Tobacco and Vapes Bill

Baroness Blake of Leeds Excerpts

Committee stage
Monday 3rd November 2025 Grand Committee

[Baroness Walmsley (LD)]

My Lords, just to clarify on the previous group and to quote myself, I advised caution about the idea of combining the two kinds of licences, specifically because of the strong possibility of fundamental change to the remit of the alcohol licences.

On this group of amendments beginning with Amendment 32 in the names the noble Lord, Lord Kamal and the noble Earl, Lord Howe, it is important that the Government do not delay unduly in laying out the details of the new licensing scheme. That is only fair to retailers who need to respond to it. However, it is also important to get it right, and it is a highly technical issue. There will be a lot of noise about the workability of elements of this Bill without adding to that by getting the licensing scheme wrong, and I am sure the Government are aware of that. However, I am also aware that the Government have already issued a further call for evidence on the technicalities of the scheme, which I hope will help them to iron out any problems. I hope that they do not hang about over this, as they did with putting the Bill into your Lordships’ Committee—which we awaited with bated breath; it took a long time—but I do not support rushing such a technical process. Therefore, I do not support putting these amendments with their specific timescales on the face of the Bill. I look forward to the consultation.

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

My Lords, I thank noble Lords for the amendments in this group.

I note the comments from the noble Lord, Lord Kamall, that the noble Lord, Lord Mott, is not in his place to speak to his amendments, but I will just touch on them briefly, if I may. Basically, his amendments seek to require licensing regulations to be made within three months of the relevant provisions in the Bill coming into force. The amendments would also extend the existing retailer register in Northern Ireland. I emphasise that, of course, the Government share the noble Lord’s desire to move as quickly as possible to implement the licensing scheme. That is why we have recently launched the call for evidence on the range of issues that we have laid out, including questions on the design of the retail licensing scheme. The feedback received will be absolutely critical, and we want to get on and launch this as soon as possible. However, it is also important that the Government have sufficient time to ensure that the regulations are properly thought through. I hope that the noble Lord, Lord Mott, when he hears the discussion, will be reassured and understand that three months is not sufficient time to run a consultation, analyse the feedback received and prepare well-considered regulations. That is as much as I shall say on his amendments.

Turning to the amendments in the name of the noble Lord, Lord Kamall, I hope to give him the reassurance that he seeks, as we discussed in last week’s Committee, that I understand these particular concerns. His amendments would similarly require Ministers to publish draft regulations implementing a retail licensing scheme for England and Wales within six months of the Bill achieving Royal Assent.  The Government are committed to ensuring that those impacted by regulations and those with expertise have the opportunity to contribute their views. We want to minimise additional costs and burdens as far as possible, while ensuring that the scheme is a success and achieves our aims of supporting legitimate businesses as well as tackling those that disregard the law.  Again, the recently published call for evidence seeks input on a range of topics, including the implementation of the retail licensing scheme. As I have said, this will inform the consultation, which we will launch as soon as possible.

To respond directly to the noble Lord’s comments, our call for evidence also asks about the implementation of the scheme and how long will be required to implement the policy. We will, of course, work through the appropriate channels to ensure that businesses have the necessary guidance to implement the changes. I cannot emphasise enough that this is for all businesses, regardless of their size or the organisations that represent them. We want to make sure that we get that message out loud and clear, so that they have confidence that their views will be regarded with the same importance as all those who contribute to the policy.

I note the noble Baroness’s comments about making sure that we get this right, so we cannot be beholden to specific timeframes on the face of the Bill. We all acknowledge that this is a complex policy and, while we want to move swiftly, it is important that there is enough time to ensure that the policy is properly thought through before developing regulations. I repeat that requiring the Government to publish draft regulations before adequate consultation may risk creating a flawed policy. For the reasons that I have outlined, bringing together previous comments, I hope that the noble Lord will feel able to withdraw the amendment.

[Lord Kamall (Con)]

My Lords, I am grateful to the Minister and to all noble Lords who spoke in the debate on this group of amendments. The intention was always that these would be probing amendments; whether it was three months, as from my noble friend Lord Mott, or six months, as from us, we wanted to get some certainty and find out whether, at this stage, any thought has been given to an outline timetable. This is so that the retailers that will have to face this new licensing regime can understand the different stages—the Minister laid out some of the consultation stages—and the overall timetable. Here we are, getting towards the end of the 2025, and they are wondering, “When will this new licensing regime be in place? Will it be sometime in 2026 or in 2027?” That is the sort of outline assurance they want.

