Diabetes: 10-Year Health Plan

Baroness Merron Excerpts

Thursday 26th June 2025 Lords Chamber

[Baroness Humphreys]

To ask His Majesty’s Government whether their forthcoming 10 Year Health Plan will reflect the priorities set out in Diabetes UK’s 10 Year Vision for improved prevention, early diagnosis and access to care and technology for people with diabetes.

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

My Lords, the 10-year plan is not focused on specific diseases and conditions but will instead set out the changes that our NHS needs to be fit for the future—from hospital to community, from analogue to digital and from sickness to prevention—all of which closely align with the priorities in Diabetes UK’s 10 Year Vision.

[Baroness Humphreys (LD)]

I thank the Minister for that positive Answer. More than 12 million people in the UK now have diabetes or prediabetes, with research showing a staggering 51% increase in the last eight years in the prevalence of type 2 diabetes among under-40s in England, at an age when the condition is more aggressive and the risk of complications is higher. To help reverse this trend, will the Government embed suggestions from Diabetes UK’s 10 Year Vision into their 10-year plan, including the creation of a healthier food environment, with a ban on TV advertising of unhealthy food and an extension of the soft drinks industry levy?

[Baroness Merron (Lab)]

I can say yes to both of those because we have already committed to do that. The advertising restrictions were a manifesto commitment and will be implemented from 6 January. I can also tell the noble Baroness that from October this year, as the result of a consultation, the industry has already voluntarily agreed to abide by those restrictions. We had to make changes to make it more workable and I am glad we did that to get the right approach. I am also glad that we worked to get the voluntary agreement. I also said yes to the noble Baroness in respect of Diabetes UK’s 10 Year Vision, which we are very grateful for. I am also grateful for Diabetes UK’s interaction, which has been considerable, in the consultation on our 10-year plan. I thank Diabetes UK and I am sure the noble Baroness will join me in that.

[Baroness Williams of Trafford (Con)]

My Lords, following the report from the charity Breakthrough T1D, which found that people in lower socioeconomic groups and those over 65 were least likely to be aware of new technologies such as the hybrid closed loop systems, what plans do HMG and NHSE have to raise awareness of the latest technologies available to type 1 diabetics of all ages and socioeconomic groups?

[Baroness Merron (Lab)]

The matter of health inequalities is, obviously, one we are very concerned about. A national review is currently under way to update on monitoring, including of various groups. NHS England supports ICBs in improving diabetes care, including through the use of the medical technologies that the noble Baroness referred to, and, importantly, in reducing the variation in care that we still see across the country. It does that by using national data and insights, funding local clinical needs and addressing health inequalities through the national diabetes prevention programme. I certainly agree with the noble Baroness about the importance of raising awareness and the incredible contribution that new technology is playing. It has to be available for all and I hope we will establish that in the way I have mentioned.

[Lord Patel (CB)]

My Lords, I declare an interest as a patron of the South Asian Health Foundation. The south Asian population has a very high incidence of diabetes, particularly type 1, which is probably related to a strong gene marker. Some 50% of people with type 1 diabetes have some kind of gene marker. Those who have a strong gene marker in a particular region, the HLA region of chromosome 6, have a very high incidence. My point is that, if we screen people, particularly those with a family history of diabetes, for genetic markers, we will identify them much earlier, even in childhood. The prevention that is therefore required—changing their environment and diet—becomes more effective. This ought to be one of the preventive strategies for diabetes in high-risk populations.

[Baroness Merron (Lab)]

The noble Lord is quite right in his observations, which play to the point of the NHS that we want to see not just now but in the future. Noble Lords may have heard the announcement earlier this week that the Government are committing the necessary funding to screen babies early in their lives through the use of genomics, in order to, as the noble Lord said, identify underlying conditions that can be dealt with early on. There are some that cannot be prevented, but if they are diagnosed and anticipated, their management will be much better.

[Lord Rennard (LD)]

My Lords, continuous glucose monitoring and Mounjaro have helped me to come off insulin after 20 years of daily injections and have greatly improved my diabetic control. Such innovations are undoubtedly a cost saving to the NHS in the long run. Does the Minister think we are looking far enough into the future when we consider the cost-benefit analysis of their use? How can NHS spending plans take into account their long-term benefits to the economy by keeping people in work and getting many people back to work?

[Baroness Merron (Lab)]

The noble Lord, Lord Rennard, knows that it is always good that we hear about his own experience, because he epitomises the changes that are possible. I believe there is an understanding—not least because, as noble Lords will know, the Chancellor very recently gave the department a settlement that was, in large part, because of not just immediate need but looking to the future and the kind of NHS that is fit for the future we will see identified in the 10-year plan when it is published. Technology is certainly a huge part of that, which is why CGM and the hybrid closed loop system—the latter of which began to be rolled out in April 2024—are so important. There have been huge advances and they will be part of that NHS of the future that we seek to build.

[Baroness Altmann (Non-Afl)]

My Lords, I am delighted that the Government are producing their 10-year plan, and we look forward to seeing it. Following on from the question from the noble Lord, Lord Rennard, about protecting the labour force, can the Minister say something about fracture liaison clinics being rolled out across the country, to follow up on commitments made in the past that these clinics will be available across the country? These clinics can help boost productivity in the workforce; help older people, especially women, stay in the labour force; and prevent the fractures that so often force them out of work or cause accidents for older people.

[Baroness Merron (Lab)]

Fracture liaison services do an incredible job. I refer the noble Baroness to the words of the Secretary of State—I will not quote them because I do not have them to hand and there is nothing worse than misquoting somebody, particularly the Secretary of State—who has made his intentions quite clear on fracture liaison services. We certainly appreciate their value and the need to make that kind of provision available across the country.

[Lord Scriven (LD)]

With regard to what the Minister said about the DNA database of children with diabetes and other conditions, what are the mechanisms in place if a child, at the time they reach Gillick competence, no longer wishes to have their data on that DNA database? Will there be mechanisms so that the child can at that point withdraw their data and prevent it being used?

[Baroness Merron (Lab)]

All the usual provisions will apply, but, as we develop the system, all that detail will be confirmed. I will ensure that the point the noble Lord raises is fed into that consideration.

NHS and Social Care: Joint Working

Baroness Merron Excerpts

Thursday 26th June 2025 Lords Chamber

[Baroness Pitkeathley]

To ask His Majesty’s Government what plans they have to promote joint training programmes and opportunities for joint working for staff who are separately employed by the NHS and social care agencies to encourage integration between the two services.

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

My Lords, the Government are committed to developing an integrated health and care workforce which is skilled and well supported and has opportunities for high-quality learning, to enable staff to develop and progress their careers across an integrated system. We are also implementing joint induction for all health and care staff, a mid-career management programme and, during 2025-26, the introduction of new management standards and unified core leadership and management standards for managers.

[Baroness Pitkeathley (Lab)]

I thank my noble friend for that positive reply. Does she agree that one of the main barriers to integration between health and social care is the lack of knowledge of the skills and experience of other professionals? Should the importance of integration therefore be included in initial clinical training, and should clinicians of all kinds be encouraged to understand the work of others by job rotation, so that they can be helped to appreciate the role of other colleagues and the importance of all professionals to patient care, no matter which agency employs them?

[Baroness Merron (Lab)]

I very much agree with my noble friend about the importance of integration. As she explained, it is not necessarily about training to be joint, but about the approach. I will feed back her particular suggestion about job rotation to Minister Karin Smyth, who is responsible for developing the workforce plan. I will also share her view—again, I am sure she will see this reflected in the workforce plan when it is published following on from the 10-year plan—on the importance of multidisciplinary teams in many areas. The one that we are talking about, health and social care, is a prime example.

[Baroness Watkins of Tavistock (CB)]

My Lords, I thank the Minister for her previous very positive answers, but one of the biggest barriers to working together is different terms and conditions for care and health workers: in particular, the lack of pay for care workers who have to go between different visits in rural areas and have significant dead time. If we are really to move this forward, should we not put pressure on councils to ensure that the contracts they let allow for the time travelling between people who are being cared for?

[Baroness Merron (Lab)]

The noble Baroness raises a practical and realistic point that many care workers speak about. She will know that we are implementing a new fair pay agreement that, for the first time ever, will reflect what people actually do. Also, for the first time, there will be a universal career structure for adult social care that supports care workers. The approach that the Government are now taking shows a line of movement that takes seriously the pay, terms and conditions of care workers. I should also add that the noble Baroness, Lady Casey, will have free range to decide how she wishes to conduct her review of social care. Perhaps the noble Baroness, Lady Watkins, will ensure that she speaks to the noble Baroness, Lady Casey, about that.

[Lord Lansley (Con)]

My Lords, does the Minister agree that sometimes the most effective integration of care is around the decisions and choices of the care recipient themselves? To that purpose, would she agree that the NHS should be pursuing personal health budgets that can be combined with direct payments from social care entitlements, so that recipients of care can design their care, which will sometimes include the appointment of staff who are able to meet both purposes?

