Grand Committee
Cancer Outcomes in the UK
(1 day, 4 hours ago)
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Lord Patel
That the Grand Committee takes note of cancer outcomes in the UK and of plans to improve them including diagnostic care and research.
Lord Patel (CB)
My Lords, sitting on the same side as the Minister does not mean that I am on her side. I thank all noble Lords taking part in the debate and look forward to their contributions. There is a formidable array of talent, so the Minister should get a good response. I thank her for making time to respond to the debate, although, at the end, she might wish that she had not done so.
No one can be in any doubt that poor outcomes for patients with cancer in the UK need urgent attention. Today is World Acute Myeloid Leukaemia Day, which observes a blood cancer with low survival rates, primarily because of late diagnosis. One in two people in the UK—
Baroness Bottomley of Nettlestone (Con)
Is it possible for the noble Lord to speak a bit louder? We old, deaf people back here find it quite hard to hear him.
Lord Patel (CB)
Can everyone hear me now? Can the noble Baroness, Lady Bottomley, hear?
Lord Patel (CB)
Thank you. One in two people in the United Kingdom will develop cancer. Being born with cancer is rare, but a new cancer diagnosis is made every 75 seconds. The UK consistently ranks near the bottom of the table for survivals and deaths from cancers. That is despite several cancer plans and strategies for change, which are often heralded as world class. In 2011, we had Improving Outcomes: A Strategy for Cancer; in 2015, we had Achieving World Class Cancer Outcomes; and in 2019, we had a plan to make cancer a priority. None of those plans delivered the promises made. The result is that cancer outcomes have not improved much in England for nearly two decades.
Cancer care is a touchstone of the wider NHS, which itself is also delivering poor performances. It is in that environment that we will discuss the plan. We now have the Government’s National Cancer Plan for England: Delivering World Class Cancer Care. What is different about this plan? The Government say that
“it heralds a full modernisation of our approach to cancer care … fit for the future”.
The report is ambitious but lacks detail on implementation plans, which I hope the Minister will tell us about today.
What are the key commitments? The first is to improve five-year survival rates, so that, by 2035, three in four people with cancer will live more than five years, either cured or living well. The second is to restore performance in meeting cancer waiting-time standards by 2029. The third is to expand screening programmes, including lung cancer screening, by 2030. The fourth is to increase genomic and genetic testing, so that genetic tests are to be reported within 10 days for 96% of patients. The fifth is to accelerate the use of AI, robotics and modern imaging for early diagnosis. The sixth is to reduce variation in accessing new treatments and technologies and to address inequalities. The seventh is to strengthen cancer alliances among system leaders and to boost research and clinical trials.
I have mentioned but a few. All of that and more is being promised when cancer services are under immense pressure. Demand continues to rise, with a complex case mix. Most importantly, staff shortages persist, particularly in radiology, oncology, cellular pathology and cancer specialist nurses.
The shortfall in workforce in critical areas of cancer care is significant. In radiology, it will be 39% by 2029; in oncology, it will be 19%. For nursing and specialist nurses in cancer care, there is a 10% shortage in most trusts. There is a shortage of 4,000 specialist cancer nurses and 6,000 nurses in community diagnostic centres. In histopathology, only 3% of departments say that they have adequate staffing. The Royal College of Radiologists and the Royal College of Pathologists say that, with the shortage, the workforce will not be able to deliver on the needs in the cancer plan. To do so, the workforce may need to grow by as much as 45% by 2035. In radiology alone, that may cost £1.5 billion a year. I ask the Minister when the Government will publish a fully funded workforce plan for cancer care. We look forward to that soon.
I will now pick up on some of the key commitments, as I do not have time to go through them all. On the commitment for three in four patients to survive five years by 2035, the current average survival for five years is 55% to 60%. Of course, it varies with cancer types: it is good for prostate and skin melanoma, but survival rates are much lower than in many other countries for equivalent cancers across the board. On restoring performance for standards of, for instance, early diagnosis at stages 1 and 2 in 80% of cases by 2029, that is improving: it has now improved to 72.8%. Sixty days from the first referral to treatment is a standard that has not been met since 2015. For treatment in 31 days from diagnosis, the target is 96%; currently, it is not doing badly at 93%.
On expanding screening programmes and eliminating cervical cancer by 2040, the increase in HPV vaccination and self-diagnosis HPV kits is the way that the Government hope to meet that target. The current uptake of the HPV vaccine is 75.5% in girls and 70.5% in boys, with huge regional variation: for instance, in London, it is only about 64%. What plans do the Government have to improve uptake of vaccination and how will the elimination target be met? As far as the HPV kits are concerned, what happens if a woman self-tests and finds that she is HPV positive? The services need to match up to what the patient might need.
Another target is increased genetic and genomic tests. The plan suggests that there might be value in testing whole-genome sequences, the so-called polygenic risk scores aligned with the lifestyle, but they are of no value because the risk is not yet identified or valued. It is different if you are testing for inherited genetic diseases, such as if a patient has a BRCA gene, as then you might follow up with others in families. But the value of whole-genome sequences as polygenic risk scores cannot be right.
Genome testing for mutations in cancer, of course, is important for personalised treatment, and the target is for 98% in 10 days. Currently, it meets this for 68% of patients, because of the workforce issues. What might be the implications if the treatment is delayed because these tests are not reported in time? For instance, a four-week delay in treatment increases risk of death by 6% to 8%, so it is important that these tests are reported quickly. These days, without genomic mutation testing, treatment cannot be started with cancers.
Another target is to accelerate use of AI, robotics and modern imaging for early detection. It is true that in the trials carried out using the triad—it is important to use the triad of AI, robotics and modern imaging—it is quicker to obtain a tissue sample, for instance, but these have to be done together and there are costs of equipment, training and robotics.
The Government hope in the report to increase the use of robotics from 70,000 currently to half a million by 2035. Small studies show benefits, because it fuses metabolic and structural data for better staging and treatment of cancers, but the digital pathology staff remain a key workforce required for this. Can this be standardised across the whole NHS rather than in specialist units alone?
The next issue is funding. Together with staffing, funding is a critical issue. The Government have made a commitment of about £6.5 billion, rising to £15 billion depending on progress. However, estimates from the Health Foundation suggest that, to roll out AI, robotics, modern imaging and digitisation across the NHS, we will need £14.5 billion to digitise the NHS, capital infrastructure worth £5 billion, one-off implementation costs of £2.5 billion and recurring costs of £1.5 billion. Does the Minister think that this is realistic and that the Government will be prepared to fund it?
The main other issue is reducing inequalities in cancer care. We must reduce inequalities in cancer outcomes for deprived populations. The biggest challenge is in the 20% of deprived people, because there is a 60% higher death rate in this population. Late diagnosis is more common in this population, there are low treatment rates, people are more likely to have cancer diagnosed in an emergency in the A&E department and there are low screening rates. Focusing on reducing inequalities in cancer care will be key to meeting the targets set in the plan.
Who is going to do this? The suggestion is that the cancer alliances will be responsible for planning and tracking the delivery of cancer services in deprived areas with an extra £200 million in funding. Is that likely to be adequate funding, knowing that it will require new staff to man these services? I ask the Minister, therefore, what the metrics for the improvement in care of the deprived population will look like.
The developments in technology, drugs and diagnostics in healthcare and cancer care come thick and fast. Many are mentioned in the report. Some of them are not even yet validated. Treatments are very expensive. For instance, CAR T-cell immunotherapy would cost in the region of £280,000 per treatment per patient. The technology is expensive. The current percentage of people getting chemotherapy, radiotherapy, cell and gene therapy and immunotherapy in England is lower than in countries with better cancer outcomes. Implementing what works and improves outcomes for the whole of the population—early diagnosis and prompt treatment, with the workforce to deliver that—will result in better outcomes. I repeat that, knowing what we know, early diagnosis and prompt treatment will improve outcomes well before we use these technologies. They are important, but we need to do that first. Patchy introduction of state-of-the-art technology, early-phase research into the practice of untested diagnostics, science fiction and a promise of personalised nirvana tomorrow will not be the answer.
The plan is thin on the prevention of cancers apart from on tobacco control, which I applaud—and we all applaud. Treatment using GLP-1 and GLP-2 blockers for obese people is not stopping obesity; it is treating obesity, at a cost. In the plan, there is nothing about what the Government will do to reduce obesity, or on the reduction of alcohol consumption, but we know that 40% of cancers are related to lifestyle issues. Can the Minister explain why the report is so thin on prevention?
I will make a comparison to one country. Much of the cancer plan comes from learning from the Danish model. Denmark, some 25 years ago, had similarly poor outcomes for cancers. It embarked on an incremental cancer plan to the point that it is now recognised as the country with the best cancer outcomes. Its latest plan is to focus on helping people living with cancer and those in end-of-life and hospice care. I am sure that the noble Baroness, Lady Finlay, wants to know when England will get such a plan. To invest in this, Denmark is to spend 690 million Danish kroner. It does not sound like big money, although its population is small.
The key feature of the Danish plan and the better results is political consensus. The noble Earl, Lord Howe, might remember that, in a debate that we had about the long-term sustainability of the NHS, I said that the NHS’s survival depends on a political consensus. The then opposition Health Minister, the noble Lord, Lord Hunt of Kings Heath, laughed and said, “Dream on”. I guess that that is still the problem. If we do not have political consensus, we will just have more problems.
Funding was the other issue. All the five-yearly plans in Denmark were funded. Importantly, there was a promise to the people that the service would deliver early diagnosis within 14 days or less and that treatment would start within 14 days or less. The promise was that, if you did not get that, you could go to any other region in Denmark for your treatment or even another country. Would the Government make such a promise to the population of England?
The Government’s plans are ambitious, but will the Government maintain a consistent commitment to delivery no matter what it takes? Otherwise, in three to four years’ time, we will debate a new cancer plan that will be even better and world-class. However, I wish the plan well and I hope that we begin to get results quickly.
Baroness Warwick of Undercliffe (Lab)
My Lords, I thank the noble Lord, Lord Patel, for securing the debate and pay tribute to his indefatigable commitment to improving health outcomes and championing research and to his powerful and moving speech. I am pleased to have the opportunity to contribute to the debate. I know that I will not be the only speaker whose family has been touched by cancer. Seeing much-loved family members or friends suffer is the reason we can all agree that patients deserve timely diagnosis and the best possible treatment. In the past, I have spoken about pancreatic cancer and brain cancer from my own family perspective. I will focus my remarks on these and other cancers, including cancers of the liver, lungs, oesophagus and stomach, which are grouped, rather grimly, as the least-survivable cancers.
I warmly welcome the recently published national cancer plan, which has brought these rarer cancers into focus. For the first time, we have a national plan that makes specific commitments to less common cancers and I commend the Government for that. The plan aims to have three out of four people diagnosed with cancer survive five or more years by 2035, as the noble Lord, Lord Patel, pointed out. It recognises that progress for people affected by less survivable cancers is key to this aim. As the Less Survivable Cancers Taskforce notes,
“these cancers account for a disproportionate number of cancer deaths and require focused action if overall survival targets are to be met”.
Earlier detection and faster diagnosis for all forms of cancer are critical to improving people’s access to treatment and, ultimately, their chance of survival, but progress on the rarer cancers still lags behind progress on others. Survival rates for these cancers have remained largely static over the last 25 years, partly because their often vague and non-specific symptoms can make early diagnosis very difficult. Just 28% of less survivable cancers are diagnosed at stages 1 or 2, compared to 54% of all cancers. A large proportion of people with less survivable cancers are diagnosed in A&E, so the national cancer plan’s strong focus on early diagnosis is welcome.
It is an excellent and ambitious plan informed by cancer professionals, patients and their families but, as ever, it will take funding to secure real improvement and change. Like others, I am aware that this plan is launched at a time when there seem to be substantial economic growth problems and demand on public spending is being stretched in all directions. We need to be realistic about what can be done here and now. Our efforts must be focused on what will have the greatest impact. I was therefore very pleased to read last week that we are making progress in our efforts to cut set-up times for clinical trials. Approval processes in the UK have been slow and bureaucratic, so faster access to new treatments and medicines can be only a good thing. Will the Minister say more about how we can now encourage people to access clinical trials and tackle historically low patient recruitment?
We need to prioritise research, particularly into the less survivable cancers. We know that rare cancers account for some 47% of UK cancer diagnoses and some 55% of cancer deaths, yet they receive a fraction of research funding and clinical trial work. The Rare Cancers Act, passed last month, is a huge step towards addressing this imbalance, and I pay tribute to Scott Arthur MP, who saw it through its passage in the House of Commons, and my noble friend Lady Elliott of Whitburn Bay, who steered it through its final stages in this House. It will drive research innovation to improve treatments and survival for rare cancers, including brain tumours and pancreatic cancer. Can the Minister give us any encouragement on moves to appoint a national clinical lead for rare cancers, as called for in the Act and in the National Cancer Plan for England? I am very conscious of the substantial funds made available only eight years ago, following the death of our noble friend Lady Jowell. A very small proportion of that money has yet been spent, and that was eight years ago.
In finishing, I want to highlight some encouraging developments in diagnosing a cancer that currently has a UK survival rate of just over 8% and that has affected my family particularly. Innovative diagnostic tests and emerging AI technologies have real potential to help GPs triage patients with vague symptoms. For example, the VAPOR breath test for pancreatic cancer being developed at Imperial College and part funded by Pancreatic Cancer UK can detect volatile organic compounds released from tumours at an early stage. Results are showing that this quick test, which involves breathing into a bag at the GP’s surgery, can pinpoint whether a person is likely to have pancreatic cancer, with the results available to GPs in three days. This would put an end to the patient going backwards and forwards to the GP many times with non-specific symptoms and allow for earlier treatment. The test is now undergoing national clinical trials, and it could be in GP surgeries within the next five years. I end by saying: we live in hope.
Baroness Bottomley of Nettlestone (Con)
My Lords, I, too, most warmly congratulate the noble Lord on securing this debate. I always think health matters should be handled by a former president of a royal college, and it is excellent that we have another former president of a royal college with us today. This should be a criterion for joining the Lords, and we should have far more of them. I declare my interests. Many noble Lords know that I have been involved in the appointment of key leaders of eminent health and academic institutions for the past 26 years or so. I should also say that I am the mother of a gynaecologist and the grandmother of a medical student.
Cancer is one of those issues that tells us quickly and clearly whether a health system can turn scientific excellence into public benefit. The Government are right to call cancer performance a tide on which all ships rise. They are also right to say that science and innovation will be the engine of our reinvention. I thought the noble Baroness was going to talk about universities and academic research, which she would have had greater right to do.
These are not casual phrases; they are statements of national ambition and they are fully justified. England remains a country of distinguished scientific and clinical strength. We are capable of world-class discovery, trials and research leadership. The challenge now is whether that strength is translated reliably into public benefit—faster diagnosis, quicker access to treatment and more equal outcomes, as the noble Lord said, for patients across the country.
There is much in the national cancer plan that deserves genuine welcome. It is more serious than many previous strategies about research, clinical trials and innovation. It commits to research remaining
“an enabler for the lifetime of the plan”.
It promises annual progress reporting and sets out in-depth three-year reviews, which is the right direction. It also sharpens the real test before us: it is no longer simply whether England can produce excellent cancer research, which we can; the tough question is whether we are as good at adoption as we are at discovery. It is whether Ministers can show, in practical terms, who is responsible for each research priority, by when and by what measure of success they will be judged.
As noble Lords are aware, the central issue is translation. We know that this country can lead in genomics, diagnostics, cancer biology and trial design. The harder test is whether innovation travels quickly enough from the laboratory bench to the clinic, and then from the great research centres to the district hospitals and the patient, who is anxiously and often fearfully waiting. This is the point at which scientific strength either becomes public benefit or remains trapped as potential.
The Institute of Cancer Research puts this with admirable clarity. Professor Kristian Helin warns:
“Cancer research cannot succeed in isolation. It relies on a strong life sciences and higher education ecosystem, underpinned by world-class infrastructure, sustainable investment and access to the best skills and talent”.
Can the Minister say who, across government, is responsible for making sure that research, universities, immigration, infrastructure and NHS reform are pulling in the same direction? I quickly pay credit to the noble Lord, Lord Vallance, who has been the most wonderful advocate and leader in this sector. Ministers of whichever department would pay respect to his contribution.
Cancer Research UK—I pay tribute to its chair, who will have much more to say on this, or he may talk about his experience as chief executive of the NHS—makes a similar point in more practical language. Will this plan be the turning point for cancer that patients deserve? It will require much faster progress. The next step must be translating it into delivery—a telling phrase: delivery, not declaration. Have we heard it before? We have, but this time it needs to happen. When will we see the full implementation architecture behind the research and innovation elements of the plan? In plain English, when will we know where responsibility sits, what resources are attached and what would count as success or failure by the midpoint of the plan?
We have been warned before that the problem is not only strategy but consistency. I was interested in what the noble Baroness said about Denmark. Summarising research from the International Cancer Benchmarking Partnership, Professor Ellen Nolte said that
“sustained and consistent strategic planning and investment are crucial”.
That is not a throwaway line; it is one of the clearest lessons from comparative success. Countries that improved did not merely publish attractive plans. They backed them, refreshed them and stayed with them. Can the Minister assure noble Lords that this cancer plan will be treated not as a launch but as a governing discipline? What protections are there against the familiar pattern in which bold strategic language is followed by uneven implementation and fading attention?
Clinical trials are crucial, and this is where it becomes real for patients. The plan says that
“every cancer patient gets the opportunity to access relevant clinical trials quickly, fairly and easily”.
I pay tribute to my noble friend Lord O’Shaughnessy’s important review, which set out 27 recommendations and argued that the NHS should become
“the world’s leading platform for health and life sciences research”.
There has indeed been genuine progress, for which I pay tribute to the Government.
The Government report that the average set-up time for commercial, interventional, clinical trials has fallen from 169 to 122 days. That is dramatic. The latest UK clinical research delivery data shows that 71% of commercial contract CTIMPs applying between April and September 2025 recruited a first participant within 150 days. These are steps in the right direction.
The MHRA and the wider system also deserve credit. The Government say that trial applications received rose by 9% between January and November last year, compared with the previous year. Scientific advice meetings on clinical trials rose by 75%. This is real improvement and should be acknowledged, but of course speed is only one part of the story; fairness also matters. Who hears about the trial? Who lives near enough to join it? Who can manage the travel, time off work and family pressures that participation involves? Can the Minister commit to publishing participation data by geography, deprivation and ethnicity—the noble Lord made this point—so that the House can judge whether access is truly widening?
The question becomes sharper still. Cancer Research UK warns that around 90% of patients are recruited to non-commercial studies. The plan gives too little assurance that these trials will not be left behind. The ABPI’s latest report shows why that matters. The number of new industry trials initiated in the UK encouragingly rose last year.
I see that I need to speak faster. I want to say something about workforce, because the Minister has been asked very clearly about that. Obviously, it is a critical factor. I cite the Royal College of Physicians, the Society of Radiographers and many others. We need the people to make it happen. Were the Minister able to have another debate, I could give the rest of my speech.
England’s cancer challenge is less about what we can discover and more about what we can translate. We know that this requires the NHS, industry, academia and charities working together, and I believe that, with determination, we can see real progress.
Baroness Watkins of Tavistock (CB)
My Lords, I congratulate my noble friend Lord Patel on securing this important debate, to which it is a pleasure to contribute. I declare my interest as a fellow of the Royal College of Nursing, and I am delighted that I will be followed by a previous president of the same organisation—making at least three in the Room. I intend to cover elements of the themes identified in the plan on community services, the value of screening, the workforce necessary to deliver for patients and the worried well, and an emphasis on psychological support, as well as the protection of patient data and the control of its use for UK-led research and prevention of cancer.
I join others in welcoming the ambitious plan, which will require cultural change across the workforce to improve the communication between assessment, diagnostic and treatment teams, as well as the use of AI and digital information. The aim is to provide seamless delivery of care closer to patients’ homes. This, of course, should be cost effective. The plan has been described as a revolution, and it is vital that the strategy for implementation and delivery is clearly led and monitored to ensure that the change actually happens. With the emphasis on community-based care, the current workforce will, in many instances, need the opportunity to refresh and enhance its skills and knowledge for delivering care outside acute hospital settings. As many people know, I help lead some of that, closing a large mental hospital into community care. The challenge may be similar to achieve this plan—not that I am suggesting we can shut the Royal Marsden.
Clinical staff often work alone in the community, which can be challenging for staff who spent most of their careers with easy access to other multi-professional team members for support and guidance, particularly when a patient’s condition suddenly rapidly deteriorates. Staff must be confident and skilled to provide care in the community, which will call for professional development and dedicated preparation time. The King’s Fund argued that a persistent shortage of radiologists, pathologists and severely overstretched nursing teams often results in haphazard organisation and innovation, rather than planned organisational change. The cancer plan highlights some excellent examples of innovation from the Humber and North Yorkshire Cancer Alliance pilot, using nursing and pharmacy teams to introduce home-based delivery of some subcutaneous chemotherapy drugs. The Christie supportive oncology services demonstrate the value of integrated care provision, from psychology support to dietary advice and symptom management.
The issue at hand is how such innovation can be rapidly and efficiently scaled up nationwide. One patient using the Christie service said:
“The cancer treatment helped, but it was the wider support that”
the service
“gave and continue to give that had the most impact on my quality of life … The team saw me as a whole person, not just as someone with cancer”.
Yet age-standardised premature cancer mortality is twice as high in some areas of the UK than in the best performing ones. The plan acknowledges the need to increase investment in research and open clinical trials more widely, so that patients who want to do so can have the opportunity to participate. Patients from deprived areas, particularly in rural and coastal parts of the country, such as where I live, are less likely to be offered the opportunity to be in trials, as are those from Black, Asian and other ethnic minority groups, who remain underrepresented.
With NHS digital systems advancing and patients’ individual records stored in their NHS app, protecting personal data is crucial. Data should be used only for British research to drive new knowledge and enhance care. The future workforce plan aims to equip managers and clinical and support staff for effective delivery. Staff need dedicated time for training and research, particularly in fields such as nursing. This protected time would support professional growth, boost morale and help retain staff.
Action 23 states that
“every patient will have a clinical nurse specialist or other named lead to support them through diagnosis and treatment”.
As such, clinical nurse specialists will need to be more central in workforce models and must be adequately trained in psychological support for patients with long-term physical and mental health care needs, because people now live with cancer for long periods. Many people who live with cancer fear recurrence, so it is important to focus on living happily and productively for the best quality of their lives, including working, where it is feasible to do so, as the plan states.
The NHS is, rightly, free at the point of delivery for screening, diagnosis and treatment, yet there is little mention in the plan of the need to consider withdrawing some screening programmes at a certain age—for example, for breast cancer over the age of 70—because the cost benefit, many would argue, is unjustifiable. A small cohort would of course benefit, so the NHS allows an opt-in mechanism. However, that has the potential to increase health inequalities, with the worried well requesting the service, which the private and contributory healthcare systems of many other countries would not pay for as a benefit.
Withdrawal of treatment is always a difficult issue and requires delicate conversations between the patient, their family and significant others and the clinical team involved. Such withdrawal must be decided on sound guidance based on relevant research knowledge. British universities are central to cancer research, but there is very little information about their role in this plan.
It is estimated that nearly 40% of cancers are preventable by reducing tobacco and alcohol use, increasing exercise, improving diet and lowering obesity. The Government must be congratulated on the Tobacco and Vapes Bill but, as the noble Lord, Lord Patel, said, the plan makes no reference to the fact that a minimum unit price for alcohol could make inroads too.
Will the Government consider mandating protected time for continued professional development for clinical healthcare staff to support their adoption of the new technologies, the faster treatments and the vision of this plan? Can the Minister say whether screening programmes will be reviewed to ensure cost-effective investment for specific cohorts, and whether appointing a named national lead for screening innovation should be considered? In addition, can she confirm that the use of patients’ clinical records for research will be led by British universities, in partnership with the NHS, using clinical trials that recruit from the whole country, and that they will not be sold for commercial use?
Baroness Rafferty (Lab)
My Lords, it is a pleasure to follow the noble Baroness, Lady Watkins, a fellow nurse. I add my congratulations to the noble Lord, Lord Patel, on securing such a timely debate. There is a lot to commend in the National Cancer Plan for England, but, speaking as a nurse and a workforce researcher, I think that there are definitely challenges, as we have heard, to be met in ensuring that services meet the physical, psychological and social impact of cancer care.
Cancer detection rates are increasing alongside survival rates and complexities of diagnostics as well as care pathways in a population with growing co-morbidities. The national cancer plan advocates for every cancer patient to have access to a clinical nurse specialist, as we have heard. However, it is uncertain how likely it is that this will be achieved with the lack of nurse specialists currently available in the workforce, as the noble Lord, Lord Patel, highlighted.
There is strong evidence that specialist and advanced practice nurses are cost-effective and clinically effective. These highly skilled and educated nurses lead clinical services and the administration of complex chemotherapy protocols. Anyone in contact with chemotherapy services will be aware that this is nurse-led and stressful work, as the pressure is on to ensure that high volumes of patients are treated safely. Burnout rates for chemotherapy nurses remain high. Specialist and advanced practice nurses are a precious human resource that needs to be supported.
One of the challenges to accessing treatment is the availability of training and education for specialist nurses, as highlighted by the noble Baroness, Lady Watkins. According to a recent survey by the UK Oncology Nursing Society, training and education is patchy across the country. Two factors constrain the expansion of this highly skilled cancer workforce: the limited supply of supervisors to support advanced practice nurses and funded opportunities to develop their capacity. Access to training and education is essential to build the necessary confidence and competence in delivering ever more complex care. Core to these skills are expertise in advanced communication, psychological support skills, which the noble Baroness, Lady Watkins, highlighted, and symptom assessment and management.
Nurses are also integral to cancer research, especially the running of clinical trials, as the noble Baroness, Lady Bottomley, highlighted. The MRC trials infrastructure demonstrates a high reliance on research nurses for patient recruitment, and the review conducted by the noble Lord, Lord O’Shaughnessy, into commercial trials showed a worrying decline in the number of such trials conducted in the UK. This has profound implications for our standing as a life science destination and the part that that plays in our economic growth.
Oncology nurses are also researching patient outcomes and filling important gaps in the evidence base of symptom management through their research. I shall provide some examples from my experience as a supervisor of doctorates—one of my students happens to be here today, which is brilliant. One student undertook a co-design study with patients who had developed peripheral neuropathy from chemotherapy, which is a horrible side effect. She was intent on mitigating some of the further complications of this painful—terribly painful, in fact—and debilitating condition. Another is currently examining the sexual recovery of women after bladder removal for cancer. It is quite staggering that this remains largely a hidden problem yet has profound impacts on the women concerned and their partners, often traumatising women in the process. Another student pioneered a new way of measuring workload for cancer nurses. Strong evidence links patient mortality and education in acute care, so it is not inconceivable that the same principles might apply to cancer patients.
Despite the value placed on specialists and advanced practice nurses, it is worth noting that the British Medical Association has recently raised concerns about the expansion of advanced practice nurses substituting for medical roles, arguing that some employers are using them to replace doctors and that that poses a threat to patient safety. It is unclear what the specifics of this evidence might be but, based on my own and colleagues’ research, nurse autonomy poses no threat to multidisciplinary teamwork. On the contrary, it is an essential underpinning for enhanced interprofessional working between nurses and doctors.
Turning the plan into a reality requires a workforce that is supported, skilled and enabled to work differently. The Government’s forthcoming NHS long-term workforce plan refresh will be a pivotal moment to set the direction for cancer care. It must set out how nursing roles will be funded and supported to deliver the plan. Can the Minister confirm what support the Government are putting in place to enable the professional career development of cancer nurses?
Baroness Bloomfield of Hinton Waldrist (Con)
My Lords, I, too, thank the noble Lord, Lord Patel, for securing this debate and for introducing it so powerfully in his usual inimitable fashion. I declare my interests as a trustee of the Royal Marsden Cancer Charity, as a former patient and as someone married to a current patient.
We all recognise the ambition behind the National Cancer Plan for England. It sets out a vision of earlier diagnosis, faster treatment and improved survival—goals that command universal support across this House. But ambition, however welcome, is not the same as delivery, and it is on delivery that this plan invites scrutiny.
First, on early diagnosis, the plan rightly emphasises catching cancer sooner, when outcomes are far better. The new 28-day faster diagnosis standard is a meaningful step forward and the UK is improving five-year survival rates across a range of cancers, with particularly strong performance in breast and some children’s cancers. Yet the plan leans heavily on expanding screening and awareness, without adequately addressing the capacity constraints already facing primary care and diagnostic services. General practitioners are overstretched and diagnostic hubs, though welcome and promising, remain unevenly distributed. Without a credible workforce strategy, radiologists, pathologists and specialist nurses, the aspiration of earlier diagnosis risks becoming little more than a slogan.
Secondly, on children’s cancer, we have seen important advocacy, including the Solving Kids’ Cancer response to the 10-year plan, which rightly highlights that childhood cancers are biologically distinct and require tailored approaches. Yet the national plan does not fully reflect that specificity. Children’s cancer should be treated as a dedicated priority, not simply folded into a general cancer narrative. Survival rates for some paediatric cancers have improved, but progress has stalled in others, particularly rare and aggressive forms. Families still face fragmented pathways, limited access to trials and inconsistent genomic testing. If we are serious about improving outcomes, this requires dedicated investment, co-ordinated research infrastructure and guaranteed access to specialist centres and innovative therapies.