It was very helpful of the Minister to mention some of the consultation stages, but it would also be helpful if, perhaps in writing, she could give us a timetable that relates to real dates in the next two or three years—and, in doing so, avoid “in due course” or “as soon as possible”—so as to reduce the uncertainty for those retailers that will have to prepare for this measure. I also welcome the acknowledgement from the Minister of the importance of consulting small retailers—that point has already been made in our debates on previous groups—as well as her understanding of the role that these small retailers play. The burden for them is very different and disproportionate as compared to that for some of the larger retailers.

In general, we welcome the tone from the Government and understand that there must be consultation stages. However, we are asking for some sort of outline timetable in writing, if possible, on when the Government envisage the licensing regime being in place—with the usual caveats, perhaps, depending on what comes back from the consultation. Some certainty would be really welcome at this stage.

Having said that, and having reflected on the comments from the Minister, I beg leave to withdraw the amendment in my name and that of my noble friend Lord Howe.

--- Later in debate ---

Given the parlous state of the finances of some of our local authorities—some, such as Birmingham City Council and Woking Borough Council, had to go into administration, in 2023—it is clearly a reasonable precaution to ensure that these vital services are protected. According to local authorities themselves and an authoritative note from the House of Commons Library from July 2024, this is because all local authorities are under financial pressure due to rising populations, housing pressures, higher demand on social care and the limit above which they cannot raise council tax. In the light of the possibility that many other local authorities may have these financial pressures, I believe that Clause 35 et cetera are necessary precautions.

[Baroness Blake of Leeds (Lab)]

My Lords, in responding to these comments from the noble Earl, Lord Howe, I am grateful for the opportunity to explain further the clauses relating to enforcement powers, which I think is what he is seeking from these amendments, and to look at the opposition from the noble Lord, Lord Kamall, that Clauses 35, 36, 129 and 30 stand part of the Bill.

Clause 35 provides a power for the Secretary of State in England or Welsh Ministers in Wales to carry out the investigation and enforcement of a particular case or a particular type of case instead of local authority trading standards. Similarly, Clause 36 provides a power for the Secretary of State and Welsh Ministers to take over the conduct of any legal proceedings relating to an offence under Part 1 or under any regulations made under Clauses 13 or 14 regarding the display of products or prices. Clauses 129 and 130 serve a similar purpose in relation to Part 6, which makes provisions on advertising and sponsorship. Clause 129 provides a power for the Secretary of State, Welsh Ministers, Scottish Ministers or the Department of Health in Northern Ireland to make a direction about the enforcement of the Part 6 provisions. Clause 130 provides a power for the appropriate national authority to take over the conduct of any legal proceedings within their respective jurisdictions relating to an offence under this part of the Bill.

These clauses replace and are based on existing legislation. Trading standards operate in all local authorities, and it is standard practice that they would undertake required local enforcement action and pursue legal proceedings. However—this is referring to the comments made by the noble Earl—these powers provide a useful safeguard for the unlikely situation in which a local authority is unable or unwilling to take enforcement in a particular case. These powers reflect the landscape in which tobacco control measures operate. Individual local authority trading standards departments might not have the resources or willingness to take enforcement action and legal proceedings in cases where this action involves or has significant implications for large multinational companies. In instances such as these, these powers may be used to ensure consistent, strong and effective enforcement.

The noble Earl raised the devolved Administrations. Health is a devolved matter and the Bill builds on the existing legal frameworks of all four of the nations. This means that there are some differences in the provisions between each nation. I think we have outlined how the accountability of these powers will be managed through the different existing arrangements.

The noble Earl also raised the specific matter of scrutiny. I hope I have covered the points throughout the comments that I have made.

I hope noble Lords are reassured that these are necessary clauses based on existing legislation. Together they ensure effective enforcement and therefore should stand part of this Bill.

[Earl Howe (Con)]

My Lords, the purpose of a clause stand part debate at this stage of the Bill is to ask some questions. There is no implication that the clause should be deleted. I simply wanted to ask those questions and to ensure that some answers are placed on the record, and I am very grateful to the Minister for doing just that.

I welcome her explanatory comments; it is right, in the light of what she said, that Ministers should have the tools they need to ensure effective enforcement where the public interest demands it. However, I remain concerned that the powers set out in these clauses are unqualified, and I would like to think about that further. I recognise that it is possible to conceive of circumstances where ministerial intervention might be justified—for example, where a case raises genuine national issues or where there has been a manifest failure to act for whatever reason. However, that is precisely why I felt some form of conditionality ought to be built into the legislation.

I appreciate that there is precedent for provisions of this kind, and I am grateful to the Minister for her explanation. Between now and Report, I will consider whether the Bill could be improved with the addition of some clear thresholds, safeguards or procedural tests. For now, I am content to move to the next group of amendments.