[Baroness Merron (Lab)]

I certainly agree with the noble Lord about the importance of the individual needs of the person at the centre. For too long—and part of this is a lack of integration—the needs of the person who receives, wants and needs that care and support have not been at the front. On his suggestion, I would just counsel waiting for the 10-year plan. It may not do exactly what the noble Lord says, but it will set out a way forward on how we will resolve such matters. I am sure that he will participate in further discussions about how we can get to the place that we all want.

[Baroness Burt of Solihull (LD)]

My Lords, I was very pleased to hear the Minister’s words on the progress and planning for this NHS 10-year plan. I was looking through, well, everything that I could find, really, and I could not find that any progress had been made, so I wonder whether the Minister could update the House on what is happening now and when she thinks we might start implementing this programme.

[Baroness Merron (Lab)]

I am not entirely sure, but I think that the noble Baroness is referring to my first Answer.

[Baroness Burt of Solihull (LD)]

Yes, I am.

[Baroness Merron (Lab)]

Good—thank you. This derives from the review by Sir Gordon Messenger. The first review was in 2022 and Sir Gordon came up with seven recommendations to strengthen leadership and management. To build on that, in November, Secretary of State Wes Streeting asked Sir Gordon to deliver further recommendations. That is why we now have a new national entry-level induction for new staff. As of 25 April this year, for example, it is being used by nearly 70% of trusts and ICBs to support staff enrolment. That shows how much it was needed and how much change it will make.

[Lord Rook (Lab)]

My Lords, the Archbishops’ Commission on Reimagining Care identified a number of solutions to tackle the workforce challenges in adult social care. These included better pay, improved career progression and role redesign. Could the Minister outline some of the steps that the Government are taking to address low pay, and to develop better training and development programmes and a more strategic approach to career progression in the sector?

[Baroness Merron (Lab)]

I very much welcome that report and am pleased that the Government have been responsive to identifying what we need to do. I never tire of saying that, to support the workforce in the way that my noble friend said, we are introducing a new fair pay agreement for adult social care and implementing the first universal career structure for adult social care. That will—and I know noble Lords are concerned about this—lift the status and attraction of work in social care. I believe that, alongside, for example, the apprenticeships that we are now making available and many other measures, we will get to a place where those in the workforce are doing the job we would like them to do and are being properly recognised on all counts for it.

[The Lord Bishop of Sheffield]

In the light of the 2023 Hewitt review into integrated care systems, how are the Government building greater awareness of adult social care in the NHS workforce in order to enable greater collaboration?

[Baroness Merron (Lab)]

Well, it is absolutely part of training, and the movement towards that integration of understanding across both sectors has been continuing for some while. The right reverend Prelate gives me the chance to say that we also have a digital platform that allows skills to be recognised across. The more we can do in that way, both technically and with people, the more success we will have in being integrated and building care around the person who requires it.

[Baroness Stedman-Scott (Con)]

My Lords, as I understand it, one of the principal issues about the integration of healthcare and community social care is the lack of data integration. Many hospitals still rely on manual processes to send discharge letters to GPs and social care providers. Would the Minister be good enough to tell us what the Government are doing to drive forward automation of discharge letters and similar clinical information?

[Baroness Merron (Lab)]

The noble Baroness is quite right in her observations on the need to move to much better services here. First, on her point about discharge letters, appointment letters and so on, the Government have already committed funding and direct support to local areas that are not currently providing what we might call 2025-standard communication. Noble Lords will see a considerable change; some trusts are already doing that and doing it excellently, but we want to bring that up. On the noble Baroness’s specific point, I can tell her that we are continuing to encourage the use of digital social care records to make sure that the individual’s medical record is there. Over 85% of people who draw on registered care now have a digital social care record. I hope that I have gone a bit further than the noble Baroness was asking.

Perinatal Mental Health

Baroness Merron Excerpts

Wednesday 25th June 2025 Lords Chamber

[Baroness Berger]

To ask His Majesty’s Government what assessment they have made of the spending on perinatal mental health services in England in the financial year 2024-25.

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

My Lords, this Government recognise the importance of perinatal mental health services. Spending on specialist community perinatal mental health services continued to increase in 2024-25. The latest NHS figures show that integrated care boards spent £212 million that year, which is an increase of £18 million from 2023 to 2024. This does not include spending on mother and baby units. The final spend for those in 2024-25 is not yet available, but £58 million was spent in 2023-24.

[Baroness Berger (Lab)]

I thank my noble friend the Minister for her reply and declare my interest as chair of the Maternal Mental Health Alliance. It is heartening to hear the Government’s assessment that there have not been any real terms cuts to perinatal mental health services this year. That is in spite of evidence from the Royal College of Psychiatrists. I listened very closely to what my noble friend said. She will know that maternal suicide remains the leading cause of maternal death in this country six weeks to a year after birth. Will the Government look to reintroduce the target to increase access to perinatal mental health care, which was dropped from the 2025-26 NHS planning guidance, to ensure that commissioners do not divert funds elsewhere?

[Baroness Merron (Lab)]

I pay tribute to my noble friend for her work as the chair of the Maternal Mental Health Alliance. I share her great concerns about the rate of suicide among new mothers in particular. The NHS planning guidance is not an exhaustive list of everything the NHS does. I am sure my noble friend will remember that the Darzi review highlighted that one of the problems in the NHS was too many targets. We have reduced the number of national priorities by focusing on what matters most to patients but, as my noble friend acknowledged, maternity funding has not been cut. Indeed, healthcare systems leaders now have more autonomy to meet the demands of their local populations.

[Baroness Gohir (CB)]

My Lords, I declare an interest as CEO of Muslim Women’s Network UK. We conducted maternity research in 2022 and found that there is a lack of awareness in some minority ethnic communities that women can suffer from poor mental health during and after pregnancy, which results in the situation that, when women ask for help, they are not believed by their families and are accused of being a bad mother or even possessed by evil spirits. Will the Government look at doing some awareness raising of perinatal mental health in minority ethnic communities and make those services more accessible to those women?

[Baroness Merron (Lab)]

The noble Baroness raises a very important point, particularly on voices not being heard. I am sure she heard the announcement on maternity safety made by the Secretary of State on Monday. He highlighted the issue of women’s voices and that women are so often not listened to. That is particularly the case among the minority ethnic groups the noble Baroness referred to. I assure her that that is taken into account. I am glad to say that there are record numbers of women accessing community perinatal mental health services. On the point raised, that is why it is for local areas to serve their local communities in the way she describes.

[Lord Scriven (LD)]

My Lords, given the £8.1 billion annual cost of untreated perinatal mental illness, will the Government mandate a ring-fenced, inflation-proof budget for perinatal mental health services within ICBs to ensure sustainable long-term investment, rather than relying purely on discretionary funding?

[Baroness Merron (Lab)]

I do not share the view that it is discretionary funding, not least because what matters are the outputs, which are, as I described, that a record nearly 65,000 women accessed a specialist community perinatal mental health service or maternal mental health service in the 12 months to April 2025. That gives some idea of the scale—that is a 95% increase compared with four years earlier. So the output is absolutely there. Was it ever the case that all needs were met? No, it was not, even before the change to the planning guidance and the ring-fencing. I emphasise again that this Government’s whole approach is to ensure that local communities are properly served. That is why ICBs can make decisions about how they provide what I regard as first-rate services.

[Lord Patel (CB)]

My Lords, I support much of what the noble Baroness, Lady Berger, said, particularly about the leading cause of maternal deaths—39% of them—being suicide. Not only that: 37% of those mothers who took their own lives had a known history of mental health issues, yet they were not properly looked after. That is the main problem. Although guidelines exist for screening mothers during pregnancy and after the birth of a baby, they are not universally followed. There is a great variation in the adoption of these guidelines and using the screening tools that are available to identify mothers at risk during pregnancy. We need to put much more effort into that. On the cost, there is only one small model that describes the benefits of identifying mothers at risk during pregnancy and after delivery. We need a detailed study to show the cost-benefit analysis of doing that.

[Baroness Merron (Lab)]

The noble Lord, building on my noble friend’s point, makes a very important point. I will add to what he said. The impact on affected families is absolutely devastating and has very long-lasting effects, particularly on children. As the noble Lord said, the suicide prevention strategy outlines what clinicians should do, which is complete screening of women’s mental health during pregnancy and the first year after pregnancy. I hear the points that the noble Lord made and will put them into my discussions about suicide prevention, because I am also concerned about the number of people who take their own lives who are in no contact with the health services; we have to find a way of making contact with them. This is less the case in this circumstance, but that theme is still there. I thank the noble Lord for that contribution.

[Baroness Williams of Trafford (Con)]

My Lords, following an Answer to a Written Question from my noble friend Lord Kamall, data shows that last year only one post was available in the north-east and one in the south-west for obstetrics and gynaecology specialist training stage 3, and only four posts were available in London. How will the Government rectify the dearth of provision?

[Baroness Merron (Lab)]

As the noble Baroness is aware, the long-awaited 10-year plan will be with us shortly. That will set out the parameters for change and the services that we need. Following that, there will a long-term workforce plan, which will deal with the kind of matters the noble Baroness referred to.