On specialist centres, the plan must not blur the distinction between general cancer care and specialist excellence. The Royal Marsden and the Institute of Cancer Research remain among the world’s leading cancer institutions, with the Marsden identified as one of the top five cancer centres globally for research impact and the country’s only specialist NIHR biomedical research centre for cancer. That matters because a serious national cancer strategy must support both broad improvement across the NHS and world-leading specialist research that drives the next generation of treatments. We should not ask our flagship centres to carry international responsibility without giving them the sustained support that they need.
Thirdly, the plan speaks of reducing waiting times and meeting treatment targets. But we must be candid: the NHS has struggled to meet its existing cancer waiting time standards for several years. Simply restating targets does not make them achievable. What is missing is a clear funded pathway to recovery, one that accounts for workforce shortages, ageing equipment and the persistent backlog exacerbated by the pandemic. Targets without tools will not deliver results.
Fourthly, as many have mentioned, there is the question of inequality. Cancer outcomes in England vary significantly by geography, socioeconomic status and ethnicity. The plan acknowledges these disparities, but its remedies remain broad and underspecified. We hear of targeted interventions and community engagement, yet there is little detail on how these resources will be shifted to the areas of greatest need or how success will be measured. Without a sharper focus and accountability, inequality risks being noted but not narrowed.
Fifthly, on innovation and infrastructure, particularly the overlooked issue of medical radioisotopes, modern cancer care increasingly depends on nuclear medicine, both for diagnostics and targeted therapies, yet the UK remains heavily reliant on international supply chains for key medical radioisotopes, which are vulnerable to disruption. A serious national cancer plan should address this strategic gap. Developing a domestic supply, whether through research, reactors, cyclotrons or alternative production methods is not merely an industrial question but a matter of clinical resilience and patient safety.
We have a plan, project ARTHUR, to site a reactor at the old Trawsfynydd site in north-west Wales, supported by the Welsh Government and the local skilled population. I urge the Minister to look seriously at this plan. Without secure access to these materials, some of the very innovations that the plan champions cannot be reliably delivered.
Sixthly, on patient experience, the plan speaks of holistic care, mental health support, rehabilitation and survivorship, and this is welcome. Maggie’s, the independent charity that I know well, helps to provide this support across the country in its 24 centres sited alongside hospitals. Yet many patients today still report fragmented care, poor communication and insufficient support after treatment ends. These are not peripheral concerns; they are central to outcomes and quality of life. A truly patient-centred plan would embed these elements as core standards, not optional extras.
Finally, on accountability, the plan sets out ambitions over the coming years, but it lacks clear milestones and transparent reporting mechanisms. Parliament and the public must be able to track progress in real time to understand not only what is promised but what is delivered. Without this, there is the risk that the plan will become another well-intentioned document that fades from view.
None of this is to dismiss the importance of having a national cancer plan. On the contrary, it is precisely because cancer care is so vital that we must hold such plans to the highest standard. We need a strategy that is not only ambitious but credible, not only comprehensive but deliverable, and not only forward-looking but grounded in the realities of today’s NHS. If this plan is to succeed, it must be strengthened with a robust workforce strategy and a serious commitment to children’s cancer; securing domestic capabilities in critical technologies, such as radioisotopes; realistic funding; targeted action on inequality; equitable access to innovation; and clear mechanisms for accountability. Without these, we risk raising expectations that cannot be met, and that is something that neither patients nor clinicians can afford. The challenge before us, as ever, is not to write plans but to make them work.
Baroness Nargund (Lab)
My Lords, I thank the noble Lord, Lord Patel, for securing this important debate and for his excellent introduction. I declare my interest as the founder and a trustee of Health Equality Foundation, a UK national charity.
I welcome the Government’s National Cancer Plan for England and pay tribute to the Secretary of State, Wes Streeting, for his moving forward. I and many others are grateful for his openness about his own cancer experience and his dedication to improving cancer outcomes. The scale of the challenge is clear: cancer is the biggest killer in our country. The UK ranked 26th out of 36 developed countries in cancer mortality rates in 2021. The latest NHS digital data shows lower survival rates in the most deprived areas. As such, I applaud the Secretary of State’s unapologetically bold plan. Such determination is needed.
The last Labour Government’s introduction of the two-week referral pathway in 1999 was a landmark moment. It is encouraging to see the Government building on that legacy, with a goal of saving 320,000 more lives by 2035. I speak with over 40 years’ experience in the health service and 30 years’ experience as a consultant gynaecologist at St George’s Hospital. I served as a junior doctor on medical oncology wards, and I have close friends and family who have faced cancer.
I shall focus specifically on gynaecological cancers and the inequalities that run from incidence to outcomes. Gynaecological cancers affect more than 22,000 women each year in the UK. Around 60 women get a diagnosis every single day. Ovarian cancer alone causes more deaths than the other four gynaecological cancers combined, yet only about one-third of cases are diagnosed early, according to Ovarian Cancer Action. The inequalities are glaring. Research from Target Ovarian Cancer found that Black, Asian, minority and ethnic women wait, on average, six days longer than white women to begin treatment after their referral for ovarian cancer.
Uterine cancer, the fourth most common cancer in the UK for women, shows higher incidence rates among Black women. Data from Cancer Research UK shows the impact of socioeconomic deprivation on cancer rates: mortality from cervical and uterine cancers is 61% higher in the most deprived communities, while vaginal cancer has one of the steepest deprivation gradients, with 88% higher incidence in the most deprived areas of our country.
To improve outcomes and tackle deep-rooted inequalities, I shall raise areas where ambition must be matched by delivery. On screening and innovation, the ambition to eliminate cervical cancer by 2040 is world leading, and I welcome the rollout of HPV self-sampling. However, for other gynaecological cancers, our early-detection tools remain inadequate. The UK Collaborative Trial of Ovarian Cancer Screening with the protein biomarker CA125 and ultrasound scans demonstrated that detecting more early-stage disease did not translate into fewer deaths. On the other hand, cell-free DNA screening for ovarian cancer is emerging as the most promising screening tool for the general population. Investment in this area, and in biomarker research, early detection algorithms and clinical trials should be encouraged. As the renewed women’s health strategy highlights, femtech has a role to play, but it must be clinically evaluated with peer-reviewed research and linked to NHS pathways to reach all women, not just those with the means to seek it out.
On HPV vaccination, when misinformation reduced uptake in Ireland, disadvantaged schools were hit hardest and recovered slowest, according to a report in Vaccine. Having led a British Red Cross vaccine campaign for ethnic minorities in our country, I know that communities place their trust in friends, families and local organisations. Will the Minister ensure that the Department of Health and Social Care works closely with the voluntary sector and local government to counter misinformation in underserved communities?
On clinical research, a Target Ovarian Cancer survey found that only 23% of women with gynaecological cancer were asked about joining a clinical trial, despite 60% wanting to. I applaud the plan’s commitment to accessible trials, but access must not be determined by postcode. As the King’s Fund has highlighted, this requires the expansion of trial workforce capacity across the country. Will the Minister confirm how the Government intend to ensure that capacity keeps pace, particularly in deprived areas?
Finally, on community diagnostic centres, I welcome the £2.3 billion investment in diagnostics in the community and the commitment to post-menopausal bleeding clinics. We need genuine one-stop diagnostic facilities in community centres. By repurposing the existing resources from secondary care to communities and using the single purchasing power of the NHS to procure ultrasound machines and other testing facilities, this could be achieved in the community. Will the Minister confirm that community diagnostic clinics will be implemented as genuine one-stop shops for gynaecological cancer diagnosis, with particular attention to deprived communities in our country?
The Government’s ambition that three in four people survive cancer by 2035 is one that I support whole- heartedly, but it must reach every woman in our country—those in deprived communities, those from ethnic minority backgrounds and those with the gynaecological cancers that have been underfunded for far too long.
This plan can be the turning point to bridging the gender health gap and addressing inequalities in access and outcomes for the biggest killer in healthcare. I fully endorse the national cancer plan and look forward to its implementation.
Lord Kakkar (CB)
My Lords, I join other noble Lords in congratulating and thanking my noble friend Lord Patel for having secured this important debate and having introduced it, as he always does, in such a thoughtful and sensitive fashion. In so doing, I remind noble Lords of my own interests as the chairman of King’s Health Partners and of the King’s Fund.
I start by congratulating, through the Minister, His Majesty’s Government for having established such a thoughtful, comprehensive and forward-looking national cancer plan, and for having described a substantial ambition extending, as we have heard, over 10 years. It covers so much of what is essential in ensuring that we have a joined-up strategy that can potentially achieve the impact and ambition so rightly described.
In its initial description, the ambition covers the problem that we currently face: we experience, as a nation, untimely delays in diagnosis, access to imaging and access to a proper histopathological evaluation of biopsy samples; and an inability, therefore, to apply advanced diagnostic and characterisation techniques to targeting therapeutic intervention in an increasingly precise fashion. There are delays in establishing treatment for patients and in ensuring that patients are able to participate in clinical trials. We have done little of what needs to be done to drive a proper national programme for prevention in the area of cancer. It is of course vital, and there is a necessity—because, actually, we are making substantial progress and we must not be too gloomy—to start focusing on survivorship and how we are able to help patients beyond that initial therapeutic intervention when they are potentially not cured and have to continue to live with their cancer.
As we have heard, it is also very clear that previous Administrations have made substantial efforts to secure improved clinical outcomes for patients with cancer. Much of that innovative and imaginative approach to improving clinical outcomes in cancer has happened at a time in our national history when the NHS has benefitted, as have many other public services, from the so-called peace dividend—the period since the end of the Cold War. In 1990-91, NHS spending was some 4% of GDP, and in the year 2023-24, it was some 8%: a near doubling from £1 in every £25 of public expenditure some 30-odd years ago to £1 in every £12 of public expenditure.
That was a period of substantial plenty, when strategies and plans were presented but, regrettably, did not achieve absolutely what was intended and expected. As a result, this new cancer plan now lands at a time when our fiscal situation in the country, with the demands for increased defence expenditure, makes it highly unlikely that the substantial increases in public funding that have previously been devoted to healthcare will be available in the future.
It is therefore right that in this Grand Committee debate so many noble Lords have identified the question of how this plan will be implemented. What are the potential restrictions, not only financial but organisational and structural, that are likely, regrettably, to ensure that much of this great ambition that is absolutely necessary for the future health and well-being of our fellow citizens will not come to pass?
In this respect, it is very important, as we heard from the noble Lord, Lord Patel, to look at examples from other national experiences. The International Cancer Benchmarking Partnership has looked at these questions. As we have heard, the jurisdiction of Denmark represents an important example of what can be achieved: the clear lesson is that there has been consistency after a national cancer plan was adopted. That consistency manifests itself over many decades in political consensus. At a time when there was substantial opportunity for various Administrations to make further and increasing commitments to healthcare expenditure, it was possible that our country could live without consensus about the long-term delivery of health strategies, but we are no longer in that luxurious position.
I would therefore be interested to hear from the Minister how, in taking forward this impressive plan, His Majesty’s Government propose to achieve the substantial consensus—not only political but professional and, more generally, among the general public—that will see this strategy live through its 10 years, modified if it requires modification, but without wholesale dismissal. Those who deliver have to be in a position to do so with some certainty.
Secondly, in the circumstance we find ourselves with the economy and our fiscal constraint, how do His Majesty’s Government propose to find the substantial additional investment that is inevitably required when one looks at the ambition of this plan? As we have heard from other noble Lords, there are so many areas that we would all support, but each will require substantial investment—beyond the investment that is already made in delivering the day-to-day care that is required for cancer patients today and the increasing demands on that care through the adoption of already available innovation—to be provided at scale and pace across the entire country. Therefore, we need clarity about the approach to funding, the approach that will be taken in the Department of Health and Social Care now that it has incorporated the functions of NHS England back into the department and the approach that will be taken to prioritise funding on cancer over other priorities that will inevitably be identified for other disciplines and for the management of other clinical conditions.
Finally, so much of what is described in this impressive plan is predicated on the basis of ensuring that research is no longer an adjunct to the delivery of cancer care, but central to it. One of the points that we have heard, which is absolutely correct, is about accelerating the opportunity for clinical trials. We know that patients managed on clinical trial protocols, or in the clinical environment where they can access clinical trial protocols, have improved clinical outcomes. There is a need to drive broader equity in access to those clinical trials.
In addition, it will be vital to ensure that there is consensus on the use of data. Data will be critical to drive the innovation agenda and the implementation agenda. Can the Minister give a view on the approach of His Majesty’s Government to ensure that there is broad societal consensus on the use of data, on a routine and regular basis, to achieve so much of this ambition?
Lord Drayson (Lab)
My Lords, it is a privilege to follow the noble Lord, Lord Kakkar, and to contribute to this debate on the National Cancer Plan. I thank my colleague on the Science and Technology Committee, the noble Lord, Lord Patel. I draw the Committee’s attention to my declared interests in the register, and also my 30 years’ experience as a life sciences entrepreneur, covering vaccines, medical devices and, most recently, AI.
The Government’s National Cancer Plan is to be welcomed, as it sets out the ambition for earlier diagnosis, faster access to treatment and more personalised care. However, it does this at a time when the UK’s economic circumstances make the ability to fund this ambition challenging, to say the least. There is a growing appreciation, as a number of noble Lords have already mentioned, that the nation’s health is linked to the nation’s wealth, and cancer survival rates provide a potent measure of both. Increasingly, the public are aware that, as our economy stagnates, our ability to fund the most advanced and effective treatments declines. The rationing of drugs and treatment in hospital corridors are as much a symbol of our failure to create the wealth needed to fund a first-class healthcare system as they are a symbol of dysfunction within the NHS system itself.
The National Cancer Plan is comprehensive in its description of the importance of embracing the potential of modern life sciences, across genomics, AI and robotics, to name just a few. The plan is heavy on aspirational actions, such as:
“Action 3. We will harness AI to speed up lung cancer diagnosis”.
But it is light on details of implementation.
In my opinion, the UK does not have an innovation problem in cancer care, and the plan describes many terrific examples of such innovation in islands of improvement across the country. We have a world-class life sciences industry, but it increasingly struggles to scale. So often, the impact of new technologies such as AI and genomic medicine depends not on scientific potential but on how quickly they are adopted across the NHS as a whole and then embedded into the routine care of patients. Time and again, we make the discoveries but then do not have the will or the money to adopt and benefit from them. So our life science innovators drift abroad or get acquired, and the innovation that should improve patient care and help fund our NHS is lost.
My eldest daughter, hearing that I was giving this speech today, happened to visit the Science Museum yesterday. She is currently doing a post-doc studying the effect of radiation treatments on the brain. She was struck in the current exhibition in the Science Museum by how many innovations UK science has delivered to the world, but how few of them have led to the industrial capacity that generates the wealth to help fund our NHS.
Poor procurement of technology by the NHS is at the heart of the problem. It is a balkanised and fragmented process across the trusts and other groups involved in procurement at both national and local level. It lacks a joined-up approach based on evidence, and it lacks a clear, long-term strategy for procurement that aligns health outcomes with the nation’s economic growth.
There is a shortage of expertise in the NHS in technology adoption and management, in particular of AI, and an overreliance on very expensive management consultants that charge huge fees. Failures in NHS procurement not only undermine the quality of care and waste taxpayers’ money but create a barrier to businesses and investors wishing to invest in UK life sciences. Life is particularly hard for small companies. The unwillingness of NHS trusts to accept evidence from other trusts means that companies spend ages repeatedly doing pilots across multiple trusts, never getting to a critical mass of business in the UK market.
The fact is that the NHS determines the fate of our UK life sciences industry, an industry in which we have had a great track record of science innovation but now lack scale. Just look at the life sciences sector that was listed on the London Stock Exchange 20 years ago compared with the list now. It is a pale shadow of its former self.
Much is said in the cancer plan about how artificial intelligence will have an enormous impact on cancer detection and the discovery of new cancer medicines. However, if the UK does not develop the onshore expertise to create software systems aligned with the values of our NHS and our society, the NHS will have no choice but to continue to buy systems that, like Palantir’s, are closed, cause vendor lock-in and lead to wealth being created elsewhere. We will then continue to import the biases that were embedded in those systems when their AI algorithms were trained on the US healthcare system. Our NHS will become less fair and less aligned with the values of our society, and the wealth created by the AI wave will accrue overseas.
We must scale the innovations in cancer treatment that we know work, ensuring that our pension money is invested at home in innovative British companies that can supply them, and we must invest in the infrastructure needed to support the adoption of these innovations. Only then will we enable our NHS to deliver the high-quality cancer care that people want and help create the wealth needed to pay for it.
Lord Taylor of Warwick (Non-Afl)
My Lords, I also thank the noble Lord, Lord Patel, for securing this timely debate. One of the lessons of history is that, so often, we fail to learn the lessons of history. I say this particularly in relation to prostate cancer. It is the most diagnosed cancer in men aged over 45 in England. There are higher risks of prostate cancer linked to ageing, black men and family history. Early diagnosis is critical. Survival is nearly 100% when detected early, but it drops to around 50% at stage 4. Yet one in five men—that is 10,000 annually—is still diagnosed too late. Despite these earlier warning signs, there is still no UK-wide screening programme for prostate cancer.
This is a cancer that affects men from every social and professional class. Some of the most well-known names in the world have spoken of their prostate cancer diagnosis. Some of them are still with us; others are not. They include Robert De Niro, Warren Buffett, Colin Powell and Nelson Mandela. Closer to home, this cancer has affected Ian McKellen, Stephen Fry, Rod Stewart, Andrew and Julian Lloyd Webber, and, another knight of the realm, Chris Hoy. I mention these names because the fact that these famous men have been prepared to discuss their personal diagnosis has helped expose the need for more active screening.
Although prostate cancer is the most frequently diagnosed cancer among men in 112 nations, the testing procedures vary greatly from country to country. For example, some nations, such as Sweden, have trialled organised screening programmes involving PSA—prostate-specific antigen blood tests—and subsequent MRI, or magnetic resonance imaging, tests for men of a certain age. But America and Australia have elective individual decision-making approaches. My first question to the Minister is: what analysis of other nations’ prostate cancer treatment strategies are the Government carrying out? Have they come to any conclusions about the way forward for the United Kingdom? Organisations such as Prostate Cancer UK, Prostate Cancer Research and the British Association of Urological Surgeons all support the introduction of a screening programme. The Telegraph has been campaigning in recent months for men with the highest risk of the disease to be offered a test.
According to Prostate Cancer Research and Deloitte, targeted screening is not only life-saving but cost-effective. Their modelling shows that it could deliver a £14,000 net socioeconomic benefit for every high-risk man diagnosed. Bearing in mind the reluctance of some men to submit themselves to rectal examinations, what assessment have the Government made of the BARCODE 1 study on the early detection of prostate cancer using saliva samples to identify high-risk patients? I am pleased that the UK National Screening Committee has now recommended national screening for men aged 45 to 61 with certain confirmed gene mutations, but when will it next be considering whether to extend this to other men at risk of prostate cancer?
As for cancer more generally, NHS England has advised caution when making comparisons between historic and latest available data on cancer. This is because cancer registrations in England can take up to five years after the end of a given calendar year to reach 100% completeness due to continuing late registrations. If we cannot get the data right, how can we have confidence in the information being provided? Additionally, diagnoses of cancer are registered for each separate cancer, so this means that a person diagnosed with more than one type of cancer would appear more than once in the total data. As the noble Lord, Lord Kakkar, said, data is vital. I am a vice-chairman of the All-Party Parliamentary Group on Artificial Intelligence. Can the Minister indicate what plans there are to improve medical data collection, because this is key, perhaps by using more AI technology? Also, what plans do the Government have to invest more in AI and robotics to help spot cancers earlier and increase access to innovative cancer treatments as soon as they become available?
Regarding international comparisons, the UK has lagged behind other countries on mortality rates. According to the Organisation for Economic Co-operation and Development—OECD—data on deaths from cancer in developed countries showed that we presently rank 26th out of 36 countries for cancer mortality rates. It is against that background that I welcome the Government’s publication on 4 February of this year of their 10-year National Cancer Plan for England, but I note that some cancer and public health academics have been critical. For example, the London School of Hygiene and Tropical Medicine has raised concerns with the plan’s delivery model, arguing that it lacks clarity on what additional resources and leadership capacity would be required to achieve its ambitious goals.
A relevant issue is the Terminally Ill Adults (End of Life) Bill. An important factor in end-of-life management is palliative care and pain relief, yet in the UK some independent hospices rely on charity to fund up to 70% of their costs. The quality of palliative care is very much a postcode lottery. Will the Government consider putting more funding into palliative care?
The good thing is that, on average, we are all living longer, but our life should be measured on its quality, not only on its length. So much of cancer care depends on the power of the purse, but we also need more emphasis on prevention and early detection. As the saying goes, cancer can be a dark place to be in, but we can bring light.
Baroness Redfern (Con)
My Lords, it is a privilege to have the opportunity to contribute to this important debate regarding improving cancer outcomes and diagnostic care and research. I congratulate the noble Lord, Lord Patel, on securing it.
I shall first concentrate on the importance of early diagnosis, which, as we are all aware, can and does improve cancer outcomes. I note that in the 12 months to September 2025, early diagnosis rates were 3.5 percentage points above the pre-pandemic level, equating to around 10,000 more people being diagnosed at stages 1 and 2.
I also welcome the commitment to reducing the significant number of rare and less survivable cancers that are diagnosed in an emergency setting. I specifically mention children and young people whose cancers are often more aggressive and faster growing, and which require specialist intervention to ensure that the right treatment is given at the right time in the right place.
When patients receive a cancer diagnosis, everything is fluid and seems uncontrollable. They are desperate for treatment to begin but, all too often, patients living in rural and coastal communities have longer waiting times for a preliminarily diagnosis. As research shows, for some cancers, a four-week delay in starting treatment increases the risk of death by 10%.
All sides of this Room desperately want to see clear improvements in cancer survival and outcomes, so this plan has to demonstrate commitment to a detailed trajectory for improvement against real-time scale settings.
I will also focus on radiotherapy. I very much welcome more diagnostic centres with more community diagnostic centres being opened on evenings and weekends, and investments in 28 cutting-edge radiotherapy machines engaging in a more fluid process. But the crux of the matter is that we urgently need many more radiographers. This would make it easier for radiotherapy centres to use cutting-edge, stereotactic ablative radiotherapy, which is crucial to so many patients. An end of radiotherapy deserts is what we all want to see.
The national figure for access to radiotherapy is 53%, which does not seem particularly high in itself. However, compare this figure to that in my area, Yorkshire and the Humber region: it is 35%, which cannot be fair. Improved data transparency on the quality of care and performance of trusts’ cancer outcomes should not be dependent on someone’s location in the country, so much more work is required to bring postcode lotteries to an end.
Targets in the plan are also welcomed but, if they are to be met, there is a need for workforce expansion, especially in radiology and clinical nurse specialists. The radiotherapy workforce stands at approximately 6,400, with a 15% vacancy rate for clinical oncologists and a 10% vacancy rate for therapeutic radiographers and healthcare science workers. We also need improved training and pathways into oncology and radiotherapy specifically.
The withdrawal of the previously agreed £15.5 million to support the implementation of AI auto-contouring across England was a damaging blow to progress in radiotherapy, as this software can reduce the planning process, saving consultants lots of precious time. It is estimated that there are at least 22 machines currently operational past the 10-year recommended lifespan and, by the end of 2026, that increases by an additional 27, so the need for a rolling programme of machine replacement is very clear. It is urgently required.
Finally, more outlining of operational details and milestones is required to deliver these cancer ambitions. As many others do, I look forward to future early diagnosis in this field, which will fundamentally improve outcomes for all cancer patients, wherever they live. I look forward to the Minister’s response.
Baroness Finlay of Llandaff (CB)
My Lords, like others I am most grateful to my noble friend Lord Patel for securing this debate today, which is acute myeloid leukaemia day—so it seems very appropriate. I declare my interests as a professor of palliative medicine at Cardiff University and am employed at Velindre cancer centre, as well as my vice-president roles with various hospices, particularly City Hospice, Marie Curie and Hospice UK. I also declare my position with Cicely Saunders International, because its research in palliative care is the main research point not only for the UK but across the world. My other declaration must be as chair of the Bevan Commission in Wales, because I am mentoring one of our fellows on a project on early diagnosis of post-menopausal bleeding.
I will take a slightly historic view on this. The Calman-Hine report came out in 1995; it was the first report on cancer services and set out a cancer plan to take things forward. The current cancer plan reflects the importance of having vision and ambition because, without that, things will not change. One has to set a path forwards, and the Calman-Hine report did. It changed the organisation and structure of cancer services at the time, started multidisciplinary team working, and created centres and units.
That report was also the first time that palliative care was recognised as an integral component of cancer services from the time of diagnosis through all stages, not only in end-of-life care. It tried to set uniform standards and ensure a holistic approach, with early intervention that recognised the physical, psychological and social support needed by people from the time of diagnosis onwards. There is evidence in oncology that, usually within eight to 12 weeks of diagnosis, if palliative care services are available in parallel with the cancer services, there are improvements in quality of life and mood, patient and caregiver satisfaction, and cancer survival overall.
Unfortunately, though, the NICE guidance recommendations on 24/7 access to specialist palliative care services have not been fully implemented, neither those from 2004 nor from 2011. So will this plan integrate with the palliative care plan and strategy that we anticipate will come forward in the autumn? Without that integration, we will not meet patient need. It has already been said that two-thirds of hospice funding is from the charitable sector, yet Marie Curie estimates that about a third of people dying have unmet palliative care needs. It has been estimated that up to 90% of people dying in hospital without any specialist palliative care support available have their needs unmet.
Frailty, of course, makes everything worse in cancer treatment, from diagnosis right through to outcomes. As has been said by the noble Baroness, Lady Nargund, and the noble Lord, Lord Patel, for the ethnic minorities there is poorer access to everything, including palliative care. There is poorer access to emergency palliative care in both deprived areas and rural areas.
Where financial data is available, it has been shown by Peter May and colleagues from Hull York that, in England in 2022, specialist palliative care supported over 20,000 patients to leave hospital and have their care outside it. They calculated that, overall, this input from specialist palliative care saved £800 million, with a saving of 1.5 million hospital bed days. That is not insignificant at all. For each patient with home specialist palliative care involved, there was a saving of almost £8,000, with quality-adjusted life years also improved. For hospital patients, it was not quite as much: it was £6,500 in cost savings, but with that same improvement in quality of life.
One of the problems has already been alluded to: although the faster diagnostic standard had been met, the delays from the decision to treat, and indeed from referral to start treating, has meant that targets have not been met to date. Almost half of young people later diagnosed with cancer attend three or more GP appointments before receiving a referral to cancer services for diagnosis, meaning that teenagers have the longest time to diagnosis, with 67% diagnosed as an emergency. This puts huge pressure on parents in particular, who have to provide emotional support and take time off from work, and it of course has an enormous financial drain on the whole family.
At this point, I point out that some of these young people have very rare tumours. If we look at ocular melanoma, which is a very rare tumour, there is a subgroup of patients who will respond extremely well to some treatments that are not yet NICE-approved and not available on the NHS, even though they have been used and developed for over 20 years. Therefore, families—here I declare an interest as having a family member involved—are having to support their treatment, because the dramatic response means that they are living, rather than having already died, leaving young families.
As well as putting pressure on NICE to review the way it looks at the management of some rare cancers, will the Minister also look at the workforce training needs? Sadly, there is evidence that, even though over 90% of those dying will have some palliative care needs at some level—which is often adequately provided by generalist services when they have back-up from specialist services—the electronic staff record of nursing staff in the community shows that only a small number have actually had palliative care and end-of-life role training. The problem is that this means that about 78%—over three-quarters—of home care workers report insufficient training in pain management or anticipatory prescribing, while two-thirds have never received formal training and do not have access to palliative care services during their shifts out of hours.
There is much to be done, but much that can be improved. I hope that this plan will move us forward with better integration. The evidence shows that where we have better integration of services, it costs less and the clinical outcomes are improved.
Baroness Ramsey of Wall Heath (Lab)
My Lords, I too congratulate the noble Lord, Lord Patel, on securing this important debate. I declare my interest as a member of the General Medical Council.
Like many other noble Lords, my interest in this very important subject is personal. My father and older sister both died of lung cancer. My father became addicted to smoking back in the days when tobacco companies pretended that the products they were selling were not killers. By the time he showed symptoms, it was too late to operate on him, even though he was otherwise very fit and healthy. He died at the age of 66, only one year into his retirement. I was pregnant with my firstborn, so he never got to meet his grandchildren. I have spoken about my sister before in the House. She had profound and multiple learning and physical disabilities and lived for years in an NHS mental hospital, before she went into the community, where staff and patients were smoking everywhere. She may well have been a victim of passive smoking.
Given this background, noble Lords can see why I very much welcome today’s debate and the Government’s national care plan. My interest is also a professional one: I have had a nearly 20-year career as a non-executive in various NHS organisations in local, regional and national roles, including as chair of the Lambeth Primary Care Trust and Addenbrooke’s Hospital in Cambridge, plus being on the board of UCLH in London.
