Tobacco and Vapes Bill

Baroness Merron Excerpts

Committee stage
Monday 27th October 2025 Grand Committee

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

My Lords, I am most grateful for the amendments and also the contributions today. As we know, this group of amendments seeks to change or to place conditions on our smoke-free generation policy. As the noble Lord, Lord Young, and the noble Earl, Lord Howe, both observed, this group is very much at the core of the Bill and I understand the amount of interest that we have had today.

Let me say at the outset that there are a number of areas raised by noble Lords that I will return to in much greater detail, including, as the noble Baroness, Lady Walmsley, to: verification and retailers in group two; illicit sales and licensing in group 13; tobacco products that are in scope in group 16; and vaping, which is in groups five and six. I look forward to the detail of those debates when we get to them.

Perhaps I could say that I am grateful for the supportive comments on this Bill, which, as we have been reminded throughout, was introduced under the previous Government. Credit goes to them for doing so, in particular for the commitment that was shown by the former Prime Minister, the right honourable Rishi Sunak. I am therefore grateful to my noble friend Lady Carberry, the noble Baroness, Lady Northover, and the noble Lord, Lord Bourne, who helpfully reminded us all that this is a health Bill, and that is what we are here to consider. I also thank the noble Lords, Lord Bethell and Lord Young, and the noble Baroness, Lady Walmsley, all of whom have been supportive of the smoke-free generation principle and have emphasised to the Committee today the amount of public support for that and its role in stopping the cycle of addiction.

I will start with the amendments tabled by the noble Lord, Lord Murray of Blidworth, which propose changing the age of sale and proxy purchasing offences. These amendments would make it an offence to sell tobacco products, herbal smoking products or cigarette papers to a person under the age of 21. They would also make it an offence to buy or attempt to buy these products on behalf of anyone under the age of 21.

I am also grateful for the points that were just made by the noble Earl, Lord Howe, on this group of amendments. I cannot fail to emphasise that smoking is indeed the number one preventable cause of death, disability and ill health. It is unique in its harm, because it claims the lives of around 80,000 people a year in the UK, it causes one in four of all cancer deaths in England and up to two-thirds of deaths in current smokers can be attributed to smoking. I am sure that, over the years, noble Lords have heard the Chief Medical Officer’s opinion of the contribution that smoking makes, and that there is no safe level of smoking.

To the point raised by the noble Baroness, Lady Fox, who spoke about restrictions on adults’ individual autonomy, three-quarters of people who smoke wish that they had never started smoking. The majority want to quit and we want to help them. In my view, smoking is not about freedom of choice; I believe that the tobacco industry takes that choice away through addiction, particularly at a young age. In my view and that of a number of noble Lords whom I have heard speak, there is no liberty if we are speaking of addiction.

Almost every minute, someone is admitted to hospital because of smoking and up to 75,000 GP appointments can be attributed to smoking every single month. There is, as has been referred to, an economic cost. It is estimated to cost our society more than £21 billion a year in England alone, including £3 billion a year in costs to our health and care service. This is far from insignificant.

That is why this Government has made a commitment to create a smoke-free generation, so that anyone born on or after 1 January 2009 will never be legally sold tobacco products. I recall the noble Lords, Lord Scriven and Lord Mackinlay, making a particular reference to the potential contribution of people bringing tobacco back from abroad, but the noble Baroness, Lady Fox, and the noble Lords, Lord Murray and Lord Strathcarron, talked about the Bill prohibiting smoking. Let me make it clear: the smoke-free generation policy is not about criminalising people who smoke. It will not be an offence to possess or consume tobacco, regardless of your age. I can tell the noble Lords, Lord Scriven and Lord Mackinlay, that we are not imposing new restrictions on bringing tobacco back into this country.

I agree with my noble friend Lady Carberry. It is my belief—it is not just a belief, in fact; it is based on experience—that, if we raise the age of sale to 21, to which this group of amendments refers, the tobacco industry will simply change its business model and target older adults; a number of noble Lords referred to this. It will not meet our ambition of a smoke-free UK.