[Baroness McIntosh of Hudnall (Lab)]

My Lords, I had not intended to ask a question but, following on from the contribution from the noble Lord, Lord Patel, impacts other than the most undesirable one of suicide come from postnatal depression. Among those are an inability of new mothers to cope well with the demands on them and therefore provide the care that very young children need. Is the Minister confident that the way that the NHS now—I am struggling not to say “gets rid of”—moves mothers out of hospital very soon after birth provides the right start to the sort of care that particularly vulnerable women need immediately after giving birth?

[Baroness Merron (Lab)]

My noble friend raises a very useful consideration. Decisions about how long a new mother stays in hospital are a local matter and specific to that woman. The other point I want to raise is that the services we are talking about have actually been expanded to provide care to women for up to two years after birth. That is incredibly important, as is providing a mental health assessment and signposting support for partners, who we should also remember in all of this. The services we are talking about cross the entire span and go on for two years beyond it. That certainly underpins the kind of services we want to see, but I certainly agree with my noble friend that individual cases must be seen as individual cases.

NHS: Private Equity

Baroness Merron Excerpts

Wednesday 25th June 2025 Lords Chamber

[Baroness Altmann]

To ask His Majesty’s Government what assessment they have made of the potential risks to GP services and NHS costs presented by the takeover of Assura’s surgeries by private equity providers; and whether they plan to intervene to retain domestic control of such services.

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

My Lords, Assura’s portfolio of over 500 properties is leased to GPs and other NHS and private healthcare providers. Arrangements for leased properties and their ongoing healthcare are secured through lease arrangements. A change in ownership does not affect their legal status; leases will continue to be set out and protect the terms of occupation for GP surgeries and other NHS service providers. Officials are in dialogue with Assura and prospective purchasers—and will keep monitoring proceedings.

[Baroness Altmann (Non-Afl)]

My Lords, I thank the Minister for her Answer. Following Care REIT falling into foreign hands, the board of Assura was happy to sell out to KKR, risking an uncertain future for GP surgeries serving millions of people, rather than ensuring continued UK ownership to support NHS current and future infrastructure.

The dangers of allowing overseas takeovers and private equity buyouts are written in the wreckage of our care home sector. I have two questions. First, what power do the Government have to prevent further erosion of UK critical infrastructure? Secondly, do His Majesty’s Government recognise the damage caused by the FCA to so many such real estate investment trusts, and other investment trusts, which own and manage critical UK infrastructure? The exaggerated so-called investor costs have led to unwarranted under- valuation. Therefore, foreign bidders come in and take the opportunity to snap up our future infrastructure for short-term gain, denying those opportunities to pension funds, which are the ideal long-term investors for such companies.

[Baroness Merron (Lab)]

I understand the noble Baroness’s concern, but perhaps I could assure her and your Lordships’ House that it was decided this week by the board of Assura to recommend to shareholders an offer from Primary Health Properties, which is another UK real estate investment trust, similar to Assura, which is focused on primary healthcare premises. It is the case—or was the case, depending on how you look at it—that there was another bidder for Assura: KKR. As the noble Baroness said, KKR is an American private equity and investment company, but it seems very unlikely to be successful at this stage. The assurance I can give the noble Baroness is that a change in ownership does not affect the legal status of existing lease arrangements. I would also say that the ownership of the general practice estate is very much a mixed model in which GP practice buildings can be leased from a variety of landlords, including companies such as Assura, which actually constitute quite a small proportion of the overall estate.

[Lord Winston (Lab)]

My Lords, given that there are a vast number of overseas investments in different areas of private medicine in London—for example, in vitro fertilisation, much surgery, and so on—can the Minister tell us whether there is any fundamental difference between this and Assura healthcare? Providing it is under the proper regulation of the NHS—which I believe it is—there is no particular harm that we can identify.

[Baroness Merron (Lab)]

My noble friend is quite right. What matters is the assurances that are in place to enable provision to be made, whether that is on the estate or on services, as my noble friend refers to. I can certainly assure your Lordships’ House that in preparation for this discussion of course I asked the question: are there risks? I am assured there are no risks about which we need to be concerned.

[Lord Hodgson of Astley Abbotts (Con)]

Will the Minister look at the National Security and Investment Act 2021? This gives the Government the power to designate a sector as having particular importance for the future of our country. It might be appropriate, when we are dealing with healthcare, which is obviously a key part of our infrastructure, for this to play a role in the sorts of issues she is tackling when responding to this Question today.

[Baroness Merron (Lab)]

I am grateful to the noble Lord for his suggestion. This was another area I raised with officials who have been in contact with Assura and the proposed new company, Primary Health Properties plc. The implication, I believe—I am sure the noble Lord will happily correct me outside the Chamber if this is not the case—is that somehow the Government should take on this responsibility. This would be a significant cost because the Government would have to offer in excess of the £1.79 billion currently offered by PHP and, in addition, take over £2 billion of debt raised against the properties which is secured against future rental income streams. I hope that gives some idea of the scale. There is also no strategic imperative. I understand the concerns, but the market is currently delivering, and it is expected to continue to do so.

[Lord Scriven (LD)]

My Lords, this raises a wider question regarding the NHS primary care estate. Will the Government look seriously at implementing new controls and transparent pricing benchmarks to prevent overseas investors not just imposing exploitative rents but producing punitive dilapidations, which is where they will make their money when they return the estate to the public sector?

[Baroness Merron (Lab)]

The noble Lord raises an important point. I assure him that rent and service charges continue to be set in line with the original terms if there is a change of owner. Whatever the ownership, properties occupied by GPs are required to be professionally valued by the district valuer. The service advises commissioners on whether levels of rent are value for money and align with market rents in a particular area. The other thing I might add, which I mentioned in answer to an earlier question about the mixed model of the general practice estate, is that nearly half of them are in any case GP-owned and 26% are GP leasehold. We do not currently see a problem in the way the noble Lord describes, but if there are particular examples to follow up, I am very happy to do so.

[The Earl of Effingham (Con)]

My Lords, the private sector has a significant role to play in alleviating the pressures faced by the NHS. Please allow me to quote the Secretary of State for Health. He said the independent sector can “help us out” and:

“We would be mad not to”.


Can the Minister help us understand why a number of experts in your Lordships’ House are saying outside the Chamber that there is currently excess capacity in the private sector at benchmark NHS prices? There would be no extra cost to the taxpayer but huge incremental benefits to people on NHS waiting lists. However, the spare capacity is not being used.

[Baroness Merron (Lab)]

Again, if there is particular information I should have, I would be delighted to receive that. I can only wholeheartedly agree with my right honourable friend the Secretary of State about the need to use capacity in the private sector. It is one of the ways we are driving down waiting lists and offering more appointments. As I am sure the noble Lord knows, we committed to 2 million extra appointments in our first year of government; we have far exceeded that already with 3.6 million.

[Lord Patel (CB)]

My Lords, I accept what the Minister said about how the leasing arrangements will remain the same. But can we be assured that both KKR and PHP—whichever wins the bidding war—will follow the same procedures; that is, they will be responsible for providing the equipment and the rents will not increase based on what equipment they provide, and that, therefore, patient care will remain of the highest quality?

[Baroness Merron (Lab)]

I thank the noble Lord for seeking that reassurance, which I can indeed give.

[Baroness Altmann (Non-Afl)]

I beg noble Lords’ indulgence. Will the Minister answer the second question I asked about how our infrastructure, such as these properties, is selling at hugely undervalued levels on the market because of a technical issue relating to regulations imposed by the Financial Conduct Authority?

[Baroness Merron (Lab)]

I fear I am not able to answer in the detail that the noble Baroness would like, but I would be delighted to write to her.

Medical Devices and Blood Safety and Quality (Fees Amendment) Regulations 2025

Baroness Merron Excerpts

Wednesday 18th June 2025 Lords Chamber

Moved by

[Baroness Merron]

That the draft Regulations laid before the House on 3 April and 29 April be approved.

Relevant documents: 23rd and 25th Reports from the Secondary Legislation Scrutiny Committee. Considered in Grand Committee on 17 June.

Motions agreed.

Care Workers: Foreign Worker Visas

Baroness Merron Excerpts

Wednesday 18th June 2025 Lords Chamber

[Baroness Fraser of Craigmaddie (Con)]

I beg leave to ask the Question standing in my name on the Order Paper and declare my interest as chief executive of Cerebral Palsy Scotland.

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

My Lords, the Government are reducing reliance on international recruitment in adult social care and working to improve domestic recruitment and retention. In England, we are introducing the first fair pay agreement for adult social care, implementing the first universal career structure and providing £12 million this year for staff to complete training and qualifications. These changes will help attract staff to the sector, and provide proper recognition and opportunities for them to build their careers.