Tobacco and Vapes Bill

Baroness Blake of Leeds Excerpts

Committee stage
Thursday 30th October 2025 Grand Committee

[Baroness Walmsley (LD)]

My Lords, I have a great sympathy for this group of amendments introduced by the noble Lord, Lord Kamall. There should be a limit on the strength of nicotine products which are legally for sale. Some of those products are clearly, from what we have heard from other noble Lords, very dangerous to both physical and mental health. The evidence is emerging on that.

Limiting the strength of something is not a new idea. Strength limits and price controls have been put on various alcoholic drinks, such as white cider, which has been particularly responsible for problem drinking. Like the noble Baroness, Lady Grey-Thompson, I am concerned about nicotine pouches and young people, because their packaging and flavours make them look like sweets, making them appear very attractive to children. I accept that only a small percentage of tobacco product users buy this form of tobacco product, but a high proportion of those users are young people.

There is not much evidence yet of the effectiveness of such pouches as a smoking quitting tool; they are nowhere near as effective as nicotine patches or vapes. Apparently, only about 3% of quitting efforts are based on them. In fact, you do not need a high concentration for these things to work; nicotine patches work for many users, and they are not particularly strong. However, there are clear dangers with these very strong products. Perhaps this is an area where we need further evidence, so can the Minister say whether it will be covered in the Government’s recent call for further evidence on measures in the Bill? Before we go forward to the next stage, perhaps we could get the results of that consultation.

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

My Lords, I am grateful to noble Lords for raising these points and for bringing forward the amendments to Committee today. Listening to Finn’s story from the noble Lord, Lord Kamall, it is important that we always bear in mind that we are talking about real young people and children and the actual harms that can come to them.

Amendments 13, 14, 15, 139 and 140 seek to introduce a ban on manufacture, sale and possession with intent to supply high-strength oral nicotine products, specifically those containing more than 20 milligrams of nicotine per portion. I say from the outset that we are sympathetic to noble Lords trying to define the correct and safe nicotine level of a nicotine pouch—we need to address that. As we have heard, unlike with nicotine vapes, there is currently no set nicotine limit for nicotine pouches, and nicotine strengths can be as high as 150 milligrams, with the harm that goes with that. There is also significant variation in these strengths internationally.

--- Later in debate ---

[Baroness Walmsley (LD)]

My Lords, as I understand it, following the Royal Assent of this Bill, there will be more consultations on many of the regulations the Government plan to bring forward. The call for evidence, which was published on 8 October, is already seeking evidence on some of the more technical aspects of the Bill.

I point out to those who tabled these amendments that the UK Government are a signatory to Article 5.3 of the WHO’s Framework Convention on Tobacco Control, which aims to protect health policy-making from tobacco industry influence. That is why I think that there should be no further mandation for consultation with those who have a vested interest in producing or selling tobacco products, as long as we keep an eye on small retailers. As far as the bulk of their sales of products containing tobacco—I choose the way I express it very carefully—are concerned, there will be a small impact because only a one-year cohort at a time, which is a relatively small amount, will be prevented from being sold these products. As I said on our previous day in Committee, that will give small retailers plenty of time to adjust their sales models. We will deal with things such as age verification, as well as other issues that may cause small retailers concern, in our debates on other groups; we must do that rigorously.

I point out that there is nothing to stop tobacco companies responding to past and current government consultations on proposed regulations, but, of course, all respondents are required under the WHO convention to be transparent about their direct or indirect industry links. This is appropriate given their commercial conflicts of interest, which are sometimes in direct conflict with the Government’s public health objective to eliminate smoking over a generation.

[Baroness Blake of Leeds (Lab)]

My Lords, I am grateful for these amendments from the noble Lord, Lord Kamall. Amendments 26, 27, 31, 56, 111, 150 to 153 and 213 seek to ensure that the views of consumers, businesses and retailers are captured as part of the consultations on the licensing scheme and the display regulations, as well as before Part 5 of the Bill comes into force.

Let me start by saying I strongly agree with the intention behind the amendments in the name of the noble Lord, Lord Kamall. When it comes to consulting on the regulations, of course we must ensure that those who will be impacted are able to contribute their views. I thank the noble Baroness, Lady Walmsley, for her constructive comments on the need to do that and on the way we will go forward.

--- Later in debate ---

[Lord Kamall (Con)]

I thank noble Lords who have contributed to this debate, and the Minister for her response. With these probing amendments, we were trying to make sure that the consultation was as wide as possible. We completely understand the WHO requirements, but we sometimes worry about some of the more specialist cigar manufacturers, which are not big tobacco but much smaller specialist organisations.

I seek some clarity from the Government at this point. Are they saying that the WHO guidelines mean that they cannot speak to these small, specialist manufacturers? We understand not consulting the big Philip Morris Internationals of this world, and others, but is it the Government’s understanding that they cannot speak to the small specialist cigar manufacturers because WHO guidelines preclude them from doing so? Or are they saying that they can speak to those small manufacturers?