Similarly, the Bill makes proxy purchasing an offence such that anyone over the age of 18 cannot legally purchase tobacco products on behalf of someone born on or after 1 January 2009. The noble Lord, Lord Scriven, and the noble Earl, Lord Howe, asked important questions about the handling of proxy purchasing. I have explained clearly what the offence is and who would be responsible for it. This is about protecting children from the harms of smoking. I reiterate that tobacco is uniquely harmful. As I have said, there is no safe level of smoking; I emphasise that, to my knowledge, no other consumer product is killing two-thirds of its users.

[Lord Scriven (LD)]

I just want to pursue the issue of proxy purchasing abroad. My question was not about whether people will be able to buy tobacco abroad or whether duty-free limits will cease. My question was: if somebody buys cigarettes in a jurisdiction outside the UK and, when they come back, gives one of them to someone who is not legally entitled to buy them here, will that be an illegal act for the UK citizen who has bought that product abroad?

[Baroness Merron (Lab)]

The purchasing referred to is within our jurisdiction.

That gives me an opportunity to make a general but important point. This is about changing culture and practice. It is not about everything staying the same. This is not just a message but a practice in terms of what is acceptable and what is not. All noble Lords have seen changes over the years, as I did when I was the Public Health Minister in the previous Labour Government, which have meant that we can speak about this Bill, as we are doing today, in a way that I do not think would have been possible just a few years ago. Tobacco is a deadly addiction, and preventing children starting to smoke is undoubtedly the easiest way to reduce smoking rates. We have to be bold and brave on this, which is why we are committed to creating a smoke-free generation.

My noble friend Lady Carberry mentioned the impact assessment. Modelling shows that creating a smoke-free generation is expected to help reduce smoking rates among 14 to 30 year-olds to near zero by 2050. That is a prize worth having, in my view. Over the next 50 years, it will save tens of thousands of lives, as well as many years lived in ill health with misery, discomfort and pain; it will also avoid up to 130,000 cases of lung cancer, stroke and heart disease. As I say, all of these are, I believe, prizes worth having.

On the impact assessment, a number of noble Lords said that an “age 21” policy would have just the same impact as a smoke-free generation policy. That is not true. We are aware that the tobacco industry has been telling parliamentarians this. I must say, again, that it is incorrect. The published modelling considered different scenarios for the impact of the smoke-free generation policy; it did not model the impact of raising the age of sale to 21. I believe that we have a responsibility to protect future generations from becoming addicted to nicotine; to break the cycle of addiction and disadvantage; and to allow people the chance to live healthier lives.

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[Lord Scriven (LD)]

The Minister must be clear that the report was done by KPMG; it was commissioned by Philip Morris Ltd, but it was not written by that organisation.

[Baroness Merron (Lab)]

I am happy to accept that clarification, but the point that I am driving is still being driven.

I now move on to Amendments 5 and 205 in the name of the noble Lord, Lord Moylan, which seek to introduce an interim age of sale of 21 at Royal Assent, before the smoke-free generation provisions come into force. Although I appreciate the noble Lord’s ambition in seeking to raise the age of sale for relevant products, which we are discussing, it is my view that these amendments are not necessary; indeed, they would distract from our ambitions. Let me explain why.

Under this Bill, the smoke-free generation will come into force in 2027 when people born on or after 1 January 2009 turn 18. Subject to timetabling, these amendments would mean that any interim age of sale proposed by the noble Lord would be in place for only a year or less. Retailers and enforcement agencies—they are, as many noble Lords have acknowledged, absolutely key to the success of this measure—would not be provided with any time to prepare for the increase to 21. I do not feel, therefore, that a measure such as this one would be helpful; indeed, it would divert resources.

The important matter of communication to the public came up in the debate. The noble Lord’s amendments would confuse all such communications if a different regime were to apply for such a short time.

The noble Lords, Lord Strathcarron and Lord Mackinlay—as well as other noble Lords—referred to the situation in Australia. Let me say this in response: we are not aware of any evidence for the illicit market in Australia being the result of a change in the age of sale. In fact, I am advised that Australia has not changed its age of sale since 1998. I say this to noble Lords: the UK is highly regarded for its robust, comprehensive approach to tackling illicit tobacco. Despite what the tobacco industry may say, implementing tobacco controls does not lead to an increase in the illicit market.