[Baroness Fraser of Craigmaddie (Con)]

I thank the Minister for her Answer and apologise if it feels like Groundhog Day, because I know she answered a very similar Question from the noble Lord, Lord Wood, on Monday. As the Minister well knows, solving the recruitment and retention crisis in this sector is long term, will take cross-party work and has many regional variables. In her Answer, she referred to what the Government are able to do in England, but in Scotland, where at the moment a quarter of rural and island carers come from outside the UK, we have a real issue. One provider said to me, “It’s not just about money. Despite paying above-average wages, we haven’t interviewed a British person for over three and half years”. In many rural and remote areas, agency staff are both unaffordable and unavailable. Will the Minister feed back to her colleagues in the Home Office that any cliff edge or one-size-fits-all approach that fails to take into consideration regional challenges threatens to devastate an already fragile service?

[Baroness Merron (Lab)]

First, I pay tribute to the noble Baroness for her leadership of Cerebral Palsy Scotland. As I know she is aware, adult social care is devolved, which is why I made reference to England only. I am very happy to raise the points the noble Baroness made with the Foreign Office—sorry, with the Home Office.

[Noble Lords]

Oh!

[Baroness Merron (Lab)]

Well, I will raise them with whoever the noble Baroness likes.

The other point that comes to mind is that we will also be discussing with our colleagues over the border how they can boost the domestic workforce, because it is so important that we do, and that we reduce reliance on international recruitment.

[Lord Turnberg (Lab)]

My Lords, my noble friend may have hinted at this already, but one of the ways in which we might encourage retention and attraction to the job of being a care worker is to ensure that they have a nationally registered professional qualification. Is that going to be the case?

[Baroness Merron (Lab)]

There are a number of ways that we are promoting opportunities to develop skills and knowledge, which will improve morale but also the attractiveness of working in adult social care. To that point, I am particularly pleased that apprenticeships are available for young people, so that they may see the benefits of working in the social care service.

The three main areas are an expanded care workforce pathway; the launch of the adult social care learning and development support scheme in September, which will allow funding for eligible care staff to complete courses and qualifications; and the new level 2 adult social care certificate scheme, which has been backed up by some £12 million this financial year. In all of this, we are seeking to professionalise and recruit—as well as retain—valued social care staff.

[Baroness Barker (LD)]

My Lords, the spending review promised £4 billion for social care, but not until 2028-29, and it is being carved out of the NHS. Until then, there is nothing in the spending review, so all that is going to happen is that social care employers will have bits and bobs of sporadic announcements of limited pots of funding. How on earth can they build a skilled workforce which is adequate and up to the demands that are going to be placed on it?

[Baroness Merron (Lab)]

Perhaps I could assist by clarifying that the spending review, which allows for an increase of over £4 billion of funding available for social care, is by 2028-29; it is not a matter of waiting for that long. That is in comparison with 2025-26. I hope I was helpful to your Lordships’ House in identifying a number of actions we have already taken to professionalise, upskill and allow people to build careers in the social care workforce. That is absolutely crucial. That, aligned with stopping international recruitment in this area—with a period of time for transition of some years—will shift to improve and increase the adult social care workforce in this country.

[Lord Kamall (Con)]

My Lords, while there are legitimate concerns over the levels of immigration, it is important to recognise the contribution that immigrants have made to our great country, not least to recall that after the war, our public services were saved by immigrants, especially from Commonwealth countries. We should not forget that.

My question is about the NHS and Care Volunteer Responders programme, which was set up during the pandemic and extended to adult social care in 2023. Unfortunately, the Government recently closed the volunteering service without an obvious alternative. While I recognise that volunteering will not make up for workforce shortages, what action are the Government taking to ensure that those who wish to volunteer in the social care sector can make a worthwhile contribution?

[Baroness Merron (Lab)]

While I absolutely agree about the value of volunteering, as we have discussed before, I should make clear that volunteering is not a substitute for employment on the right pay, the right terms and conditions and with the right status. I also absolutely agree with the noble Lord about the contribution that has been made by those from overseas to supporting our care services, and indeed by all care workers.

As we have discussed in this Chamber, the scheme was not simply closed. It was something that was appropriate for when we were in a pandemic but not for now. In fact, we have introduced a whole range of measures which I will be very pleased to remind the noble Lord of, to ensure that we can have more volunteers who are better used and more highly regarded. They are a complement to our workforce, and very valuable they are too.

[The Lord Bishop of London]

My Lords—

--- Later in debate ---

[The Lord Bishop of London]

My Lords, as we have heard, concerns around low pay and insecure contracts are long-standing in the social care sector. The Minister made mention of the fair pay agreement; can she explain how this will ensure that a living wage, living hours and living pensions will be paid to staff among the private social care providers?

[Baroness Merron (Lab)]

As noble Lords will be aware, the Employment Rights Bill establishes a framework for fair pay agreements. That will mean an agreement through which adult social care sector pay, as well as other terms and conditions, will be established through negotiating bodies. The negotiations will be reached by employers, workers’ representatives and others, in partnership. That will provide the opportunity to negotiate this in a responsible manner and help address the recruitment and retention crisis in the sector and support the delivery of high-quality care.

[Lord Laming (CB)]

My Lords, I am sure the Minister will agree that we have an enormous challenge to overcome the belief that all you need to do this work is a kind heart. A kind heart is important, but there is a huge range of skills that are necessary over and above that. It is important therefore that we do all that we can to provide the opportunities to develop these skills and work incredibly hard to improve the status of these workers.

--- Later in debate ---

[Baroness Merron (Lab)]

I wholeheartedly agree with what the noble Lord said. I find that a kind heart is a good thing in most professions, but we also require more skills in many professions. That is why we have set out and launched a whole range of new measures in skills, training and development—and paying and treating people properly will also hugely raise their status.

Medical Devices and Blood Safety and Quality (Fees Amendment) Regulations 2025

Baroness Merron Excerpts

Tuesday 17th June 2025 Grand Committee

Moved by

[Baroness Merron]

That the Grand Committee do consider the Medical Devices and Blood Safety and Quality (Fees Amendment) Regulations 2025.

Relevant document: 23rd Report from the Secondary Legislation Scrutiny Committee

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

My Lords, I am grateful for the opportunity to debate these regulations, which I think can fairly be described as routine. The Medicines and Healthcare products Regulatory Agency charges fees for most of its services and, to ensure continued cost recovery, updates its fees every two years. This regularity provides certainty to customers and enables better financial planning. This statutory instrument helps to achieve this by doing three things.

First, it updates the fees that the MHRA charges in relation to its activities in regulating medical devices and blood components for transfusion. These fees were last updated in April 2023. The implementation date for the proposed changes is July 2025 and they will ensure cost recovery until 2027. This will apply UK-wide, with the fees being the same across the United Kingdom. The total cost to those who pay the MHRA’s fees from this instrument is estimated to be £0.7 million per year after inflation.

Secondly, the instrument introduces a fee for a new, optional service: a regulatory advice meeting for medical devices. In addition to publishing guidance and addressing written inquiries, this new service will further support manufacturers in their understanding of the application of the UK’s regulatory framework to their products. I am glad to say that this service was well received in the consultation. It will be mainly for those developing novel and/or complex products where the application of legislation is not as straightforward or easily understood as it might be. We have had many discussions on removing obstacles to getting products to market which support better care for patients. I hope that this will make a contribution in this regard.

Thirdly, the instrument will introduce a new payment easement for small and medium-sized enterprises for the MHRA’s medical device clinical investigation fees. While this easement will not reduce the overall fee, which would require cross-subsidisation, it will enable the fee to be paid in two instalments, providing flexibility and, I hope, supporting the businesses concerned.

It might be helpful if I highlight the important role that the MHRA plays in safeguarding public health and the importance of the agency continuing to be properly funded to deliver its role. The MHRA is a world-leading regulator of medicines, medical devices and blood components for transfusion in the UK. It plays a vital role in protecting and improving public health. It is, I suggest, an engine for UK growth and innovation; it is certainly an indispensable part of the UK health system and plays a major role globally, working with international partners.

The principles for how the MHRA charges fees are set by HM Treasury in its guidance, Managing Public Money. The basic principle is to set statutory fees to recover full costs. This means that the regulated bear the cost of regulation and that the MHRA does not profit from fees or make a loss that would then have to be subsidised by government departments or the UK taxpayer. It is, of course, standard practice for government bodies that operate on a cost-recovery basis to update their fees. It is also standard practice for other regulators, which is the reason why I described this statutory instrument as “routine”.

All fees are set by taking into account various factors that reflect the cost of the activity—for example, the activities involved in delivering a service, the time taken and the number and grade of staff involved. This process is informed by the recording of staff activity, which is the practice of monitoring and recording certain activities performed by the MHRA’s staff to establish how long they take and, so, how much they cost. In addition, also in line with the HM Treasury guidance, the MHRA includes the costs of necessary corporate overheads and system investments. Regular fee uplifts ensure financial sustainability and enable the MHRA to deliver the responsive, efficient service that its customers rightly expect.

It is worth noting that this instrument does not change the MHRA’s fees in relation to medicines regulations. Given the different legal positions in relation to the powers to make regulations about fees relating to medicines, medical devices and blood components for transfusion, two statutory instruments have been used for the MHRA’s fee uplift. A second instrument for human medicines fees has, therefore, already been laid before the UK Parliament and the Northern Ireland Assembly and has already come into force.

