependence on nicotine. Our amendments therefore ensure that such emergent technology features can be appropriately regulated to reduce the appeal to children.

I turn to Amendments 124 and 131 tabled by the noble Lord, Lord Lansley. Let me first reassure him, as well as the noble Earl, Lord Russell, with regard to Amendment 124, that the powers in the Bill already enable us to regulate markings, which could include digital markings such as QR codes, to be used as part of a system to authenticate products. On Amendment 131, with reference to the device itself, I am very grateful for the noble Lord’s suggestions and his contributions on how best to future-proof the Bill, including on age-verification technology.

While it is not the Government’s policy to verify age at the point of use, and we have no intention to do so at this time, we recognise that need, as I have said, to be able to regulate technology to protect public health and respond to evidence, as the noble Lord, Lord Lansley, acknowledged. It is for this reason that we are introducing the new regulation-making power on technology to which I have just spoken. I therefore ask the noble Lord to withdraw his amendment.

--- Later in debate ---

[Lord Kamall (Con)]

My Lords, I start by thanking my noble friends Lord Udny-Lister and Lord Sharpe for their amendments in this group. I begin with the amendments proposed by my noble friend Lord Udny-Lister. Many noble Lords have raised concerns about the unintended consequences of this Bill. Just yesterday, HMRC published data showing that legal tobacco sales in the United Kingdom fell by 52% between 2021 and 2025. That statistic will be welcomed by those who want to eradicate smoking, but there is still some way to go in encouraging smoking cessation. My noble friend’s amendments simply ask a question akin to that debated in group 5—namely, how far we should go with regulation of vaping and nicotine products, especially when we are trying to promote them as alternatives to smoking tobacco?

Of course, some regulation is certain to be necessary with products such as vapes, but we have to be careful that we confine them to responsible use. We should also be careful not to use a sledgehammer when a nuanced approach might be a more effective way forward in a particular circumstances and settings. If we overdo the restrictions, we risk driving smokers away from quit aids and alternatives such as vapes towards easily available alternatives—unfortunately, such as illicit tobacco, which we know is still too accessible to some smokers. Many noble Lords have spoken to their own experience in local authorities about trying to tackle illicit tobacco. In the right settings, advertising and displays of vaping products can play a role in encouraging adult smokers to switch from cigarettes to less harmful alternatives, and we know that many are already doing so. It is important for the Government to find the right balance.

I turn to the amendment from my noble friend Lord Sharpe of Epsom. There is really little that I can add to the case that he has made so persuasively. The hospitality sector has faced sustained pressure in recent years, including rising energy costs and an increase in the cost of taking on new employees, staff shortages in some areas and increasing regulatory burdens. It is therefore reasonable that when we introduce further restrictions, we carefully consider their cumulative impact on licensed venues.

My noble friend’s amendment is tightly drawn. It would apply only within the curtilage of premises licensed under the Licensing Act 2003; only where advertisements are not visible from outside; only in age-restricted venues with appropriate safeguards; and it explicitly excludes tobacco products. It also provides for regulations to be subject to the affirmative procedure, and requires consultation and a full impact assessment, something very much in line with better regulation, in which many noble Lords believe. That framework suggests a helpful attempt to strike a balance, maintaining strong protections for children and the wider public while recognising that adult-only controlled environments may justify a different approach. It seems reasonable to at least explore whether limited, carefully regulated flexibility of this kind could be accommodated without undermining public health objectives. I hope that the Minister will look favourably on such flexibility.

[Baroness Merron (Lab)]

My Lords, I am most grateful for the contributions to this debate. I begin with the amendments in the name of the noble Lord, Lord Udny- Lister, Amendments 149, 151, 155, 157, 159, 161, 163 and 169.

Survey data shows that there has been a significant growth in awareness of vaping promotion among young people, with 55% of all children aged 11 to 17 aware of promotion in shops. This figure relates to 2025, and that is up from 37% in 2022. We are therefore delivering on our manifesto commitment to stop vapes from being advertised to children, while still enabling them to be promoted by public health authorities as a means for adult smokers to quit smoking, something that noble Lords have emphasised correctly, once again, in this group.