[The Deputy Chairman of Committees (Baroness Fookes) (Con)]

My Lords, we have another Division, so the Committee is again suspended for 10 minutes.

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[Baroness Merron (Lab)]

My Lords, I hope my responses have been a reassurance to the Committee and that the proposers of these amendments will feel able not to press them.

[Lord Murray of Blidworth (Con)]

May I ask one question? The Minister has not yet touched on the issue of Northern Ireland. Is it right that the Windsor Framework precludes the generational smoking ban coming into effect in Northern Ireland?

[Baroness Merron (Lab)]

The Bill is UK-wide, as the noble Lord will be aware. It has been developed in partnership with the Scottish Government, the Welsh Government and the Northern Ireland Executive, and the intention is that the measures in the Bill will apply across the UK. I assure him that, in preparing the Bill, the Government considered all their domestic and international obligations and the Bill does comply.

[Lord Murray of Blidworth (Con)]

I thank the Minister for her answer and her remarks, and all noble Lords who have spoken in this fascinating group. While the amendments themselves are not fascinating—because I proposed them—the speeches of noble Lords have been. They have shown a consistent and deep interest in the topic and a variance of views.

A number of issues remain unanswered, as highlighted by the somewhat roundabout answer on the compatibility of the generational ban with the Windsor Framework. Noble Lords will no doubt still have a number of other questions, in particular in relation to the fact that there is no proposal in the Bill for possession of tobacco to be an offence, nor the smoking of it. Instead, we are told that there is to be an offence of supplying cigarettes and buying them for another. That sort of offence is unworkable and unenforceable, and is effectively window-dressing for a scheme that is highly unlikely to succeed. That perhaps stands as a totem for a problem with the generational ban more generally—it is unworkable and unenforceable and will lead to greater criminality.

We saw from the speeches by Members across the Committee that there is a range of views. Accordingly, I suspect that there is a real risk that, if this Bill were to pass with the generational ban in it, it would be revisited in the same way as occurred in New Zealand when realisation of successful implementation was seen to be too far off and the approach changed. With that, although I reserve the right to reconsider the issue on Report, I beg leave to withdraw the amendment.

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[Earl Howe (Con)]

My Lords, I turn next to my noble friend Lord Lansley’s amendments, which would introduce requirements and provide enabling powers for age-verification technology to be built into vaping devices themselves. This proposal opens up all sorts of interesting avenues of thought. The idea of age-gating devices, using technology to prevent use by those who are underage, is innovative by any standards. As we heard from my noble friend, there is already at least one technology that would facilitate this; like him, I am led by the manufacturers to understand that it has been successfully trialled in the United States.

There could be distinct advantages to such a system: it would close a loophole that rogue sellers currently exploit; it would be more effective as a way of reducing the incidence of underage vaping; it could avoid unpleasant confrontations in retail stores, about which we know retailers are very worried; and, as my noble friend said, it would not affect the way in which adults use vapes as a way of quitting smoking. From the Government’s point of view, an amendment along the lines of my noble friend’s would act as a form of future-proofing the Bill, because it would enable them to regulate the technology in devices or packaging— a power that this Bill does not currently give them. Can the Minister tell us whether the Government have considered systems of this kind and whether officials are aware of developments in this field?

I turn to the amendment in the name of the noble Viscount, Lord Hanworth, which calls for a review of age-verification methods. The Committee will be grateful to him for raising this idea; it links into my noble friend Lord Lansley’s amendment, but it also speaks to the crucial principle that we must remain properly informed about how these measures will work in practice. This Bill introduces a major new regulatory framework, so it has to be monitored and tested against real-world evidence. Age verification will, as I have said, be central to the Bill’s success, so we need credible and accurate systems to facilitate it. The noble Viscount is therefore right to emphasise the need to engage directly with those on the front line: the retailers who will have to implement these rules every day. Their experience will be one of the best indicators of whether the system is working as intended.