In summary, ensuring that the MHRA is sufficiently resourced will help it to deliver its services more reliably and to provide patients, the public and industry with the service that they expect. I beg to move.

[Lord Scriven (LD)]

My Lords, I thank the Minister for outlining the purpose of these regulations so eloquently and succinctly. It is clear that the change to the fee structure for regulating medical devices and medical products is part of a realm of profound importance both to public health and to the future of healthcare in the UK. As Liberal Democrats, we unequivocally support a robust, efficient and well-resourced Medicines and Healthcare products Regulatory Agency, but it is important that our regulatory bodies possess the financial stability to ensure the safety, quality and efficacy of medical products and blood safety, which touch the lives of millions throughout the year.

I am not going to speak on these regulations at great length; I just want to tease out a couple of issues about which I would like a little more information from the Minister. First, increasing the fees will mean that costs will be covered automatically. What mechanisms are in place to ensure that efficiency and effectiveness are in place, rather than just ballooning costs that it would be assumed the industry would absorb? I am not clear from reading the impact assessment or the regulations exactly how the Government will ensure that the cost really is the cost and is not excessive cost.

Secondly, it is clear in the impact assessment that most of those who gave feedback to the consultation question were against these fees. How have the Government taken into consideration the reservations, not just of the “no” element but in particular that the fees were seen in some cases to be disproportionately high and to exceed inflation? How has that developed? Why are these costs disproportionately high and why do they exceed inflation?

Finally, it is important to increase the fees to ensure the agency’s work can continue but, critically, the impact assessment demonstrates a lack of concrete detail on how these increased fees will translate into tangible improvements in these MHRA services. Although the rationale for increased fees is often framed around enhancing regulatory efficiency and speed, the document provides insufficient assurances of the measurable commitments as to how the additional revenue will be specifically utilised. There is no clear framework for accountability that demonstrates how these funds will lead to faster approvals or increased safety. How will the department measure such improvements? In particular, what improvements are expected on the back of this fee increase?

These regulations are a serious matter. They impact on the health of our nation and, to some degree, the vibrancy of our life sciences industry, but we must ensure that our regulatory framework is not only robust but forward thinking and truly serves the best interests of every patient in the UK by ensuring that the increased cost will both increase efficiency and, we hope, improve the services that the MHRA provides.

--- Later in debate ---

I think we all agree that the MHRA plays a critical role in ensuring the safety, effectiveness and quality of medical devices and blood components in the United Kingdom. It is in everyone’s interest that the agency is properly resourced and capable of meeting its obligations. Although we on these Benches support the principle of cost recovery, we believe that the approach should be proportionate, carefully assessed and subject to clear oversight. Let me be clear: we do not raise these questions because we oppose these regulations. None the less, we urge the Government to proceed with care to ensure that the fees are fair, that innovation is supported and that the regulatory burden does not risk deterring investment or undermining the UK’s position in global life sciences. I know that all parties want to see the UK at the forefront of the global life sciences industry. I look forward to the Minister’s response.

[Baroness Merron (Lab)]

I am most grateful to both noble Lords for their constructive contributions and their support for these measures. I welcome their questions and will do my best to respond to them.

I will first make a few general points that may assist. Noble Lords acknowledged the role of the MHRA, the essential services it offers and the crucial role it plays. It is also understood that it needs financial backing to do that. Therefore, in supporting these regulations, we will enable the MHRA to continue to contribute to the Government’s health mission and to balance its responsibilities to maintain product safety and champion innovation. As the noble Lord, Lord Kamall, said, that is so important to us as a country and an economy, as well as to the National Health Service.

The MHRA is not alone in how it is funded. Most regulators levy charges for their work, and—in response to the question about international comparisons—it is also accepted international practice for healthcare product regulation to follow this trajectory; for example, the European Medicines Agency and the US FDA also charge fees. I certainly feel that the cost recovery approach, which neither noble Lord questioned as a fundamental, ensures that services are paid for by those who use them rather than by the taxpayer—namely, patients.

The noble Lord, Lord Kamall, raised some questions about small and medium-sized enterprises. While I understand that increases in costs can place more relative strain on SMEs compared with larger companies, the MHRA has existing SME payment waivers and easements, and the instrument creates a new SME payment easement for some fees for the medical device clinical investigation service. We have sought to be responsive in this regard.

On supporting innovation and maintaining the UK’s attractiveness as a place to develop and launch medical products, I certainly want to see the UK as the go-to country for that. It does this in several ways— for example, by providing scientific advice and stream- lining regulatory processes to help reduce costs and the time to market. This is a high priority within our Government.

The noble Lord, Lord Scriven, raised questions relating to where costs have exceeded inflation, why this is and what the Government are doing about it. All fees are set to recover costs and it is the case that some services were found to be underrecovering more than others, so this is putting it back in the right place. It is not related directly to inflation but to the real costs and, in some areas, there are concerns about that.

[Lord Scriven (LD)]

Maybe I was not clear in my questioning. It is not about where it goes but this: if there is an automatic assumption that industry will cover the cost, what mechanisms are in place to make sure that there is efficiency, rather than a bloated approach where people think that, as costs will be recovered, they can do whatever they wish? That was the question, particularly regarding the inflation issue.

[Baroness Merron (Lab)]

That is understood. I am going to come on to that, because I think it is important. Of course, with any uplift in fee, I would expect that to be the case, but I have a particular response as I continue. The uplifts we are speaking about today ensure ongoing, reliable delivery. They are necessary for the continued delivery of initiatives that promote growth and innovation. We are not just standing still; we are looking to the future. To the noble Lord’s point, industry has been clear that it supports these fee uplifts as long as they are accompanied by reliable performance.

Although noble Lords have not specifically raised this, I add that the MHRA recognises that there have been some delays in some of its regulatory services of late and these delays were felt by those who pay fees. I am pleased to say that, from 31 March this year, all backlogs were cleared that relate to its statutory functions. Throughout its work to eliminate these backlogs, the MHRA put patients first and prioritised licence applications according to public health need, including those needed to avoid medicine shortages. Importantly, the MHRA is working to ensure that this continues, so that we have predictable, optimised and sustainable services across all the functions.

I can assure the noble Lord, Lord Scriven, that the MHRA is taking steps to improve its performance and efficiency, not least because it does not wish to get into the situation of a backlog again. This includes a modernised RegulatoryConnect IT system and improved agency structures and processes. On accountability, it will also publish performance targets and report against them online and in its annual report and accounts. There are also mechanisms in place for monitoring the impact of these changes. Ministers, including me, meet the MHRA regularly and the MHRA and the department monitor the impact via stakeholder feedback and ongoing performance and finance reporting. I assure the noble Lord, because I know it is a particular interest, that we have key performance indicators in place to monitor the delivery of these services.

I return to the point about small and medium-sized enterprises that the noble Lord, Lord Kamall, raised. In most cases, SMEs are dependent on grants from the NIHR and others, so there is no cost to them as a company when they submit an application to the MHRA. The noble Lord also asked about the assessment of increased fees on SMEs. Benchmarking fees compared to those of other regulators is somewhat difficult, to be quite honest, because of the difference in the way that the regulators operate and their different funding models. For example, a different model is where the regulator is subsidised, which is not the case here. With regard to employer national insurance contributions, the noble Lord is correct that the MHRA is subject to the increases in employer national insurance contributions. The agency believes that these fees will cover the costs of the increase in NI contributions. If there are any shortfalls, efficiency savings will have to be used to manage them appropriately.

[Lord Scriven (LD)]

If fees equal cost, I am not clear how calculations have been made that say that the NIC increases have not been put into that cost to be part of the fee increase, because it is a known cost. I am not clear why that suddenly becomes a potential cost reduction or inefficiency gain within the service.

[Baroness Merron (Lab)]

I may not have been as clear as I would like to have been. I will try again. The national insurance contributions increase is an increased cost and that will have been factored into the new fees that are being put forward. The gentle challenge from the noble Lord, Lord Kamall, was about whether the MHRA could manage it. I am saying that if there were any difficulty in management, it would not be a case of putting up the fees further; it would be a case of managing efficiency costs within the MHRA.

[Lord Scriven (LD)]

Just for clarity, is the NIC cost known and has it been included in these fee increases? It is an important point. I do not want to push the Minister in terms of the actual figures, but I assume that the NIC figure is known and has been included in this fee increase. Therefore, there would be no need for the agency to deal with any difference, because it is a known figure and will be in the fee structure.

[Baroness Merron (Lab)]

I am just waiting for a bit of inspiration.

[Lord Scriven (LD)]

Does the Minister want me to continue talking?

[Baroness Merron (Lab)]

Perhaps it would be best on this occasion if I review what the noble Lord has said and what I have said and write to him to clarify anything that is not quite clear.

In conclusion, I thank noble Lords for their contributions and for their support for the MHRA to ensure that it has the resources that it needs to continue delivering reliable services and can deliver its important public health role.

Motion agreed.