I remember well the previous Labour Government’s efforts to tackle cancer. I became the chair of Lambeth Primary Care Trust during the period of the 2000 plan, which introduced national targets to speed up treatment: no more than a two-week wait from GP referral to diagnosis and no more than a month from diagnosis to treatment. Great progress was made. In 2005, even the always sceptical National Audit Office reported that:
“Substantial progress has been made in implementing the NHS Cancer Plan, with many targets in the Plan met … This should contribute to the downward trend in cancer mortality rates and continue to bring significant benefits to patients”.
That Labour Government were surely right to start with speeding up treatment. Once you know that someone may well have cancer, time is of the essence.
However, we all know that this is only one leg of a three-legged stool, with early diagnosis and prevention completing the set. Prevention of lung cancer is, of course, why the Tobacco and Vapes Bill, steered through the House so effectively by the Minister, is such an important piece of legislation. I have been hugely proud to support it, and I have spoken about it in this Room, as I know many others here have. It is too late for my father and sister, but it will save the lives of thousands of others. Early diagnosis of lung cancer is a key and enormously welcome commitment in this Labour Government’s new cancer plan.
It is not before time. It is shocking to learn that early diagnosis rates were flat for the best part of the past decade. It is little wonder that the Cancer Survival Group at the London School of Hygiene & Tropical Medicine reported last year that,
“the speed of improvement in the survival index for all cancers combined has slowed – it increased nearly three times faster in the early 2000s than in the early 2010s”,
placing us 21st out of 28 European countries when it comes to five-year lung cancer survival rates, for example.
However, early diagnosis rates have increased significantly in the past few years, and successful implementation of the National Cancer Plan for England will enable us to build on this welcome improvement, particularly when it comes to lung cancer. As the plan points out, lung cancer screening is already proving transformational. Critically, three-quarters of patients whose lung cancer has been diagnosed as a result of screening are at stage 1 or two, in contrast to fewer than one-third of those diagnosed outside the programme. That programme would probably have saved my father’s life. The most encouraging news is that it is tackling inequality too, as screening can be targeted to where it most needed. This is why the plan is able to point out that the use of lung cancer screening has helped to reduce the overall gap in cancer early diagnosis between the richest and poorest areas by one-quarter.
I am delighted to hear the commitment to complete the rollout of lung cancer screening within the next four years, meaning that
“meaning every eligible person in England will have received their first invitation for a check”
by 2030, with the intention that at least 23 cancers will be diagnosed earlier by 2035, potentially saving thousands of lives, and that,
“because smoking is a risk factor for other cancers, trials are under way to check whether ‘moving the scanner down’ may be a cost-effective way to look for other cancers when people are receiving lung cancer scans”.
Of course, writing these commitments down does not make them happen. Delivery is a hugely complex task, as others have referred to, requiring the hard work and commitment of huge numbers of dedicated people and the resources they need to succeed. Labour delivered well on its last cancer plan, and I very much look forward to it doing so again this time around.
Lord Stevens of Birmingham (CB)
My Lords, I pile on to the congratulations to the noble Lord, Lord Patel, on this fantastic session. Given the excellence of the contributions that we have already heard, I will just draw out a small number of things. I will try not to be duplicative of the brilliant contributions that the Committee has heard.
I declare my interests as chair of Cancer Research UK and chair of King’s College London’s council. Cancer Research UK has a proud tradition of supporting research in the UK as well as internationally. Some eight out of 10 medicines that NHS cancer patients use were either developed by or with Cancer Research UK. CRUK has pointed out that we are indeed the beneficiaries of that research. We have seen a 29% reduction in the death rate from cancer since 1989. The Government’s very welcome new NHS cancer plan points out that five-year survival rates increased from about 50% to 60% between 2008 and 2022. Your chances of dying from cancer on an age-adjusted basis are lower now than they were five years ago, 10 years ago or 15 years ago, but for all the reasons we have heard, there are no grounds for complacency. There is an enormous opportunity in front of us, and the cancer plan is right to set that out.
As other noble Lords have pointed out, in order for it to succeed it must meet two signature commitments: that three-quarters of people get diagnosed at stage 1 or 2 by 2035 and, linked to that, the expectation that three-quarters of people will survive five years as a consequence. That makes complete sense, but we should reflect on what have been the barriers to achieving that up to now, so that we get it right over the next decade.
There is a caveat: we need to be careful that we do not just increase the proportion of stage 1 or 2 diagnoses by detecting a lot of what would otherwise have been indolent cancers that would not have gone on to cause people problems. That has got to be matched by seeing an age-standardised reduction in the number of people diagnosed at stage 3 or 4, so we really are clear that we are getting stage shift and not just expanding into a wider group for whom the diagnosis would not necessarily have been a problem.
That is significant, because our understanding of cancer biology continues to evolve. The standard assumption that individual mutations at cellular level grow, spread and develop into advanced disease or systemic diseases such as cachexia turns out to be not quite right. My colleague Professor Charlie Swanton at the Francis Crick Institute has pointed out, for example, that a typical 60 year-old will probably have 100 billion cells in their body with some form of cancer mutation. So, in a sense, the question is, why is cancer not more common, given that underlying fact?
Continuing to invest in research to understand the tumour microenvironment and the way in which oncogenes and suppressor mechanisms interact and cancer spreads is what we are going to have to achieve if we are going to make the progress needed to get to the 75% target. That cannot be achieved just by sweating the NHS assets, as it were. For important conditions—the glioblastomas, pancreatic cancers and ovarian and oesophageal cancers—we need to continue to shift the frontier of research in order to produce those benefits.
The research and life sciences environment in this country continues to be hugely important. We are a bit of an outlier as a country in that of our non-commercial cancer research, two-thirds is funded by charities and slightly less than one-third by government. That is a lower proportion than for other major conditions and a lower proportion than is seen in other countries. So it is vital that we think about the entire research infrastructure and, as the noble Baroness, Lady Bottomley, briefly alluded to, we cannot be blind to the pressures on our brilliant British universities, which have done so much. However, in order to sustain that, we are going to have to, through the broader set of approaches that the Government take, make sure that they have the resourcing to do that.
We are not going to get to the goals in the new cancer plan without further progress on some of the cancers of unmet need through the research enterprise, but it is also the case that there are several things inside the NHS that have got to work, and I suspect that my colleague the noble Baroness, Lady Gerada, will shortly talk about the pressures on primary care, given that that represents the first point of contact for most cancer patients.
It is the case, of course, that, whereas the share of NHS resources going on primary medical care increased between 2015 and 2020, it has since fallen back. I am anticipating that the Minister may say that the Government do not think that spending-share targets are a good way of measuring these things: that is certainly their position on mental health, although it appears not to be their position when it comes to pharmaceutical spending, where there is a novel commitment that we will spend an extra 0.3% of GDP on our medicines pricing, linked to the deal done with the Trump Administration. Nevertheless, for primary care and mental health, apparently that logic does not apply.
We will want to really understand how we make the primary care element of the NHS robust over the coming 10 years. We want to understand the referral thresholds. The reality is that about 22% of cancers are diagnosed in patients from a GP referral on a non-cancer referral pathway, not the urgent suspected cancer pathway, so we need to make sure that the new GP contract, which incentivises a 25% reduction in referrals, is not cutting across the referrals that we need to detect cancer early, including in the specialities that are covered by the scheme—gastroenterology, gynaecology and urology. The NICE referral pathway, NG12, needs a refresh to make sure that people are getting referred appropriately and that the filtration is not artificially stopping people from getting checked up as they should be.
The Government are to be commended on the expansion of the community diagnostic centres—that is an excellent model, and we need more of them. There is capex and other support to do it. That is good. The lung health check programme, to which the noble Baroness, Lady Ramsey, referred, has been a brilliant success. The long-term plan in 2019 gave us the rollout for that. More than 2.5 million people have been invited. As she said, it has produced the extraordinary result that 76% of people getting a lung cancer diagnosis through that lung health check do so at stage 1 or stage 2. That is the kind of stage shift we are looking for overall, achieved through that novel programme. As she also rightly said, it has, unlike most other screening programmes, produced another extraordinary result: poorer people are more likely to get an early diagnosis through that screening programme than better-off people. That is a direct impact on health inequalities that we do not see elsewhere.
Those kinds of models are hugely important. We need to see continued innovation in that area. If we pull all these pieces together—the resourcing, continued research and the focus on what has and has not worked in the NHS—I see no reason why we cannot continue to make really significant progress on cancer over the decade ahead.
Baroness Paul of Shepherd’s Bush (Lab)
My Lords, like many before me, I thank my noble friend Lord Patel for securing this debate and other noble Lords for the excellent contributions that have been made so far. I beg your Lordships’ indulgence—my comments are of a more personal nature than some of the others we have heard. I hope that noble Lords will accept that. The themes and targets in the cancer plan are among the many things I will touch on in my more personal remarks.
I want to focus on clinical trials, one of the great engines of medical progress. They underpin the medicines that extend lives, relieve suffering, and in many cases deliver cures that would have been unthinkable a generation ago. They also support the UK’s ambition to be a global leader in clinical research and can be an engine for much-needed economic growth in our country.
But today I draw attention to a group of patients for whom the current clinical trial system does not really work properly: those who are diagnosed with life-limiting conditions and for whom time is short. I know that rare cancers are for the first time mentioned in the cancer plan. I also know that there is a significant commitment to clinical trials. I want to make certain that those who have rare cancers that are diagnosed late have access to those clinical trials. For those individuals, time is not abstract—it is measured in months, not years—and it is about the quality of life, not just the length of it. Our trial infrastructure is not really built for that reality. Normally, you have to fail standard treatments and then navigate complex rules in order to participate in any of the trials.
As I speak today, I remember our much-missed colleague Baroness Margaret McDonagh. She was my great friend, and watching her die from glioblastoma, a rare and devastatingly aggressive cancer, brought home to me the reality of what a rapidly progressing, life-limiting illness can be. It exposed the gap between the urgency faced by patients and their families and the pace at which our systems operate.
The brutal truth is that a patient diagnosed with glioblastoma today will, in almost all cases, be offered the same treatment, delivering the same average expectancy of nine months, as they were offered 40 years ago. That stasis cannot be explained by lack of scientific promise, because we have seen extraordinary advances in medicines, diagnostics and data in that time. Yet far too few of the solutions reach patients with the most aggressive and rare cancers.
Since Margaret’s death, her sister Siobhain McDonagh and her outstanding clinician, Dr Paul Mulholland, based in UCLH, have worked tirelessly to improve outcomes for glioblastoma patients, raising funds for trials when the NHS has not been able to pay for them, championing research and repeatedly confronting the many barriers that stand in the way of progress. Their experience shows a culture stacked against urgency and innovation, with long lead-in times for decisions, inertia, caution and conservatism in the system, slow processes and obstacles that deter clinicians from pushing the frontier of treatment and offering patients new and innovative treatments.
Dr Mulholland has been running immunotherapy trials using medicines that have transformed outcomes in other cancers to test whether they can help with glioblastoma too. Immunotherapy, as many noble Lords know much more than me, works by triggering the body’s own immune system to fight cancer, and it has transformed outcomes in conditions once considered untreatable. Dr Mulholland is trialling a new approach in which some glioblastoma patients receive immunotherapy before tumour removal, when their body is at its strongest, to see if that produces better outcomes. One patient who has been widely reported in the press, Ben Trotman, who was part of that trial, has lived for more than two years beyond his nine months’ diagnosis of glioblastoma, and his cancer remains under control. During that two-year period, he and his wife have had a baby, Mabel. I regard her as a miracle made possible by this innovative trial.
But such breakthroughs require patients to reach trials early enough and a system willing to test new approaches with urgency and ambition. We need to be honest about risk. Many of these patients are already dying, so why not let them, with full consent and proper safeguards, try promising new treatments where there is a scientific case to give them a go? The potential benefits for them are more time and a better life, and increased knowledge for us about what does or does not work. What greater legacy could there be than that?
I ask the Minister: what specific steps are the Government going to take under the cancer plan to ensure that the increased clinical trials are also available to those with the shortest timescales and in the most urgent period of need?
Lord Evans of Rainow (Con)
My Lords, I thank the noble Lord, Lord Patel, for securing this important debate. When I was a Minister, the noble Lord used to stand up and ask me extremely searching questions—well, they were searching questions to me—to which I did not always know the answer. Come to think of it, there are a couple of noble Lords in the House who used to do something similar: the noble Lord, Lord Sikka, and the noble Baroness, Lady Finlay. I used to go back to the department and ask for answers to these legitimate searching questions, but sometimes the answer was not forthcoming. So I used to press and stretch the civil servants to come back, because I had to come back and report to the noble Lord, Lord Patel.
But I started thinking for myself and looking into some of this, and the answer came down to technology. The noble Lord, Lord Drayson, has really made my speech—one of the problems with speaking at the end is that everything has been said. He is right that, two or three years ago, artificial intelligence was just starting to make an impact in certain industries. He made a very powerful point.
Time is short and I have a few things to say. I am speaking as a former Minister who looked into this matter and as a Member of Parliament to whom constituents used to come, pleading for treatment or to get assessment and diagnosis. Not knowing is a problem if you have a lump but you do not know what it is. They used to come to MPs’ surgeries, not just mine, to see if they could cut through the red tape to try to get an answer from the local NHS trust. I used to do my best to help, but it happened frequently.
As I say, I am a family man and have had two experiences of cancer. The first was my late sister, who died of pancreatic cancer. I was listening attentively to the comments of the noble Baroness, Lady Warwick, who mentioned a spray that can detect pancreatic cancer. That was not available until relatively recently. Pancreatic cancer is a terrible disease.
The second was my late mother, who lived to quite a good age. Ovarian cancer is not always easy to detect. I was surprised as a carer that it took a while for the GP to make a referral and, once you got the referral, to secure a scan and get communication from the hospital to the patient—that is, my mother, who had dementia. In a way, she could not understand that; they should talk to the carer. I thought it was old-fashioned to write a letter to someone who could not read it rather than dealing with them directly, perhaps using artificial intelligence, via the NHS app to speed things along.
My contribution to this is that early and timely diagnosis is important to ensure that the right treatment can be given at the right time to get the best possible outcomes, especially for children and young people, whose cancers are often more aggressive and faster growing and require specialist treatment. Despite this, young cancer patients regularly report needing multiple visits to doctors before a cancer diagnosis is given. Data shows that the median time for under-18s to be diagnosed after first symptoms is 4.16 weeks; it takes longer than this for half of them. Teenagers from 15 to 18 years of age have the longest time to diagnosis—a median of 8.7 weeks. Some 60% are diagnosed as an emergency. On average, 14 different healthcare professionals are consulted.
This is further reflected in the NHS cancer patient experience surveys, which show that more than two in five children and young people, 42%, see their GPs three or four times after their cancer symptoms before being told to go to hospital. This compares to the majority of adults, 62%, seeing their GP just once. Not only does this prolong receiving a diagnosis but it can impact trust and relationships with healthcare professionals throughout treatment and after. This experience can be worse for minoritised groups. Data on time to diagnosis is not routinely monitored for children and young people nationally, despite those issues. It is crucial that a diagnostic interval measure is introduced for young cancer patients, as was committed to in the national care plan, to consistently track and improve time to diagnosis.
I have a question for another special person, the Minister, whom we are very lucky to have in your Lordships’ House—she does a fantastic job as Minister. The noble Lord, Lord Stevens, talked about sweating NHS assets, but I am not asking about that. The noble Lord, Lord Patel, and others referred to the Danish model. Denmark has a population of 6 million. In London the figure is 10 million, in Manchester it is 3 million and England as a whole it is 60 million. The noble Lord, Lord Drayson, made a point about artificial intelligence—he talked about economic growth, wealth creation, NHS trusts not talking to one another and scaling up our own domestic industry—and he is exactly right.
My question is not original but is about a pilot scheme to implement artificial intelligence, in order to establish best practice and set international standards of early diagnosis for all cancers but particularly those of low survivability. There are 36 integrated care boards—there were 42 in my day, but I understand that they have been condensed. Not all are the same: we have different populations, rural areas, seaside communities, post-industrial towns and metropolitan areas. We should appoint the best and the brightest from the NHS or industry to implement artificial intelligence throughout the NHS.
What does success look like and how do you measure it? I respectfully say that the best survival rates in the G7 would be a good starter, but artificial intelligence is an opportunity for the NHS to modernise its back-office administrative processes. As noble Lords have pointed out throughout this debate, there is so much good research out there that AI has to have an impact. That is not about sweating the assets but about improving the current workforce, certainly in the back office, so that they can at least communicate with those hard-to-reach populations and communities in the country.
That is my question to the Minister: can we have a pilot scheme of hand-picked individuals and integrated care boards in select areas of the country, to see whether we can introduce this to the NHS to make a difference and the world-beating healthcare system that we all want?
Baroness Gerada (CB)
My Lords, I am grateful to contribute to this debate, and I too thank the noble Lord, Lord Patel. I declare my interest: I am a practising GP just across the river, and, over the past 40 years, I have diagnosed and cared for many tens of thousands of patients with cancer. We currently use AI to help us: we use it with our e-consultation system, which can identify red flags. Together with our electronic medical records, that explodes at us and asks, “Have you thought of cancer?” We already have the brightest and the best; they are just located in general practice. As has been alluded to, I disclose that I am a former chair and president of the Royal College of General Practitioners.
I agree with many of the contributions that have already been made. In the contributions that I have made already in my short time here, I have drawn attention to the mounting pressures facing general practice and the implications for patients and the wider NHS, and I will focus briefly on that. I worry that initiatives such as the national cancer plan, which rightly place primary care at the forefront of early diagnosis and referral, are in danger of overestimating what general practice can realistically deliver in its current state for the patients we serve.
Without addressing the underlying constraints in the workforce, funding and capacity, we risk placing further pressure on a system that is already under real strain, as has been mentioned. In so doing, we may undermine the very ambitions that the plan is trying to achieve. These pressures are compounded in some areas by outdated or inadequate premises, which further restrict GPs’ ability to expand capacity and to do what is expected of us.
The Royal College of General Practitioners has repeatedly warned that general practice has not received a sufficient share of NHS funding to match rising demand. Without increased investment, the shift of care into the community will not be sustainable. The King’s Fund, which has been mentioned several times today, has highlighted a persistent structural imbalance in the NHS, with a higher proportion of funding and staff allocated to hospital services than to primary and community care.
Despite general practice being the front door of the NHS, the workforce remains heavily concentrated in hospital services. As highlighted in the Health Service Journal—HSJ—last week, the proportion of NHS doctors working as GPs has fallen significantly, from one in five a decade ago to closer to one in seven today. Less than 15% of the workforce—GPs and nurses—are now located in primary care, with 80% of the nursing and medical workforce now working in hospital settings. This cannot be right, given that evidence published over the past 70 years, both in this country and across the water, shows that placing GPs at the front door of any health service results in more accessible, higher-quality and more cost-effective care, including cancer care. Moreover, evidence from the Royal College of General Practitioners shows that strengthening continuity of care—the bedrock of my profession—can reduce avoidable hospital admissions and improve cancer diagnosis, treatment and prevention. Patients prefer continuity of care.
Recent figures published in Parliament, and highlighted in the Health Service Journal just last week, show that the share of NHS spending on general practice has fallen to about 8%—its lowest level in the past decade, down from 9% around five years ago. It always amazes me that there are currently 360 million consultations per year—GPs are about 180 million of those—for an average cost of £150 per patient per year. Noble Lords can do the maths: every man, woman and child on average consults six to seven times per year with their GP for £150. These figures reflect a long-standing structural imbalance in how care is resourced and delivered, and it is becoming increasingly difficult to ignore. To me, that raises a very clear implementation risk for the cancer plan, which relies heavily on GPs for early diagnosis and cancer pathways. Without adequate investment in primary care capacity, we will not be able to do that.
We need more GPs. Health Foundation modelling indicates that we need an additional 6,500 GPs by 2030 to meet the needs of our ageing, increasingly complex population. We need more GPs spending longer with their patients and communities to achieve the ambitions laid out in the cancer plan. I would be grateful to hear from the Minister how the Government intend to address the current imbalance, whereby general practice receives a relatively small share of NHS funding while delivering a substantial proportion of patient contacts.
Delays in accessing primary care risk translating directly into delays in cancer detection, where, as we have heard, earlier diagnosis is often critical to outcomes. Ultimately, if we expect earlier cancer diagnosis to be delivered through general practice, we must ensure that general practice has the capacity to deliver it.
Baroness Ritchie of Downpatrick (Lab)
My Lords, it is a pleasure to follow the noble Baroness, Lady Gerada. I congratulate my noble friend Lord Patel on securing this important debate, which places emphasis on diagnostic care, research and the necessary delivery mechanisms to implement the National Cancer Plan.
I am a breast cancer survivor who was on a clinical trial—the add-aspirin double-blind trial—for five years. The result of that trial in both Britain and Ireland will be revealed next year, with the aim of showing—I hope—that taking aspirin can help in the reduction of breast cancer. That is what I hope the research will show; we will see in time.
There is no doubt that research needs meaningful government and charitable investment, which in turn requires sound management. I acknowledge those who have provided briefings for us all today, including the Institute of Cancer Research, Young Lives vs Cancer, Leukaemia UK, Breast Cancer Now and the Royal Pharmaceutical Society—to name just a few. All the briefings highlight the importance of frequent and early screening, diagnostics and equitable access to more effective treatments, as well as the need to strengthen clinical trial infrastructure and create closer links between trials and clinical practice. They also highlight the importance of research and innovation, including the need to improve genomic testing in the UK by mandating faster test turnaround times and to standardise and make accessible a centralised data collection linked to other databases.
Undoubtedly, the National Cancer Plan for England sets out ambitious and necessary targets to improve cancer outcomes, which I welcome. Research is fundamental to delivering all these outcomes, but we will not hit these targets if they are not driven by the latest research. Universities are the primary delivery mechanism for this research, and they are under significant financial strain. The financial health of the universities is the litmus test for the UK’s scientific future. The key challenge is delivery, as was pointed out by Professor Kristian Helin of the ICR and in a subsequent blog by Ollie Richards, the advocacy manager for the Institute of Cancer Research.
The ambitious targets in the National Cancer Plan will not be met without cutting-edge cancer research to drive new standards of care, alongside time-saving and cost-saving efficiencies. The plan aims for 75% of people diagnosed with cancer to survive at least five years: a 25% increase on current levels. Achieving this will require more than incremental gains; it will depend on better treatments, more precise targeting of therapies and a deeper understanding of cancer biology, all of which is rooted in research. At the time of my diagnosis eight years ago, I was told that they were able to diagnose the content of a tumour and direct the treatment to the tumour: that was the difference and the improvement. It encouraged me to go on my treatment plan.
The ambition to diagnose 75% of cancers at stage 1 or 2 cannot be achieved through awareness of existing screening alone. It will require new screening approaches, more sensitive diagnostics, and improved risk stratification—again, all driven by research. This work is already under way at the Institute of Cancer Research at the Royal Marsden, and there is an exploration of saliva tests to assess the genetic risk of prostate cancer, showing that, for some men, it can outperform the current PSA test.
The National Cancer Plan includes targets on diagnosis and treatment times and an additional 9.5 million diagnostic tests by 2029, but volume alone is insufficient. Faster pathways depend on innovation and technologies that streamline diagnosis and reduce treatment burden. Therefore, research is critical here. Dr Matthew Blackledge’s quickDWI project is developing a five-minute MRI scan with the potential of transforming the patient experience, which frees up NHS capacity. Similarly, the PACE-B trial at the Royal Marsden and ICR demonstrated that higher-dose radiotherapy can cut treatment time by up to 75% for some prostate cancer patients. We cannot ignore the importance of early-stage research and discovery science helping to answer key biological questions. It is often the least visible and most vulnerable part of the system—a concern increasingly voiced across the sector in recent months.
The bottom line is that cancer research does not happen in a vacuum. It depends on sustained investment, policy stability and access to the best talent. If we want research to deliver the National Cancer Plan’s ambitions on survival, early diagnosis and faster treatment, all of us—Parliament, the Government, research institutions and clinical practitioners—have to ensure that the system that underpins it is strong enough to deliver what the National Cancer Plan requires. In this respect, I ask my noble friend the Minister what plans the Government have to do just that. I welcome the National Cancer Plan and I want to see it implemented, but I want to see how it will be implemented and the resources revealed to do just that: to ensure that this National Cancer Plan is capable of implementation with sufficient resources in research and innovation and within the universities.
Baroness Walmsley (LD)
My Lords, I am very grateful to the noble Lord, Lord Patel, for giving us the opportunity to talk about cancer today, because I am a very lucky woman: like the noble Baroness, Lady Ritchie, I am a cancer survivor. My cancer was picked up by routine screening, so I am just as much of a fan as the noble Lord, Lord Stevens, of routine screening.
I am delighted to be able to talk about the National Cancer Plan, which covers improvements in targets for prevention, diagnosis, treatment, care and research. Yet, of course, all these are underpinned by a sufficient, properly trained workforce—with ongoing CPD, since the science is constantly changing. The Government have promised the NHS workforce plan by this spring, yet, despite the sunshine outside, for the Government, spring has not yet quite sprung. Will the Minister be able to confirm when we will get it, and can she say whether it will deal with not just clinicians but technicians, and not just initial training but a reliable system of CPD to keep practitioners up to date, as the noble Baroness, Lady Watkins, has also requested?
There are many areas where efficient workforce planning is vital for achievement of not just the cancer plan but the 10-year health plan, including, as it does, moving from hospital to community, and many examples have been raised by speakers today.
A couple of hours ago, I raised an Oral Question about the issue of newly qualified midwives being without a post despite the issues of unsafe staffing levels in maternity services. In Wales, paramedic students are being told there are no posts for them in Wales when they qualify; they will have to go and work somewhere else. The number of posts for health visitors has been halved over 10 years, leading to some having enormous case loads, which were highlighted in the media this week. These are just a few examples of poor workforce planning in the general NHS workforce, but I recognise that this is not easy.
There are of course many examples of shortages in the cancer workforce, including of GPs, as the noble Baroness, Lady Gerada, just told us. They are all vital to early diagnosis, which we know leads to better outcomes. Yet the role of some groups is underestimated: last week, I went to my local dentist for a check-up; she checked me for oral cancer, and for any swellings in the lymph nodes in my neck, which might indicate cancer. Thousands of people cannot get an NHS dentist and cannot afford to pay, as I did, and therefore do not get these cancer checks, as well as having their teeth fall out. Dentists also part of the cancer workforce.
The Government plan for 28 more radiotherapy machines, which—as the noble Baroness, Lady Redfern, said—are probably enough only to replace the outdated ones. My party has proposed that the ambition should be more like 200, but we are aware that this would have to go alongside training more technicians. Is there a plan to do so across the health service?
This brings me to diagnosis and the question of investment in haematology, pathology and several other sectors which noble Lords have mentioned. Many years ago, I worked as a cytologist in the pathology lab of a major cancer hospital in Manchester. I was screening cervical smears for cancer and pre-cancer cells so that patients could have further examination and timely treatment. Since then, productivity has vastly improved with mechanisation of slide preparation and AI-assisted interpretation of samples. There is even more potential for this sort of improved productivity today, so that patients can get their results quickly and proceed to treatment. The noble Lord, Lord Kakkar, talked about the importance of doing this kind of investment when we have a cash shortage.
However, while this requires some investment, it is certainly cost-effective, as indicated by many studies. Waiting for test results is very stressful for patients—as I am sure has been experienced by several noble Lords at some points in their lives—and can be dangerous, as mentioned by the noble Baroness, Lady Redfern. Consultants need these test results to aid early diagnosis, but most areas are unfortunately well behind the targets.
Turning to prevention, there are three major areas I will mention. First, there is a long list of cancers that could be prevented by lifestyle changes. Smoking tobacco has long been the most common cause of cancer, and we are grateful to the noble Baroness, Lady Ramsey of Wall Heath, for her speech on this. Over recent years we have had legislation which has helped to reduce smoking and secondary smoking, the most recent of which was the Tobacco and Vapes Bill which finally went through your Lordships’ House yesterday. I congratulate the Minister and the Government on this legislation, which will certainly protect young people from taking up smoking and increase the opportunity for smokers who wish to quit to get help, thereby reducing their risk of getting lung and mouth cancer.
However, it is vital that community-based stop-smoking services have sufficient resources to be able to offer the full range of help. For example, most do not have the funding to afford prescriptions for the drugs which are proven to help smokers for whom other methods have failed. Vapes have proved to be a very effective quitting tool and should be widely available as such, including on prescription. However, I am pleased that the Government have taken powers to restrict the opportunity of manufacturers to attract, through advertising and marketing, children and non-smokers to start vaping, and I look forward to the regulations to put these into practice. We do not yet have enough information about any long-term dangers of vaping, especially on young and developing lungs.
The second lifestyle factor is diet. In addition to diabetes and musculoskeletal problems associated with overweight, there is a very long list of cancers caused by bad diet and obesity. In response to an inquiry in your Lordships’ House in 2024, which I had the honour to chair, the Government have put a number of our recommendations in place—thank you very much—but a great deal more needs to be done, and more quickly. The effect on the economy of the lost years of life and the lost working years due to illness caused by obesity has been well documented. It is tempting for some to suggest that it is all down to willpower, but that is not the case. We make our decisions on diet in an obesogenic environment, and many people cannot afford a healthy diet, so they are susceptible to a whole list of cancers. My committee proposed a comprehensive cross-government, long-term strategy to improve the nation’s diet.