I turn to the amendments in the name of the noble Lord, Lord Davies of Brixton, introduced by the noble Baroness, Lady Northover, which seek to place a statutory requirement on businesses to operate age-verification policies in England and Wales. These are well-intentioned amendments, and we share entirely the objective of preventing underage sales. However, as I read it, the Bill as drafted already makes it an offence to sell tobacco or vaping products to anyone below the legal age and provides for a due diligence defence for retailers who have taken all reasonable precautions. In practice, that means having and enforcing an age-verification policy, which is the very outcome that these amendments seek to achieve. The familiar Challenge 25 model is already a well-established part of a range of retailer compliance. So, although we understand and respect the motivation behind these amendments, we do not believe that it is necessary to restate these duties in the Bill.

I welcome the amendment from my noble friend Lord Young of Cookham, which would prohibit the online sale of tobacco products. This raises serious and timely questions around enforcement, fairness and the protection of legitimate retailers. My noble friend put his case very well. Online sales prevent a potential route for illicit or underage trade; as purchasing habits continue to shift online, that risk will surely only increase. We therefore see every benefit in exploring whether a prohibition or stricter control of online sales is appropriate.

If I were to voice a caveat, which I am sure my noble friend would not object to, it would be that we must always ensure that law-abiding retailers—those who comply with the law and operate responsibly—are not disadvantaged. Any new regulation has to be clear, enforceable and fair. The central question here is: has the Minister given any thought to this issue? If so, what capacity do the Government have to enforce a measure such as the one suggested by my noble friend? What mechanisms exist to distinguish legitimate traders from those operating illicitly? Can we control online sales in the way we would like to do? I am sure that the Minister will be the first to recognise that, if unregulated online trade becomes a loophole—indeed, it already is—it will seriously undermine the objectives of the Bill.

[Baroness Merron (Lab)]

My Lords, this group of amendments addresses the important topics of age verification and online sales. I am grateful to all noble Lords for not just their contributions but the intent behind these amendments—an intent that I have heard as being presented to assist the Bill. I am grateful for noble Lords’ considerations; I have certainly heard the support given by the noble Lord, Lord Bourne, to a number of these amendments.

I turn to Amendments 24 and 25 tabled by my noble friend Lord Davies of Brixton, who is not able to be in his place. We wish him well. I thank the noble Baroness, Lady Northover, for presenting these amendments, which would introduce a requirement for a person carrying on a business selling tobacco, herbal smoking, vaping or nicotine products, in England or Wales, to operate an age-verification policy. I certainly welcome the intention to prevent underage sales and to express a view—as I have heard not just from the noble Baroness but from other noble Lords—about supporting retailers to do the job that we are asking of them. I associate myself with that, but we believe that the Bill’s current provisions are sufficient in this regard.

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[Lord Lansley (Con)]

Is the Minister aware of the retailers—some 3,000 of them—which have written to Ministers to make the point, which emerged in a number of noble Lords’ speeches, about how concerned retailers are about the emphasis upon them denying access to vapes? The use of age-gating technology would substantially relieve those pressures on retailers.

We need to look at what the evidence may be about whether adult smokers who wish to quit by using vapes would be at all deterred by the age-gating technology. To that extent, what worries me is that we may conclude, either through international experience or pilot schemes in this country, that they are not deterred at all. Then suddenly we do not have access to a technology that would deal with illicit sales and proxy purchasing, which the point-of-sale restrictions will not bite upon. I worry that we should have the powers available.

[Baroness Merron (Lab)]

I understand the point the noble Lord makes. I believe I said that it potentially risks making vapes less accessible. I know that that is not a view that he shares. I also agree that, where there is evidence, we need to be focused on it in the measures we are taking. But the position I have outlined is the case. I will reflect on the comments that he and other noble Lords have made, which I have heard very well. I understand the concerns of retailers and I am very aware of them; that is why we continue to work so closely with their trade associations to overcome difficulties. We do not want retailers to be put in a position where they cannot do the job that they want to do. We will continue in our work in that way.