Human Medicines (Amendments Relating to Hub and Spoke Dispensing etc.) Regulations 2025

Baroness Merron Excerpts

Tuesday 17th June 2025 Grand Committee

Moved by

[Baroness Merron]

That the Grand Committee do consider the Human Medicines (Amendments Relating to Hub and Spoke Dispensing etc.) Regulations 2025.

Relevant document: 25th Report from the Secondary Legislation Scrutiny Committee

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

My Lords, as I know we all acknowledge, community pharmacies play a vital role in our healthcare system by ensuring that patients have access to medicines and acting as an easily accessible “front door” to the NHS. They dispense around 1.1 billion NHS medicines every single year.

Traditionally, all dispensing processes have been done in a single pharmacy or by a dispensing doctor. In hub-and-spoke dispensing, routine tasks such as sourcing, preparing, assembling and labelling medicines are carried out at a central “hub”, which is separate from the “spoke” pharmacy where the prescription is received. Hubs often make use of automated processes to realise economies of scale and to increase efficiencies. Such arrangements already exist in the UK, but the Medicines Act 1968 restricts their use to community pharmacies that are part of the same legal entity. Not all pharmacy businesses are able to invest in their own hub-and-spoke model, as compared with the larger pharmacy chains.

The Government are committed to supporting the community pharmacy sector and to cutting the red tape that frustrates it. The proposed changes have been a long time coming. If approved today, as I hope they will be, they will allow all pharmacies, including small independents, and dispensing doctors to utilise hub-and-spoke arrangements if they choose to do so.

Staff in hub-and-spoke arrangements report a calmer, more focused environment—I think we would all welcome that. In hubs, there are fewer disruptions and the use of automation reduces the risk of dispensing errors. At spokes, staff have more time for complex cases and patient care, making better use of their skills—something that the Government aim to support. The legislative changes we are debating will help all pharmacies and dispensing doctors realise these benefits, instead of limiting them to a few.

Turning to the details of the SI, we propose to amend the Human Medicines Regulations 2012 and the Medicines Act 1968, using the powers in the Medicines and Medical Devices Act 2021. The proposed changes to the Medicines Act 1968 adjust the definitions of “wholesale dealing” and “retail sale”, and remove the legal restrictions that prevent hub-and-spoke dispensing between different legal entities. The amendments go beyond simply removing the barrier that currently limits hub-and-spoke dispensing to pharmacies within the same legal entity. Noble Lords will, I hope, be pleased to know that the amendments include additional elements to ensure the safe and effective implementation of the policy by putting in place provisions to ensure accountability, governance and transparency for patients.

The proposed changes to the Human Medicines Regulations 2012 create a new model of hub-and-spoke dispensing, establishing a framework for the sharing of patient information between the hub and the spoke, and set criteria for the newly permitted arrangements. These criteria are: that both a hub and a spoke must be pharmacies registered with the pharmacy regulator, unless a spoke is a dispensing doctor practice; that there must be written arrangements between any hub and spoke, which must include a comprehensive statement in relation to their responsibilities, to ensure that each party is clear about the processes and activities for which they are responsible; that the medicine label includes only the name and address of the spoke, so that patients know who to ask any questions about their medicines; and that the spoke must conspicuously display a notice on its premises and online in relation to the dispensing arrangements.

The changes also establish an information gateway. This achieves several purposes, such as the conditions for lawful sharing of the relevant patient data between the different legal entities that operate these arrangements.

On the timescale, it is proposed that all legislative amendments come into force in the October this year across the UK. This will allow time for secondary legislation to be amended, as appropriate, across all four nations, and give the pharmacy sector time to explore the relevance and possibilities of the new hub-and-spoke arrangements to its businesses.

I hope that I have been able to set out what we are proposing and the rationale behind it. I look forward to what will, I am sure, be an informed and constructive debate. I beg to move.

[Viscount Stansgate (Lab)]

My Lords, I broadly support these regulations. I hope that my noble friend the Minister will not mind my intervening briefly to ask a couple of questions; I have no wish to detain the Committee.

Obviously, I understand that community pharmacies have been playing an increasingly expanded clinical role in treating minor illnesses and improving medicines’ safety and optimisation. To improve the efficiency of dispensing, these regulations will help support community pharmacies in taking on a more clinical role. The purpose of these regulations, which is to free up smaller pharmacies and enable them to undertake hub-and-spoke models, is, I am sure, a good one. First, does my noble friend the Minister have any idea of how welcome this will be to smaller pharmacies? Is it expected that a great deal of them will undertake these new arrangements outwith the previous restriction on being in the same legal entity?

Secondly, having recently been to my local pharmacy and having talked to the pharmacists there, I was struck by the strain that they are under, both in terms of their workload and financially. Am I right in thinking that this hub-and-spoke model, which will be made more widely available, will in some way help smaller pharmacies deal financially with the situations that they face? Am I wrong in thinking that there is a financial dimension to this? If there is, I would be very grateful for any reply that the Minister can give, but, in summary, these regulations are a step in the right direction.

--- Later in debate ---

[Lord Kamall (Con)]

My Lords, I thank the Minister for introducing this statutory instrument in her usual succinct way and all noble Lords who spoke in this debate. We on these very efficient Benches—so efficient that we have only one person here today, which is very good for productivity—recognise the Government’s intention to modernise pharmacy through the introduction of hub-and-spoke arrangements and to increase efficiency and free up pharmacies to focus more on patient care, finally getting away from the 1945 model that we have been stuck with where patients try to get an appointment with their GP in the morning and, if they are fortunate enough to see them, get triaged off to a pharmacist or to secondary care. This is much more efficient, and we welcome it.

I also welcome what many other noble Lords have said about more diagnosis and testing occurring at the level of the pharmacy. As we saw, one of the silver linings of Covid was the fact that people got more used to home testing. If we can see more home testing and more pharmacy testing out in the community, maybe we can reach those communities that we have found very hard to reach until now. We thought about this lots when I was in government; all Governments think about how to reach those hard-to-reach communities.

That said, while the aim is understandable and commendable, we have some concerns. First, the Government have chosen to proceed with only one model—the patient-spoke-hub-spoke-patient model—rather than the two models proposed by the previous Conservative Government, the other of which was patient-spoke-hub-patient. We see this as a significant narrowing of options, particularly when the consultation revealed a divided response from stakeholders. As the noble Lord, Lord Scriven, said, while large pharmacies were very much in favour of the model that the Government ended up choosing, many smaller and independent pharmacies remained opposed, as well as patients and providers who may have benefited from the second model, where patients are dispensed to directly.

In the world that we live in, with Amazon, eBay and the advent of direct-to-consumer online pharmacies, which will dispense only if there is a valid prescription—they are not just selling stuff off prescription—it is really important that we encourage that innovation. It would be wonderful for patients, particularly those with limited mobility who find it difficult to get to pharmacies, to be able to order on the NHS app, have it approved and know it will be delivered to them within so many hours or days. That would be a far more efficient model. I hope that we are not inhibiting online pharmacies with all those safeguards.

I completely understand that there is always a balance between innovation and safety and precautions. Can the Government explain why they chose only one model? Was it because of concerns over safety, good lobbying or the interests of larger pharmacists being heard over the smaller pharmacists? We would be very interested in that. We are concerned about limiting it to a single model, particularly when we know that community pharmacies dispensing for GPs and distance sellers are finding innovative solutions.

Secondly, there is funding and support. The updated impact assessment openly admits that there is considerable uncertainty over the cost of establishing these hubs, their operating expenses and the level of uptake. Once again, there is an impact on smaller pharmacies. How do the Government intend to avoid the risk that smaller providers could be left behind or forced out of the market, reducing choice for patients and challenging the role of small community pharmacists? Are they concerned about this? In addressing that, have they looked at any incentives or ways to help smaller pharmacists who may not have the resources for that upfront investment?

Thirdly, the question of oversight and transparency remains. The Minister will be aware that I ask a lot of questions on patient data and accountability of data. The Government are yet to clarify who will be responsible for collecting and publishing data on the implementation and impact of these new arrangements, particularly in light of the abolition of NHS England. This oversight is crucial not only to ensure patient safety and quality of service but to understand the broader impact on costs and service delivery.

Let me be clear: we support the idea of the single patient record and the federated data platform. One of my jobs when I was a Minister was to make sure that we joined up and digitised the data as quickly as possible. We know what efficiencies that could lead to in our healthcare, but patient safety and data protection must be addressed with rigour. The framework for sharing patient information between hubs and spokes is a key feature of this reform, yet the SI and the supporting documents provide limited detail on how patient confidentiality will be maintained and how the risk inherent in multiparty data sharing will be mitigated.

We do not oppose the principle of modernising pharmacy dispensing through the hub-and-spoke model. We were disappointed that one model was chosen, as we thought we could have some innovation with the other model. Without clearer information and incentives to smaller providers, we worry about smaller community pharmacies being pushed out, particularly in the light of having only one model. How will the Government make sure that that risk is avoided? We urge them to engage more fully with all stakeholders, clarify their plans for funding and data governance, remain open to innovation and not close down other options prematurely. With that, I look forward to hearing from the Minister.