Last year, the Government set up a national food strategy led by Defra, but we are not hearing much about it. It should cover a whole raft of government departments, so can the Minister say how her department is contributing to that? It really affects the budget of the NHS in the long term. Legislation on healthy food is undoubtedly required, and the Government will no doubt soon hear proposals for a healthy food Bill in the debate on the King’s Speech.
Having formerly worked in the area of cervical cancer, I was thrilled when a vaccine against the human papillomavirus was developed. It is offered free to teenagers as part of the school-based vaccination programme. As chair of your Lordships’ current ad hoc committee on childhood vaccination rates in England, I have heard evidence that the uptake of the HPV vaccine has fallen from 90% when it was first offered to only 72% now, and this puts the Government’s objective of eliminating cervical cancer by 2040 in great danger—the noble Baroness, Lady Nargund, mentioned that. Therefore, what is the Minister’s department doing about that, and how is she working with the Department for Education to improve the situation? I am hearing that some schools are refusing to work with the vaccination services offered to their pupils, and some find getting parental consent very time-consuming. Perhaps the Minister will write to me about that when she has spoken to her colleague.
Finally, on research, as I mentioned, vaccines have already been developed to prevent or treat cancer, and there will be more. Only yesterday, the media reported a vaccine that considerably extends the survival of patients with pancreatic cancer. This raises the question as to what the Government are doing to enable more of this sort of work and the clinical trials that are basic to it, as mentioned by the noble Baronesses, Lady Bottomley and Lady Paul. Clinical trials are absolutely vital in order to bring treatments to patients, and we need to make them easier.
I served on another of your Lordships’ committees—the Science and Technology Committee—with the noble Lord, Lord Drayson, who mentioned some of the findings of one of its most recent reports. But, in addition to the report on the difficulties of scaling up small businesses in this country, including life science businesses and other scientific businesses, the committee wrote an urgent letter to the Secretary of State for Health about the missed opportunity of attracting more researchers from the United States to come here if they are unhappy with the situation there. I am hearing that it would cost an American researcher £18,000 to come with a spouse and one child, to get visas and to pay the NHS charge in advance. This is more of a barrier than an encouragement. The committee heard that other countries are being much more opportunistic than us on this matter. Why are we lagging behind, when other countries have managed to strengthen their cancer research workforce? We need to get good people from wherever they are willing to come to us. Let us stop pussyfooting around and get on with it.
Earl Howe (Con)
My Lords, I declare my interest as an honorary fellow of the Royal College of Physicians. If I have learned one thing during my time in the House of Lords, it is that any pronouncement emanating from the lips of the noble Lord, Lord Patel, should be listened to with the utmost care and attention. I therefore say at the outset that his analysis of where we stand as a country in our ability to diagnose and treat cancer in all its forms can surely not be bettered. We have since heard some excellent speeches from around the Room, which have usefully developed the messages that the noble Lord, Lord Patel, so capably articulated.
Our starting point, as all others have said, must be the Government’s recently published national cancer plan, which I for one found an inspiring read. I very much welcome the ambitions set out in it, particularly because they are not only outcome-based but based on outcomes that are in many cases pretty challenging to achieve. That has to be the right approach, but every challenging target carries with it an implicit invitation to the wider world to hold the system to account for its delivery. With the cancer plan, that is not entirely a straightforward matter.
The ambitions in the plan are, quite rightly, many. They cover not only the desired ends but the means. We can measure success, or the lack of it, in the traditional way, by reference to the waiting time standards, and those are extremely important, but when we look at some of the other boxes that the plan sets out to tick—for example, quality of life improvements; reducing regional inequalities, which the noble Lord, Lord Patel, emphasised; reducing inequalities for children and young people; as well as such things as fostering a whole-society approach to prevention—we begin to see how many areas there are to be monitored and for which credible metrics will need to be devised.
I was glad to see that the Government have thought about this in the area of diagnostics, which will of course be crucial to the success of the plan. The four new key metrics that have been designed to track improvements in early-stage cancer diagnosis are excellent but, as the plan sets out, there is a whole set of measures on which such improvements will themselves depend: for instance, the expansion and wider take-up of screening; the enhancing of the NHS app and getting people to use it; and the general speeding up of the patient pathway.
As the plan concedes, quite refreshingly, a lot will also depend on basic improvements in administrative efficiency across the NHS, which, I am afraid, has been a depressingly difficult nut to crack in a number of areas. Let us not forget that put together, these ambitions, if they are to be met to their fullest degree, will require a focus on that rather elusive concept, championed so effectively by the noble Lord, Lord Darzi, in the last Labour Government, of quality—quality of process, quality of care and quality of outcomes. So it is good news that the National Quality Board will be taking it as part of its remit to adopt what the plan calls a
“more rigorous and evidence-based approach to quality improvement”.
Much will also depend, though, on local commissioners and providers monitoring their own performance and being swift to pounce on system weaknesses where these appear. For that, they will need the tools to do the job, chief among which are data and modern IT to deliver it. There are NHS trusts that are still dependent on slow and outdated software which, from a manager’s point of view, makes life extremely frustrating. The chief executive of the King’s Fund, Sarah Woolnough, was right to point out that many hospitals still cannot share imaging or pathology results in a timely way for that very reason. I hope the Government have this problem within their sights: it is important.
After all the consultation that took place on the cancer plan, which was considerable, it was not surprising to see that criticism of the plan from around the health community has been almost entirely of a constructive nature. The questions that have been posed have largely centred on the obvious challenges around delivery.
The King’s Fund, Cancer Research UK, the Royal College of Physicians and the London School of Hygiene & Tropical Medicine, to take just four examples, have expressed very similar anxieties, many but not all of which can be placed under the broad heading of “resources”.
The main anxiety, which I share, and which is shared by other noble Lords today, is that of human resources. There is a section of the cancer plan which addresses workforce issues, but it frankly put me off by being overly political, which was not at all necessary. The Government seem determined to rubbish the long-term workforce plan published by the previous Government, but I remind the Minister that it was a plan that, like the cancer plan, was widely consulted upon and widely welcomed when it came out. It most certainly did not focus simply on expanding workforce numbers but went into detail on where in the system more staff were needed, along with their skills and training, including continuing professional development. It also talked about clinical leadership, which I did not see much referred to in the cancer plan.
The elephant in the room is the demand curve. Doing better on prevention and early diagnosis will take cost out of the system, but with the best will in the world, the effects will not be felt for a number of years. Meanwhile, the demand for cancer services will continue to rise, as it has done inexorably over recent years. As noble Lords have said, our cancer outcomes as a country are nothing like as good as they should be. Nevertheless, and contrary to what you might think reading the cancer plan, the Government of which I was a member made considerable progress in cancer care and treatment. Mortality in many of the major cancers fell significantly, despite rising incidence.
However, as we know, the NHS struggled to meet its targets because of constraints around capacity. I very much welcome the sections of the plan that address capacity in diagnostics, one of the main areas in which the NHS has struggled, but at the same time, we are asked to accept that training and better equipment will in due course reduce the need to recruit staff. I am willing to believe that, but only up to a point. The efficiencies that the Government rightly want to see cannot and will not be delivered overnight or in short order.
Further down the patient pathway, we will need more clinical and medical oncologists, and we will need to train them. The Government have already pledged to create several thousand more specialty training places, but following the recent breakdown of negotiations with the BMA, we now learn that these places will not be on offer until next year at the earliest, which is not a very encouraging start to the cancer plan’s workforce ambitions.
Therefore, delivery at pace is a concern. That applies to another area: research and innovation. We have made progress in the setting up time for clinical trials, as others have said, and I welcome the Government’s plan for a clinical trials accelerator. The expansion of genomic science and facilities such as the UK Biobank have enabled major advances over the past 15 years, but again, it is about people. Our homegrown pipeline of research graduates is simply not going to be sufficient for our national needs. For the UK to remain competitive, we have to keep attracting international talent into our laboratories, and the costs associated with this are far higher than in other developed countries.
Of course, that is only part of the challenge. To have an effect on cancer outcomes—which is in the end what matters—the fruits of research need to be accessed by NHS patients. The National Healthtech Access Programme is a welcome concept, but to achieve success, it must spread proven new technologies beyond the bounds of our major teaching hospitals and somehow overcome the ingrained resistance towards innovation on the part of the wider NHS. How will it do that?
The National Cancer Plan for England is an excellent document, but because of that, it is a complex jigsaw with many pieces. For the Government’s ambitions around cancer to be achieved, all those jigsaw pieces must be put in the right places and seamlessly joined up. For that to happen, the system as a whole must contain the right accountability mechanisms to ensure delivery over a period of years. I look forward to seeing how those delivery and accountability mechanisms take shape over the course of the coming months.
The Parliamentary Under-Secretary of State, Department of Health and Social Care (Baroness Merron) (Lab)
My Lords, I congratulate the noble Lord, Lord Patel, on securing this excellent debate. I thank him for bringing his considerable expertise and careful consideration—as he always does, as other noble Lords have said—to these matters. He has assembled a pretty daunting selection of noble Lords, for which I am also grateful.
I thank all noble Lords for their contributions, which have been incredibly well informed, personally felt and thoughtful. There is much that I will share and examine further with my ministerial colleagues. Sharon Hodgson, the Minister for Public Health and Prevention, is driving forward the implementation of the cancer plan. To pick up the specific point about GPs, I note that Stephen Kinnock, the Minister for Care, is the responsible Minister for that area; I will raise the searching comments from the noble Baroness, Lady Gerada, with him.
I appreciate how personal and affecting the debate is for so many—if not everybody—whether they have said it or not, either directly or indirectly. That has inspired us much. By using the word “inspired”, I am quoting the noble Earl, Lord Howe; I was delighted to hear him talk about the cancer plan as an “inspiring read”—he really should review books—and “excellent”. The noble Earl’s assessment of it being a jigsaw is absolutely spot on, and that has been acknowledged throughout.
I will do my best to respond to a number of points. I suspect that I will not manage to do so entirely, but I hope noble Lords will be assured that their comments and questions will be taken up.
For me and noble Lords here today, strategy is one thing but implementation is the main thing. Many noble Lords, including the noble Baronesses, Lady Bottomley and Lady Bloomfield, the noble Lord, Lord Patel, and others challenged the point about implementation, so I will speak briefly about that. There will be a reformed national cancer board. It will be accountable for delivery and include cancer experts. It will track progress, update Ministers and monitor the impact, including—following the points raised by my noble friend Lady Nargund—by dealing with inequalities; that will be key in its monitoring. Updates will be published annually on the national cancer plan’s progress. I look forward to more challenge and engagement from noble Lords in relation to that.
On outcomes, as we have heard, the best way is to diagnose and to treat early to improve outcomes, which is why the cancer plan sets an ambitious goal to meet all cancer waiting times standards by 2029. We are already making strides towards this goal—not least by reducing the NHS waiting list overall by 405,000 since July 2024—but we have a very long way to go in this area of cancer.
The point about inequalities—whether we are talking about race, deprived communities or any other significant factor—came up so much, and rightly so. The noble Baronesses, Lady Redfern, Lady Bottomley and Lady Nargund, and the noble Lord, Lord Patel, among others, referred to this. As was said, the improvement of care for deprived, disadvantaged or less equal communities will be monitored through the NHS cancer waiting time standards. Data is published at integrated care board and provider level, and the NHSE acute provider table of all 134 providers supports this transparency. It is about getting attention to where it is needed most.
The cancer plan’s central ambition is to transform survival rates, committing to 75% of patients diagnosed from 2035 being cancer-free or living well within five years. What an ambition that will be to achieve. It will be the fastest rate of improvement in cancer outcomes this century and lead to an additional 320,000 lives saved over the course of this plan—and of course, for every life saved, many more are affected.
On diagnostics, one way in which we can achieve our ambitions is by improving cancer diagnosis in the community—the noble Lord, Lord Taylor, spoke to this point. As noble Lords have acknowledged, last week we announced plans to open four new community diagnostic centres in England over the next year, while also announcing that a further 32 of the 170 CDCs that are currently providing valuable diagnostic capacity will be expanded and enhanced. They are a major move towards a neighbourhood health service.
By extending new capacity—which was referred to by the noble Baroness, Lady Bloomfield—we are also optimising our cancer screening programmes to catch it earlier. I make particular reference to HPV, which was raised by the noble Baronesses, Lady Watkins and Lady Walmsley, and the noble Lord, Lord Patel. From this year, young people who missed out on the vaccination at school can have it administered from a pharmacy. That is to help us move to the elimination of cervical cancer by 2040. I really welcome that. It is about recognising that some people have missed out and providing the service easily and locally in the trusted pharmacy.
My noble friend Lady Ramsey and the noble Lord, Lord Stevens, referred to the national lung cancer screening programme. This will be fully rolled out by 2030, inviting more than 6 million people and identifying at least 23,000 cancers at an earlier stage. I am glad that the noble Lord, Lord Stevens, made the point that those who are more disadvantaged are benefiting from this to a greater degree. Disadvantage is being matched with greater and disproportionate—as in the right amount of—care and attention, and I hope we will see more of that.
On the matter of treatment, I say to the noble Baroness, Lady Redfern, that we will be taking a new approach: more patients will be able to access specialist training centres; by 2028 the NHS app will be the front door for managing our healthcare, and it will have a particular resonance for cancer care; and by 2035 we will bring together genomic and lifestyle data with the all-important single patient record, which will provide the kind of joining up that noble Lords have referred to.
I turn to the important matter of workforce, which was referred to by many noble Lords, including the noble Baroness, Lady Walmsley. I share the frustration of the noble Earl, Lord Howe, about the effect of industrial action on the service to patients and the kind of progress that we seek to make.
The noble Baroness, Lady Walmsley, almost asked me, “When is spring?”, and my noble friend Lady Blake whispered, “It’s still quite cold outside”. But there is indeed to be the publication of the 10-year workforce plan, which will set out a multi-disciplinary approach and will pay greater attention to the role of the workforce. I very much look forward to it supporting this cancer plan, as well as others.
My noble friend Lady Rafferty asked about the training of clinical staff. We will establish new national training standards for surgeons, in particular surgeons in robotic surgery. Over the first three years of the cancer plan, we seek to create some 5,000 learning and training opportunities for people per year in cancer-critical roles. That shows its importance in our approach.
As noble Lords have said, we have to take steps to seize and embrace research breakthrough. I am sure that the noble Lord, Lord Stevens, will take this back, but Cancer Research UK has rightly pointed out that, if we shift the dial on outcomes, that requires us to target rarer cancers, which noble Lords have referred to, where progress has often been slow. As your Lordships will know, we are fully implementing the Rare Cancers Act and are glad to do so. That will make it easier for patients to take part in cutting-edge clinical trials, the importance of which my noble friend Lady Paul spoke to. I can tell my noble friend Lady Warwick that we will appoint a national specialty lead who will advocate for rare cancer patients and oversee the delivery of research in England.
A new cancer trials accelerator will increase the speed and reach of trials. Up to 10,000 personalised cancer vaccine doses will be delivered through clinical trials by 2030. To respond to my noble friend Lady Paul, the Government have committed to reducing the set-up time for clinical trials to under 150 days, to earn the UK the real honour and practicality of being a world leader. We will streamline the implementation of proven technology, as well as boosting access via our new national healthtech access programme.
Just as we are targeting rarer cancers, we will also target specific groups—to which I have already referred—to ensure greater progress. That requires the use of data and data collection, which the noble Lord, Lord Kakkar, spoke about. The national cancer plan includes, for example, real-time pathway analytics, streamlined cancer metrics to expose unwanted variation, which is absolutely crucial, and providing trusts and cancer alliances with more granular and actionable data. Without data we cannot target where we need to go.
As noble Lords know, April is not just part of spring; it also marks the publication, last week, of our renewed women’s health strategy, in which we set out actions to expand genomic testing for those with a lifetime risk of breast and ovarian cancers. We will also look to improve the detection of endometrial cancer. I am grateful to my noble friend Lady Nargund, who spoke to the important matter of gynae cancers.
On linking women’s health to AI, I hope noble Lords will recall that we now have the EDITH—Early Detection using Information Technology in Health—trial, which will see nearly 700,000 women take part in a world-leading trial to test whether AI can increase the number of cancers detected in the national breast screening programme. To the point on workforce, this will also mean that the radiographers will be key, but we will need not two but one for each case—that is how we can harness AI. I agree with the noble Lord, Lord Evans, about the great improvements that AI can make, including in back-office functions. My noble friend Lord Drayson also spoke to the importance of harnessing the benefits of AI, and I assure noble Lords that we will continue to do that.
I will make a couple of final comments on innovation, productivity and funding, but, before I do, I will comment on prevention. Noble Lords have referred to this. We will stop as many cancers as we can by—these are just examples—cracking down on illegal underage sunbed use, eliminating cervical cancer through HPV vaccination, tackling obesity and creating the world’s first smoke-free generation. I am grateful to noble Lords, including the noble Baronesses, Lady Ramsey and Lady Walmsley, for welcoming the Tobacco and Vapes Bill. It is a step change in our work and will save thousands of lives.
On productivity, and on a point raised by the noble Lord, Lord Patel, we estimate that we will see up to a 21% gain in productivity as we invest in digital and robotic automation-enabled histopathology—pronouncing that is where I need the noble Lord, although it is also my writing—pathways, with further capability enhancement by AI. So we are not standing still on productivity and workforce, and I agree with the noble Baroness, Lady Finlay, about the importance of bringing together strategies and approaches. We will achieve in the cancer plan only by doing that. The noble Baroness rightly raised the issue of palliative care.
On funding and resources—the noble Lord, Lord Kakkar, raised this—there are significant commitments, and I will mention just some of them: £10 million a year for children and young people to be able to access their treatment without financial penalty; £200 million for cancer alliances to improve performance; and £2.3 billion in diagnostics, which should deliver 9.5 million additional tests by 2029. I think that gives a sense of our commitment.
My noble friend Lady Ritchie asked about resourcing for innovation. I assure my noble friend that we are working with education colleagues in the way that she asked, and there will also be a plan in place, which we are developing, for how we resource innovation. I am grateful for her comments.
This was such a rich debate. I feel I have picked out themes, and I will reflect, as will my ministerial colleagues, on the very real and informed points that noble Lords have made. The thing I did sense is that we all want this national cancer plan to work. I look forward to continued scrutiny, contribution and expertise from noble Lords. Lastly, I once again thank the noble Lord, Lord Patel.
Lord Patel (CB)
My Lords, I thank the Minister for her comprehensive response. She might reflect on some of the other points that she was not able to answer, such as the one on isotopes, which is very important. We have debated that before. One or two noble Lords quite rightly mentioned children’s cancers, which the report mentions very thinly. There is an issue with children’s cancers, including the suggestion that a well-run, efficient children’s cancer unit is under threat of being shut down. That cannot be so, and it needs to be investigated.
Aside from that, I thank all noble Lords. The Minister is quite right: there is a daunting array of them, even to me, and I have six double-sided pages of the important contributions made. If I were to summarise, your Lordships would not like me because they would be here for a long while, so I will not. Each and every contribution was brilliant. I thank noble Lords not just for turning up but for making such a good contribution. To me, the summary of it was that there were constructive, helpful comments to help this national plan, which on the whole each and every speaker welcomed. They were not criticising it overtly—apart from me—and I am sorry that I teased them at the beginning.
The noble Earl, Lord Howe, made a comment about me and the way I have engaged with him over time in debates. The problem is that, with his silken charm, you never know whether he is being kind to you or about to put a dagger in you. But it is always delightful to listen to him, and he made some important points, again in a helpful way. I hope we will soon see the workforce plan. It is absolutely crucial to have a workforce plan focusing on cancers again to deliver the workforce we require for all the things we want to do. I thank all noble Lords, and I thank the Minister very much. I agree with the comment made by one Member that we are lucky to have her as a Minister.
House of Lords
Midwives: Graduate Guarantee
(1 day, 4 hours ago)
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Baroness Walmsley
To ask His Majesty’s Government what progress they have made towards achieving the graduate guarantee for newly qualified midwives.
The Parliamentary Under-Secretary of State, Department of Health and Social Care (Baroness Merron) (Lab)
My Lords, the graduate guarantee creates additional temporary registered midwife roles and enables newly qualified midwives to apply to join the NHS workforce. This supports the transition from education to employment. Since September, over 850 of these roles have been created, backed by £8 million. This includes part-time and full-time jobs. NHS England is working closely with universities and employers to align graduate numbers with vacancies through improved workforce planning, enhanced support for students and co-ordinated local recruitment.
Baroness Walmsley (LD)
I thank the Minister for her Answer. The graduate guarantee is very welcome but, already, 31% of newly qualified midwives do not have a job or are on fixed-term contracts. First, how will the Government ensure that workforce planning is aligned to the number of posts available so that the skills of newly qualified cohorts are not wasted? Secondly, given the concerns about unsafe workloads in midwifery and maternity services, how will midwives have the time to discuss with their clients health issues such as diet and vaccination?
Baroness Merron (Lab)
On the second point, the noble Baroness is quite right: it is important that midwives have that time. That is what we anticipate will be the case—I refer her to the forthcoming workforce plan, which will improve the situation. With regard to the position that the noble Baroness describes, I agree that this needs sorting out, and I recognise the figures that she has shared. That is why we have brought in the graduate guarantee scheme—so that we can get people from their training and education into the NHS and can ensure that midwives are recruited on the basis of looking to the future rather than of the existing headcount. So we are future-proofing this.
Baroness Rafferty (Lab)
My Lords, the graduate guarantee applies also to nurses but, sadly, the provision is quite patchy. What steps are the Government taking to support employers to recruit newly qualified nurses?
Baroness Merron (Lab)
Through NHS England’s student movement tool, forecasting on the workforce and national analysis are being undertaken to assess the areas of risk—my noble friend is right to raise those concerns. That is shared with NHS England’s regional teams so that they can manage and monitor workforce positions directly with providers.
Baroness Manzoor (Con)
My Lords, I welcome the comments made by the Minister. However, she will be aware that, as well as having a shortage of midwives in place—and we have seen the terrible effects of poor service delivery in antenatal and postnatal care—we have a significant shortage of health visitors, who give advice regarding immunisations, development, feeding and so forth. Some of those health visitors have caseloads of up to 1,000 families. That is not sustainable and, frankly, is quite dangerous. What are the Government going to do to address this?
Baroness Merron (Lab)
Again, I refer to the forthcoming 10-year health and care workforce plan, which will take a multidisciplinary approach. I certainly share the noble Baroness’s views about the value of health visitors. As we move services into the community and develop the neighbourhood health service, that will require the greater use of roles such as health visitors. Ultimately, this is a local matter about local employment of staff to meet local need.
Baroness Burt of Solihull (LD)
My Lords, given the concerns about unsafe workloads in maternity services, how do the Government justify a situation where qualified midwives are available but not being brought into permanent roles?
Baroness Merron (Lab)
That is the very reason why we have brought in this guarantee, because it provides an immediate route into employment for those who are newly qualified. A number of things about that are important, including reducing the risk of graduates leaving the profession because they cannot find jobs. The reason why there are an additional 850 time-limited or temporary roles is to get people in under existing budgets but also to get staff to enter the workforce where there are not immediately permanent vacancies. It is a strong way to address the point that the noble Baroness raises.
Lord Kamall (Con)
My Lords, as we have heard from other noble Lords, we have two situations. One is that 31% of newly qualified midwives have been unable to secure posts; the other is that we have well-documented shortages. The Minister talked about the graduate guarantee, but are there any other initiatives available to midwives and nurses who may wish to take up these jobs? Other noble Lords have talked about the number of hours that midwives have to work. How do we make sure that we retain existing midwives so that some are not leaving by one door as others are coming in by another?
Baroness Merron (Lab)
I was about to answer the noble Lord’s first question by talking about retention and then he helpfully raised retention. Retention rates for existing midwives are improving, as is the number of midwives. That includes a mentoring scheme, strengthening advice and support on pensions, flexible retirement options, and publication of menopause policies and guidance to support midwives to stay in work. We also have unit-based retention leads to focus on this and provide support to midwives. I think that is a really important initiative.
Lord Sahota (Lab)
My Lords, given that the National Health Service is always short of nurses and midwives, do the Government have any plans to bring in any overseas nurses and midwives to fill the jobs?
Baroness Merron (Lab)
The issue is more a misalignment of numbers than a straightforward shortage, as the number of midwives has increased. There was a 2.6% increase in January 2026 compared to the year before, so the trajectory is good. The misalignment, as I have explained, is that we are dealing with a situation where midwives are being trained but they cannot get jobs. That is what we have to bring together and what we are doing through the graduate guarantee scheme.
Baroness Prentis of Banbury (Con)
My Lords, does the noble Baroness share my concern that there is an increasing trend towards encouraging women to give birth in large hospital centres further from their homes and does she agree that an increase in midwives—as well as in obs and gynae professionals of all sorts—would enable us to behave more like France and Germany do, for example, and aim for units of between 2,000 and 4,000 births a year?
Baroness Merron (Lab)
Obviously, what matter most are patient safety and patient satisfaction, and I am very much looking forward to the independent report from my noble friend Lady Amos in this regard, because she is focusing on that. I am sure that she will consider the best place. I cannot comment on whether the noble and learned Baroness’s assertion will be the best option here, but there was a separate call for evidence under the workforce plan so that we could hear directly from maternity and neonatal staff.
Lord Wigley (PC)
My Lords, does the Minister accept that while patient safety is, of course, the primary thing, there is also a very strong obligation to ensure that promises made to young people going in for training are fulfilled? We are aware of these challenges in Wales. Surely there needs to be a more integrated approach to workforce planning to ensure that in future we do not get this embarrassing situation.
Baroness Merron (Lab)
I certainly agree with the noble Lord. I know he will understand that I can refer only to England in this context, but I take his point about Wales. I mentioned earlier that this situation very much needs sorting out and that is what we are doing. We are working closely with employers and universities. We are improving workforce planning, enhancing support for students and co-ordinating more local recruitment activity. As I have outlined, plenty of work has been undertaken and I am sure we will continue to monitor and do more.
Electricity: Domestic Pricing
(1 day, 4 hours ago)
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Lord McCabe
To ask His Majesty’s Government what plans they have to review the effect of the marginal pricing structure on the cost of electricity for domestic consumers.
The Minister of State, Department for Energy Security and Net Zero (Lord Whitehead) (Lab)
Delivering lower bills and a secure energy supply for working families and businesses is at the heart of the Government’s sprint toward homegrown clean energy. Marginal cost pricing has historically incentivised the cheapest forms of energy to provide as much power as possible. That worked well when the competition was between fossil fuel producers, but less well when there are many cheaper bids from renewable sources for power supply but still the price can be set by more expensive and volatile gas. Accelerating the development of renewable generation, as we are now through clean power 2030, will progressively reduce to a residuum the amount of time that gas sets the price.
Lord McCabe (Lab)
I am grateful for that Answer and I welcome the direction of travel on energy security and price stability, but do we not need to work harder and faster to decouple gas from electricity prices? Is it not true that gas accounts for about 30% of electricity generating but that the effect of gas on the price mechanism is responsible for the huge bills landing on households and businesses up and down the country?
Lord Whitehead (Lab)
My noble friend is absolutely right. Although gas accounts for only 30% or so of the market, at the moment it sets the price over 60% of the time with marginal cost pricing arrangements. It is right that we need to go faster and further. Indeed, today the Government have announced plans, among many other things, to ensure that the element of the renewable input into the system—on renewables obligations rather than fixed-price contracts for difference—can be moved over to that latter category as soon as possible, thereby bearing down on the amount of time that gas sets the price in the market.
Earl Russell (LD)
My Lords, we cannot afford continued fossil fuel dependency. We welcome the move from legacy contracts to cheaper ones. Indeed, my party proposed similar over a year ago. I support the Greenpeace Power Shift RAB model to remove gas, the most expensive component, from the market. Are Ministers still looking at these proposals, and will they take them forward? If not, why not? Together these proposals fall short, and that is my worry here. Despite the way they have been trailed, they will not deliver the savings we require.
Lord Whitehead (Lab)
The Government are looking actively at many different ways of going further and faster as far as the green energy revolution is concerned. Indeed, they are actively looking at the Greenpeace and Stonehaven report on not only delinking but strategic reserves for gas in future. My personal view is that what they are proposing is a little early in the cycle but, nevertheless, could be an important element later on, in how the system stabilises itself once it is mainly renewables and low carbon.
Lord Redwood (Con)
Is the quickest way to get energy prices down not to cut some of the rip-off taxes that the Government impose? How does imposing an extra windfall tax help?
Lord Whitehead (Lab)
Imposing an extra windfall tax, on those elements of the system that are within the renewables orbit but outside the CfD arrangements, takes away the excess profits that those elements make as a result of being aligned with gas in charging those volatile prices. So it is a very sensible thing to do, to make sure that excess profits are not taken from consumers but instead reside with them as lower prices.
Lord Vaux of Harrowden (CB)
To follow up on that, can the Minister explain how a windfall tax paid to the Treasury ends up reducing people’s bills?