Tobacco advertising, including for heated tobacco products, is already prohibited under the Tobacco Advertising and Promotion Act 2002, and will remain so under the Bill. On Amendment 168 in the name of the noble Lord, Lord Sharpe, I can clarify that the advertising provisions do not restrict the use of, or sale of, products, and therefore should not overly impact on the hospitality sector. I will come back to reference to the hospitality sector, following the comments of the noble Baroness, Lady Fox, when we get to the final group, which is coming up next.

Evidence for tobacco has found that partial bans, as referred to in this amendment, are not as effective as comprehensive bans in reducing tobacco consumption. I therefore feel that it is extremely reasonable to draw similar conclusions for vape advertising. Under current legislation, there are already strict restrictions for vape advertising. We believe that the promotion of vaping to quit smoking is best led by the appropriate public health authorities, because they can provide tailored advice to the individual with the necessary behavioural support.

In response to the comments of the noble Baroness, Lady Fox, the Bill already includes defences for the limited circumstances in which advertising would be appropriate. As I outlined on the first day of Report, following my prior assurances on public health campaigns, we are introducing a specific defence which will strengthen this capability by allowing businesses, such as pharmacies and GPs—something that noble Lords rightly drew my attention to—to advertise non-branded vapes, if it is part of a campaign agreed with the public authority for public health purposes. We are not considering further exemptions due to the risk of loopholes, the potential for poorly enforced entry rules, and the fact that evidence has shown that comprehensive bans on tobacco advertising have reduced consumption, but partial bans, as I mentioned before, have had no significant effect.

On Amendment 152, in the name of the noble Lord, Lord Udny-Lister, the language of “has reason to suspect” is standard practice and already included in the existing Tobacco Advertising and Promotion Act 2002. This wording is specifically designed to avoid loopholes and to ensure that those involved in the design of advertisements cannot evade responsibility by claiming ignorance where there are clear grounds for suspicion. I say again, this is standard legal practice.

Finally, on Amendment 153, in the name of the noble Lord, Lord Udny-Lister, it is important that we recognise and respect the established criminal law system within each nation of the UK. As noble Lords will know, Scotland has a separate criminal justice system, and 12 months is the maximum penalty on summary conviction for this type of offence and is fixed in line with its criminal justice system. For the reasons that I have set out, I hope that the noble Lord, Lord Udny-Lister, will withdraw his amendment.

NHS: Violence Against NHS Staff

Lord Kamall Excerpts

Monday 2nd March 2026 Lords Chamber

[Baroness Merron (Lab)]

I think I understand my noble friend’s question; if I have misunderstood, I will gladly write to her. The point here, I think, is about not just practice but culture. We need to see good leadership. We need good organisational culture to improve staff engagement and staff responsibilities when faced with dealing with such incidents. Again, our NHS working cultures need to be more compassionate and more inclusive, and they need better support, including around occupational health and staff well-being. Practitioners are part of the solution, and of course we give them our full support.

[Lord Kamall (Con)]

My Lords, in advance of this Question, the Medical Defence Union wrote to a number of noble Lords, for which we are grateful. It outlined that if a healthcare professional is the subject of violence in the workplace, the police may be required to arrange for a forensic physician to examine the victim. This experience of course doubles the terrible experience that the individual has been through and is daunting for them. Can the Minister confirm what steps or guidance the department and NHS England, as long as it continues to exist, are putting in place to support medical staff in such instances?

[Baroness Merron (Lab)]

I understand the point. All NHS staff have access, for example, to a helpline for support and to Practitioner Health for when they need more complex mental health support. Of course, anyone who is experiencing violence or abuse should report it to their line manager so that it can be properly investigated, including reporting it to the police. These are very difficult situations for the person who has suffered abuse and for members of the team who have to support them. I take the point about forensics; forensic investigation can worsen it, but it is also necessary to secure conviction where necessary.

Medical Training (Prioritisation) Bill

Lord Kamall Excerpts

3rd reading
Wednesday 25th February 2026 Lords Chamber

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

My Lords, NHS staff told us through the 10-year health plan engagement that they were crying out for change. This Bill is but one step in delivering that change. It will ensure a more sustainable and resilient medical workforce. It will ensure that we make the best use of the substantial taxpayer investment in medical training, and it will give our homegrown talent a clear path to becoming the next generation of NHS doctors.