[Baroness Merron (Lab)]

My Lords, I thank noble Lords on all sides of the Committee for their helpful contributions to today’s debate. I get a sense of support for where we are going and questions about how it will happen, which I completely accept. This instrument is part of a package of measures to relieve pressure in community pharmacy and improve patient care and the ability of the NHS to serve patients, particularly in a community setting—one of the main pillars of change for our NHS fit for the future. It builds on legislation that is already in place to enable pharmacies to increase efficiency by dispensing medicines in their original packs. Pharmacy technicians are now able to act under patient group directions to supply medicines, and the Government will shortly bring forward legislation to enable them to be authorised to do more in the pharmacy.

My noble friend Lord Stansgate raised a number of issues; he asked how it has been received and raised the financial sustainability and attraction of these measures. I reiterate that the changes being introduced are enabling. They are purely voluntary. It is entirely up to pharmacists, which are independent businesses—it is important to remember that—to decide whether they feel that engaging one, two or several hubs is going to be beneficial to their business model. It is up to them to decide.

--- Later in debate ---

[Lord Kamall (Con)]

I appreciate the response from the Minister. She said that she will keep this under review. As part of that review, are the Government or officials looking at ways in which they could mitigate concerns about model 2 in terms of those relationship and safety concerns? That would perhaps enable investigation of a future model 2.

[Baroness Merron (Lab)]

It would be fair to say that the review will be on how well this is working rather than an attempt to move to model 2. In all the modelling, we believe this is the best way to go. Patient safety is paramount, as it always should be, as is the expansion of services to individuals, but we will keep the whole matter under review.

There were two other questions. The noble Lord, Lord Scriven, asked about the fee structure. The spoke will still receive the fee for dispensing and the paying hub for the services it provides. We are not planning to dictate how the fee structure will work between hubs and spokes, as I said in an earlier answer.

[Lord Scriven (LD)]

This is an important point. This could create market distortion. If there was a hub with a number of community pharmacies as part of its parent group, is the noble Baroness saying that it could give an advantage to those pharmacies against an independent pharmacy that was not part of the hub group and therefore could charge that pharmacy a higher fee for providing exactly the same service? That could create market distortion. It is important that we understand that that could not happen within these regulations. If the Minister cannot give that answer, I ask her and her officials to go away, think about this carefully and write back. It is an important point.

[Baroness Merron (Lab)]

The whole point of the regulations, as well as cutting red tape, is about levelling the playing field. I understand the point the noble Lord is making, and I re-emphasise that arrangements between hubs and spokes are for them to make, rather than us to set. I am happy to look at the point the noble Lord makes and to write to him further with more detail.

[Baroness Finlay of Llandaff (CB)]

I will pick up on this because it is a concern. In her summing-up speech, the Minister spoke about the business interests of the hub and the spoke. A concern is whether you could have a hub, which will be a large, possibly even multi- national, provider that could create a monopoly. As has been recognised during this debate, in rural areas, in particular, dispensing doctors are often a small group. Pharmacy services have a relatively low turnover but are important to such communities that are a long way from other places and where the services provided by the pharmacist are particularly important. Yet, as a small spoke, they may not have the power to negotiate with a strong central hub that may well be driven by shareholders and profit. There is a little bit of me that would really like this to somehow be a not-for-profit arrangement over the whole of it, but I realise that that is not feasible.

[Baroness Merron (Lab)]

Perhaps it might be helpful to noble Lords if I refer to the Competition and Markets Authority in this regard because it noted that the proposed amendments that we are speaking of today are broadly competitive. It also acknowledged that there could be potential long-term competition risks if the market develops in such a way that pharmacy access to medicines, for example, is through an increasingly limited number of hub suppliers.

As the noble Baroness, Lady Finlay, suggested could happen, we might have only a few larger hubs emerging. I understand the concern that that could affect the availability of medicines for patients and their pricing. However, because of the recommendations from the Competition and Markets Authority, the department has committed to review the impact on competition once the hub market is sufficiently established. We will then assess whether action is needed to alleviate any barriers to the development of what, I believe, we all want to see: a dynamic, competitive hub market.

[Lord Scriven (LD)]

I am sorry to pursue this, but, in the impact assessment, the Government do not state how many hubs will be created. How can they reassure communities that these regulations will not distort the market? It is a very important issue for community pharmacies, which are dispersed. There is now a genuine concern that the Government do not even know how many hubs will be created—that links to the exact point that the Minister just made on the number of hubs.

[Baroness Merron (Lab)]

It is not possible to predict—although I do not think the noble Lord, Lord Scriven, is asking me to do so—how many pharmacies will take up this arrangement, because it is an enabling piece of legislation, not a requirement. It is also a matter between those businesses. To remind noble Lords, we already have provision in place for suitable pharmacy provision across the country, whether it is rural or urban, and that sits outside the regulations we are talking about today.

The noble Lord, Lord Scriven, asked about the regulation of hubs, and I can assure him that they will be registered pharmacies regulated by the General Pharmaceutical Council in Great Britain or the PSNI in Northern Ireland. The General Pharmaceutical Council has great experience in inspecting hubs and has substantial intelligence on what practical arrangements have been adopted by hub-and-spoke operators that work well. The pharmaceutical council will also ensure that all standards for registered pharmacies are met and—to the point raised by a number of noble Lords, including the noble Lord, Lord Kamall—that patient safety is protected.

To conclude, I emphasise that hub-and-spoke arrangements are not new, as large companies already operate their own hubs. This is probably a discussion for another day, but some people might suggest that that was an example of some market influence, if I can tactfully put it like that. In the meantime, I thank all noble Lords for their contributions, consideration and questions, and I beg to move.

Motion agreed.

Learning Disabilities Nursing

Baroness Merron Excerpts

Tuesday 17th June 2025 Lords Chamber

[Baroness Monckton of Dallington Forest]

To ask His Majesty’s Government what steps they are taking to develop and maintain the specialist branch of learning disabilities nursing.

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

My Lords, we recognise the vital role that learning disability nurses play in supporting those with learning disabilities, and we are committed to developing that workforce. We continue to work with partners to attract people into the profession through various routes, including apprenticeships, and provide a non-repayable grant and additional learning disability nursing payment. Later this year we will publish a refreshed workforce plan to ensure that the NHS has the right people with the right skills in the right places.

[Baroness Monckton of Dallington Forest (Con)]

I thank the Minister. The Darzi report highlighted that people with learning disabilities have greater health inequalities than the general population and are four times more likely to die from treatable causes. The Mencap campaign Nurses Not Hearses confirmed that services where there are learning disability nurses have fewer such deaths. However, this nursing workforce has reduced by 42%, universities are closing their courses—there is not one left in the south-east—and the profession is at risk of extinction. Will the Minister commit to ensuring that learning disability nursing is embedded in upcoming policies, including the 10-year plan?

[Baroness Merron (Lab)]

I pay tribute to the noble Baroness for her work as a campaigner in this area, particularly through Team Domenica. I know that through my office she will be meeting the Minister for Care next month to discuss all these important issues. It certainly is the case, and is totally unacceptable, that people with a learning disability die earlier on average than the general population. In England alone, we are talking about 1.5 million people with a learning disability, and they have significant health inequalities. Learning disability nursing is one of the four specialist fields of nursing, and those areas will be attended to in the forthcoming workforce plan. That will tie in with the 10-year plan, which is the first plan that will be published and noble Lords will not have to wait too long for it. The commitment to improving care for those with learning disabilities, and, if I might say so, with autism, is absolutely going to be in there; the noble Baroness will recall the discussions that we had, for example, on the Mental Health Act. I hope that this will show the way in which we are going, but I certainly agree with her about how much more there is to do.

[Baroness Finlay of Llandaff (CB)]

My Lords, will the Government undertake to ensure that in their workforce plan the training of undergraduate nurses in all courses, and for undergraduate medics and allied health professions, includes training on managing a situation where people have degrees of impaired mental capacity, and that judgmental views on disability are removed from any aspect of discussion because they are prejudicial to the way that people are handled when they present as emergencies? The problem is that people with learning disabilities can present at any time of the day or night to any of the services.

[Baroness Merron (Lab)]

The noble Baroness is quite right. One of the difficulties is that sometimes there is misdiagnosis, where it is incorrectly assumed, for the very reasons that the noble Baroness gives, that the presenting condition is the learning disability when actually it is a different condition. I agree about the need that the noble Baroness outlines. In reports such as the LeDeR review and Transforming Care, there is a national focus on reducing health inequalities and increasing awareness of this very point about diagnostic overshadowing. I will ensure that that is key to what we are doing.

[Lord Scriven (LD)]

My Lords, the Minister just referred to the LeDeR report, which points out the persistent avoidable deaths of people with learning disabilities. Yet we now have a seven-month delay for the latest annual report, which shows a lack of urgency. Does the Minister agree that this leads to a genuine perception that the sector’s critical concerns are not being prioritised, and that this in itself hinders promotion of learning disabilities nursing?