Clarification on that from the Minister would be welcome. Is she able to give an answer, or shall I witter on a bit and hope that the officials can give her an answer in that time? I will do that; I am trying to be helpful. That clarity is essential. I am not asking that they call in the likes of the big firms, such as BAT and Philip Morris, every time they want to do a consultation; we know what their business models are. This really is about the small specialist manufacturers who feel that they are excluded and lumped in with big tobacco all the time. Their demographic is very different. It is an ageing demographic; perhaps literally a dying demographic —who knows?

The newspaper that came to see me told me that its readership was not consulted even though their trade associations claimed that everything was fine. Therefore, we need to understand those nuances. In my experience, I have seen some trade associations claiming to represent a wider membership than they do. They are not the ones who are damaged.

I welcome the sentiment behind the noble Baroness’s response. I had a conversation with the Minister only yesterday about a particular organisation not feeling that it had been consulted. Immediately, she said, “Let’s meet with that organisation”, so I recognise the sentiment. However, I would like that clarification now if it is available.

[Baroness Blake of Leeds (Lab)]

We require all those with links, direct or otherwise, to the tobacco industry to disclose them when answering consultations. I hope that is the clarification that the noble Lord requires.

[Lord Kamall (Con)]

Just to understand, they can be consulted—that sounds reasonable; I do not think anyone would say otherwise. It is important that they do not hide where they are from.

If there are organisations that have written to me about this in the past and I have had conversations with them, I am sure that the Minister will be open to having conversations where appropriate. With those reassurances, I beg leave to withdraw the amendment.

--- Later in debate ---

Amendment 28 not moved.

[Baroness Blake of Leeds (Lab)]

I am at the mercy of the Committee, but we have some more time and the ability to go on until 5.15 pm. If noble Lords agree, we have one more group to do to get to the target. Shall we continue?

[Lord Kamall (Con)]

My Lords, my noble friend Lord Mott is not here to move Amendment 29 and has obviously not sent a substitute to speak on his behalf. What is the procedure from here?

[The Deputy Chairman of Committees (Lord Haskel) (Lab)]

I suggest that the Committee adjourns.

[Baroness Blake of Leeds (Lab)]

No, it was clearly advertised that the amendment was part of the target, so I suggest that it is not moved.

Clause 16: Prohibition of retail sales of tobacco products etc in England without a licence

Amendment 29 not moved.

Tobacco and Vapes Bill

Baroness Blake of Leeds Excerpts

Committee stage
Monday 27th October 2025 Grand Committee

[Baroness Northover (LD)]

My Lords, I will speak to Amendment 199 in my name, which complements Amendment 193, which was so effectively introduced by the noble Lord, Lord Young, and which I have also signed.

Amendment 199 would require the Government to publish and fund a comprehensive communications plan for the smoke-free generation policy. We have referred to the wealth of experience among us when it comes to implementing tobacco control measures: a number of those who are taking part in today’s discussion were involved in the 2007 smoke-free legislation, the subsequent rise in the age of sale and the introduction of plain packaging in 2016. We worked across parties. There are valuable lessons to be learned from how those policies were implemented.

The 2007 campaign for smoke-free indoor public places was, in many ways, the gold standard for large-scale public health communication. Its clear and consistent message—needed, wanted and workable—underpinned every aspect of that campaign. Early identification of those at risk of non-compliance ensured smooth implementation and effective enforcement. Government-led TV adverts made it absolutely clear that it was the Government, not the hospitality sector, who were informing the public of the changes. Venues and public spaces were equipped with the resources, signage and materials that they needed well in advance of implementation. The result was 98% compliance from day one. Public support was strong and the legislation was practically self-enforcing. Even the noble Lords who put what I see as the weakening amendments at the beginning of this debate said how well that had gone.

Crucially, the debate surrounding that policy also raised awareness of the harms of smoking and led to an increase in people’s attempts to seek to quit smoking. That is precisely the outcome we should be aiming for with this legislation. Although the rising age of sale will apply only to those born in or after 2009, this policy presents a significant opportunity to raise the profile of smoking-cessation services and to invite everyone to be part of this smoke-free generation.

I have tabled this amendment to ensure that the Government publish a clear and ambitious communications plan to achieve that. At its heart must be strong public health messaging, which is inclusive, evidence based and backed by a dedicated budget. Next year’s October campaign, which seeks to encourage smokers to stop, should be led by the Department of Health, sending a clear message that every smoker can join a smoke-free future. Now, this annual campaign is led by stakeholders, with little input from the department. This should change.