With that, I hope the noble Lord will feel about to withdraw his amendment.

[Lord Moylan (Con)]

My Lords, I thank the Minister for her concluding remarks and for the sensitive and attentive way that she commented on the debate; she has clearly listened to what noble Lords said and sought to respond within the limits of government policy. As far as my own amendments are concerned, I heard what she said with just a hint of encouragement; there was not a slamming of the door at least, so I look forward to seeing what the Government come forward with on Report.

Concerning the other amendments in this group, I refer to the fact that the noble Baroness, Lady Walmsley, used the words unintended consequences. The Bill potentially has quite a lot of unintended consequences. Some of them relate to age verification and the role of retailers in the architecture created by the Bill. There are potential lacunae in the Bill.

I simply say that the sooner the Government come forward with draft regulations and a clear idea of what is being required, the happier noble Lords will be and, more importantly, the happier the retailers—including online retailers—will be with the Bill as it goes forward. I hope that the Minister recognises that and feels that the Government can act on it. Perhaps we might even see some draft regulations before the Bill completes its passage through your Lordships’ House. In the meantime, with that hopeful and optimistic wish on my lips, I beg leave to withdraw my amendment.

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[Baroness Merron (Lab)]

My Lords, I thank noble Lords for their thoughtful contributions. As they have acknowledged, the Government are taking bold action to create the first smoke-free generation. Our published modelling shows that smoking rates in England among 14 to 30 year-olds could be close to 0% as early as 2050. I make that point particularly in respect of Amendment 4, tabled by the noble Lord, Lord Bethell.

I sympathise with the intention of his amendment and with the other amendments we have debated in this group. Let me assure noble Lords that, as is consistent with best practice, we will evaluate this legislation as is appropriate and helpful, such as by monitoring smoking rates over time. We need to ensure that no one is left behind in this smoke-free UK that we seek to create.

However, I say to the noble Lord, Lord Bethell, that we do not believe that an outright ban would be the most effective or proportionate way of encouraging current smokers to quit. As he knows, we are taking an evidence-based approach to supporting current smokers to quit and have invested an additional £70 million both last year and this year to support local authority-led stop-smoking services in England. We are continuing our national smoke-free pregnancy incentive scheme to support pregnant smokers to quit, which the noble Lord, Lord Young of Cookham, referred to.

I turn to Amendment 193, tabled by the noble Lord, Lord Young of Cookham. I aspire to be as mindful as I know he is of the importance of parliamentary scrutiny of the implementation of legislation. As I mentioned, we will assess the implementation of the Act, which is consistent. For measures implemented by secondary legislation, we will publish post-implementation reviews as appropriate. I can also commit to publishing a report on the Bill before Parliament, in line with our requirements, so we do not feel that it is necessary to outline this in the Bill. There are no plans to develop a report on specific targets or to publish a road map at this time, because we are focusing our attention and total ambition on making sure that we can deliver the Bill and work on the regulations that will follow.

The noble Lord, Lord Young, asked about a retained target to have a smoke-free England by 2030. We are going even further than the Smokefree 2030 target. As I have mentioned throughout, our ambition is for a smoke-free UK and creating the first smoke-free generation.

Finally, I turn to Amendment 199, tabled by the noble Baroness, Lady Northover. The Government are committed to ensuring the successful implementation of all measures in the Bill, as I am sure she appreciates. We will ensure that the public, retailers, enforcement bodies and other relevant groups are aware of all measures and their associated commencement date. We will publish clear guidance in advance to aid a smooth transition. The noble Baroness’s amendment also seeks to include measures to raise public awareness. That is absolutely key, as the noble Baroness, Lady Walmsley, also said.

I say to noble Lords that we run successful public health campaigns to support smokers to quit and to inform the public on the harms of tobacco. Indeed, this month is our annual Stoptober campaign. I therefore reassure the noble Baroness that my officials are working to ensure that everyone will be informed about the smoke-free generation policy and the benefits of quitting and continuing that route.