Lord Whitehead (Lab)
The effect of the windfall tax is, essentially, to start returning some of those excessive bill contributions back to bill payers so that their overall bills are less than they otherwise would be.
Baroness McIntosh of Pickering (Con)
My Lords, does the Minister not agree that Denmark—where renewables, on which Denmark excels, are highly developed—is the largest producer of oil and gas in the European Union? We will continue to need fossil fuels, in addition to renewables, going forward.
Lord Whitehead (Lab)
The reference that the noble Baroness makes to Denmark is an interesting one, inasmuch as the Danish system is wholly integrated between renewables, heat and power of different kinds—particularly district heating and various such things, which can be used in conjunction with other forms of energy to provide a balanced overall system. It is true that Denmark continues to produce oil and gas but also that Denmark is, along with the UK, looking at methods of making sure that relates to production for the future rather than exploration.
Lord Grantchester (Lab)
My Lords, this is one aspect of the high cost of electricity in the UK. The wider question it raises is: what plans do the Government have to reduce the cost of electricity? On the electrification of the energy mix of the future, which is among the many answers that my noble friend the Minister may wish to give, do the Government need to consider bringing forward a strategic national plan with a focus on the lessons to be learned from this present crisis?
Lord Whitehead (Lab)
I thank my noble friend for that question, because he has, remarkably, just anticipated the development of the strategic spatial energy plan and a reformed national pricing delivery plan, both of which came out this morning. Both plans address exactly the longer-term balance arrangements as far as electricity is concerned, particularly how prices can be the lowest possible for the deployment of electricity and gas resources across the country.
Lord Teverson (LD)
My Lords, the most effective way of bringing down household energy bills is through the energy efficiency of homes. I welcome the Government’s move to apply the future homes standard, which will bring up energy efficiency, but they are not going to implement it until 2028—before which, some 100,000 or more homes will be built inefficiently. Can the Government please bring this forward, at least to 2027?
Lord Whitehead (Lab)
I thank the noble Lord for that question. I cannot stand here and guarantee that that move will be brought forward by one year, as he suggests. It is a very sound idea. The future homes standard, which is now in place, is instead of the net-zero low-carbon standards that should have been implemented about 15 years ago, if the previous Government had not thrown them out. We are catching back up, as far as possible, and making sure we can get that done in good order.
Lord Moynihan (Con)
My Lords, by our doubling down on intermittent renewable wind and imported Chinese solar, as the Secretary of State announced this morning, does the Minister agree that while the wholesale price link to gas and electricity constitutes, as he said, only some 30% of the consumer price, the main culprits of ever-escalating industrial and domestic prices are the Government’s green levies, the taxes and the system costs, which constitute the remaining 70% and are increasing month by month? When will the Government address these costs?
Lord Whitehead (Lab)
Of course, the Government have addressed those costs, particularly in the recent move to take elements of the levies away from levy arrangements and into the general Exchequer. That is part of the £150 off energy bills that the Government have recently reported. The noble Lord is absolutely right about the effect of levies on prices, but I hope he will also accept that that is exactly what the Government are doing at the moment: bringing prices down for the consumer by transferring how those levies work for the future.
The Earl of Clancarty (CB)
My Lords, it is good news that the Government have enabled standing charges to be reduced, but should standing charges not be got rid of completely? They are basically daylight robbery.
Lord Whitehead (Lab)
The noble Earl treads a fine distinction between the possible daylight robbery of standing charges and the fact that some charges need to be levied collectively because of the various fixed costs that the system has, which have to be contributed to in order to deliver the service to individual consumers. How you charge those standing charges is a matter of considerable debate and something that the Government are looking at. Whether, for example, you charge them as an overall fixed sum or as a sum per household, depending on its energy bills, is a matter of considerable debate at the moment. The idea that standing charges should relate more exactly to what standing charges should be for in the first place is a point well made.
House of Lords: Legislative Procedures
(1 day, 4 hours ago)
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Lord Brooke of Alverthorpe
To ask the Leader of the House what plans she has, if any, to establish a modernisation committee to review the effectiveness, efficiency and cost of the House of Lords’ legislative procedures.
The Lord Privy Seal (Baroness Smith of Basildon) (Lab)
My Lords, it is helpful to review and consider the effectiveness of our procedures. I will continue to advocate for any changes through agreement in the usual channels and through the Procedure and Privileges Committee. I have no plans to set up a modernisation committee at the moment.
Lord Brooke of Alverthorpe (Lab)
My Lords, just over 15 years ago, there was considerable dissatisfaction here with the way our scrutiny work was being performed. The Leader’s Group was set up and reported in 2011, recommending improved focus and better organisation for more effective and efficient scrutiny. In the light of recent events, some of us have come to the view that it is high time again that we had a look at the way that we are undertaking our legislative procedures. I know that the Leader has been taking some steps to effect changes and wants to use the Procedure Committee, but I believe that we should have a more effective and fundamental review, in the way that we had in 2011, and that this would be better established by a separate Select Committee. I hope she will review her position on that and move forward soon.
Baroness Smith of Basildon (Lab)
I always hate to disappoint my noble friend. There are many strengths to the work that we do in here on scrutiny, but I agree that, as it draws to a close, the current Session of Parliament has presented some challenges and at times has tested our procedures. I am always interested to hear proposals from noble Lords across the House. However, it is quite often the case that I have three noble Lords talk to me and give me five different ways of doing something. It is quite hard to find consensus at times. We do need to look at these things, and the Procedure Committee is a good way forward, but we will not stop there. This morning, I convened one of our regular meetings with the usual channels, where we discuss these issues, and the Lord Speaker came along as well. We want to give attention to these issues, but I am not convinced that the committee that my noble friend suggests is the best way of doing so.
Lord Lisvane (CB)
My Lords, leaving aside the question of whether that largely meaningless word “modernisation” is an appropriate one to use in this context, could the Leader of the House, in her consideration of these issues, give priority to effectiveness over efficiency? When it comes to legislation, Governments love efficiency, but it is very often inimical to exacting scrutiny and challenge, which is the role of your Lordships.
Baroness Smith of Basildon (Lab)
The noble Lord has a good point; I am not sure that there is necessarily a difference. However, how effective we are in managing our time and the issues that we want to raise is a key issue for this House. How we use our time, whether we are making the best use of our time, and whether we are ensuring that the scrutiny we give to legislation is proportionate and will be listened to is a matter not just for the Government but for every Member of this House. If the Government are to listen, we have to play our part. A self-regulating House is also a House that has to show some self-restraint to ensure that our voice is heard in the right places.
Lord Goddard of Stockport (LD)
My Lords, does the Leader agree that we do not need a modernising committee to tell us that frequent sittings past midnight are not the best way to do business? As far as I am concerned, it is not an efficient way of operating, and it fails a duty of care to not only staff but Members. In the new Session, if we could work more closely and, to paraphrase the Chief Whip, “talk less, vote quicker”, we would become more efficient and perhaps do business in a more timely manner, which would mean that the exceptional after-midnight sittings are the exception, not the rule.
Baroness Smith of Basildon (Lab)
My Lords, I think the whole House would agree that very late nights should be the exception. The noble Lord suggests we talk less—I have to say one of the sadnesses of this role of mine is that I talk less in this House than I did before I did this role. But it is about making effective use of the time we have to make our points, have our debates and reach conclusions. There are times when we have felt that debates have been a little longer than they needed to be, but at no point do we in Government want to take steps to limit the scrutiny; we just want to do it more effectively.
Baroness Andrews (Lab)
My noble friend Lord Brooke of Alverthorpe has already referred to the work of the committee in 2010-11. One of the recommendations—and there were quite a few that were not implemented—was that the House start on Mondays, Tuesdays and Wednesdays at 2 pm. That was considered a step far too far in 2010. Fifteen years on, can the Leader tell us whether the time might be ripe now, finally, for looking at and rethinking the time the House may start its business and maybe finding a way for us to use our time and expertise more effectively?
Baroness Smith of Basildon (Lab)
My Lords, before answering this Question I looked with some care at the recommendations from the Goodlad committee, and a number were not accepted at the time, including that Ministers should be able to answer Questions in either House, that the Lord Privy Seal should have a dedicated Question Time, and that there should be a more proactive role for the Lord Speaker. Those did not find favour with the House at that time—I hesitate to look at the Lord Speaker’s face at this point.
The issue of how we use our time is really important, and I draw the noble Baroness’s attention to the next report from the Procedure and Privileges Committee—which I think is coming to the House on Thursday—about using time. The committee is recommending from all parties that we look at the time we spend debating SIs and that some extra time be available in Grand Committee, including, where required, a sitting that would start on Tuesday mornings. It is not about curtailing or extending time; let us use the time we have as effectively as we possibly can. The other thing I am keen to do is give certainty to Members about when business is happening and how long business will take, because that helps Members participate.
Lord True (Con)
I understand the principle behind the Question; there is too much repetitive talk in this House, often between different stages. But that is a matter for restraint on all sides. Will the noble Baroness opposite accept that I welcome very much the initiatives that she has been taking in the usual channels, and I support them in all defined ways to make our proceedings more expedient and work well for everybody? Will she also support the principle that I held to when I was Leader: not to seek in any way to limit the freedoms of individual Members in this House to exercise their rights? It is through those freedoms, not shared by MPs, that this House has become the great revising Chamber that it is.
Baroness Smith of Basildon (Lab)
I do not seek to curtail freedoms. I do not know whether there is anything specific the noble Lord has in mind. In a House that is self-regulating, we also seek self-restraint. That self-restraint is something that the whole House wants. The certainty for Members that the House is run in an orderly way—which was part of the point of our discussions in the usual channels this morning—is important. It is beholden on the whole House, as well as the leadership of the House, to ensure that Members abide by the conventions and do not feel they are something we can bypass when we feel like it.
Baroness Smith of Llanfaes (PC)
My Lords, can the Leader of the House give an update on the progress that has been made, or not made, towards the Labour manifesto’s commitment to
“replacing the House of Lords with an alternative second chamber that is more representative of the regions and nations”?
Baroness Smith of Basildon (Lab)
There is probably not much I can say that is helpful to the noble Baroness. She will recall that the measures in the Labour Party manifesto are in three stages. The first stage, which was the removal of the hereditary Peers, will be completed at the end of Prorogation; for the second stage, we are awaiting the report from the committee looking at participation requirements of and retirement from the House; the third stage will be a matter for the Labour Party to progress in policy terms, and I cannot give her an update on that at this stage.
Baroness Ludford (LD)
Does the Leader of the House welcome, as I do, what I think is a new spirit of intention, moving from proceedings to services that support Members, to engage with and respond to Members? I think that is led by the new Lord Speaker and the new Clerk of the Parliaments. I think it is very welcome that we are going to be listened to more about the services and how they are delivered in this House.
Baroness Smith of Basildon (Lab)
I did not quite catch that, but I think that the noble Baroness referred to services of the House. My impression is that the current Lord Speaker and the past Lord Speaker and the Administration of the House have been talking and engaging more with Members, and that should continue. I will certainly keep an eye on that, because Members have an interest in how those services are delivered and how to make best use of them.
Lord Carlile of Berriew (CB)
Does the Leader agree, in relation to Private Members’ Bills starting in the House of Commons, that we should move toward standard pre-legislative scrutiny of the workability of those Bills before their detail is debated in either House?
Baroness Smith of Basildon (Lab)
I suspect that that is not a generic question but one about a specific Bill. I do not think that it would be a standard procedure to have it in place for every Bill. I share the disappointment of many noble Lords that we have not concluded, or are unlikely now to conclude, the passage of that particular Private Member’s Bill, to send amendments back to the House of Commons. The responsibility of this House should be to ensure that we give proper scrutiny and send Bills back. Whether pre-legislative scrutiny would have assisted is something to consider, and it might be something that sponsors of Bills will want to look at in future.
Sudan
Lord Bates
To ask His Majesty’s Government what assessment they have made of progress towards alleviating the humanitarian crisis in Sudan following the Third International Sudan Conference on 15 April.
Lord Bates (Con)
My Lords, I beg leave to ask the Question standing in my name on the Order Paper, and in doing so I draw attention to my role as an officer of the All-Party Parliamentary Group for Sudan and South Sudan.
The Minister of State, Foreign, Commonwealth and Development Office (Baroness Chapman of Darlington) (Lab)
Last week at the international Sudan conference in Berlin, the Foreign Secretary announced £146 million of new humanitarian funding for Sudan this year, which will reach nearly 2 million people. This includes doubling UK support for local Sudanese responders delivering vital aid in the hardest-to-reach areas. But funding alone cannot solve this manmade crisis, and that is why the Foreign Secretary joined participants in urgently pushing for an immediate ceasefire and for every possible tool to be used to improve humanitarian access to get aid in.
Lord Bates (Con)
I thank the noble Baroness for that very helpful Answer and for her personal commitment and engagement on this important issue. Sudan is the greatest humanitarian crisis currently happening in the world, with 33 million in desperate need of humanitarian assistance, including 17 million children, and 13.5 million people having fled their homes in search of food, water and safety. The situation is getting worse every day. The events in Berlin last week were very welcome in producing additional much-needed assistance and pledges for humanitarian aid, but the great crisis now is how that aid, which has been pledged, will reach the people in such desperate need in Sudan at present, when vital humanitarian access is being so cruelly denied by military forces and even by its own Government.
Baroness Chapman of Darlington (Lab)
The noble Lord is absolutely right. This is not particularly a challenge with money; last week, the international community rallied together and raised more than £1 billion to spend on aid for the people of Sudan. As he rightly says, it is how we get that aid to the people who need it most. We are doubling the amount that we spend with local responders, because often they are the right people and the best people to co-ordinate in the most effective way on the ground. It is vital that the warring parties in Sudan, and anyone who is obstructing access for aid, stops doing that immediately. It has almost become competitive, to see who can put the most restrictions on agencies, which are hoping to get aid to where it is needed. It is completely wrong—the aid is there and the resources are there, and we just need the ability to get access.
Lord Alton of Liverpool (CB)
My Lords, in this fourth year of Sudan’s war, will the Minister take the opportunity to underline the link between the 14 million people whom the United Nations High Commissioner for Refugees says are displaced in Sudan and the desperate Sudanese people who end up in small boats in the English Channel? Secondly, can she say how the Government are responding to what a UN report says are defining characteristics—“hallmarks of genocide”—with mass killings of over 59,000 people, rampant sexual violence and war crimes, including attacks on hospitals, ambulances and medical workers?
Baroness Chapman of Darlington (Lab)
As the noble Lord knows, the UK is supporting a sexual and gender-based violence representative to make sure that there is accountability. The fact that sexual violence is used in the way that it is, to the extent that it is in Sudan, often with absolute impunity, is something that the international community needs to act on now and make sure that we reflect on constantly once this is over, because it is something we have seen before, we see it repeatedly and we need to be steadfast in our determination to outlaw it. What the noble Lord says about displaced people is also correct: there are Sudanese people finding their way into small boats and crossing to the UK, but by far the largest number of Sudanese displaced people—around 5 million of them—are living on the border, either in Chad, in South Sudan, in Uganda or in Egypt. That is where the majority of people are and where the focus of our support is, to help those people close to their homes.
Lord Purvis of Tweed (LD)
My Lords, it is a stain on the international community that this war is now entering its fourth year. Of course, the UK is the penholder at the United Nations and therefore there should be an even greater moral duty that we do more to ensure that there are practical steps to protect civilians and that there is access to basic humanitarian aid, as the Minister said. Does she agree that there is inspiration in the very diverse and decentralised community groups that are doing amazing work to save lives and provide some form of assistance? I have been in touch regularly with many of these groups and they are calling for the UK to take the lead in a political process that can start now to ensure that civilians are part of the future and that there is transitional justice to ensure that those who have committed these horrific crimes are held to account for them.
Baroness Chapman of Darlington (Lab)
I could not agree more. I have met with the local responders too, and they are an incredibly impressive group of people. They are very well organised and are using technology and developing apps to make sure that their limited resources are allocated in a way that is most efficient and responsive to local need. It is something that I do not think many of the larger agencies could possibly achieve anywhere, never mind in Sudan. They are essential to our effort, which is why we have doubled the funding to them.
The noble Lord is also right to say that the UK has a leadership role to play here, on a civilian track. We are prepared to do that and we are doing that. I do not think that this is a time for getting too far ahead of others, because that kind of leadership does not seem to have been very effective in this circumstance, and it is important that we work closely with Sudanese voices and work in a way that is led by them and centred on their needs. It was good to see, at the conference last week, that strand of work having such focus. That is important, and he makes a very good point.
Baroness Royall of Blaisdon (Lab)
My Lords, last year, OCHA and organisations on the ground working with the humanitarian aid agency reached 17 million people in Sudan. This year, the aim is to reach 20 million people. They do a fantastic job, working in great danger. Will my noble friend join me in paying tribute to their courage?
Baroness Chapman of Darlington (Lab)
I do. I met Tom Fletcher yesterday to talk about exactly this. I pay tribute to all those who are working in the most dangerous and difficult circumstances in Sudan. It is tragic that we see so many of them losing their own lives as part of that endeavour, so I join my noble friend in her remarks.
Baroness Sugg (Con)
My Lords, as the noble Baroness has highlighted and acknowledged, the conflict in Sudan has been marked from the very beginning by horrific violence against women and girls, including sexual violence, abductions, forced marriage and countless other abuses. How are the Government supporting UNFPA and other local organisations to ensure that UK aid is specifically reaching women and girls caught up in this conflict?
Baroness Chapman of Darlington (Lab)
We have put in gender-based violence advisers on the border to help with the psychosocial effects of what people have had to endure. We are now the biggest funder internationally, I think, of UNFPA, because this is such a priority for us, but the noble Baroness is right to draw our attention to the fact that this method of violence, this subjugation, terror and attempts to humiliate and control women in this conflict as a weapon of war is abhorrent and is among the worst that we have ever seen. I hesitate to compare different humanitarian crises, but this is on the largest scale that we have seen this century.
Lord Stirrup
My Lords, we have spoken before in this Chamber about the link between the war in Sudan and instability more widely in the Horn of Africa. Does the Minister agree that we need to do much more to persuade and convince the people of this country that this is not a war in some distant country they can forget about, but that it is closely linked in the long term to our own economic growth and inflation rates?
Baroness Chapman of Darlington (Lab)
I think it would be great to have much more focus globally on the conflict in Sudan and the suffering of the people of Sudan. That includes the public consciousness in this country, because, in the end, that does help force political focus internationally as well. But there is no doubt that the conflict in Sudan is in many ways an expression of disagreements that have emerged elsewhere. The noble and gallant Lord talks about the horn, but obviously in Somalia, Yemen, even across to Iran, we see this instability—it is all connected. It is very poorly appreciated how closely connected these conflicts are. The more we can do to make that case, the better.
Lord Callanan (Con)
My Lords, with so many terrible conflicts ongoing in the world at the moment, there is a danger of this one falling underneath the radar, so it is right that we are discussing it today. I thank the noble Baroness for the funding announcements that she has made. Perhaps some of them are more closely linked, as she indicated. Is she aware of the reports yesterday from the US of the arrest of an Iranian woman accused of selling £50 million-worth of bombs, drones and ammunition from the Iranian revolutionary guards to the Government of Sudan?
Baroness Chapman of Darlington (Lab)
We are deeply concerned that there are arms flows through many, many routes. Nobody should be selling arms to Sudan. There is an embargo in Darfur that should be extended and should be properly enforced.
The Deputy Speaker (Viscount Stansgate) (Lab)
My Lords, that concludes Oral Questions for today. When I sit down, any Members who wish to leave before the next business are invited to do so quickly and quietly.
Arrangement of Business
(1 day, 4 hours ago)
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Captain of the Honourable Corps of Gentlemen-at-Arms and Chief Whip (Lord Kennedy of Southwark) (Lab Co-op)
My Lords, I was hoping for a larger audience. Before we commence today’s next business, I want to briefly update the House on the plan for tomorrow. After Oral Questions, the House will consider the message from the House of Commons on the Crime and Policing Bill. The QSD, led by the noble Baroness, Lady McIntosh of Pickering, will then be considered immediately. In the course of tomorrow, the House will receive a message from the Commons on the Pension Schemes Bill. It will be considered as soon as possible after the QSD, but it may be necessary for the House to adjourn during pleasure for a short time while everything in for ping-pong is prepared. Once the message has arrived and is available in the Printed Paper Office, noble Lords will have one hour to table any Motions. The precise deadline for tabling will be advertised on the annunciator and via the usual channels once it is known.
I would, however, strongly encourage any noble Lords considering tabling to discuss this in advance with the Public Bill Office. After the tabling deadline has passed, the Public Bill Office will produce a Marshalled List, and the usual briefings will be needed some time after that. The precise time we expect to commence the debate on the Bill will therefore be advertised on the annunciator and via the usual channels, as soon as it is known. I will update the House further tomorrow. I will also now arrange for an email to be sent today to every Member—I had hoped that we would have had a larger audience when I made this announcement.
The Deputy Speaker (Viscount Stansgate) (Lab)
My Lords, I apologise to the House for denying the Chief Whip the audience that his message deserved.
Health and Social Care Act 2008 (Regulated Activities) (Amendment) Regulations 2026
(1 day, 4 hours ago)
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Baroness Merron
That the draft Regulations laid before the House on 26 February be approved.
Relevant document: 54th Report from the Secondary Legislation Scrutiny Committee. Considered in Grand Committee on 15 April.
Infected Blood Compensation Scheme
(1 day, 4 hours ago)
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Baroness Finn (Con)
My Lords, I begin, as I have previously, by welcoming the progress made by the Infected Blood Compensation Authority and the Government in delivering payments. I commend the diligent work of Sir Brian Langstaff and his team, and all those who contributed to the inquiry and its additional report, which continues to shape the compensation scheme that is trying to bring some measure of justice to the victims of this terrible scandal and their families. I also pay tribute to those who have campaigned so tirelessly and bravely for so long in the face of such appalling harms inflicted by the state.
I note the Statement made in the other place and particularly the scale of the delivery now under way, with over £2 billion paid and thousands of individuals having received offers. That is an important milestone in what remains a profoundly long and painful process. Much in what has been set out will be welcomed across this House and, most importantly, by those who have lived with the consequences of this injustice. I also recognise that many of the changes now being brought forward are the result of consultation with the infected and affected community, reflecting the issues they have consistently raised throughout the process. That includes improved recognition of harms arising from infection in childhood, better provision for mental health impacts and loss of earnings where careers were curtailed, and specific new awards around unethical research, including for those who were children at Treloar’s school. These are significant and necessary developments, and I recognise the seriousness with which they are now being addressed.
This House has returned to these issues repeatedly, rightly so given the scale of the injustice and the length of time victims have waited. The question now is not whether the scheme has been improved but whether it can deliver what it promises in practice—fair, timely and trusted compensation at scale. I would therefore be grateful if the Minister could address three areas in her reply.
On delivery, we have already noted that £2 billion has been paid out to 3,161 people, but given that 18,053 have registered their intent to make a compensation claim, can the Minister provide an update on the pace at which the Infected Blood Compensation Authority is expanding the number of claims it can process? Given the scale of what remains ahead, is she confident that IPCA has sufficient staffing and professionalism to address the numbers involved so that victims can receive compensation swiftly?
Secondly, on consistency and implementation, while the tariff-based approach is designed to reduce complexity, several of the new elements, particularly those relating to psychological harm, loss of earnings and exceptional loss, inevitably require judgment in application. Can the Minister set out what safeguards will be in place to ensure consistent decision-making across caseworkers, particularly where evidence is limited or assessments of opportunity or mental health harm are required?
Thirdly, on timing and certainty, the Statement indicates that further legislation will be required to implement these changes. Given the length of time since the inquiry’s additional report and the proximity of the coming parliamentary Session, can the Minister be more specific about the legislative timetable and confirm whether the necessary legislation will be included in the forthcoming King’s Speech?
This scandal represents a catastrophic failure of the state and the response to it must meet that scale. Compensation alone can never fully account for what has been lost, but it must be delivered in a way that is fair, accessible and efficient for both infected and affected individuals. Today’s Statement represents progress, but for many what matters now is not only what has been announced but what will be delivered and whether the system has the capacity, clarity and consistency to deliver it.
As we consider what must happen next, we must recognise an unavoidable truth: for many victims, compensation has come too late. Too many have passed away without receiving a penny, and their families continue to carry the weight of that injustice. Their absence should remain at the forefront of our minds as this scheme moves into its next phase.
The Deputy Speaker (Viscount Stansgate) (Lab)
My Lords, the noble Baroness, Lady Brinton, is taking part remotely, and I now invite her to speak.
Baroness Brinton (LD) [V]
My Lords, I thank the Government for this Statement, and the technical expert group—TEG—at IBCA for its detailed report, which sits behind the proposed changes to the scheme outlined in the Statement. There are many victims who will be reassured by most, though perhaps not all, of the changes.
It is good news to hear that over 3,000 people have now received an offer of compensation, and I note that the Statement says payments have been made to all eligible groups. Can the Minister say how many of that number are from the affected group? While accepting that the Government’s priority has been to secure compensation for infected victims first, it is still true to say that a number of the affected victims are themselves frail and elderly, or, worse, very ill. Does IBCA have a date by which the scheme will be up and running for all affected victims, and will those I have outlined be prioritised as an urgent group?
It is very good news that the Government are removing the 25% deduction applied to past care compensation, which is exactly what Sir Brian Langstaff’s inquiry recommended, but why has it taken well over a year for this decision to be made? Since the spring of 2024, one of the issues that I and others have repeatedly raised with the last Government, as well as with this one, is that the state should not claw back any past benefits, including care costs, from these families who have had to turn to benefits and care support because of a fundamental failure of the state. In so doing, they—both infected and affected—lost jobs, their careers and sometimes their homes, and, much worse, had to live on the breadline for many years. To penalise them at the compensation stage was cruel, so it is good that the deduction is stopping.
However, the bigger point stands, and I know the Minister will recognise this, as she and I often talk about the bigger picture of other schemes as well. This governmental approach is seen in other schemes, and too often the change comes after extended delays. Further, trust with the victims has been lost. Will the Government please rethink this approach in future schemes before decisions are made?
A further point on the care award is that it is not clear whether affected victims who were carers are yet recognised in their own right, or whether the entirety of the care award, including the carer’s element, will remain solely with the estate of the infected person. I wonder if the Minister can update the House.
The changes outlined in the TEG report follow on from the complications of a number of different schemes over many years in the past, using different matrices, and indeed through devolution. Many, especially the ones relating to psychological damage, are welcome. Before Christmas, the TEG published details of how to handle historic suicide in the compensation scheme. The wording of that paragraph in the report has caused real consternation and distress among victims, both the infected and the affected, especially those who have already lost loved ones who were infected to suicide.
The commentary paragraph in the TEG report outlines the complexity of suicide and recognises that it is retraumatising for a family member to have to raise it with IBCA. However, it then goes on to say:
“Even with the best explanation, we believe that linking more compensation to evidence of suicide creates a risk that the Scheme is misinterpreted, and places vulnerable people at risk if they feel pressured to harm themselves to help their families get more compensation”.
Anyone who has lost a loved one to suicide for whatever reason knows that suicide is not a rational act; it is an act of desperation. To suggest that victims might resort to it solely for financial benefit as a small part of a grant of total compensation is just staggering. It has caused real distress and a further loss of trust, again. I hope that this issue can be reviewed.
Finally, it is very good news that compensation is to be given to victims treated unethically, especially the children at Lord Mayor Treloar’s School. I want to ask the Minister two questions in relation to the unethical behaviour by doctors who used infected blood in research projects without informing the victims or, if they were still children, their parents. First, are the police looking at what evidence remains? I know the NHS has said that many documents have been destroyed, but if IBCA has enough evidence to know that they were infected—and in many cases it knows when—then surely any surviving doctor should be questioned. Secondly, will IBCA ensure that there was no other unethical treatment given to people in later decades, not just those infected through the early research projects 50 years ago?
As ever, I am aware that I have asked a number of technical questions to the Minister; if the replies are not to hand, please will she write to me with them?
The Parliamentary Secretary, Cabinet Office (Baroness Anderson of Stoke-on-Trent) (Lab)
My Lords, as ever, I am grateful to the noble Baronesses for their thoughtful and productive points. This is a collaborative effort and we all share one goal: to get this right. I hope your Lordships can appreciate that this announcement marks a significant step towards delivering a compensation scheme that not only works better for the infected blood community but explicitly reflects the feedback and views that the community provided to the Government.
I want to take this opportunity to thank all those who responded, particularly those from the infected blood community. I know many of these responses included testimony of people’s personal experiences, and I want to assure those who were brave enough to share their stories that we are grateful and that we appreciate the additional burden this places on them. I hope our changes to the scheme announced in the House of Commons last week reflect their experiences, their bravery and their loss.
The consultation was not unanimous on every point, nor would I expect it to be. The experiences of those infected and affected are unique and variable, and I am sure that there are issues where some may still feel that their personal experience is not adequately reflected by the compensation scheme. However, I firmly believe that the changes we are making bring us as close as possible to a scheme which truly reflects the range of impacts on a person’s life, while still being deliverable within the scheme’s tariff-based approach.