The communications around the disposable vapes ban were clearly ineffective. That was a Defra policy, but it published guidance only for businesses; there was nothing at all for the healthcare settings that use these products in smoking cessation. The Government will need to do better. I am sure that the Chief Medical Officer is aware of that, not least through his experience of Covid. There are in this Committee various people, not all on the same side, who have a lot of public affairs experience. I would love them to put their minds and experience to this; that would be really worth while.

A well-structured plan would also ensure that retailers are engaged early on, provided with concise materials, signage and briefing materials and supported to play their crucial role in this policy’s success. Engagement should be broad, involving local authorities, trading standards, the NHS and higher and further education. Such proactive collaboration would, as in 2007, reduce the need for enforcement by fostering widespread understanding and voluntary compliance. Obviously, such a communications plan needs robust monitoring, evaluation and engagement. Some noble Lords have already expressed concern about the novel nature of this policy; I hope this proposal demonstrates how the Government can provide reassurance through clarity, transparency and careful planning. The UK has a vibrant creative sector. Let us harness that in an ambitious and effective public information campaign, as happened with the 2007 ban on smoking in public places.

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

My Lords, we are running out of time. If we want to finish the group, we will have to finish by 8 pm—otherwise, we will have to break midway through. It is up to noble Lords whether they want to keep their comments to a minimum so that we can finish this group.

[Baroness Grey-Thompson (CB)]

My Lords, I shall speak very briefly to Amendment 193, to which my name is added. I thank the noble Lord, Lord Young of Cookham, for explaining its aim so well. I also support Amendment 4 from the noble Lord, Lord Bethell, and declare an interest as president of the LGA and chair of Sport Wales.

With my background in sport, I know that there has been a lot of nudge behaviour in stopping smoking. Some really good work has been done in Wales on smoke-free sport, and the Football Association of Wales has done work on banning smoking around youth games. However, this does not go far enough. I must apologise, as I am working on this and the Infrastructure and Planning Bill, and I have just come out of a debate on how to ensure that we have good physical activity and improve the health of the nation. The adverse impact of smoking on the health of the nation is partly why I am speaking on this Bill.

I am slightly surprised by some of the briefings that I have received, which seem to be more content with vaping than I expected. I am constantly told that it is much better than smoking, but it is hardly healthy. I have never smoked or vaped, so I probably do not come at it with the fervour of a reformed smoker, but I believe that a great deal of harm has been done by smoking and vaping. I shall discuss some of that in later groups. While smoking cessation services have gone some way, they do not go far enough. This amendment is part of a concerted effort to move forward. The way to do it is through a new clause that very clearly lays out the road map so that we can move towards a smoke-free United Kingdom.

Mental Health Bill [HL]

Baroness Blake of Leeds Excerpts

Report stage
Wednesday 2nd April 2025 Lords Chamber

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

My Lords, it gives me enormous pleasure to respond to my noble friend Lady Keeley’s amendment. I had not joined the team during Committee, so I was not present at the meeting that everyone has described, but I have read the verbatim report and I express my thanks for the sincerity and the careful, thoughtful way that the arguments have been put forward by all noble Members who took part and those who have spoken today.

I am, of course, aware of the wider strong support for this issue. I am very grateful for the references to the different organisations that have engaged in this. I am also struck by the comments from the noble Baroness, Lady Barker, about reference to other professionals—all those unsung heroes who do not get the recognition they deserve. I think that we all join together to express our gratitude.

I express my condolences to the family of Paul Sammut. As we have discussed, his case has helped bring this to our attention. We recognise the concern around unequal coverage and rights to redress under the Human Rights Act, and the court judgment has highlighted the need to clarify the position of private mental health and care providers under the Human Rights Act when providing mental health-related care arranged and paid for by the NHS and local authorities.

Tonight, I commit that we will return to this issue when the Bill goes to the other place. There, we can have proper discussion and further consideration of some of the issues raised. My noble friend Lady Keeley has raised the issue of the wider implications of this, and I am particularly conscious of the references to children’s services. It is an issue that we have, of course, been discussing with the DfE, which has responsibilities to look at the ramifications for it.

We need to keep working on this, recognising the gap that my noble friend and others have raised in this place, but committing to taking it forward as part of the legislative process. I know that my noble friend the Minister has put a lot of time into this and is thankful for the input. She has graciously offered further meetings on this point as we move forward in the discussions and we look forward to the outcomes in due course.

[Baroness Keeley (Lab)]

My Lords, I am very pleased to hear that Ministers will pick up this issue and hopefully take action to close this gap in human rights protection during the Bill’s passage in the other place. I thank noble Lords, and noble and learned Lords, for their support for this amendment in Committee and today. It has been important that we have that support, as my noble friend Lady Chakrabarti said. I want to thank the Minister. She has done a huge amount of work with us on this amendment and I thank her and my noble friend Lady Blake for agreeing to take action on this important issue of human rights protection. That said, I beg leave to withdraw the amendment.