To the point made by the noble Baroness, Lady Walmsley, about social media campaigns, earlier this year we launched the first ever campaign to inform young people about the health risks of vaping. The campaign featured on social media and paid media used by young people, and the noble Baroness will be delighted to know that that included working with trusted influencers to speak directly to—how might I put it?—a younger audience.

On the comments by the noble Lord, Lord Harlech, the matter of which tobacco products are in scope will be covered in detail in group 16, and I look forward to discussing that.

On the basis of those responses, I hope the noble Lords will feel able not to press their amendments.

[Lord Bethell (Con)]

My Lords, I thank the Minister for her concluding remarks, which were thoughtful, detailed and thorough. I congratulate the Government on pursuing these measures with the energy and determination that Rishi Sunak brought to it when he was Prime Minister. They still enjoy widespread support in all corners of the House—not unanimous support, but widespread.

I am grateful for the Minister’s commitment to the £70 million cessation budget and to the smoke-free pregnancy programme that my noble friend Lord Young of Cookham mentioned. I am grateful for her commitment to evaluation and assessment and to a post-implementation review. These are standard. I hope very much that she has taken on board the comments about the need for a clear road map and for accountability, and I am grateful for everything that she said on that.

I also emphasise the importance of a public health campaign—whether it should use influencers and Kardashians, I am not quite sure—and I pay tribute to the DHSC and the NHS for their public health campaigns, which have proved to be effective: they are good curators of the nation’s health when it comes to campaigning. I emphasise to the Minister the critical importance of getting both the guidance and the communication right. We do not legislate in order to communicate, but the communication of good legislation is very important.

I also stand by the Minister’s comments on cigars and other tobacco products. I thought my noble friend Lord Harlech made extremely clear and persuasive points. I totally take on board everything he said on my 2040 extinction proposal and would very much like to talk to him about that in future, and how it might be shaped.

With that in mind, I beg leave to withdraw my amendment.

MBRRACE-UK Report 2025

Baroness Merron Excerpts

Thursday 23rd October 2025 Lords Chamber

[Baroness Berger]

To ask His Majesty’s Government what assessment they have made of the MBRRACE-UK 2025 report Saving Lives, Improving Mothers’ Care 2025: Lessons learned to inform maternity care from the UK and Ireland Confidential Enquiries into Maternal Deaths and Morbidity 2021–23.

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

My Lords, although the maternal mortality rate has slightly decreased recently, this report makes it quite clear that further urgent action is needed. That is why this Government have launched an independent investigation into NHS maternity and neonatal services, with interim findings expected in December. Moving from care to prevention, the publication of a new maternal mortality care bundle planned for next month targets the five key areas that disproportionately contribute to maternal mortality.

[Baroness Berger (Lab)]

I thank my noble friend the Minister for her reply. I want to ask specifically about the issue of late maternal deaths, which were significantly higher in this reporting period. Deaths linked to mental health issues, including suicide and substance use, were the leading cause of late maternal deaths. Almost half of women who died by suicide were from the most deprived areas. What can we do to stop it being the case that if you are from a poorer background, you are most likely to take your life during this period? Would the Minister consider introducing an urgent referral pathway for women with complex social needs?

[Baroness Merron (Lab)]

My noble friend is quite right in her observation. The maternal care bundle will be a real focus for change and tackling inequalities. Maternal mental health is one of the areas that has been identified for urgent action, because of the ability to improve outcomes and reduce inequalities. Identified pathways, as she describes, are part of the solution that we have under way.

[Lord Patel (CB)]

My Lords, we have another MBRRACE report and the same message. Black women are at twice the risk of dying and Asian women have a higher incidence than white women, and we are not addressing the issues that lead up to these deaths in these minority groups. Can the Minister tell us what measures the Government are likely to take in the maternity review to address this?

[Baroness Merron (Lab)]

This Government are committed to closing the black and Asian maternal mortality gap. It is unacceptable that, in 2025, black women are twice as likely to die in childbirth. I was speaking yesterday with a clinician who said that for every woman who dies, 100 women experience a severe maternal morbidity event, such as stroke, kidney failure or acute psychosis, which can lead to lifelong health implications, as the noble Lord has referred to. The maternal care bundle, which we have developed in partnership with MBRRACE, proposes intervention on the issue of blood clots, which are three times as likely to occur in black women and can have tragic consequences.