The issue of bottlenecks for postgraduate medical training has been growing since the removal of the resident labour market test in 2020. I am most grateful to Parliament for expediting the passage of the Bill to tackle this problem, while giving it the careful scrutiny it deserves. I express my gratitude to noble Lords across the House for their constructive engagement throughout its passage. I wish to thank and credit noble Lords for passing the Bill unamended. My thanks are also due to officials and leaders from the devolved Governments for their support and commitment to ensuring we have a process that works for all of the United Kingdom, and for their determination to ensure that all legislative requirements were met within what was, and is, a challenging timeframe. I thank my officials in the department, as well as our lawyers, for their tireless work over these past few months.

We are clear that this Bill does not and cannot resolve all the workforce issues within our National Health Service. It sits alongside a range of action that the Government are taking to ensure that the NHS has the right people in the right places, with the right skills to care for people when they need it. The changes that the Bill introduces for foundation specialty training are a crucial step forward and will lead to a more sustainable medical workforce that can meet the health needs of our population.

I again thank all noble Lords who contributed their knowledge and insight during the Bill’s consideration. I beg to move.

[Lord Kamall (Con)]

My Lords, although this was emergency legislation, we have had detailed and constructive debates on prioritisation. We have also had the opportunity to debate some of the deeper issues around the supply of medical specialty training places, and I am grateful to the Minister for her letter. We will continue to hold the Government to account on the delivery of these places over the coming years. As we have said previously, the Bill is not a complete solution to the problem, as the Minister graciously acknowledged. We accept that it is a step forward.

During our debates, we touched on a number of issues, including whether UK citizens who are graduates of UK medical schools should be given first priority. We discussed the issue of international medical graduates who chose to contribute to the UK system of healthcare rather than go to another country, but who may now find themselves at the back of the queue. We discussed graduates of overseas branches of UK medical schools, some of which follow the same curriculum as UK medical schools, and whether some could be granted so-called grandfather rights. We also pressed for secondary legislation to be subject to the affirmative procedure. We understand why the Government have come to their position and why Ministers have not been able to take action on these points in this emergency legislation. However, given more time, I hope Ministers will continue their work to resolve these concerns, which were eloquently set out by a number of noble Lords from all Benches.

There was some debate about whether this was really emergency legislation or whether, in reality, it was simply giving the Secretary of State a bargaining chip in negotiations with the BMA. That may be no bad thing in itself, but the question remains of whether emergency legislation should be used to give Ministers bargaining chips.

Before I sit down, I thank the Minister and her officials for all their engagement throughout the Bill. As His Majesty’s loyal Opposition, we look forward to working closely with the Minister as the Government press ahead with its implementation.

[Baroness Gerada (CB)]

My Lords, I know it is not normal to speak at this stage, so I will be brief. I thank the Minister and everyone who has worked on this Bill, but I want to raise one or two anxieties which have already been touched on.

I believe that the Bill fundamentally challenges one of the principles that I have always held dear, which is fairness. It is unfair to international medical graduates, who we have entreated to come to this country for the last two decades—we have even paid for them to come —to work in hard jobs, in places where UK graduates did not want to do them. Now that we have more people than places, we are basically pulling the rug from under them. We are jeopardising their careers, their futures, their families and their visas.

It is also unfair to those UK nationals who chose, again in good faith, to study overseas and now have been treated like international medical graduates, when they are not. Finally, it is unfair to the commitment that the Department for Education has made around transnational undergraduate and postgraduate education. This Bill, I am afraid, takes away that commitment and says that we do not really mean what we say.

However, I look forward to working with Ministers and officials to see whether we can address some of what I fear will be the unintended and, I suspect, intended consequences of this Bill.

Tobacco and Vapes Bill

Lord Kamall Excerpts

Report stage
Tuesday 24th February 2026 Lords Chamber

[Baroness Northover (LD)]

My Lords, this group of amendments relates to heated tobacco and its inclusion in the Bill, and in particular the rising age of sale. It is essential that the measures in the Bill apply to all tobacco products without exception. We have learned repeatedly that, where legislation leaves loopholes, the tobacco industry exploits them. We saw this with cigarillos—products defined as cigars but designed to resemble cigarettes, evading plain packaging with the flavour and pack size rules, as we discussed in Committee.