For infected people, the changes will increase the amount of core compensation available and increase the options available for supplementary compensation awards. For affected people, additional compensation will be available to those eligible. I encourage noble Lords to read the full response, but, in the interest of today’s debate, I want to set out for Members of your Lordships’ House who do not follow this in necessarily the same detail as the many of those who are living through it do some of the key changes we are making.
First, I know the special category mechanism is a key issue of interest across your Lordships’ House. We are introducing a new supplementary award to give additional compensation to people who have been assessed as eligible for SCM and who can now demonstrate to IBCA that they meet the criteria. After considering the community’s views, we will now ensure that every eligible person has this award backdated to 2017, which is when the SCM was first introduced. We will increase the core injury award for several groups of affected people, including bereaved parents whose child sadly died before they turned 18, bereaved partners, and siblings affected under the age of 18. These changes give more compensation to affected people whose experience of the scandal was egregious beyond my comprehension. These awards will require no additional evidence from applicants.
The matter of unethical research, which was rightly raised by the noble Baroness, Lady Brinton, is of particular concern. Anyone who has engaged with the inquiry’s findings will know that it is one of the most shocking aspects of this scandal. We heard that the existing approach may not have compensated everyone who suffered this wrongdoing. We have therefore changed the scope of the award so that anyone treated in the UK for a bleeding disorder in 1985 or earlier will receive further compensation. It is clear from the consultation responses that the award amount offered does not reflect the harm done. We are increasing the unethical research awards. These include increasing our proposed award of £25,000 to those who attended Treloar’s to £60,000, as well as introducing a new unethical research award for those treated elsewhere for a bleeding disorder during childhood at a rate of £45,000. We are also tripling the award for those treated for a bleeding disorder in adulthood to £30,000.
The consultation also invited respondents to raise any other concerns they have with the design of the scheme. One of the most compelling things we heard was that the scheme does not sufficiently recognise the profound impact of infection during childhood. We have heard the community clearly on this matter and we will make a further change to the compensation scheme to address the feedback. We will introduce a 50% increase to the core autonomy award for people who were infected at the age of 18 or under.
Although I have set out only a few of the changes we are making, they reflect the questions asked by the noble Baronesses, and I hope they go some way to show our commitment to listening to the community and to making decisions with those impacted at the very forefront of our minds. In answer to the noble Baroness, Lady Finn, in order to make these substantial changes to the compensation scheme, we will bring forward further legislation in this calendar year—although whether it will be included in the King’s Speech is slightly above my pay grade.
I turn to some of the other points raised. With regard to IBCA and the extension of the cohorts, noble Lords will appreciate, because we have discussed this in your Lordships’ House on several occasions, that there is an issue of test and learn here. IBCA was a brand new organisation established to distribute £11.8 billion-worth of compensation. That is taxpayers’ money rightly going into compensation to those people who have been affected by this heartbreaking scandal, but it is vital that we get it right. So, to make sure that we do not have to keep going back to cohorts and so that we can make this right, each new cohort is taken through a test-and-learn experience. Given the experience of IBCA up until this point—we have seen that work with the infected community—I have therefore confidence in it to take the next steps. However, nothing is fast enough, and I hope to get as much out of the door as quickly as possible.
The noble Baroness, Lady Finn, was absolutely right also to raise consistent decision-making. Training is at the heart of everything that is happening at IBCA, including how the claims managers operate and making sure that there is consistent application.
On the points raised by the noble Baroness, Lady Brinton, I reassure her about our prioritisation in terms of all cohorts, where we are now prioritising the elderly and those who are nearing end of life; although everyone deserves their compensation, we are doing that so that we can get it to them as quickly as possible so that they personally have some benefit from it. I look forward to discussing future schemes with the noble Baroness in great detail, and I am sure many Members of your Lordships’ House will want to look at any future schemes to see what lessons have been learned from this scheme and from others.
The noble Baroness raised a very important point about suicide. I will write to her on that, but I have heard what she has said about the paperwork. I will say only that with regard to severe psychological harm, which is the closest space which I can move to in terms of suicide, infected people who can show that their circumstances require more financial loss and care compensation for psychological harm can apply to the new award for SCM. This applies to those whose circumstances require more compensation than the core route provides but who do not meet the eligibility criteria of the existing severe health condition for severe psychiatric disorders.
I was also asked about issues pertaining to carers. If someone who provided care to an infected person is not otherwise eligible for compensation in relation to that person—for example, as an effective sibling or parent—then they may be eligible for compensation as an affected carer and will be eligible to receive an injury award and a social impact award. Otherwise, infected people can continue to give all or some of their care compensation to affected people who provide that care. In the package of changes the Government have announced, we have increased the levels of compensation available to several groups of eligible affected people, but no specific changes are being made to the compensation available to carers.
The noble Baroness, Lady Brinton, also asked me about police investigations. The National Police Chiefs’ Council has engaged senior investigators to conduct a review of all available evidence. That work is ongoing and has proven to be much greater in volume than originally anticipated, and I look forward to hearing their findings. One of the most heartbreaking things—if you can rank heartbreak when we are talking about these issues—or perhaps challenging issues here is the fact that there are still people who should be being held accountable for their actions.
We can all agree that getting this compensation scheme right is of the utmost importance. The Government are committed to ensuring that the scheme reflects the lived experiences of those infected and affected in a way that allows for the swift delivery of compensation by the Infected Blood Compensation Authority. These things, hand in hand, go some way to delivering not only justice but, I hope, a sense of peace for the community, if that is even possible.
The reality is that no amount of money is going to fix what was so badly broken here, but, at the very least, the compensation can go some way to supporting the families affected. The community and their stories must always be put first. Sir Brian Langstaff and his team always took this approach. Following the inquiry’s closure in March, I personally thank them for the sensitivity and care with which they carried out their important work. It is with this dedication to the community’s cause over nine years that we have reached this point today, and I know noble Lords across the House echo my gratitude.
The decades of tireless campaigning and the continued determination of the community is a story of strength which will resonate for generations to come. The changes to the scheme we have discussed today will provide uplifted compensation to many infected and affected people in a way that better reflects the unique experiences of so many. Beyond the compensation scheme, I hope they also feel that this consultation has given them a voice and shown that the Government remain committed to doing everything they can to work together to truly get this right. That is, after all, the least we can do.
Baroness Featherstone (LD)
My Lords, I thank the Minister, because she is sincere and has done a lot to convince us that real change is happening. As ever, sadly, I have to declare an interest, as one of my sister’s twin boys was a haemophiliac who was infected with hepatitis C. He died aged 35, leaving a 10 month-old baby girl. Sadly, his mother—my sister—who campaigned for justice on the contaminated blood scandal for over 40 years died a few weeks ago so, sadly, will never see justice done.
A lot of other elderly and frail people, whom I believe the Minister raised in her response, are dying off. I want to know whether the Minister is aware that there is a great deal of concern about affected people who are not estate beneficiaries, because the Government insist that all infected claims must be processed before their affected loved ones can be considered. People are, effectively, being left to die without justice. Although the Minister raised the issue, I would like to know exactly what steps the Government are taking to prioritise estate claims of the elderly and frail beneficiaries, such as parents, ex-wives and siblings, who are not estate beneficiaries but have suffered terribly and are left waiting in prolonged anguish for the estate claim to be processed.
Baroness Anderson of Stoke-on-Trent (Lab)
May your sister’s memory always be a blessing. Your tireless activism will continue in her name—sorry, it was not meant to be me who got tearful. The noble Baroness has fought tirelessly with her sister. It is important that her name, Della Ryness-Hirsch, is on the record.
On the specifics that the noble Baroness raised, I will make sure that she receives a very detailed briefing and she can have whatever meeting she likes to discuss this in very great detail, as I have said to her. But let me be clear: the Government are prioritising those people who are reaching the end of life. All cohorts have now been opened by IBCA; that includes those affected. The noble Baroness may have specific concerns on behalf of her family, but I know that she also now carries a greater weight of fighting for the memories of all those people in this cohort and to make sure that justice is not just done but seen to be done and delivered. We will work together to make sure this happens.
Lord Bichard (CB)
My Lords, there is much to welcome in this Statement and I do welcome it, although some of it is belated. But we should never forget that this scandal, tragedy, or whatever term you want to use, happened because many public servants, I am sad to say, behaved despicably.
Although I can welcome the Statement about how the inquiry and its findings are to be implemented and compensation is to be paid, I do not see much evidence across government of addressing the problems that we clearly have with standards of behaviour in public service, which I think many people do not want to acknowledge—let alone do anything about. I do not think the answer is more efficient inquiries or even duties of candour. It is quite clear that the current arrangements, codes and advice that we have are not working. The greatest testimony to the courage of the people who have been affected—I have met many of them—would be if we used this as a way of addressing failures of public service in this country.
Baroness Anderson of Stoke-on-Trent (Lab)
I am sure the noble Lord will be delighted that I was appointed, seven weeks ago, to be the Minister responsible for standards in government. I am very much exploring all the issues that pertain to both the current standards regime and any changes that will need to be explored going forward. I look forward to discussing it all in detail with Members of your Lordships’ House.
The noble Lord is absolutely right that, on matters pertaining to the infected blood scandal and others, there was a failure of public servants. That is one of the reasons why the noble Lord may not think that the forthcoming duty of candour legislation will help to fix it. I truly believe it will. A great deal of this is about cultural change and about how, 31 years after their introduction, we embed the Nolan principles in all aspects of public life and make very clear the responsibilities that people have. I think people in some areas, both then and now, have forgotten their responsibilities. It is important that we ensure they are reminded of them.
Baroness Sanderson of Welton (Con)
My Lords, I too welcome the unethical research awards, but I want to raise something that has been raised with some of us here by the infected and affected. I recognise the uplift, but there are concerns about how those final figures were arrived at. One of the concerns is that this sets a legal precedent; God forbid that there are any future victims of unethical testing. I know that people would welcome a little more detail, perhaps not today but in writing, about how those figures were arrived at. There is concern for others, not just for the people affected this time.
Baroness Anderson of Stoke-on-Trent (Lab)
The noble Baroness raises a very important point. While I pray to God that there is not another example of quite the horror of this, the reality is that this is not the only compensation scheme running; there have been other moments in our history. I will write to the noble Baroness with the detail of how we got to this point with the calculations, and to make sure about any precedents that have been set. I appreciate the concern. However, it is incredibly important that we recognise what happened at Treloar’s as well as the ongoing memorialisation that will be happening for the victims of Treloar’s.
Package Travel and Linked Travel Arrangements (Amendment) Regulations 2026
(1 day, 4 hours ago)
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Baroness Lloyd of Effra
That the draft Regulations laid before the House on 2 March be approved.
Relevant document: 55th Report from the Secondary Legislation Scrutiny Committee
The Parliamentary Under-Secretary of State, Department for Business and Trade and Department for Science, Innovation and Technology (Baroness Lloyd of Effra) (Lab)
My Lords, I welcome the chance to explain why these regulations are important, why an update to the current framework is necessary and how our approach safeguards holidaymakers while helping the travel industry to prosper.
Travel is central to everyday life for millions across the United Kingdom. For many households, a holiday is the biggest non-essential purchase they will make each year. Holidays support well-being and create precious shared moments for family and friends, as well as offering opportunities to discover new places, food and culture in the UK and abroad. The sector is also a major contributor to the economy, accounting for around £58 billion of UK output and supporting more than 1 million jobs.
Package holidays are a substantial part of that picture. In 2022 the UK package holiday market was worth around £11 billion, spanning high street agents, airlines, accommodation providers and small tourism firms across the country. Each year roughly 15 million to 20 million people in the UK take a package holiday, often choosing that option for its convenience and the additional protections it provides. The package travel regulations sit at the heart of those consumer protections, and these amendments are designed to help businesses to succeed while protecting holidaymakers. Put simply, the regulations are there to ensure that the package travel market functions properly. They reassure consumers, who often pay well in advance, sometimes many months before travelling, and they give traders a clear set of rules within which to operate. In practice, the framework provides insolvency protection if a firm fails, requires clear pre-contract information, sets out who is responsible when things do not go to plan and limits unexpected price increases after a booking is made.
These protections are valued by travellers and reputable operators alike, but they are effective only when they are clear, well understood and proportionate. Experience has shown that some parts of the current regime are not delivering as intended—they can be confusing for consumers and unnecessarily complicated for businesses. Following extensive engagement with industry, consumer bodies and other stakeholders, the Government have identified a set of targeted, practical reforms that will better serve both travellers and traders.
First, we will abolish the current category of linked travel arrangements. At present, LTAs sit somewhere between a package and a simple stand-alone booking and require businesses to put insolvency protection in place. However, the evidence is clear that this category is not meeting its original aim. Too often, consumers cannot tell whether protections apply and businesses are left uncertain about the precise obligations they must meet. That lack of clarity helps nobody. It can weaken confidence, drive up disputes and create avoidable costs, particularly for smaller operators.
Under these reforms, where a consumer makes bookings that in practical terms look and feel like a package—for example, purchasing multiple travel services through the same trader during a single visit—they will receive package protections. This will bring consumer protections in line with how people reasonably understand their booking. Alongside that, we will ease requirements for businesses that do no more than facilitate a customer to make a second booking within 24 hours. That means, for instance, that domestic tourism businesses can signpost customers to one another without automatically triggering wider regulatory obligations, supporting partnership and growth, while consumers remain protected by wider consumer law.
Secondly, reflecting the complex web of relationships involved in delivering a package holiday, we will make new provision to bring greater certainty about refunds and redress where organisers rely on third-party suppliers. Where services are cancelled, organisers will be entitled to receive funds from those third parties within 14 days, aligning organisers’ refund rights with those of consumers. We will also clarify the rules governing organisers’ ability to seek redress from third parties so that financial risk is shared more fairly across the supply chain.
For consumers, removing the confusing linked travel arrangements category and setting out more clearly when package protections apply will make the rules easier to navigate. Greater clarity reduces uncertainty and disputes, helps people book with confidence and reinforces trust in the market. When consumers are treated fairly, they are more likely to return, supporting growth and, in turn, the wider economy.
Consistent, high-quality protections encourage people to book with confidence, which in turn supports demand and rewards those businesses that comply with the rules. For businesses that sell packages, these proposals simplify compliance by removing unnecessary complications. At the same time, strengthening clarity around redress from third-party suppliers means that costs and liabilities can sit more appropriately with those responsible for failures. That will support better planning, healthier cash flow and more effective collaboration across the sector. Subject to parliamentary approval, the regulations will come into force in April 2027, giving the sector almost a year to prepare for and implement the new arrangements.
To conclude, the package travel regulations support a relationship that is both complex and essential, between holidaymakers and the businesses that serve them. Consumers depend on firms to deliver trips that are frequently paid for long before departure and businesses depend on consumer confidence to invest and grow. These regulations make the relationship work by setting out clear rights and duties for both sides. The amendments preserve the central bargain: strong and trusted protections for consumers, alongside a regime that is practical, workable and proportionate for businesses. The reforms demonstrate the Government’s determination to uphold strong consumer protections while stripping away unnecessary red tape, helping travel businesses flourish and supporting growth in every part of the UK. I beg to move.
Viscount Thurso (LD)
My Lords, I declare my interests as president of the Tourism Society of the United Kingdom, and all the other things I am involved in within the hospitality industry—none of which now, sadly, is remunerated. I congratulate the Minister on underlining the importance of the hospitality and tourism industry to the United Kingdom. Certainly, I believe that it is one of our great growth industries and has tremendous potential for the future.
We are supportive of these proposals, which are broadly very sensible. The travel industry and the whole way in which people book their holidays have changed dramatically in my working lifetime and particularly over the last 15 or 20 years. The 2018 regulations were an attempt to corral some of the worst practices that were going on, with the development of the internet in particular. That they have been reviewed and considered and these proposals have been brought forward is indeed welcome. Getting rid of the two types of linked package, type A and type B, with type A going into the full package and type B disappearing, will be very welcome to many SMEs in particular. Frankly, my own little business in Scotland, that was probably in B, will be a beneficiary of that.
I have spoken to as many people in the industry as I can, and there is broadly a great welcome. I ask the Minister to keep a close eye on the implementation. I am glad that the year has gone in to give people time to make the necessary changes. There are some concerns about costs. The cost to business over 10 years, which is estimated at £98 million but offset by gains of £117 million, falls on slightly different people, so there are winners and losers in this. Broadly speaking, that is not a huge factor, but I think we should keep an eye on where the costs are just to make sure that we have got that right. I ask the Minister to continue to consult with the industry, both on the implementation of these regulations and what might be done to improve them in future. With that, I welcome their introduction.
Lord Sharpe of Epsom (Con)
My Lords, I follow the noble Viscount in agreeing that the consultation needs to be ongoing, and I will come back to that theme in a second. It is important that the Government reduce the administrative burden as well as protecting consumers, and this legislation attempts to do so. The Government say that the purpose of the package travel framework is to give consumers appropriate protections while also supporting growth, innovation and collaboration in the travel sector.
Therefore, there are parts of this instrument that we support. The removal of the confusing linked travel arrangements category and the clarification of rights around redress from third parties respond to genuine problems. The Government say that the present framework creates confusion for consumers and unnecessary complexity for businesses, and that stronger, clearer rules can support confidence and demand. But the real question for the House is whether the Government have listened carefully enough to what businesses told them in the consultation—a point I will come back to.
The Government’s own consultation response says:
“Stakeholders consistently highlighted the disproportionate compensatory obligations the regulations place on travel operators … especially in relation to being the compensator of last resort”.
It also records concern about the interaction between ATOL and the package travel regulations for firms selling both flight and non-flight products.
First, on domestic packages, the Government found that 65% of respondents supported exempting UK-only packages without passenger transport from the regulations. Accommodation providers and leisure businesses said the current rules can discourage them from offering simple bundled products. Some said the legal and insurance responsibilities attached to packaging up a stay with an activity or voucher act as a deterrent, especially for smaller operators, but the Government have ultimately decided not to proceed.
My first question to the Minister is this: if the Government accept that many domestic tourism businesses are being discouraged from innovating, what practical alternative are they offering those firms today? If they will not legislate in this area, how exactly will they help smaller domestic operators to bring new products to market?
Secondly, on insolvency protection, the Government say that trust providers supported allowing organisers to combine trust protection with bonding and that 57% of respondents said that greater flexibility would help businesses meet their obligations, but the same response also makes it clear that industry fears piecemeal reform. Businesses warned that more flexibility without clearer trust account rules, stronger insurance obligations and better oversight could actually weaken protection and widen the gap between regulatory intent and industrial reality. My second question to the Minister is: what work is the department doing to address the broader structural problems that businesses have identified on insolvency protection, rather than leaving them unresolved, and what timetable is there for that work?
Thirdly, on redress and refunds from third parties, the move to create a 14-day period for refunds of cancelled services and clarify that there is a right to redress is welcome, as far as it goes. However, there are ongoing difficulties with enforceability, especially against overseas suppliers, so my third question is: what use is a strengthened right to redress if a small or medium-sized organiser still cannot enforce it effectively against a supplier overseas, and what support enforcement mechanisms will the Government put in place?
Fourthly, on other tourist services, the consultation exposed a real problem for many smaller businesses. The Government found that 55% of respondents wanted the “significant proportion” test removed. This test is used to decide whether an added tourist service, such as an excursion, spa treatment or event ticket, is valuable enough compared with the rest of the booking to make the whole arrangement a regulated package holiday. A modest add-on can become a significant proportion simply because the room rate is low, drawing smaller firms into regulation more easily than larger ones selling the same product. So my fourth question is: what further work will the department do with industry to produce a clearer and fairer test for other tourist services, particularly for smaller operators who say the present rules can work against them?
There is a further concern that we feel Ministers have not properly answered. Under the Government’s approach, firms may no longer be fully in control of when they are selling a package. The industry’s concern is that package status could be triggered not by a deliberate commercial decision of the operator but by the behaviour of the consumer during a single online journey. That matters because full package status brings with it major legal obligations including insolvency protection, organiser liability, refund obligations and, of course, wider compliance costs. The gateway concepts on which this reform depends—the “single visit” and “facilitates”—remain undefined in legislation. Businesses are being asked to accept materially greater liability, while the key terms determining when that liability arises are still unclear.
That lack of clarity creates a risk of unintended package organisers. Hotels offering add-ons, airlines selling accommodation or car hire through third-party plug-ins, and banks, supermarkets or white-label distributors that host travel products may all find themselves pulled into package organiser status without ever having consciously chosen to enter that market. The Government say that these reforms will make the rules clearer for consumers and support compliant businesses, but many in the industry fear the opposite: that it will mean more uncertainty for firms, more complexity in compliance systems and more scope for accidental liability. Can the Minister confirm that her department will publish statutory or regulatory guidance defining “single visit” and “facilitates” before any commencement date takes effect, so that operators at least have legal certainty about the scope of the new package definition?
There is one final question that I feel obliged to ask, because the Act under which this regulation is being made, namely the Retained EU Law (Revocation and Reform) Act 2023, actually expires in June this year. What replaces it? That is a question which my noble friend Lord Moylan asked during a debate on a transport SI recently, and to which the Government have yet to provide a satisfactory answer. Could the Minister have another go now, please?
We will not oppose these regulations today. However, I hope that the Minister can answer the questions I have raised.
Baroness Lloyd of Effra (Lab)
My Lords, I thank noble Lords for their contributions to this debate on the Package Travel and Linked Travel Arrangements (Amendment) Regulations 2026, and for underlining the importance of the sector. I also thank the noble Viscount, Lord Thurso, and the noble Lord, Lord Sharpe, for welcoming the measures we are putting forward today to simplify the rules. We will keep a close eye on implementation.
Lord Sharpe of Epsom (Con)
I welcome the Minister’s commitment to talk to the industry more about these regulations, but can she commit to listening to what they have to say? The reason I mention that is that the option to absorb LTA(A) into the package definition was never presented to the industry as a specific, serious or preferred option—the closest it came was as one of four multiple-choice questions. It is very important that the industry be listened to when it is airing its concerns, particularly about single visit and facilitation. I ask that of the Minister, and I apologise for delaying her.
Ministerial and other Salaries Act 1975 (Amendment) Order 2026
(1 day, 4 hours ago)
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Baroness Anderson of Stoke-on-Trent
That the draft Order laid before the House on 5 March be approved.
Relevant documents: 55th Report from the Secondary Legislation Scrutiny Committee and 53rd Report from the Joint Committee on Statutory Instruments (special attention drawn to the instrument)
The Parliamentary Secretary, Cabinet Office (Baroness Anderson of Stoke-on-Trent) (Lab)
My Lords, this order is a necessary measure to address the historical misapplication of the Ministerial and other Salaries Act 1975, which sets ministerial and other officeholders’ pay. The other officeholders are the Leaders of the Opposition in both Houses, the Speakers in both Houses, the Opposition Chief Whips in both Houses and two Opposition Assistant Whips in the House of Commons.
In 1997, a formula was introduced to link pay increases for Ministers and certain officeholders to senior Civil Service pay bands. The formula set out that ministerial salaries should be increased by the average annual change in the midpoint of the senior Civil Service pay bands. During the financial year 2023-24, the Cabinet Office identified that the formula had been misapplied. Since the introduction of the formula in 1997, the salaries of Permanent Secretaries had often been excluded from the calculation, despite the legislation not permitting such an exclusion. This technical misapplication of the law has happened under successive Administrations, over several decades. The formula was originally proposed by the Senior Salaries Review Body, which recommended that Permanent Secretary pay should not be included in the calculation for ministerial pay. The Government believe the policy that has been often applied since 1997, in line with the Senior Salaries Review Body recommendation, is the correct approach and are introducing this Order in Council to ensure the law aligns with long-standing policy.
The order performs two primary functions. First, it resets the statutory salary levels for all Ministers and specified officeholders. Given the misapplication has been applied for several decades, resetting the salaries in law provides legal clarity and a baseline for any future uplifts. These reset figures were calculated based on the average annual change in the midpoint of the senior Civil Service pay bands including the Permanent Secretary pay band for each financial year since the misapplication was identified, in line with the formula set out in the legislation.
Secondly, the order amends the formula to exclude the Permanent Secretary pay band from future calculations. This change simply formalises the policy approach that has been applied in practice, by all Administrations, for over two decades. For the initial year beginning 1 April 2026, the order sets out a transitional measure where the higher of the old or new formula will be applied to ensure that no individual is disadvantaged by the order’s retrospective effect. The impact of this order is minimal; it affects only ministerial office holders and a small number of other office holders in Westminster. Due to incomplete records, it has not been possible to determine the exact financial impact of this misapplication. Analysis shows that no individual has gained or lost a substantial amount.
I want to be clear that for Ministers, this order will result in no change to actual take-home pay. The Prime Minister has maintained the policy of freezing ministerial salaries, and Ministers will continue to waive their statutory entitlement. In fact, ministerial salaries for Members of the House of Commons have not increased since 2008. Ministerial salaries were actually cut in law, via an Order in Council, in 2011. Lords ministerial salaries have not risen since 2008 and were cut in 2011, but in 2019-20, they began to claim their full salary entitlement. They were again frozen in 2020-21 and remain so today. The other officeholders make a personal decision on whether to take the salary they are entitled to in law or to waive part of the salary in line with the ministerial salary freeze. The order therefore does affect the salaries paid to these individuals who choose to take their entitled salaries. The Government have been unable to calculate their annual pay increases while work on this order was ongoing, so we will provide back payments covering annual pay increases owed to current and former officeholders in these roles dating back to 1 April 2023.
The legislation is also linked to the salaries of the Chairman and Deputy Chairmen of Ways and Means in the other place, whose salaries increase through the same formula but are paid by Parliament. They will also receive back payments dating back to 1 April 2023. The total cost of back payments to the Government is just over £15,000. This is for the roles paid by the Government: the Leaders of the Opposition in both Houses, the Speaker in the House of Commons, the Opposition Chief Whips in both Houses and two Opposition Assistant Whips in the House of Commons. The total cost of back payments to Parliament is between £7,000 and £19,000. This is for the roles paid by Parliament: the Chairman and Deputy Chairmen of Ways and Means in the other place and the Lord Speaker.
It is important to note that the majority of the back payments represent money that would have been paid if the misapplication had not been identified. I am grateful to the Secondary Legislation Scrutiny Committee and the Joint Committee on Statutory Instruments for their consideration of this Order in Council and for their respective reports. I shall briefly address the issues they have raised.
The Secondary Legislation Scrutiny Committee noted that it has taken three years for the Cabinet Office to resolve this issue. Although a small issue, it is a complex and technical one; it is right that the Government took the time to ensure that the misapplication was addressed correctly, and I am sure that noble Lords will support this order which addresses this long-standing misapplication of the law.
The Joint Committee on Statutory Instrument has reported that this Order in Council appears to have retrospective effect without the express authority of the parent legislation. The Cabinet Office considers that the Act provides power for limited retrospection, and that the retrospective effect of this order is justified and fair. This is because backdating of salary increases is normal practice given that, for senior civil servants, salary increases are usually not known until the summer but pay increases take effect from the 1 April. In addition, as I have set out, the impact of this order is minimal, affecting Ministers and a small number of other officeholders.
In summary, the Government are bringing forward this Order in Council to address a historical misapplication of the Ministerial and other Salaries Act 1975, which sets ministerial and certain officeholders’ pay. This is a necessary measure to address a technical misapplication of the law and will ensure that the law aligns with long-standing policy. I beg to move.
Lord Redwood (Con)
I am grateful to the Minister for the technical explanation of a complex matter, but could she also answer a couple of relevant questions? First, what is the progress on having more Lords Ministers in receipt of salaries, after our recent discussions and legislation on extending the number of paid posts? What progress is there on helping Ministers rather more by clearer definitions of their aims and their targets, with suitable mentoring and support and, if necessary, performance reporting, so that we can all see that these well-justified salaries are indeed well justified and are resulting in better government?
Baroness Finn (Con)
My Lords, I thank the Minister for introducing this order. As she has set out, it is a sensible and largely technical measure that would bring the law on ministerial and officeholder salaries in line with the current practice of excluding Permanent Secretary salaries from the calculation of annual salary increases. It brings the statutory framework in line with the approach that has in practice been followed by successive Governments since 1997. It does not change the underlying policy; rather, it corrects a discrepancy in the legislation relating to the treatment of Permanent Secretary salaries within the relevant calculation. It also addresses the criticism, as the Minister pointed out, from the Secondary Legislation Scrutiny Committee that this issue has not been previously addressed despite the discrepancy being noted by the Cabinet Office in the 2023-24 financial year. On that basis, I do not take issue with the intent of the order.
The principal point on which I would welcome further clarity relates to ministerial pensions. The Government have been clear that ministerial salaries will remain frozen in practice and that take-home pay will therefore be unaffected by this order. However, the order alters the maximum salary that they may receive under the Ministerial and other Salaries Act 1975. It would be helpful, therefore, to understand whether future pension entitlements will be calculated on the basis of that legal maximum salary or on the salary actually received. If it is the former, this measure may have the effect of increasing pension accrual despite the continuation of the pay freeze. I would therefore be grateful if the Minister could set out how pension calculations will operate, and whether any additional cost to the public purse is expected as a result.