[Baroness Merron (Lab)]

It is probably helpful to say to your Lordships’ House that there have been significant changes to how we respond to care for individuals with learning disabilities within the UK. Like in other specialist areas, there is a move towards multidisciplinary teams, which I certainly welcome. I also emphasise the role of learning disability nurses, who are absolutely key, as is the training of all staff. That is why we are so committed to rolling out the Oliver McGowan training, which I know is highly regarded by all staff.

[Lord Watts (Lab)]

My Lords, we inherited a shortage of nurses and doctors, and it is important that we train and recruit new nurses. But does the Minister agree that, in the meantime, we have some marvellous people from the Philippines who are acting as our nurses and supporting our health service, and that it is important that we do not cut them off while we train our own people?

[Baroness Merron (Lab)]

I agree. We have many excellent staff from countries around the globe who are very committed, professional and hard-working. I presume my noble friend is referring to changes in international recruitment. I can assure him that that is why, certainly in respect of care staff, there is a transition period until 2028 to make sure that we have the recruitment in the right place.

[The Lord Bishop of London]

My Lords, the NHS England 2025 best practice guide has a number of suggestions for growing the learning disability nursing workforce, including requiring CQC-registered providers to provide staff with training for learning disabilities and autism. Can the Minister say what the Government are doing to ensure that this is implemented equitably across the integrated care systems?

[Baroness Merron (Lab)]

We are very focused on that, and NHS England is working with all areas of the country and local services to ensure that that is the case. There is a national plan for learning disability nursing that has been developed with key partners and focuses on four priorities: attracting, retaining, developing and celebrating the workforce. It is very important that we elevate the standing of learning disability nurses, to whom we are all grateful.

[Lord Kamall (Con)]

My Lords, I thank my noble friend Lady Monckton for raising the important issue of a workforce that understands how to deal with those with learning disabilities. Given the importance of this, will the Government consider committing to a targeted health promotion strategy, perhaps in partnership with local community organisations and sections of the private sector, to enable all children with a learning disability to access early promotion, intervention and prevention services to help them develop healthy habits and to improve long-life health outcomes for this vulnerable group?

[Baroness Merron (Lab)]

This is indeed a vulnerable group, as the noble Lord says, and it is probably best that I refer to the upcoming 10-year plan, which will deal with inequalities throughout a number of sectors, including the most vulnerable and including this group.

[Lord Patel (CB)]

My Lords, coming back to original Question, in which the noble Baroness, Lady Monckton, alluded to a drop in recruitment of 42% and only one place where such learning disability nurses are trained, is there not a need to expand ways of getting more people to train for learning disabilities without the penalty of fees for three years and for them instead to train as apprentices, where they do not have to incur such fees? Is that not an impediment to the recruitment of more nurses?

[Baroness Merron (Lab)]

Certainly, apprenticeships are important, and that is one of the ways we have expanded the routes into the nursing profession, including learning disability nursing. That means that the apprenticeships we are applying allow opportunities for people from all backgrounds and in underserved areas, which is another important area of ensuring that we remove the barriers to training in clinical roles.

Adult Social Care

Baroness Merron Excerpts

Monday 16th June 2025 Lords Chamber

[Lord Wood of Anfield]

To ask His Majesty’s Government what steps they are taking to remedy skills shortages and workforce gaps in the provision of adult social care.

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

My Lords, the Government are committed to recognising the adult social care workforce as the professionals they are. In April we expanded the care workforce pathway with four new role categories providing guidance on care workers’ career development. We are continuing the learning and development support scheme, backed up by up to £12 million in funding, and introducing new digital workforce tools. That is in addition to introducing legislation for the first ever fair pay agreement for care workers.

[Lord Wood of Anfield (Lab)]

I thank my noble friend for that Answer. I draw the House’s attention to my interests in the register. Social care workers do an extraordinary job, including with my own mother, but there are huge skills shortages in this sector, estimated at over 130,000 at present. Partly as a result of that, the sector is dependent on foreign workers, who make up 20% to 25% of the workforce, yet last month the Government said the recruitment of overseas care workers will end in 2028. That is the year when the report by the noble Baroness, Lady Casey, on the future of social care will be published. What is the Government’s strategy in the interim period now that 2028 is the cut-off date for recruitment from overseas—before the plan for reform of the sector has been published?

[Baroness Merron (Lab)]

It is probably worth me saying that, while the changes announced in the recently published immigration White Paper mean that overseas recruitment for adult social care will end, as my noble friend said, that is because, as he will know, the Government wish to reduce reliance on an overseas workforce. That is why there is a transition period. Until 2028 the visa extensions and in-country switching will be able to continue. The Government are also taking a range of actions to make the sector more available, more highly professionalised, more skilled and better rewarded than we have seen thus far. In all these ways, the transition period is important. The estimate is that the transition period will allow this change to be made, and better support and professionalisation for domestic as well as existing international workers can continue.

[Lord Laming (CB)]

My Lords, can the Minister go a bit further on that very helpful reply? Taking into account the range and nature of the personal care that these social care staff provide daily, is it not time that we got on urgently to professionalise the service, to make sure that they all get the proper training and that their status is rewarded with appropriate recompense?

[Baroness Merron (Lab)]

Yes, indeed. I pay tribute to the adult social care workforce who work hard, day in, day out, to provide the standards that the noble Lord refers to for those in our communities who are often the most vulnerable. I could give a range of examples but will refer in particular to the learning and development support scheme, which was launched in September 2024. It provides funding for eligible care staff to complete courses and qualifications, including a new level 2 adult social care certificate, and has been backed by £12 million this financial year. I give that as just one example; I am sure the noble Lord will be welcoming of the other actions that the Government are taking.

[Baroness Barker (LD)]

My Lords, the spending review announced £4 billion for social care, but that £4 billion will come from the NHS and not until 2028. Can the Minister confirm that there was nothing in the spending review about the two intervening years, in which local authorities are supposed to implement the fair pay award?

[Baroness Merron (Lab)]

Your Lordships’ House will be aware of the financial situation that we inherited and seek to put right. The Government have made available up to £3.7 billion in additional funding for social care authorities in 2025-26, and the noble Baroness is right that just last week the spending review allowed for a further increase of over £4 billion to be made available for adult social care in 2028-29. We are taking a whole range of actions. The Employment Rights Bill, which we will come back to later today, seeks, for the first time ever, to bring in fair pay and professionalisation for those in the adult social care workforce. So it is not that nothing is happening in the meantime. We are making progress and ensuring that the funding will be available so that we have not just a decent adult social care workforce but a way of tackling what no Government have managed to tackle before.

[Lord Kamall (Con)]

My Lords, given the persistent workforce gaps in adult social care over many years, and given the concerns that there are over immigration—even though immigrants often do the work that local people do not want to do—can the Minister outline what plans the Government have, with a clear structure, to make this a more attractive career, particularly to young people in the UK? What are the Government doing in partnership with social care providers, which are stretched at the moment, to look at alternative ways of funding training and skills development and to make sure that this is an attractive career for those in the UK, rather than always having to rely on immigration?

--- Later in debate ---

[Baroness Merron (Lab)]

As the noble Lord rightly outlines, this is a move, over a number of years, to reduce the reliance on international recruitment. I am really glad that just a couple of weeks ago the Department for Education announced the launch of a health and social care foundation apprenticeship, set to begin in August this year. This is focused on young people and will give them a paid route into the sector so that they can earn as well as gain skills and experience. It will be a wonderful foundation for young people, ensuring that they are encouraged into what is an extremely valuable sector and will have the right skills, including technical skills, and the ability to carry out the job. That is just one of the measures but it is an extremely positive initiative, as the noble Lord calls for.

[The Lord Bishop of London]

My Lords, given the well-documented regional and social economic disparities in access to adult social care, in what way are the Government, in focusing on the shortages in the workforce, focusing their efforts on tackling this inequality in access?

[Baroness Merron (Lab)]

In general terms, of course, the independent commission into adult social care will be part of our critical first steps towards delivering a national care service. The commission, as the right reverend Prelate is well aware, will be chaired by the noble Baroness, Lady Casey. I agree with the right reverend Prelate that there are particular demands in certain local areas, and the strategy will take account of that, including the fact that, based on the growth of the population aged 65 and above, the sector may need 540,000 extra new posts by 2040. That is a big challenge, but by setting up the professionalisation, the training, the skilling and the fair pay for people, it is one that we will be in a much better place, across the country, to be able to deliver on.

[Baroness Butler-Sloss (CB)]

In supporting the noble Lord, Lord Laming, I ask the Minister whether anything can be done officially to raise the status of care workers. Status is often very important for people wondering what sort of job to have.

[Baroness Merron (Lab)]

The noble and learned Baroness is absolutely right about status, which assists retention as well as recruitment. Clearly, the first ever fair pay agreements will make that possible. The need to work with various partners across the sector was raised in an earlier question. The way in which those negotiating bodies will work will absolutely bring together all the partners in the sector to get to the right place. That will certainly include fairer pay, which we will see through the Employment Rights Bill, but also training and skills and the care workforce pathway, the care certificate and having a skills record. These represent a comprehensive package to raise the status in the way that the noble and learned Baroness asks for.