The Bill is a chance for truly comprehensive legislation. I am particularly concerned about Amendment 89, which would remove the phrase

“or consumed in any other way”.

That would leave the door wide open for further innovation from the industry to continue selling tobacco products here in the UK. The regulatory powers in the Bill must be broadly defined, including powers over packaging and presentation. This is not overreach; it is future-proofing based upon our past experience. Without it, we invite industry innovation designed solely to sidestep regulation and undermine public health.

Heated tobacco products should not be conflated with vapes. Vapes can be and are recommended for smoking cessation, following evidence, including a Cochrane review, showing that they are a helpful tool for smokers. Heated tobacco products do not meet that standard and are not recommended by NICE. They are used by fewer than 1% of people in the UK, yet awareness of them is rising, particularly among young people. Alarmingly, nearly one-quarter of 11 to 17 year-olds are now aware of these products, and that may well be the result of their marketing in supermarkets and online.

I therefore welcome government Amendments 217, 218 and 219, which ensure that the comprehensive definition of a tobacco product applies from the moment the Bill comes into force. That will help to address the ongoing and unacceptable advertising of heated tobacco products in supermarkets and elsewhere. If we are indeed serious about creating a smoke-free generation, all tobacco products, including heated tobacco, must be included without ambiguity or exception.

[Lord Kamall (Con)]

My Lords, my noble friend has tabled a number of amendments on heated tobacco products. Although there may be some concern about what is behind them, they raise important questions that I am afraid the Government have yet to answer with any real precision.

As I noted in Committee, there appears to be some evidence that individuals who switched from conventional cigarettes to heated tobacco products show lower levels of exposure to harmful chemicals than those who continue smoking. I am just comparing them to cigarettes, not to vapes. To be clear, I do not suggest that this settles the question of harm—these are relatively new products, and the long-term evidence base is still developing—but it means that the Government cannot simply treat heated tobacco products as interchangeable with conventional cigarettes without explaining why they refuse to consider their relative harm compared to cigarettes. I am talking about not absolute harm, but relative harm.

There is also the practical question of where these products may be used. The position on indoor and outdoor spaces remains, as far as I can tell, unclear. Heated tobacco does not produce combustion or sidestream smoke in the conventional sense, and yet it is not obvious from the Bill how the Government intend to address that distinction—if they intend to address it at all.

More fundamentally, can the Minister explain what specific evidence underpins the decision to include heated tobacco in the generational ban? I am sure all noble Lords accept that current evidence shows that vapes are relatively safer than smoking. It may be that vapes are relatively safer than heated tobacco, but as yet, we have not seen definitive evidence. Unfortunately, as noble Lords have said, much of the research on heated tobacco is funded by the tobacco industry. I can understand the concern there. I hope the Minister will correct me if I am wrong, but there is no definitive independent research on the relative harms of heated tobacco. If there is definitive research, can the Minister write to noble Lords with links to the relevant academic papers? I think we saw one link to a meta study that was not very good, but there has been no meaningful in-depth research.

This reminds me of a conversation I had with a friend, who told me that when they tried vapes to quit smoking, it unfortunately did not do the job for them. When they went back to their doctor, he said that he was not supposed to do this, but he suggested heated tobacco as a relatively less harmful alternative. While he hoped his patient might have switched from cigarettes to vapes, since this had not happened—we do not live in a perfect world—he preferred his patient to use heated tobacco to going back to cigarettes. Once again, this was a practical approach based on relative harms.

I completely understand the concern that, if we overpromote heated tobacco, we might find that smokers switch to it rather than vapes. Given that the policy rationale rests substantially on reducing harm—we should be looking at absolute harm and relative harm— I would welcome clarity on whether the Government are satisfied that the case for treating heated tobacco like cigarettes is proven. It will be interesting to see that distinction between heated tobacco and cigarettes. Is the science still sufficiently uncertain to warrant a more cautious approach?