More broadly, this measure raises a question regarding the scope of the ministerial pension scheme itself. Unlike with other public service pension schemes, there does not appear to be any provision for forfeiture in cases of serious misconduct. In contrast, we have long accepted in principle across the public sector that pensions may, in defined and exceptional circumstances, be subject to forfeiture where there has been criminal conduct connected to office. Given that disparity, it would be helpful to understand whether the Government have considered bringing forward legislative changes to place ministerial pensions on a more consistent footing with other public service pension schemes in this respect.
I note that similar issues are already being examined elsewhere in relation to standards in public life, and it would seem desirable for the legislative framework here to be equally coherent. In that context, I would be grateful if the Minister would inform the House whether the Government intend to bring forward an amendment to the current Pension Schemes Bill to address this issue, or whether they have concluded that no legislative change is required. If the latter is the case, I ask the Minister to outline the reason for maintaining the present position, given the clear precedent for forfeiture provisions in other public service pension schemes. It would also be helpful to know whether this matter is under active consideration within government, or whether it has been ruled out entirely.
Baroness Anderson of Stoke-on-Trent (Lab)
I thank the noble Lord and the noble Baroness. Like magic, I have just received the answer to one of the noble Baroness’s questions. I will address the questions as they came and start with the noble Lord, Lord Redwood.
The Bill we discussed last week is currently awaiting Royal Assent and is not yet an Act, but, on a personal level, I am awfully grateful to your Lordships’ House for passing that legislation. As the Minister for Standards in the Cabinet Office, I was here, as the noble Lord will be aware, when we discussed it. As the Minister for Standards and Conduct across government, the subject of mentoring and support in the area for which I have responsibility and more widely has been the subject of conversations I have had. I look forward to being able to bring forward recommendations when I have been in post slightly longer looking at this in the round. I reassure the noble Lord that this is under active consideration.
In response to the noble Baroness, Lady Finn, pensions have been based on claimed salary, not entitled salary, since 2015. On the issue of forfeiture—a nice segue, if I may congratulate the noble Baroness— I will write to her with the detail but there are currently no active considerations in this space, so we will not be bringing forward an amendment to the Pension Schemes Bill, which I am sure noble Lords will be grateful of at this stage of ping-pong. Having said that, the noble Baroness raises a very important point about wider standards issues and how everything operates in the round. She and I are jointly committed to upholding the highest standards in public life, and I will write to her with all the details on her specific questions.
I thank noble Lords for their consideration of this order. Though technical in nature, the measure is essential for maintaining the integrity of our statutory framework and ensuring that the law accurately reflects decades of established policy. As I have outlined, this order is fundamentally about regularisation; we are addressing a historical discrepancy that has spanned multiple Administrations and several decades. By formalising the exclusion of Permanent Secretaries’ pay from the ministerial salary formula, we are not creating new policy. I thank all noble Lords for the points they raised in today’s debate and I commend the order to the House.
Criminal Justice (International Co-operation) Act 1990 (Amendment) Order 2026
(1 day, 4 hours ago)
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Lord Hanson of Flint
That the draft Order laid before the House on 26 February be approved.
Relevant document: 55th Report from the Secondary Legislation Scrutiny Committee (special attention drawn to the instrument)
The Minister of State, Home Office (Lord Hanson of Flint) (Lab)
My Lords, in moving this instrument I will speak also to the Controlled Drugs (Drug Precursors) (Amendment and Revocation) Regulations 2026, both of which were laid before the House on 26 February. For ease of discussion, if the House will allow me, I will refer to the first of these two instruments as the regulations and the second as the order.
These instruments are somewhat technical in nature, but they have a bigger picture behind them. Both are intended to tackle the terrible harms caused by illegal drugs. Drug misuse has a profound impact on crime, health and productivity. Nearly half of acquisitive crime and over 50% of homicides are linked to drugs. In 2024, drug misuse deaths in England reached almost 3,500—the highest on record. Drug misuse costs the economy some £20 billion per year. The Government are committed to protecting our communities by reducing drug-related harms.
Drug precursor chemicals—DPCs—are used to make illicit drugs, but some have legitimate industrial uses. Controlling them is a vital way of tackling drug harms. It is important also as a vital string to our bow economically. It is always better to address a problem closer to source, and so it is better to tackle drug supply before a drug has even been made. There are two ways in which we control DPCs. The first is to place controls on their legitimate use, to minimise the chance that substances which were intended for bona fide industrial purposes could be diverted to producing illicit drugs. The regulations we are debating today address this. The second way is to criminalise the deliberate illicit use of DPCs for the purposes of making drugs. The order we are debating today addresses that.
To take the regulations first, currently companies must, in most cases, apply for licences and other authorisations to use DPCs. They must also, in most cases, properly document and label DPC consignments, and they must always tell the National Crime Agency whenever they have reason to believe a DPC may be diverted for illicit use. Those requirements were an EU responsibility before Brexit. Since then, EU rules have continued to apply in Northern Ireland under the Windsor Framework, whereas in Great Britain a similar system applies as assimilated law. These regulations correct some deficiencies in that assimilated law.
First, Ministers currently do not have an effective power to control new DPCs in Great Britain. The list of chemicals subject to control in Great Britain, as it was, has been effectively frozen in time since January 2021. Since then, the EU has controlled 10 new DPCs and 14 related substances. Those controls have therefore applied in Northern Ireland but not in Great Britain, on the other side of the Irish Sea.
The substances are used to produce MDMA, more commonly known as ecstasy, with fentanyl, whose deeply harmful nature is sadly all too familiar and which is particularly in use in America. Substances such as that known as crystal meth and amphetamines are also used. All of those, except amphetamine, are class A drugs, and for good reason. Fentanyl can, among other things, cause people to stop breathing. Ecstasy can lead to serious consequences, particularly for those with heart conditions, blood pressure problems, epilepsy or asthma. It was mentioned 78 times on certificates for death registered in England and Wales in 2024. Methamphetamine, quite apart from its severe health consequences, is linked to violent crime. The regulations will add those 10 DPCs and related substances to the control regime in Great Britain and will allow Ministers to control others in the future.
The second deficiency in the assimilated law is that there is currently no clear statutory mechanism to control the movement of DPCs between Great Britain and Northern Ireland. The regulations will now provide one. Such controls are a vital way to prevent the diversion of DPCs to illicit use and to discharge our responsibilities under international law. At the same time, we recognise the importance of enabling trade to flow as smoothly as possible within the UK, and we are therefore waiving the need to pay a fee.
Finally, while the requirements on companies across the UK to label and document transactions involving DPCs and to tell the National Crime Agency of their suspected diversion apply to one set of chemicals, the criminal offences for not doing so apply to a different, smaller set. It cannot be right that there are legal requirements on companies but no sanctions for ignoring them. The regulations will ensure that the offences apply to the same DPCs as do the positive requirements.
I turn to the order. This instrument will extend the list of DPCs that it is a crime to supply or make if the defendant knows or suspects that they will be used to make controlled drugs. The order adds to that list 12 DPCs and 16 related substances that the United Nations controlled between March 2014 and March 2024. These DPCs are also used to produce ecstasy, fentanyl, amphetamine and methamphetamine. This should certainly have been done earlier—I cannot comment on why it was not, as this was under a Government not controlled by my party—but I know that my colleague the Minister for Policing and Crime has taken very seriously a number of criticisms made by noble Lords on the Secondary Legislation Scrutiny Committee and acted accordingly.
Finally, in line with usual practice, I draw the attention of the House to the correction slip for the regulations. This corrected two minor typographical errors. One changes a reference from “the Great Britain” to “Great Britain”; the other replaces a reference to the third occasion when a phrase appears on the second occasion. I hope those minor amendments are accepted.
While I am on my feet on the matter of drugs, I take this opportunity to comment on a question I answered from the noble Lord, Lord Storey, on 13 April about nitrous oxide. I stated that in the year September 2024 to September 2025 there were 242 convictions for the supply of nitrous oxide, with 234 sentences to date. In fact, it was October 2024 rather than September 2024 and the 242 convictions and 234 sentences were for possession or supply, mostly possession. It is important to place that small clarification on the record.
In summary, the Government are unwavering in their commitment to tackle illegal drugs, which cause misery and harm across society, and these two instruments will aid us in that critical effort. I beg to move.
Baroness Janke (LD)
My Lords, the basic idea that the list of controlled drug precursor chemicals should be in sync across the UK and with international agreements that we have signed up to is a clear and reasonable one. More complicated is the process by which we have got here. It is also less straightforward whether the Home Office is applying the right lessons from the mistakes involved.
The controlled drugs SI would give the Government the power to align the lists of drug precursor chemicals between Great Britain and Northern Ireland in future. Given the problems of delay that have brought us here today, with it taking five years since the end of the implementation period for this SI to come forward, can the Minister set out whether the department has set any targets or guidelines for how quickly it will move in future to use such powers? The Home Office has said that work on this SI started in 2024 and that this is one of its “legislative priorities”, yet we have the SI in Parliament only in 2026. Even if we start the clock after the 2024 general election, that is still the best part of two years to serve up an SI that was already delayed and running late. Is the Minister happy with that sort of turnaround time, and is anything being done to speed up the secondary legislation process in the Home Office?
The criminal justice SI involves even longer delays and a failure to act for at least a decade to update domestic law in the light of international agreements, in an area—criminal justice—that has consistently been a priority of different Home Secretaries and Governments. It has been a decade full of tough rhetoric about crime and requests for new legislation from the Home Office, yet also one of failure to keep on top of what should be pretty basic administrative tasks: having a proper legislation log, handover notes and processes for staff, and keeping a list of drugs up to date. Yet we know that was not the case. The Minister and the Home Secretary can reasonably point out that they were not in post for most of that decade, and in correspondence with the Secondary Legislation Scrutiny Committee the relevant Minister has set out remedial steps, which is welcome.
What this leaves, though, are two concerns. First, there is the very basic nature of the mistakes: the absence of a proper legislation log and the absence of proper handover processes, particularly in a department where staff churn is a regular and even frequent occurrence. Over the years when these basic measures were missing, a variety of different staff would have churned through posts and in some way should have been aware of or responsible for such issues. That these problems persisted for so long suggests a systemic flaw in the management processes or quality in the department. Moreover, as the Home Office has, according to its correspondence with the SLSC, decided not to track down which staff were involved, it is quite possible that people who made mistakes did not know and still do not know, and need to learn from them. Those who have moved on to other roles may well be making the same mistakes elsewhere.
Lord Davies of Gower (Con)
My Lords, I thank the Minister for setting out these two draft instruments, which together update the framework governing drug precursor chemicals. On these Benches, we support the objectives of these measures. Drug precursors play a critical role in the illicit manufacture of controlled substances, and it is right that the law keeps pace with international developments and the evolving methods of criminal networks. Strengthening controls and closing loopholes is therefore both necessary and welcome.
The draft statutory instruments will bring the UK into closer alignment with its obligations under the 1988 UN convention by updating the list of substances that it is a criminal offence to supply or manufacture where there is knowledge or suspicion of illicit use. They also seek to address deficiencies in the current regime by aligning the list of controlled substances with those subject to criminal sanctions.
While the substance of these changes is sensible and, as the Secondary Legislation Scrutiny Committee has observed, not in itself controversial, the context in which they arise warrants some reflection. The committee has pointed to delays in updating domestic legislation to reflect changes to international obligations and to the time taken to resolve discrepancies between Great Britain and Northern Ireland following the end of the implementation period. There are also concerns about the clarity of the statutory basis for certain authorisations and fees. Although these issues are now being addressed, they underline the importance of ensuring that regulatory frameworks remain up to date, coherent and legally robust. The House is entitled to expect that such matters are identified and acted upon in a timely and consistent way.
In conclusion, we support these instruments and the improvements they make to the enforcement framework. I am grateful to the Minister for bringing these draft instruments to the House today, and I look forward to his response.
Lord Hanson of Flint (Lab)
I am grateful for the comments that have been made and I understand the Secondary Legislation Scrutiny Committee’s concerns. I hope that the noble Baroness will forgive me if I say that the Government came into office in July 2024 and, as soon as we identified the challenges posed in terms of orders not having been implemented previously, we took action to try to bring this back into some sort of order. There have been, self-evidently, challenges in relation to a number of issues. I cannot ultimately comment on what happened under previous Governments, but I can confirm that we took action on this issue as soon as it was identified.
I can also confirm to the noble Baroness that officials have reviewed electronic records to seek to understand why the Act was not updated earlier. Those records did not indicate the reason for these omissions. That is a fault that we are looking to review. It may be that, since the UN controlled no DPCs between 2000 and 2014, awareness of the need to update the Act when it started doing so was lost within the department. To help mitigate against that in future, we have now created a log of drugs legislation to ensure this does not happen again. Through the order we are debating today, we are trying to put those omissions right.
As the Minister for Policing and Crime set out in her letter to the Secondary Legislation Scrutiny Committee on 23 March, the Government understand the committee’s concerns about record-keeping, which has likely contributed to the delay in including the 12 DPCs and the 16 other elements in the Criminal Justice (International Co-operation) Act 1990. As a result, as I have said, drugs legislation logs have been created. The Government consider that the gap in knowledge is unlikely to have had wider implications across the Home Office, but I can assure noble Lords that the Minister for Policing and Crime has raised this issue with the Permanent Secretary. She has asked him to ascertain what Home Office legislation is dependent on or affected by international obligations and how we monitor those international obligations to ensure that any changes are reflected in UK law.
In answer to the noble Lord, Lord Davies of Gower, I know that charging and the authorisation of fees being paid was an important issue. The Secondary Legislation Scrutiny Committee looked at the issue of plans for fees which were previously charged. I am happy to confirm today that we will be offering refunds to those who have been affected. The total sum is only around £3,000, but it is still an important issue. We will be looking at how we can manage that in due course and I will certainly be examining that with my colleagues in future.
We are where we are. The Government have tried to make some changes with both these instruments brought forward today to ensure that there is a United Kingdom approach and those regulations are now in order. I commend both to the House.
Motion agreed.
Controlled Drugs (Drug Precursors) (Amendment and Revocation) Regulations 2026
(1 day, 4 hours ago)
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Lord Hanson of Flint
That the draft Regulations laid before the House on 26 February be approved.
Relevant document: 55th Report from the Secondary Legislation Scrutiny Committee (special attention drawn to the instrument)
Immigration and Asylum (Provision of Accommodation to Failed Asylum-Seekers) (Amendment) Regulations 2026
(1 day, 4 hours ago)
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Lord Hanson of Flint
That the draft Regulations laid before the House on 5 March be approved.
Relevant document: 55th Report from the Secondary Legislation Scrutiny Committee (special attention drawn to the instrument)
The Minister of State, Home Office (Lord Hanson of Flint) (Lab)
My Lords, these instruments—the Immigration and Asylum (Provision of Accommodation to Failed Asylum-Seekers) (Amendment) Regulations 2026 and the Asylum Seekers (Reception Conditions) (Amendment) Regulations 2026—were laid before the House on 5 March 2026. They relate to the Government’s stance that asylum support should be provided in a manner which is fair and only where it is genuinely justified.
These instruments are a key element of our sweeping reforms to create a fairer, more accountable system, one that protects support for those who genuinely need it while encouraging compliance and deterring misuse. Noble Lords might be interested in the fact that, as of December, there were 107,003 individuals in receipt of asylum support, with 30,657 in around 200 asylum hotels. In the financial year 2024-25, a total of £4 billion was spent on asylum support in the United Kingdom.
The Government inherited that situation and have to try to look at how we can reduce overall asylum costs. The Government have already reduced overall asylum support costs by 15% over that period, and we must continue to look at how we can make further reductions in the cost to the taxpayer.
One of the instruments before the House today removes the duty to provide asylum support, reverting to the discretionary power set out in the Immigration and Asylum Act 1999. This reinforces our ability to make case-by-case decisions and gives the Government greater flexibility in how we assess and distribute asylum support. It also allows us to take firmer action against those who do not comply with the rules.
For example, removing Regulation 5 allows us to withhold support from individuals who have permission to work and therefore should be supporting themselves. This includes those who entered the UK on work or student visas after explicitly confirming, as part of their visa application, that they had sufficient funds to meet their living costs for the duration of their stay. It is not acceptable for individuals to make such declarations in order to secure entry and then subsequently claim asylum and move on to taxpayer-funded support.
The same principle applies to those granted permission to work where their asylum claim has been pending for more than 12 months through no fault of their own. Where a person has the legal ability to earn and maintain themselves, it is only right that they do so. Reinstating this discretionary power also enables us to deny support to those who have intentionally made themselves destitute in an attempt to access the system. This is essential to protecting the integrity of our approach and ensuring that support is reserved for those who genuinely need it.
The other instrument we are debating today focuses on illegal working and makes doing so an explicit reason to discontinue an individual’s asylum support. Previously, where an individual was suspected of working illegally, this had to be investigated as fraud or concealment of funds to establish that they were no longer destitute. By setting out clearly in legislation that illegal working is itself a breach of asylum support conditions, we create a direct and transparent mechanism to discontinue support, without the need for protracted fraud investigations.
Most asylum seekers do not have the right to work in the UK, yet some choose to work illegally while also claiming asylum support and accommodation. I suggest to noble Lords that that is not right. This undercuts legitimate businesses and takes genuine work opportunities away from other citizens. It is unlawful to undertake work without the requisite authorisation, and this measure ensures that there is now a clear and proportionate consequence for those who choose to disregard that requirement.
Through the statutory instrument before the House, illegal working will be an explicit ground on which Section 4 support may be withdrawn from failed asylum seekers, therefore aligning with the changes made to Section 98 and Section 95 support that were laid on the same date as these instruments and came into force on 27 March. This ensures that public resources are directed only to those who abide by the rules and who genuinely cannot support themselves, reinforcing the credibility and fairness of the system as a whole.
Taken together, these measures will deliver a coherent system in which support aligns with responsibility. I emphasise to the House that this shift is about fairness and responsibility. Rights must come with responsibilities, and the British taxpayer cannot be expected to fund support for individuals who deliberately disregard the rules of the asylum system and the laws of the United Kingdom.
Crucially, none of these changes alters the legal safeguards that remain firmly in place. Our human rights and equality obligations will continue to provide strong protections, ensuring that we operate within a framework that upholds fundamental rights. Our intention is to provide greater flexibility over who we provide support to, ensuring that support is targeted, proportionate and sustainable. The revocation of Regulation 5 is an enabler for the development of a new framework that provides us with the ability to make changes in relation to those who have the ability to support themselves or who fail to comply with the conditions set by the Home Office or who break UK law.
This is the first step in building a modern and controlled asylum support system, which protects the vulnerable, encourages compliance and ensures public confidence. By tightening eligibility, we strengthen public confidence in the system and, I contend to the House, ensure that support is focused on those who play by the rules. I commend both orders to the House.
Baroness Teather (LD)
My Lords, I see some of the same noble Lords in their places for this debate that were here for the debate last Tuesday. I trust that the Minister is feeling much better.
As with last week, these SIs on asylum support leave much unclear and have been tabled before the accompanying impact assessments or the framework the Minister just referred to, which would help the House understand the implications. I cannot approach a debate about destitution in the asylum system as an entirely abstract topic. I cannot not see the faces of the asylum seekers and refugees I had the privilege of working with at the Jesuit Refugee Service over a nine-year period. They were men and women from many different countries who, for one reason or another, found themselves destitute along their asylum journey.
Baroness Lister of Burtersett (Lab)
My Lords, I declare my interest as a RAMP associate. As the noble Baroness, Lady Teather—who I think of as a noble friend—said in her deeply moving speech, for the second week running we are here debating secondary legislation that represents another step in what the Home Secretary has described as
“the most significant reform to our migration system in modern times ”.—[Official Report, Commons, 17/11/25; col. 509.].
In another critical report, the Secondary Legislation Scrutiny Committee has drawn the regulations to the attention of the House. The committee has been working overtime on asylum legislation, and we should be grateful to its members for their work. Once again, they complain about lack of clarity on aspects of the new policy, which
“makes it impossible to scrutinise this measure adequately”.
They draw attention to tensions and risks associated with the policy, which are not adequately addressed by the Home Office. Once again, my noble friend the Minister, who is always most gracious in dealing with our criticisms, has my sympathy for having to defend the regulations. I am glad that his throat is no longer protesting against the task, and that he feels better this week.
I will focus on the revocation of the duty to provide asylum support. Starting with process issues, the committee yet again draws attention to the lack of consultation, which was justified in the Explanatory Memorandum on grounds of the wider policy development of which this change is a part. The Home Office has given assurances that views will be sought from stakeholders once the proposals reach a “sufficiently developed stage”. The committee suggests that we ask my noble friend what criteria will be used to determine when a “sufficiently developed stage” has been reached to trigger consultation. I do ask that, but I also want to put on the record my view that the important principle of revoking a right to support for a particularly vulnerable group of people, as we have heard, should itself have been the subject of consultation regardless of wider policy development, the timeline for which remains unclear.
If, as the Home Office argues, policy is insufficiently developed for the provision of a proper impact assessment, then, as the Refugee Council argues, it should have waited and introduced a measure as part of the primary legislation expected in the next Session. Indeed, as some of us argued last week, and as my noble friend Lord Dubs, who is unable to be in his place, pointed out, this and the changes as a whole
“are quite fundamental to the way in which we deal with asylum seekers and refugees ”.—[Official Report, 14/4/26; col. 299.]
and should be included in primary legislation in the name of democratic accountability.
I welcome the fact that, despite the revocation of the duty to provide asylum support, families containing a child aged under 18 will continue to receive support for the whole household where otherwise adequate accommodation or the child’s essential living needs are not being met in line with Section 122 of the 1999 Act. I would be grateful if my noble friend confirmed that my reading of this is correct so that it is on the record.
Nevertheless, I am worried about the likely impact of the removal of the duty to provide support. The SLSC tried to get clarification of what the EM meant when it said that support will remain available to those “in genuine need”. One example given was an asylum seeker who has the right to work. When the committee asked whether support might be withdrawn where an asylum seeker is not able to exercise the right to work because they cannot find employment—particularly bearing in mind that changes to the list of jobs they are allowed to take after 12 months could mean it becomes harder for those who do not have the necessary skills—the answer was:
“We are developing our policy on this”.
That really is not good enough.
Another example given was
“where an asylum seeker could be supported by friends and family”.
How on earth will this work? Will an asylum seeker have to give a list of friends and family, and will they then be means tested to see if they can afford to support them? Even if they can afford to do so, there is no legal obligation to support family and friends in this way, in either the short or longer term. Personally, I find this suggestion extraordinary.
I am not surprised that the committee considered the inability to answer questions about the meaning of “genuine need” unsatisfactory, despite Home Office assurances that cases will be reviewed on a case-by-case basis, as my noble friend said earlier, taking account of obligations under the ECHR—which, as the committee notes, raises questions about staff resources.
Moreover, there is an underlying issue here that the report did not explore: the difference between a right and a discretionary power. The EM states that
“human rights legislation and equality law … ensure that any changes to policy will operate within a framework that respects fundamental rights”,
a point made by my noble friend. Sir Jonathan Jones KCB KC points out for the Institute for Government that this means that decisions not to grant support could be subject to judicial review. But that is a last resort, and I am concerned about the implications for everyday decision-making.
I have been around long enough to remember when some basic elements of the social security safety net were subject to discretion rather than set out as clear rights. Discretion opens the door to inconsistency and even discrimination, not necessarily conscious. Back in 1975 the official Supplementary Benefits Commission warned that discretion provides scope for decision makers’ own “moral judgments” to shape decisions on eligibility, so the promise that the decisions will be made on a case-by-case basis is not necessarily reassuring.
Discretion robs asylum seekers of dependability and certainty and reinforces their sense of precarity, which the noble Baroness referred to, along with the changes debated last week. While it might meet the letter of our international obligations, I am not sure it meets the spirit expressed in a statement from the UN’s Committee on Economic, Social and Cultural Rights that asylum seekers should be able
“to enjoy economic, social and cultural rights without discrimination”.
One reason why rights are so important in this context, as we have heard, is that they provide a firmer protection against destitution, although it should be remembered that asylum support provides a pretty minimal standard of living. Asylum seekers are already disproportionately likely to be in deep poverty and to suffer food insecurity. It is disgraceful that the press release accompanying the draft regulations had the headline:
“Asylum handouts and accommodation removed for illegal migrants abusing Britain’s generosity”,
once again conflating asylum seeking and illegal migration and using pejorative terms such as “handouts”. As Minister Norris himself said in a debate last year,
“we have legal and, I would argue, moral imperatives not to create mass destitution”.—[Official Report, Commons, 20/10/25; col. 285WH.]
Nevertheless, the SLSC was concerned about the likely risk of destitution due to the revocation of the duty to provide support and how this could lead to crime, illegal working and homelessness, in conflict with the national plan to end homelessness and, according to the Times, the subject of an internal warning from the MHCLG. It notes:
“The Home Office has not set out how it will manage these risks, and the House may wish to enquire further”.
I hope my noble friend can be more forthcoming now, including on the particular dangers for women, who Women for Refugee Women fear will be at increased risk of abuse, violence and exploitation, including being forced into sex work.
Given my noble friend’s welcome repeated assurances last week that
“equality considerations are at the front and centre of our work”,—[Official Report, 14/4/26; col. 321.]
I hope he will give this point serious consideration. Here I find it difficult to believe the Explanatory Memorandum’s statement that
“no significant … impact on business, charities or voluntary bodies”
is foreseen. Again, to pick up on what the noble Baroness said, surely the risk of destitution could have a significant impact on local authorities and on refugee and homelessness charities, which will have to pick up the pieces.
Before making my final point on these regs, I take this opportunity to raise the question of the move-on period. The Refugee Council points out that the third set of regulations published alongside those that we are debating provided the perfect opportunity to update the previous 28 days to the 42 days now in operation. I ask my noble friend why that opportunity was not taken. Will it be taken soon? Is he able to tell us what arrangements will be made for monitoring the 42-day move-on period, which is a real improvement that I welcome but is less than the 56 days in the initial pilot which was what local authorities and charities had been calling for? Is he able to commit to publication of the evaluation of that pilot before Parliament is prorogued? I raised these matters in a letter that I sent my noble friend yesterday so I apologise for repeating them today, but anything that he is able to put on the record now would be helpful.
Lord Murray of Blidworth (Con)
My Lords, I find myself in the happy position again of agreeing with the Government. I commend them for these regulations, which go some way to addressing the risk of abuse of our asylum support system. These changes are a good start, but they could go further. I have one or two questions for the Minister, though, in respect of each of the regulations before the House today.
First, in respect of the asylum support provision relating to illegal working, perhaps the Minister could tell us how it is envisaged that the Government would defend a claim brought by an asylum seeker—or a failed asylum seeker under the other regulations—who has been found to be working illegally and has had their support removed. If they make an application, as the noble Baroness, Lady Lister, has indicated, to have support restored, and then say that unless it is restored the Government will be in breach of their obligations under Article 3, how does the Home Office propose to defend the withdrawal of support in those circumstances?
The second question is in relation to the removal of the duty to provide accommodation, which came out of the EU reception conditions directive and has restored the arrangements in the 1999 Act to being a power to provide accommodation. How does the Home Office propose to examine the accommodation and support provided in our neighbouring countries? My recollection of reviewing that support is that ours is far more generous than that available in France, Ireland, Denmark or the US. Could the Minister ask his officials to look into the provision of asylum support in those countries and tell us how our present offering compares, and write back to me and put a copy of that letter in the Library, assuming he does not have those answers to hand?
I return to my main point that I am supportive of these instruments. They are a good start, and I thank the Home Office for bringing them forward.
Lord Mann (Lab)
My Lords, I congratulate the Home Office on its direction of travel, but I have a few points I think it needs to consider to get this right. It would be helpful if the Home Office were to publish more regularly the gender breakdown of asylum seekers so that we can be clear that it is a representative proportion of those to whom we may have an obligation.
It would also be rather helpful for the Home Office to do more in the international context. I recall going with the former Bishop of Durham to Burundi, where a third of the entire population had sought asylum in a neighbouring Commonwealth country, Tanzania. It is part of the Commonwealth and was previously part of the Empire. It seems to me that part of our obligation to those seeking asylum is to ensure that those large numbers who temporarily felt obliged to move to a safe haven in Tanzania were able to return—as they did, but with some difficulty—to one of the most impoverished countries in the world, Burundi.
Similarly, I visited the Rohingya camps in Bangladesh, where more than 1 million have fled from Myanmar—again, a country with which we have a very long-standing relationship. These are all asylum seekers, but it would be rather absurd for us to have a policy that suggests that the way to address those problems would be to facilitate those people coming here via organised crime gangs.
It is interesting to observe how low, or non-existent, the number of rough sleepers is in certain parts of the country. That is not correlated to wealth and income in those areas; it is correlated to the amount of casual work available—work on farms, for example, or in vape shops. There is a new mania in this country for everyone not to wash their own car but to pay someone else to do it. The evidence I have seen would suggest that many of these businesses are impossible to trace, and yet the Home Office is meant to have a system to ensure that illegal working is clamped down on. What further will be done about the registration of businesses to ensure that a business on a set and identifiable premises, which someone could go in and ask for work from, is in fact a legitimate business operating within the law, rather than a cash business facilitating the work of organised crime gangs in trafficking people to this country? In the same way that we have an electoral roll that we are required to be on, would it not be worth considering requiring a local authority to hold a business roll of who is operating a business, so that we can start to cut through? We have done this with some of the manipulation of Companies House from abroad in illegal working in this country. It would give both the country and those seeking refuge a better deal, and the criminal gangs a worse deal and less profit motivation.