Mental Health Bill [HL]

Baroness Blake of Leeds Excerpts

Report stage
Monday 31st March 2025 Lords Chamber

Moved by

[Baroness Blake of Leeds]

16: Clause 18, page 24, line 31, leave out from beginning to end of line 2 on page 25 and insert—
“(2) The treatment may be given to a patient who has capacity to consent to the treatment only if—(a) the patient has consented to it, or(b) the patient has not consented but a certificate has been given by a second opinion appointed doctor under subsection (4).(3) The treatment may be given to a patient who lacks capacity to consent to the treatment only if—(a) the giving of the treatment would not conflict with any of the following—(i) a valid and applicable advance decision, or(ii) a decision of a donee or deputy or the Court of Protection, or (b) the giving of the treatment would conflict with such a decision but a certificate has been given by a second opinion appointed doctor under subsection (5).”Member's explanatory statement
This amendment clarifies that the requirement for a certificate by a second opinion appointed doctor does not apply to urgent electro-convulsive therapy if: (1) the patient consents, or (2) the patient lacks capacity but the treatment does not conflict with an advance decision etc.

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

My Lords, I will move Amendment 16 and speak to all the amendments in this group in the name of my noble friend the Minister. I speak first to Amendments 17, 18, 19, 21, 36, 39, 45, 64, 65, 66 and 67, which follow recommendations made by the Delegated Powers and Regulatory Reform Committee and the amendments tabled by the noble Lord, Lord Scriven, in Committee.

Amendments 17, 18, 19, 21, 36, 39 and 45 remove the Henry VIII power from the Bill that allowed the Government to set out in regulations the exceptional circumstances where a second opinion appointed doctor’s certificate is not necessary to administer urgent and compulsory electroconvulsive therapy, and instead sets out these limited circumstances in the Bill. These situations arise when the regulator determines that there are exceptional circumstances delaying the appointment of a second opinion doctor and the treating clinician deems urgent electroconvulsive therapy necessary to save the patient’s life. In recognition of the seriousness of the situation, the new process will also ensure that these exceptional cases are monitored and reported on by the regulator.

Amendments 64, 65, 66 and 67 ensure that, where regulations are made under the power to make consequential provision to amend or repeal primary legislation set out in Clause 52, they will be subject to the affirmative scrutiny procedure. Amendment 65 extends this to Clause 53, which confers equivalent power on Welsh Ministers in areas of devolved competence.

I turn back to Amendment 16, which addresses concerns from stakeholders that the Bill was not explicit on whether urgent electroconvulsive therapy is permitted when the person is consenting or lacks capacity but treatment is not in conflict with a decision to refuse it—as is currently the case under the Act. This amendment makes clear that treatment in these scenarios is still permitted, addressing any possible risk of misinter-pretation.

On Amendments 20 and 22, the Bill as introduced expressly permits remote assessment by the second opinion doctor’s service only for urgent compulsory electroconvulsive therapy. These amendments clarify that remote interview and examination are permitted for all second opinions provided by people appointed by the regulator. Remote interview and examination may be used only when deemed appropriate. If not, these functions must be conducted in person. Specific guidance will be provided in the code of practice.

Turning to Amendment 26, approved mental health professionals have raised concerns that the requirement for the nominated person to sign an appointment instrument in the presence of a health or care professional “witness” could result in delays to having a nominated person in place, which could undermine the safeguard and place geographical restrictions on who could take the role. This could mean, for example, that patients who are placed in out-of-area hospitals have greater delays in appointing a nominated person.

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[Earl Howe (Con)]

My Lords, the House will be grateful to the Minister for these government amendments, which, as the noble Baroness made clear, cover two principal policy issues. Accordingly, I have two sets of queries.

On the changes for the rules for authorising electroconvulsive therapy, I am sure it is not the Government’s intention in any way to water down the safeguards surrounding the administering of ECT. However, in relation to Amendments 16 and 17, taken together, can the Minister reassure me? The Bill, as modified by the proposed amendments, will posit that there could be circumstances in which a patient who has the capacity to consent to ECT but who has not consented to it could nevertheless find their refusal to treatment overridden by the decision of a single treating clinician. Even in a situation where the judgment of the clinician was that ECT was necessary to save the patient’s life, it seems to me a significant change from the current rule whereby the decision of a second opinion appointed doctor is required in all cases where it is proposed to administer ECT to a non-consenting patient who has the capacity to consent.

Amendment 17 makes it clear that the regulatory authority—the CQC, in other words—may give permission for ECT to be administered only on the say-so of a single doctor where a SOAD is not available and “exceptional circumstances” apply. I will not ask the Minister to define what “exceptional circumstances” might consist of, but it is to be assumed that a primary example of such circumstances might be when time was of the essence and no SOAD could be located soon enough to avoid exacerbating the risk of harm or death.