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

My Lords, I appreciate the contributions made in this debate. I will start by addressing government Amendments 217, 218 and 219, tabled in my name; I am grateful to the noble Baroness, Lady Northover, for her support.

The Bill updates the definition of a tobacco product in legislation relating to promotion and advertising, and in Scottish legislation, to

“a product consisting wholly or partly of tobacco and intended to be smoked, sniffed, sucked, chewed or consumed in any other way”.

Those last few words,

“consumed in any other way”,

are the key ones. What does this definition do? It ensures that all forms of tobacco products, regardless of how they are consumed, are captured by this legislation, including—this is important to the points raised by noble Lords—any future novel tobacco products.

These amendments bring forward the commencement of this updated definition to the day of Royal Assent, rather than two months after Royal Assent. That is because the Government’s view is that all tobacco products currently on the market are already captured in the current definition, so it is appropriate for this future-proofing amendment to come into force at Royal Assent because there is no change to the law for which notice would be required.

Amendments tabled by the noble Lord, Lord Udny-Lister, seek to redefine how heated tobacco products are captured within the Bill so that they are no longer treated in the same way as other tobacco products. These amendments also seek to prevent provisions being extended to heated tobacco devices in the future.

On the points raised by the noble Lord, as well as by the noble Baroness, Lady Fox, and the noble Lord, Lord Kamall, the Bill deliberately defines tobacco products expansively and includes heated tobacco. The reason for that is that there is no safe level of tobacco consumption and all forms of tobacco are harmful.

On the points raised about evidence, there is evidence of toxicity from heated tobacco in laboratory studies; the aerosol generated by heated tobacco devices contains carcinogenic compounds. Unlike vapes, there is limited evidence that heated tobacco can support smoking cessation, despite what is claimed by the tobacco industry. On the matters of evidence raised by the noble Lord, Lord Kamall, and the noble Baroness, Lady Fox, as has been set out by all four UK Chief Medical Officers in a technical note to noble Lords, any suggestion that heated tobacco products are safe or should be promoted as quit aids in some way is entirely misleading.

I say to the noble Lord, Lord Kamall, that, through the National Institute for Health and Care Research, we are funding high-quality research into tobacco products. Between 2020 and 2025, £25 million was invested in a NIHR research programme to research tobacco control, and that will help us develop the evidence base. Exempting heated tobacco products from the smoke-free generation policy and other provisions in the Bill would simply allow the tobacco industry to continue to find a way to addict future generations to harmful and addictive products. The Bill is completely geared to go the other way.

The noble Lord, Lord Kamall, asked about heated-tobacco-free places. We will return to the whole issue of tobacco-free places when we come to group 16, so I am sure that that will be debated then. I hope that I have been able to clarify the Government’s position for noble Lords, and that the noble Lord, Lord Udny-Lister, will feel able to withdraw his amendment.

[Lord Kamall (Con)]

Before the Minister sits down, she talked about research that was done on tobacco products between 2020 and 2025. In that time, was any specific research done on heated tobacco as part of tobacco products?

[Baroness Merron (Lab)]

The specific definition is “tobacco control research”, so it would be strange if it did not include what we know about already, which includes heated tobacco. I will be glad to confirm that to the noble Lord in writing.

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[Baroness Northover (LD)]

My Lords, I am delighted to have the support of the noble Baroness, Lady Fox, on my earlier amendment on the communications strategy, and that she has come around to my point of view on this. It clearly is vital that we have an excellent, proactive communication strategy in relation to this new policy, as I argued on the first group.

These amendments seek to ensure that penalties for offences are fair and proportionate. I am very sympathetic to Amendment 60 from the noble Lord, Lord Udny-Lister, which looks like a very useful attempt to take a stepped approach to fines; it seems a very reasonable way to go about this. I look forward to hearing what the Minister says about that, and why she feels, if she does, that it is not necessary or appropriate.

We believe that Amendment 63 is not necessary, as the ability to give warnings already exists. On Amendment 17 on counterfeit products, I am delighted to return the compliment to the noble Baroness, Lady Fox, who says that she does not like to have unnecessary new offences, by telling her that we understand that this is currently an offence under the Trade Marks Act and that offences under that Act are automatically lifestyle offences, meaning that a proceeds of crime application can be used to remove criminal earnings. Maybe the Minister can comment on these various amendments.