Baroness Bennett of Manor Castle (GP)
My Lords, I was going to rise after the noble Baronesses, Lady Teather and Lady Lister, to say that they gave two absolutely magnificent speeches. I agree with them both and I will not aim to repeat them. It is quite telling that I am now speaking after we have heard strong support from the Conservative Benches for the Government’s policy, and I suspect we may hear the same from the Conservative Front Bench. As I said, I do not aim to repeat what has already been said— I agree with everything that both noble Baronesses said—but I want to make a couple of points. One is to pick up on some words from the Minister, who rightly said that most asylum seekers do not have the right to work in the UK.
As the noble Baroness, Lady Lister, said, the Government are under pressure on these statutory instruments. On being challenged by our hard-working Secondary Legislation Scrutiny Committee, the Home Office said:
“We are developing our policy”
in this space. I have a question for the Minister on something that could save a great deal of the need to house asylum seekers. Is that “developing our policy” considering allowing asylum seekers the right to work, as they have in many countries?
I note that I am going to applaud the Government here, because we have seen a very small advance in the past few weeks. We saw three weeks ago that doctors and other medical professionals who have been seeking asylum for 12 months will now be able to work in the NHS. Well, that is great, although I have to ask why they have to wait 12 months, given our great need for their services and skills, and the fact that they would inevitably benefit from being able to use their skills as soon as possible.
It is worth looking at the history of that, because it had been the case historically under the shortage occupation list, which the former Conservative Government replaced with the immigration salary list in April 2024. We have seen the BMA, REACHE—the Refugee and Asylum Seekers Centre for Healthcare Professionals Education—and others taking legal cases; it may have been that the legal pressure was enough to make the Government change their mind. But if the Government are doing that for doctors, even after 12 months, why not for engineers or scientific researchers? Why not for anyone who can contribute their skills, energy, time and talents to our country, which is, of course, everybody? Why not allow asylum seekers to work? The direct question that I put to the Minister is: in “developing our policy”, are the Government at least considering that?
I want to pick up on one other point from the noble Baroness, Lady Lister, because it really deserves to be highlighted. It is the issue of support from friends and family, which picks up on the case study that the noble Baroness, Lady Teather, presented to us. Something that I have heard from visiting refugee support groups over many years is how often a situation where someone is offered free accommodation—possibly by quite distant family or friends, very loosely defined—can quickly turn into a situation that can only be equated with modern slavery. I am thinking of one case study that I heard of: a very small and frail older woman ended up sleeping on a mat in the kitchen and working 16 hours a day, seven days a week. It appears that the Government are trying to force people to create that kind of situation, from what is being suggested with the friends and family situation.
I have a final point to put to the Minister. Having looked at the impact assessments, I note that the Secondary Legislation Scrutiny Committee said how inadequate they are. I also want to repeat the point that the idea that there is no significant impact on the voluntary and private sector is just a nonsense. I am afraid that is a nonsense statement in the impact assessment. If we are to understand the impact of these rules, my simple question to the Minister is: how many people are going to end up homeless as a result of these statutory instruments? I think that is a question we should have the answer to.
Baroness Hamwee (LD)
My Lords, I apologise that there will be some repetition of what certain noble friends, in the best sense of the word, have said. These SIs have not surprised me but I am rather depressed, in that there is an echo in them of last week’s debate. These are changes brought in ahead of our knowing what will replace current provisions, which in fact are going to continue for the time being—not that I anticipate what is coming with any great enthusiasm.
I understand that the duties reflected in the regulations are part of what it is hard not to still think of as retained EU law, now assimilated law, and that the power to amend expires in June—the Minister is nodding at that. I understand that the Government may want to avoid primary legislation, with the opportunity for greater scrutiny and amendment—I hoped that the Minister might nod at that, but he did not. Understanding this is not the same as supporting it. The Home Secretary keeps telling us that the proposals must be taken as a package, but the elements are being disaggregated.
I wrote that I hoped that one change this week would be that the Minister would not be suffering the same sore throat. Last week, some of us were not quite within distance to chuck throat pastilles across the Chamber at him.
Lord Davies of Gower (Con)
My Lords, the noble Baroness, Lady Bennett of Manor Castle, is in a very perceptive mood today. Yes, indeed, in a rare turn of events, I find myself in agreement with most of what the Minister said in this debate, and I join him in supporting these two statutory instruments.
The first instrument, the draft Immigration and Asylum (Provision of Accommodation to Failed Asylum-Seekers) (Amendment) Regulations 2026, amends the 2005 regulations of the same name. It makes a very simple but vital amendment to the 2005 regulations. The change that the Government are making, as the Minister outlined, is to permit the Secretary of State to create a new condition that failed asylum seekers can be subjected to. Under the 2005 regulations, a number of conditions can be placed on a failed asylum seeker who receives asylum support. Although illegal working is a criminal offence, it does not currently constitute a breach of their conditions. This, of course, is plainly wrong, and I am glad that the Government are making this change.
The second statutory instrument relates to the support provided to asylum seekers. At present, the Asylum Seekers (Reception Conditions) Regulations 2005 require the Home Secretary to provide support to an asylum seeker where the Home Secretary believes that the asylum seeker in question meets the conditions in Section 95 of the Immigration and Asylum Act 1999. The 2005 regulations therefore go further than the original wording in the 1999 Act. Section 95 states only that the Secretary of State may provide such support, and these regulations remove that legal duty on the Home Secretary. This is something that I entirely support.
The problem here is that, although Section 95 of the 1999 Act states that support may be provided if an asylum seeker is destitute, we know that this is not the reality. There are some who may be tempted to take the language in the Act at face value and criticise the Government’s plan for taking away support from those who cannot support themselves. This would be a wholly incorrect misinterpretation; in reality, the Government have a duty to provide support for virtually every single asylum seeker, regardless of whether they can support themselves. There is also a tranche of people who deliberately make themselves destitute so as to game the system and receive the generous, taxpayer-funded support.
It is also important to note that this is a Brexit benefit. The regulations that introduced the mandatory duty were passed in 2005 to implement EU law. The Government’s asylum White Paper acknowledges this. Can I say how welcome it is to see the Government making full use of the advantages of Brexit, even while they are trying to undermine it in some other areas? I have one observation, however: this change would make sense if the Government were adopting the Conservatives’ plans to deport all illegal migrants within a week, regardless of whether they have claimed asylum. If they were implementing that policy then those asylum seekers would not require any support from the Home Office, as they would have been detained and then deported. Unless the Minister has suddenly had a change of heart, which I doubt, there are some questions that need answering. If the Government are not going to start deporting all these illegal migrants but will be withdrawing support from them, what do they believe will happen? I would welcome some greater clarity on this from the Minister.
It would also not be right if I gave the impression that I am praising the Government for somehow solving the illegal migration crisis. The Government still refuse to establish a third-country removal centre to act as a deterrent; they still refuse to ban illegal migrants from claiming asylum; and they still refuse to take action to end the scam illegal industry around the asylum system. Where the Government have taken action, we will commend them. As such, I welcome these two statutory instruments, but the Government really still have a long way to go to truly get to grips with this problem. They need to introduce a strong deterrent and to dramatically ramp up deportations. It is my firm opinion that until that happens and until we leave the ECHR, the boats will not stop and this crisis will not end.
Lord Hanson of Flint (Lab)
I am grateful to the noble Lord, Lord Davies of Gower, who I remind the House had stewardship of this challenge and problem with his Government—including the noble Lord, Lord Murray, whose support I welcome —until 5 July 2024. Since that date, we have tried to make some progress on the 400-plus hotels that were operational at the cost of billions of pounds; with a backlog of asylum claims; with, in my view—I know this is debateable and is not the noble Lord’s view—very little action on the question of small boat crossings; and with obvious abuses on overstaying visas and asylum claims.
Since July 2024, we have tried to put in place a number of steps to speed up claims for asylum, to support people who have a right to be here and remove those who do not, to reduce the level of hotel use, which we have now done, from 400 down to around 200, and to try to end some of the abuses that we believe exist. It is an ongoing challenge and an ongoing process, but we are trying to do that in a context of published documents, published papers, an approach of fairness and meeting our international obligations.
Baroness Lister of Burtersett (Lab)
I thank my noble friend for addressing those issues. Is the intention eventually to put the 42 days into a statutory instrument? As I understand it, that is the case with the current 28 days. So if this is the new normal, it would make sense. Perhaps he will write to me if he does not want to answer that now.
Lord Hanson of Flint (Lab)
The intention is to have a 42-day period. We are publishing the evaluation very shortly. If my noble friend will allow me, I would rather reflect on this with my colleague, Minister Norris, who deals directly with these matters, on the mechanism to achieve that—but I will certainly write to her on that point when I have consulted with my honourable friend.
On the points raised by the noble Lord, Lord Davies of Gower, it is important to put on record that the Government reduced the number of migrants in asylum hotels by 19% in the year ending December 2025. Overall, asylum support costs fell by 15% in the year ending March 2025. The rules that we put in place today are designed to help us reduce those costs further by making sweeping reforms to the immigration and asylum system while meeting our international obligations. This sits alongside existing work which has seen illegal immigration and illegal working enforcement activity, going back to the point from my noble friend Lord Mann, reach in 2025 the highest level in British history. Those are important issues.
Under these proposals, we will tackle illegal working but we will not support those who have permission but choose not to, nor those who enter the country on a work or student visa with permission to work before claiming asylum, nor those who have been granted permission to work whose claims have been outstanding for more than 12 months, through no fault of their own. We will not support those who are non-compliant. This includes anyone who has not complied with the conditions we impose. That is fair to the British taxpayer. The revocation of the duty will not result in immediate changes, as I have said, to those who will receive asylum support. It is the start of the process, and development of this framework is ongoing. In collaboration with other government departments, I will bring regular updates to the House on behalf of my noble friend on what the changes are.
Finally, the noble Baroness, Lady Bennett of Manor Castle, raised allowing asylum seekers to work. That would undermine the principle of the work visa, whereby people come to the country to work. She shakes her head; this is an honest disagreement. It would undermine those points. The noble Lord, Lord Murray, asked about our assessment of neighbouring countries’ asylum policy issues. I do not have the information to hand, so, if I may, I will look at that and write to him to cover any points when I have reflected on what he said and read Hansard tomorrow. With that, I beg to move.
Asylum Seekers (Reception Conditions) (Amendment) Regulations 2026
(1 day, 4 hours ago)
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Lord Hanson of Flint
That the draft Regulations laid before the House on 5 March be approved.
Relevant document: 55th Report from the Secondary Legislation Scrutiny Committee (special attention drawn to the instrument)
Local Authorities (Changes to Years of Ordinary Elections) (England) (Revocation) Order 2026
(1 day, 4 hours ago)
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Baroness Scott of Bybrook
That this House regrets the decision-making process that led to the need for the Local Authorities (Changes to Years of Ordinary Elections) (England) (Revocation) Order 2026 (SI 2026/142) and the indecision and lack of transparency surrounding the proposed postponement of local elections; and affirms the importance of those elections now proceeding as scheduled.
Relevant document: 53rd Report from the Secondary Legislation Scrutiny Committee (special attention drawn to the instrument)
Baroness Scott of Bybrook (Con)
My Lords, some time has passed since I tabled this regret Motion, and this House has debated this issue in considering the English Devolution and Community Empowerment Bill. I am glad that the Government have responded to our concerns to make sure that we do not find ourselves in this situation again. I want to be clear from the outset that we are pleased that our local elections are now proceeding as scheduled, but we still regret the decision-making process that led to this U-turn being necessary.
This is a simple but important issue. The Government’s handling of these elections has created needless uncertainty, unnecessary costs and completely avoidable confusion for local authorities and their residents. They did this through a decision-making process that was unclear, inconsistent and lacking in the transparency that councils and voters rightly deserve and expect.
On 22 January, the Secretary of State for Housing, Communities and Local Government announced that the Government would proceed with postponing local elections in 30 councils until May 2027. Legislation to give effect to that announcement was laid on 5 February, and councils were told to plan on that basis. Less than two weeks later, the Government changed their mind. On 16 February 2026, the Secretary of State for Housing, Communities and Local Government asked the Housing Minister to reverse the decision that he had just announced. This revocation order was then laid the next day.
Baroness Bennett of Manor Castle (GP)
My Lords, very briefly, and perhaps with a little surprise, I agree with the noble Baroness, Lady Scott of Bybrook, on the Conservative Front Bench: we have to regret what happened about these elections. We can also celebrate that eventually democracy won out. I am looking forward to the affected elections on 7 May, not just because the polls suggest that they, across these islands, are going to work out rather well for the Green Party.
Regret is the right term, but we might also say that what has happened—the mess of the Government’s creation in terms of these on again, off again, on again elections—has helped to highlight the weakness of our constitutional arrangements, which really cannot be described as a democracy. We have a situation in which Westminster is dictating far too much what happens on these islands, not just in terms of elections but in so many other ways. We have local councils that have enough money and power to carry out only their statutory responsibilities; that is, those dictated from Westminster.
We really need to think about so many other issues on these islands, not just because of the outcome of the Brexit referendum in 2016, but because of the slogan that people very clearly expressed then. They wanted to take back control. People do want to take back control in their local communities and to have the power and resources there; and, crucially, they should know when the elections are going to be. That should be a regular schedule that cannot be interfered with for political convenience. I commend the noble Baroness for persisting with this, because it is an issue we need to keep highlighting. We need to keep stressing that this is just one example of the way in which our current uncodified constitution, accreted over centuries of historical accident, is not meeting our needs in the 21st century.
Lord Lansley (Con)
My Lords, I want to intervene briefly by referring to the example of Suffolk. I entirely agree with my noble friend on the Front Bench about these issues. I draw attention to the fact that I chair the Cambridgeshire Development Forum and support the Norfolk and Suffolk Development Forum, although I do not chair that. But for these purposes I am speaking simply as a Suffolk resident.
There we were in Suffolk, keen, certainly from my point of view, to progress the devolution priority programme for Norfolk and Suffolk. We were then told that the mayoral election for the Norfolk and Suffolk strategic authority was to be delayed. That decision has not been revoked. The decision to delay or to postpone the county council election in Suffolk has now been revoked, which means we will have county councillors, who I think were originally elected in 2001, serving all the way through to 2027—
Lord Lansley (Con)
Did I? Sorry—2021, serving all the way through to 2027, maybe even to 2028 in practice, and overlapping with unitary councils that are to be established with elections taking place in May 2027.
As I think I have demonstrated through my difficulty in trying to follow all this, these are unnecessarily extremely complicated processes for trying to move devolution forward and get us to the point where we are in a strategic authority with unitary councils. The lack of pace in a Government who are always telling us everything is happening at pace seems to have led to an unnecessarily complex situation, not least for the voters and residents of Suffolk. With local government reorganisation taking place at the same time, we are going to end up paying more for the processes of managing this overburdensome democratic situation. I hope that in the context of this debate, the Government will say that they will look very hard at ensuring that they compensate local authorities and support them in managing the delays that they have occasioned.
Lord Davies of Brixton (Lab)
I want to remind the House of a contribution I made during the passage of the English Devolution and Community Empowerment Bill. I listened with interest to the contribution from the noble Baroness, Lady Scott of Bybrook, but with a large degree of scepticism, because I personally experienced exactly the issue that is being complained about, at the hands of the Conservative Government. I was re-elected in 1981 to the Greater London Council, with my term due to end in 1985, and the Conservative Government—the noble Lord, Lord Baker of Dorking, is the guilty party here—extended my term of office to 1986. So, it is quite clear that there is no point of principle here. I am glad that it has ended up the way it has, but to try to make out that one party does it and the other does not is totally wrong.
Lord Porter of Spalding (Con)
Briefly, I make a plea to the Minister that she takes personal oversight of all those councils where the delays may have an impact on staff’s ability to step up and do the right things for the election. Clearly, they will all bust themselves to try to make sure everything is perfect, but it will be worth the Government making sure that they take a closer interest in all of those councils and finding down the back of the magic sofa in Marsham Street some of that spare change that they have that they can bring out occasionally if it is necessary. I do not think the teams running the elections will be waving a shroud, but if they genuinely need extra resource to be able to pay extra money to recruit people that they need at short notice, or shorter notice, the Government should be prepared to provide it. Like my colleagues on the Front Bench, I have some regrets about this, but not for the same reasons that they do.
Lord Hayward (Con)
My Lords, may I pick up on the point that the noble Lord, Lord Davies, made just now on precedent? I do not think I have heard reference to precedent elsewhere, but there is no question but that there have been occasions when elections have been delayed. However, what the noble Baroness, Lady Scott, was referring to here was the most amazing set of circumstances, whereby one week we were asked to consider an order for delays in elections on 30 local authorities, and those delays were at a point only weeks before one was heading towards notices for the election, nomination day and the like. Then, as the noble Baroness, Lady Scott, indicated, two weeks later, because of an apparent legal reconsideration of circumstances, the policy was completely reversed. As far as I am aware, there is no such precedent and, tragically, we have yet to receive an apology from the Government for the confusion—and that is all it is. It is total confusion, within a period of a few weeks going from one unclear policy to another, with the net result of substantial cost.
As the noble Baroness, Lady Bennett, identified, democracy is a frail flower, and playing around with it in the way that the Government have in the last few weeks is unacceptable. It is unacceptable not just to the public at large; we have to bear in mind the burden faced by the returning officers and their staff in the local authorities. They do a truly fantastic job in difficult circumstances. It is regularly the case that, where there are not elections in one local authority, it loans its staff to a neighbouring authority which has elections. It is not easy to find polling clerks, and what is happening is that one local authority provides the facilities for another. Here we have a position whereby people who might have been loaned to another authority are suddenly called back. There are all the other associated difficulties with calling an election, cancelling an election and then restarting an election. I will not go into them in detail, but I think most of the people in this House are only too well aware of the problems that are thrown up in the face of the EROs throughout the country by the policies that have been followed over the last few weeks.
I would have hoped that, at some stage, the Government could have apologised to the local councils, and particularly to the EROs and their staff, for the problems that they have caused, but, unfortunately, they have failed to do so. However, it is appropriate that one should identify that democracy and the way it operates need to operate on a degree of certainty, which in the last few weeks or months we have not had from this Government.
Lord Scriven (LD)
My Lords, I declare my interest as a vice-president of the Local Government Association, and I thank the noble Baroness, Lady Scott of Bybrook, for laying the regret Motion. It is a privilege to stand in for my noble friend Lord Pack, who I know is deeply disappointed that he is not able to be in his seat today. I will approach this with the same conviction my noble friend has voiced throughout this saga: that local democracy is not a plaything for departmental convenience. Although we welcome the Government’s U-turn, the how and why of this retreat remains shrouded in a fog of administrative incompetence.
The Parliamentary Under-Secretary of State, Ministry of Housing, Communities and Local Government (Baroness Taylor of Stevenage) (Lab)
My Lords, I am pleased to respond to this regret Motion for the Government. Before turning to the order itself, I think it is worth setting out the wider context for the local government reorganisation programme. We are on track and making good progress, including elections scheduled this May for east and west Surrey ahead of an April 2027 go live date, giving new councils stability and a clear mandate. We have also announced decisions in four further invitation areas: Essex, Southend-on-Sea and Thurrock; Hampshire, Isle of Wight, Portsmouth and Southampton; Norfolk; and Suffolk.
These are decisions that will improve how local government works for over 6 million people, with the next tranche on track to deliver decisions for summer 2026. This demonstrates that our ambitious reorganisation programme is on track to deliver the real benefits that we intend from it, and to deliver on the biggest devolution of power, finance and control, as the noble Baroness, Lady Bennett, described it, to local people in a generation.
Turning to the order itself, I add my thanks to those already expressed around the Chamber to the Secondary Legislation Scrutiny Committee. My noble friend who chairs that committee has been very helpful to me in debating some of the issues that have arisen during these debates.
Changes to election timing are not taken lightly. They have been used only where there is strong justification, closely linked to supporting effective local government reorganisation. In recent years, that has included areas such as Cumbria and North Yorkshire, where adjusted timetables helped provide stability during transition to new unitary councils. That same practical rationale underpins its more recent use, including in Surrey, where reorganisation is critical to ensuring the financial viability of that area’s councils.
Of course, I recognise that concerns have been raised about local democracy. Democratic legitimacy matters profoundly; people must have confidence that their vote counts and their voice is heard. But they must also have confidence that the structures into which representatives are elected are capable, sustainable and fit to deliver the services on which communities rely. Our responsibility is to safeguard both, and that applies to all parties in this House which are responsible in government. That balance has guided the Government’s approach throughout the reorganisation programme, including in listening carefully to concerns raised by councils themselves and considering the appropriate approach to election timing within the wider context of effective transition.
As the House will know, the Secretary of State’s original decisions followed representations from local authorities. In 30 areas, councils set out evidence on the challenges of delivering structural change alongside full ordinary elections, and the view that postponement would release essential capacity to deliver reorganisation. I know that the noble Baroness, Lady Scott, gave us some of the timetable, but I want to go back to before the timetable that she outlined.
On 18 December 2025, the Minister wrote to 63 councils scheduled for May 2026 elections inviting representations on whether postponement would release essential capacity, with a deadline of response by 15 January. We received 500 representations from councils, MPs, the Electoral Commission, parish councils and members of the public. Clarification letters were sent on 19 January to four councils where the position was unclear. The Secretary of State assessed each council individually, considering evidence of capacity constraints—that is, political, senior officer and electoral returning officer impact—as well as financial implications, democratic considerations and wider representations.
On 22 January, we announced the intention to postpone elections for 29 councils and allow 34 to proceed. We then received further representations from Essex County Council and Pendle Borough Council for decisions to be reconsidered. On 29 January, we confirmed the final position of 30 council elections postponed and 33 to proceed. That preceded the timetable that the noble Baroness, Lady Scott, set out; I just wanted to clarify how we had got to that situation on 5 February.
Decisions were therefore taken on a case-by-case basis, informed by all those representations, and were in line with the existing precedent for aligning electoral cycles with periods of structural transition. Following the receipt of further legal advice, the Government revoked that decision. That revocation was given effect through the order now being debated in the House. The decision was taken to provide certainty for councils, candidates and voters, with the result being that all elections originally proposed for postponement will proceed in May 2026, and preparations for those elections are continuing on the restored timetable.
Lord Lansley (Con)
The Minister has not told us at all, and nor indeed does the Explanatory Memorandum tell us, the nature of the legal vulnerability that was implicit in the decision to reconsider. The fact that the decision had to be taken by an independent Minister in her own department, not by the Secretary of State, suggests that there was a significant flaw in the original decision that was made.
Baroness Taylor of Stevenage (Lab)
I was coming to the legal advice and I will do so. I hope the noble Lord will be patient for a moment while I get to that part.
Looking beyond the delivery of the current local elections, the Secretary of State said on 23 February that the Government would reflect carefully on the concerns raised by your Lordships about the use of these powers during the passage of the English Devolution and Community Empowerment Bill, particularly the concerns expressed about postponing elections for more than one year where a council is undergoing local government reorganisation and the risk that repeated delays to elections can weaken the democratic mandate of councillors.
Against that backdrop, the Government tabled an amendment on Report to prevent double postponement for reasons connected with reorganisation. That is a concern that the noble Baroness, Lady Bennett, expressed. Again, I thank opposition Peers, particularly the noble Baroness, Lady Scott, for supporting that amendment, which your Lordships agreed on 13 April. This demonstrates that the Government remain focused on ensuring that reorganisation is delivered in a way that is orderly, provides clarity and certainty over electoral arrangements and is capable of supporting strong local services from day one.
To support that transition, the Government are providing targeted capacity support to councils undergoing reorganisation, including up to £63 million in funding to help manage the process while continuing to deliver for residents. I hope that picks up the points about funding raised by the noble Lord, Lord Porter. I wish I could find that magic sofa in Marsham Street. If he has any advice from previous Ministers who worked there, I ask him please to tell me where it is because I would like to find it. The noble Lord, Lord Lansley, also raised points about financing.
Taken together, these steps reflect a balanced approach, safeguarding local democracy, providing certainty on election timing and giving councils the tools they need to move through reorganisation successfully. For these reasons, the Government consider that the approach now in place provides clarity, accountability and a sound basis for effective transition. I am grateful to your Lordships for the care with which these issues have been considered, and I will respond to some of the points made during this short debate.
Lord Scriven (LD)
The logic of the Government’s original position clearly was not logic at all, because if the elections can now take place, as well as the reorganisation, this postponement was not required at all, was it?
Baroness Taylor of Stevenage (Lab)
The postponement was done at the request of the councils concerned, which had concerns about capacity. I think some of them may still have those concerns, but we are supporting them through that process. As my noble friend Lord Davies has said, decisions have been taken in the past to postpone elections, and there is still the power to do so when necessary, but we wanted to avoid the double postponement that some of these would have caused.
On capacity, I first pay tribute to all our local elections officers and returning officers and the staff who work in their teams. They do an amazing job and, as we all know, they have a proven ability to deliver elections—sometimes a snap general election, or by-elections when they occur—and mayoral polls at very short notice. Returning officers and suppliers have been fully supported to bring plans up to date at pace, and the decision provides the certainty that councils now need to manage logistics effectively. Spending on local elections themselves is of course a matter for local councils.
Lord Hayward (Con)
I support very strongly the position that law officers’ advice to government should remain confidential, but is it absolutely clear that the advice on which the decision to revoke the postponement of the elections was taken was markedly different from the legal advice provided previously? To be blunt, there is a suspicion in many people’s minds, probably quite reasonably, that it was the imminence of a judicial review four days after the announcement that resulted in the change of government position, rather than a change in legal advice.
Baroness Taylor of Stevenage (Lab)
I feel that the noble Lord is pushing me to do what I have just said I cannot do, which is to disclose the legal advice—I am going to stick to that line. The decision was, as he rightly says, taken by another Minister in the department because the Secretary of State had already been involved in the decision. I think we put the guardrails in place to make sure that was done in accordance with what we would all expect to happen. We will stick to the convention of not disclosing the legal advice put before that Minister.
I wanted to talk about my noble friend’s comment about previous elections that were cancelled. There were 17 elections delayed between 2019 and 2022 by the last Government to prepare for local government reorganisation, including in Weymouth and Portland in 2018, Aylesbury, Chiltern, South Bucks and Wycombe in 2019 and Cumbria, North Yorkshire and Somerset in 2021, so there was precedent for that. We took that into consideration when local authorities made representations to us.
I will just go into a little more detail on the questions raised by the noble Lord, Lord Hayward. The decision was updated following legal advice and the Government acted promptly and responsibly in light of that advice. Where decisions are revisited following legal advice, as I have said, it is entirely appropriate for a new Minister to look at that advice and now all 30 elections will proceed as scheduled in May 2026, and a revocation order was laid in Parliament in February to give effect to that decision. We engaged rapidly with councils and issued written confirmation without delay and are supporting them with their updated plans. This was done at pace. We have always said that a decision would be made on the basis of evidence available to us at the time and that is what has happened. The Government’s ambition remains to simplify local government by ending the two-tier system and establishing new single-tier unitary councils.
The noble Lord, Lord Scriven, raised the issue of town and parish consultation. I understand his point, but there was never an intention to cancel town and parish elections. I understand his point about finances and will give that further consideration. On his point about statutory inclusion of things in Explanatory Memorandums, again, I will take that away. I understand the point he is making, and we need to think further about how that might work.
In conclusion, I hope I have set out the Government’s explanation of the timeline and exactly what happened in this case. I hope I have responded to the concern of the House, both in what I have said today and in the action taken to put an amendment forward to the English Devolution and Community Empowerment Bill. While recognising the concern that has been expressed around the House, I hope the noble Baroness will withdraw her Motion.
Baroness Scott of Bybrook (Con)
Before the Minister sits down, can I ask about the £63 million? Has this already gone out to local authorities? If it has not, when will it go out?
Baroness Taylor of Stevenage (Lab)
I cannot answer the specific question of whether it has already gone out, but we have notified local authorities of what will be coming to them. When we spoke to them about the decisions taken as a result of the reorganisation, we spoke to them about funding as well. I will write to the noble Baroness with information on whether that money has gone out the door yet.
Baroness Scott of Bybrook (Con)
My Lords, I am grateful to all noble Lords who have spoken in this short debate and to the Minister for her response. However, I reject the premise of the blame game that the Government are seeking to play. The power, responsibility and ability to cancel local elections lie with the Government and the Government alone. They made the decision to cancel these elections and then they made the decision to reinstate them.
I welcome the steps now being taken, in the English devolution and so-called community empowerment Bill, to put this matter on a clearer footing for the future and to ensure that this can never happen again. Although the Government did not go quite as far as we wanted them to, I am pleased that the House’s scrutiny has brought us to this point. This is just one of many examples of your Lordships’ House demonstrating the vital and constructive role it plays as a revising Chamber.
I will not be pressing the Motion to a vote today, but I hope the Government take a clear message from it: councils must be properly supported and transparency must be the rule and not the exception for proper, functioning democracy. Before I sit down, I would like to place on record our thanks to all the local authority election staff and their returning officers, given the extra work this has caused. We know that they will deliver a safe, secure and efficient election on 7 May.