So my questions are, firstly, has this proposed change been prompted by a general awareness across the mental health sector that the availability of SOADs can frequently prove a problem in circumstances where urgent decisions are needed? In other words, to put it bluntly, are we being asked to change the law because of habitual shortcomings in NHS communication arrangements? I would be concerned if that were the case.

Secondly, what guidance, if any, will the CQC formulate for itself to ensure that, when its decision is sought to temporarily waive the requirement for a SOAD, it will not do so just on the basis of a SOAD being unavailable? Will it also commit itself to a standard procedure whereby it will seek at least some background detail from the treating clinician of the case before him or her, such as the reasons why they consider that administering ECT to that particular patient carries particular urgency? In other words, can we be reassured that the treating clinician’s opinion will be subject to at least a modicum of testing and cross-questioning before the CQC issues the go-ahead for ECT to be administered? I hope so, because anything short of that could turn into a tick-box exercise.

The other government amendment on which I would appreciate further clarity is Amendment 26, which

“changes the process for appointing a nominated person”.

One of the changes proposed is that the various statements and signatures required for appointing the nominated person no longer have to be contained in the same instrument. The other is that the nominated person’s signature no longer has to be witnessed. I was grateful for the Minister’s explanation, but it implies that the written instrument that appoints the nominated person and is signed by the patient in the presence of a witness can be executed without the nominated person themselves being in the room, or indeed anywhere near. At the moment, the Bill says:

“The instrument appointing the nominated person must … contain a statement, signed by the nominated person in the presence of”


the same person who witnesses the signature of the patient.

I previously assumed that the reason for that provision was the responsibility that the Bill places on the witness—quite a serious responsibility—to ensure, as far as possible, that the nominated person, whoever they are, is a fit and proper person to act in that capacity. It would appear now, with this amendment, that there is no need for the witness even to clap eyes on the individual who is nominated. How can that be right? Without at least meeting the nominated person, how can any self-respecting witness certify, hand on heart, that, in the words of the Bill, they have

“no reason to think that the nominated person lacks capacity or competence to act as a nominated person,”

or that they have

“no reason to think that the nominated person is unsuitable to act as a nominated person”.

Are they simply meant to take the patient’s word for it?

This alteration in the wording raises all sorts of question marks in my mind, given the concerns expressed by noble Lords in Committee about misplaced loyalty towards a particular individual, a naivety on the part of a child or young person, or even some degree of psychological manipulation of a young person—for example, someone who makes it their business to set a child against their own parents.

In Committee, the Minister herself emphasised the need for the law to prevent exploitation and manipulation. While I did not at the time think that her response was completely reassuring, I saw it at least as an acknowledgement that the role of the witness could not be fulfilled properly without some sort of contact with the nominated person. Was I right or wrong on that? It would be helpful if the Minister could explain how my misgivings in this area, about the way in which the nominated person procedure comes to be implemented in practice, might be allayed.

[Baroness Blake of Leeds (Lab)]

My Lords, I thank the noble Lord, Lord Scriven, for his comments and express my thanks also for the many contributions made by noble Lords around the House.

The noble Earl, Lord Howe, asked some searching questions. I think the main thrust of his comments was to look for reassurance that due diligence will be gone into in all of the areas that he raises. I am not sure that I can answer every line in detail, but I want to reassure him in particular about the nominated person question, which I know has caused him enormous concern.

In addition to what I have said, I emphasise that there is no intention at all to water down the safeguard, and that Amendment 26 will make sure that patients get access to a nominated person quicker, along with all the rights and powers that entails, meaning that safeguards provided by the role will not be delayed. That is the crucial point that we have to factor in as to why these amendments are deemed necessary. As he quite rightly says, this is particularly important for patients and those who may be subject to out-of-area placements.

The change that we are bringing in is that the nominated person’s signature does not need to be witnessed in person. None of the safeguarding checks is changed in any way by this. In answer to the noble Lord’s concern, we would expect that, in the majority of cases, the witness will still meet the nominated person face to face. In exceptional circumstances, where this is not possible, we believe that it is better to be able to appoint a nominated person, subject to all the appropriate safeguarding checks, than to have to wait until a person can have their signature witnessed.

A second opinion doctor is not currently required for urgent and compulsory electroconvulsive therapy; this is new under the Bill. I need to emphasise this point. What the amendment does is sets out the exceptional circumstances where a second opinion appointed doctor—sorry, it is a bit of a mouthful—is not required. I hope that gives some clarification.

We have to make sure that these are all taken in the round. I reassure the noble Earl, Lord Howe, and noble Lords across the Chamber, that many of these are regarded to be due to exceptional circumstances, where time is of the essence.