[Lord Kamall (Con)]

My Lords, my noble friends Lord Moylan and Lord Udny-Lister benefited this debate by coming forward with their amendments in this group based on their extensive experience in local government. I warmly welcome Amendment 17; counterfeiting nicotine products is not a victimless crime. It undercuts legitimate businesses that are already operating under considerable regulatory and financial pressure.

Let us be clear that the cumulative burden placed on small businesses, regulatory or otherwise, is already substantial. These businesses, as other noble Lords have said, are already playing by the rules. They pay their taxes and comply with an ever-increasing, complex regulatory framework. It is simply not fair that they should find themselves undercut by operators selling counterfeit products outside that framework entirely.

Beyond the commercial harm, there is a serious consumer safety dimension. Counterfeit nicotine products are unregulated, untested and potentially dangerous. I ask the Minister to confirm that the Government share the view that the robust criminal penalties for counterfeiting are not only appropriate but essential. I would be grateful to hear what steps are being taken to ensure that enforcement capacity exists to make sure that these penalties are meaningful.

At earlier stages of the Bill, I know there were some concerns about the capacity of trading standards, for example. The sum that the Government have made available for local trading standards is to be welcomed, but some still wonder whether it will be enough or whether it is a drop in the ocean.

My noble friend Lord Udny-Lister’s amendments reflect a sensible approach to fixed penalty notices. A step penalty structure that treats a first offence differently from repeated non-compliance is surely right. While some local authorities may already have discretion to issue a warning instead of a fixed penalty for first-time offenders, as my noble friend has raised, it is important that first-time offenders are not treated unduly harshly given the complexity of some of the regulations that these small retailers will have to face. I hope the Minister, if she feels that she cannot accept the amendments as they stand, can say some positive things about them.

[Baroness Merron (Lab)]

My Lords, this has been a helpful debate on an issue that concerns us all in this Chamber.

On Amendment 17 tabled by the noble Lord, Lord Moylan, I agree with his desire to take robust action against counterfeit products—I am sure we all do—but I cannot accept the amendment simply because I do not believe it is necessary, not because of specific objections. I heard his invitation for me to continue as I started, but, unfortunately, I cannot do so for this amendment. We believe it is not necessary, as referred to by the noble Baroness, Lady Northover, because protections against trademark infringement are already a matter for existing legislation.

On the point about necessary legislation addressing counterfeit products, which I accept, I say to the noble Lord and the noble Baroness, Lady Fox, that the Trade Marks Act 1994, as we have heard, already provides significant penalties for breaching these rules. They include: on summary conviction, imprisonment for a term not exceeding six months or a fine not exceeding the statutory maximum, or both; or, on conviction on indictment, a fine or imprisonment for a term not exceeding 10 years, or both. These are significant penalties.

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We have been talking quite a bit about loopholes, and I am struck by what the noble Baroness, Lady Bennett, said about the age range of those now taking up cigars and the malign influence of Andrew Tate and similar influencers. I spotted young men in the US, Canada and the UK smoking cigars, and I can now trace it. I was puzzled, but I now see why it has been taken up. This points clearly to the necessity to close this loophole, as I hope the Government will. We know that, where there are loopholes, they are exploited, and the exemption of cigars has proved that.

[Lord Kamall (Con)]

My Lords, my noble friend Lord Lindsay’s excellent and persuasive arguments in support of the amendments in his name and that of the noble Lord, Lord Mendelsohn, who is not in his place, cannot be bettered, so I shall not try to, except to say that I support them.

Regardless of one’s attitude to smoking, there is a general recognition of the important role that specialist tobacconists play. They are small, highly regulated businesses that serve a discerning adult clientele. They are not engaged in the mass-marketing of cigarettes, nor are they driving youth uptake. Specifically, handmade cigars are not cigarillos. Premium handmade cigars are luxury products, purchased occasionally at a considerable cost by informed adult consumers. I was surprised to learn in Committee that they attract overseas visitors, who spend huge amounts of money here in the UK because these handmade cigars are packaged and marketed in a way that is unique to the United Kingdom. It is difficult to see how such establishments constitute a meaningful threat to the Government’s stated objective of reducing youth smoking and creating a smoke-free generation.

I stress that many of the criticisms made of cigars are made of cigarillos, but it is important that we distinguish between cigarillos and the unique products that are artisan cigars, whatever one thinks of them. I do not smoke; I think smoking is a disgusting habit. I do not drink alcohol; I think drinking alcohol is a terrible thing. But I am a liberal and I do not seek to impose my views on other people. It is important to distinguish between handmade crafted cigars and mass-marketed cigarillos, which may well be attractive to young people. I believe that cigarillos should be seen in the same light as cigarettes.

Since the introduction of the Bill, there has obviously been enormous anxiety among specialist tobacconists around the country about what the Government might choose to do to their day-to-day businesses. These amendments will, I hope, provide the Minister with an opportunity to reassure the sector. There is real concern that if plain packaging regulations were to be imposed on hand-rolled cigars, this would constitute an almost instant death for every specialist tobacco business. We heard about other countries where plain packaging has been imposed, but the UK continues to attract people who want to buy the packaging and all the marketing around it, whatever we may think of it.

For the good reasons already stated, these businesses enjoy special dispensations from the provisions of the law which apply to the generality of tobacco retailing. These dispensations are well founded, well understood and respected across the supply chain. As far as I am aware, they have not been abused. Many of the complaints about the uptake of cigar smoking are in relation not to these types of cigars but to cigarillos. This area of tobacco retailing is so niche that it is irrelevant to the vast majority of smokers. There is no reasonable case for the Government to choose to exercise powers to impede, restrict or otherwise alter the day-to-day lives of those involved in this specialist sector.

To be clear, I am talking about packaging. I am not referring to any of the amendments concerned with cigar lounges. I understand the concerns that have been expressed about workers who may not wish to be exposed to cigars but have no choice but to take that job and be exposed. I am talking about specialist tobacco manufacturers and retailers. Obviously, any attempts to restrict these businesses would involve some consultation with the Department for Business and Trade, so I sincerely hope that the Minister will be able to confirm that the Government have no intentions to restrict the specialist manufacturers in this way and to make their businesses unviable.

[Baroness Merron (Lab)]

My Lords, I am grateful to all noble Lords who have contributed to this debate. On Amendments 127 and 147, tabled by the noble Earl, Lord Lindsay, and Amendment 126, tabled by the noble Baroness, Lady Walmsley, I have listened to the points that have been raised by noble Lords, not just today in the Chamber but in engaging outside the Chamber, which I have been pleased to do, and I have listened to the calls for handmade cigars to be exempt from packaging provisions in this legislation.

I remind the House, as I have had to remind noble Lords in other discussions, that the powers to regulate the packaging of all tobacco products are not new; they already exist. They were first introduced under the coalition Government as part of the Children and Families Act 2014. At the time when the powers were introduced, the Government of the time rightly recognised the need to ensure that these powers applied to all tobacco products, future-proofing the legislation, so introducing an exemption for handmade cigars now would weaken what is in effect long-standing legislation. I remind noble Lords that one of the points about the Bill is to bring together legislation that is in other areas into a Tobacco and Vapes Bill, which is what we are doing.

As I have said on a number of occasions, all tobacco products are harmful. That includes cigars and those marketed as premium or handmade. When burned, all tobacco products release toxic compounds that pose a risk to the user. In fact, research has found that some toxicants, including carbon monoxide and certain carcinogens, are higher in cigar smoke than cigarette smoke, and of course the toxicants that are found in tobacco smoke in cigars increase the user’s risk of developing diseases such as cancer, heart disease or respiratory disease. As the four Chief Medical Officers of the UK set out in their technical note to noble Lords, any suggestion that cigars are substantially safer than other tobacco products is not accurate.

Given the health harms of all cigars, it is appropriate that they are in scope of the legislation and that the Government retain our current ability, introduced in 2014, to regulate the packaging of all tobacco products. Moreover, exempting product categories is likely to lead to exploitation by the tobacco industry, which will always find a loophole to exploit. For example, following the ban on menthol cigarettes in 2020, tobacco companies began marketing cigarette-like menthol-flavoured cigarillos.