As to whether some of these provisions are based on failure, it is from learned experience and bringing together everyone who has a view to make sure that everything we bring forward is in the best interests of the patient. That is the crucial thing. This is where the detailed work will be done under the code of practice, bringing together all the different parties in a measured way. It will take a few months to do this. That is critical, so that we can all be reassured that the processes are brought into play.

I can understand the concern about making sure that communication is there in situations of stress, but I believe that these amendments are designed to address this issue, with, as I have said, the patient’s interest absolutely in the forefront. There will be opportunities as the code of practice is put together for us to make sure that our endeavours are followed, bringing the best opinion together with the best interest of the patients.

Amendment 16 agreed.

Moved by

[Baroness Blake of Leeds]

17: Clause 18, page 26, line 4, at end insert—
“62ZAA Life-saving section 62ZA treatment: modified procedure in exceptional circumstances(1) Where—(a) a request is made to the regulatory authority under section 56B for the appointment of a second opinion doctor to perform the function of giving a certificate under section 62ZA in relation to any treatment, and(b) the regulatory authority determines that there are exceptional circumstances which mean that there will be a delay in appointing a second opinion doctor,a function of a second opinion appointed doctor under section 62ZA in relation to the giving of a certificate containing a statement under subsection (4)(c)(i) or (5)(c)(i) of that section may be performed, instead, by the approved clinician in charge of that treatment.(2) But no treatment may be given in reliance on a certificate given by the approved clinician by virtue of subsection (1) once the second opinion doctor has been appointed under section 56B.(3) Each time a patient is given treatment in reliance on a certificate given by the approved clinician by virtue of subsection (1), the managers of the hospital or registered establishment in which the treatment is given must notify the regulatory authority of that treatment as soon as reasonably practicable.(4) The regulatory authority’s annual report under section 120D must include—(a) a statement of how many times the regulatory authority has made a determination under subsection (1)(b) in the period to which the report relates and a summary of the reasons why any determinations have been made, and(b) a statement of how many times during that period treatment has been given in reliance on a certificate issued by virtue of subsection (1).”Member’s explanatory statement
Where exceptional circumstances mean that a second opinion appointed doctor is not available to authorise life-saving electro-convulsive therapy, this amendment would allow the approved clinician to do so. The amendment replaces the regulation-making power currently in new section 62ZB(1).

--- Later in debate ---

Moved by

[Baroness Blake of Leeds]

22: After Clause 18, insert the following new Clause—
“Remote assessment for treatment(1) Section 119 (practitioners approved for Part 4 and section 118) is amended as follows.(2) In subsection (2)(a), for the first “and” substitute “or”.(3) After subsection (2) insert—“(2A) A person authorised by subsection (2) to carry out an interview or examination may, to the extent that they consider appropriate, carry it out—(a) by live audio link, or(b) by live video link.”(4) In subsection (3), before the definition of “regulated establishment” insert—““live audio link” , in relation to the carrying out of an interview or examination, means a live telephone link or other arrangement which enables the patient and the person carrying out the interview or examination to hear one another;“live video link” , in relation to the carrying out of an interview or examination, means a live television link or other arrangement which enables the patient and the person carrying out the interview or examination to see and hear one another;”.” Member’s explanatory statement
This new clause would enable remote assessments to be carried out by certain people for the purpose of non-urgent electro-convulsive therapy and certain other treatments. It also replaces clause 18(7) which makes equivalent provision for urgent treatment.

NHS England Update

Baroness Blake of Leeds Excerpts

Wednesday 19th March 2025 Lords Chamber

[Baroness Merron (Lab)]

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

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

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

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

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

[Baroness Tyler of Enfield (LD)]

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

Covid-19 Update

Baroness Blake of Leeds Excerpts

Wednesday 8th December 2021 Lords Chamber

[Lord Kamall (Con)]

I understand the frustration of the noble Baroness and a number of civil libertarians, but we have always been clear that we have to have a balance between keeping the British people safe by being cautious and making sure that we follow the data. We have always looked at a number of different factors, including hospitalisations, the proportion of admissions due to infection, the rate of growth in cases, vaccine efficacy and many others—but, quite clearly, when we see this doubling rate of the omicron variant and do not yet have enough data, we are being cautious. By doing this now, we could prevent a worse situation later.

[Baroness Blake of Leeds (Lab)]

My Lords, when you go on to your app, you do indeed get a message that says, “There are currently issues with accessing the Covid pass on the NHS app and the website”. Given that the advice is that this mandatory certification will be required from Friday, this is an issue not only for the individuals trying to access the certification but for the venues. Can the Minister assure us that, if the problem continues, there will be clear advice to venues as well? Otherwise, there will be untold chaos when this comes in on Friday.