I shall provide some assistance on the points being raised today. As I said, I have heard concerns from noble Lords about future packaging restrictions that could impact specialist tobacconists more significantly than other retailers, and concerns about potential unfairness arising from that. I can say, as I have said before, that it is absolutely not this Government’s intention for any future packaging requirements to put any small businesses, including specialist tobacconists, out of business. Our intent is that any future packaging regulations make the health harms of these products clear while minimising the impact on businesses.

The noble Earl, Lord Lindsay, asked about future regulation on packaging. If that is to be the case, further impact assessments will be prepared in advance, including the economic impact of any proposed regulations. The policy proposals for any packaging requirements will be a matter for consultation, and all businesses—including, I am sure, specialist tobacconists —will want to respond and will be welcome to. I want also to be clear that the Government will consider the impact any policy proposal has on small businesses, including specialist tobacconists, via future published impact assessments, as I just said. It is important, however, despite these points, that the Government retain their current powers to regulate the packaging of all tobacco products, as any carve-out would potentially create loopholes for exploitation, as other noble Lords have expressed concern about.

Amendment 192 from the noble Earl, Lord Lindsay, seeks to maintain the existing exemption to allow individuals to sample cigars and pipe tobacco indoors in an enclosed and ventilated area in a specialist tobacconist shop. The Government are, as noble Lords know, committed to protecting people from the harms of second-hand smoke, which is why we launched a consultation on expanding smoke-free places on 13 February.

On the point the noble Baroness, Lady Bennett, made, there are a number of exemptions to the current smoke-free legislation, including an exemption for sampling rooms—not smoking lounges, as the noble Baroness, Lady Northover, referred to—in specialist tobacconists, providing certain criteria are met, as outlined. The Government do not intend to remove this existing exemption for specialist tobacconists. The consultation explicitly states our intention for the exemption to remain.

Finally, Amendments 18 and 19, tabled by the noble Earl, Lord Lindsay, seek to maintain the existing exemption for specialist tobacconists to display tobacco products. There are several exemptions to the current tobacco display legislation, including an exemption for specialist tobacconists. In England, this allows specialist tobacconists to display tobacco products as long as they are not visible from outside the premises. The Government’s intention is not to remove this existing exemption for specialist tobacconists. This will be reflected when we consult on future display regulations later this year.

It is important that the Bill balances the public health aims with any disproportionate impacts on businesses, including specialist tobacconists. However, we will continue to monitor this niche market to ensure that it is not targeting young people or exploiting the existing exemptions. I hope that, on this basis, the noble Earl, Lord Lindsay, will feel able to withdraw his amendment.

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[Baroness Northover (LD)]

From these Benches, the Minister can count on our support.

[Lord Kamall (Con)]

My Lords, the hour is late and, given that some of my noble friends have left the Chamber—no doubt to enjoy a very expensive handcrafted cigar—it is left to my noble friend Lord Effingham and me to offer the opposition. If I had any temptation to call a Division, I can see that I am outnumbered.

I thank the Minister for tabling these amendments. I know that many of them are technical, but some are very important. I particularly welcome Amendment 165, which provides sensible protection for internet service providers acting merely as conduits, caching services or passive hosts. They are not really active in this space. They do not initiate, select or modify the content transmitted across their networks, and it would not be fair or practical to render them criminally liable for material of which they have no knowledge and over which they exercise no control.

Similarly, Amendments 166 and 178 ensure that legitimate public health campaigns are not inadvertently caught out by the advertising offences in the Bill. Where a person is acting in accordance with arrangements made by a public authority and for the purpose of promoting or protecting public health, it would be wrong for them to face criminal liability.

Finally, we welcome Amendment 183 because it ensures that the new restrictions do not apply retrospectively to programmes that were already in production before the new rules came into force. I suppose this is all a very long way of saying that we welcome the amendments from the Government.

[Baroness Merron (Lab)]

I am delighted to receive the support of both Front Benches, either in a few words or in a few more words. This is to fulfil a mandate to stop the blatant advertising of vapes to children, while continuing to support adult smokers to quit. I therefore commend the amendment to the House.