[Lord Kirkhope of Harrogate (Con)]

My Lords, there are considerable concerns in Leeds about the maternity services in the Leeds Teaching Hospitals Trust, including that the investigations that are now beginning will take a considerable amount of time. Can the Minister confirm that, in the ongoing inquiry into general services, a conclusion will be brought to the investigations in Leeds as soon as possible?

[Baroness Merron (Lab)]

I can give that assurance in respect of services across the country. The independent maternity and neonatal investigation will act at pace. It is an independent investigation and will be chaired by the noble Baroness, Lady Amos. In addition, the Secretary of State, Wes Streeting, is showing how high a priority it is for us to provide urgent action on this by chairing the maternity and neonatal task force himself. These projects will work at pace to bring about the change we need to see.

[Lord Scriven (LD)]

My Lords, I am pleased to hear the Minister say that this is urgent. While waiting for the review to take place, the report called for improved interagency working. While the Government are waiting for that review, are there any specific changes to information sharing and co-ordinated care pathways between maternity services, social services, specialist domestic abuse services and other statutory agencies that the Government will ask to be implemented on an interim basis, to ensure that as many women as possible live?

[Baroness Merron (Lab)]

It is important to say that we are not waiting for the results of investigations or task forces in order to take action. A number of projects are already in train and making a difference. For example, we are rolling out maternal mental health services and specialist perinatal mental health services in every area across the country. I will give one example to address the point that the noble Lord raised. A single patient record will ensure that maternity teams have all the information they need about previous consultations. That will be of great assistance in improving safety and efficiency.

[Baroness Gohir (CB)]

My Lords, NHS Resolution was, strangely, not collecting ethnicity data for maternity negligence claims. It is apparently doing so now—after I challenged them. This was the case even though minority-ethnic women have poorer outcomes. Can the Government provide assurances that ethnicity data is now being collected properly? What assessments have the Government made so far on maternity negligence claims for minority-ethnic women? I am happy to receive that information in writing.

[Baroness Merron (Lab)]

I would be very pleased to make that information available in writing. The noble Baroness makes an important point. Data is key to our advances, particularly where we are seeking to address inequalities on racial lines.

[The Earl of Courtown (Con)]

My Lords, the report makes clear that many women who died experienced multiple intersectional disadvantages—as was highlighted by the noble Baroness, Lady Berger, and the noble Lord, Lord Scriven—including poverty, mental health, domestic abuse and social exclusion. Does the Minister accept that tackling maternal mortality requires an intersectional approach that brings together health, mental health and social care services, rather than treating them in isolation?

[Baroness Merron (Lab)]

I agree with the core of the noble Earl’s observation, which is why the maternity care bundle—to be published next month and actioned next year—is so crucial. It will pick up the point he is making about the five clinical areas for urgent action. They have been chosen because of their ability to improve outcomes and to reduce inequalities, as well as their feasibility of implementation within NHS services, which I know is a matter of great interest to your Lordships’ House.

[Baroness Manzoor (Con)]

My Lords, I am pleased to hear that the Secretary of State has indicated that there will be an independent inquiry at Leeds Teaching Hospitals. Data is important, so can the Minister say what IT data in general will be collated through the NHS? More importantly, what is the governance structure for trust chairs and NHS boards in looking at risk management? Wherever we have failings, it is always a failing of leadership. How will the Government tackle this?

[Baroness Merron (Lab)]

One of the interventions aimed at addressing inequalities—which will, I am sure, be of interest—is the delivery of what is called an inequalities dashboard. That allows local systems to monitor data usage where inequalities are in place. As the noble Baroness rightly suggests, if we do not know where there is a problem then we cannot address it. That project and those on removing racial bias from clinical education, as well as those embedding the genetic risk inquiry, are data driven and will make a difference in the way that we all seek.

[Lord Scriven (LD)]

While we are talking about Leeds, can the Minister explain, following on from the previous question on leadership, how the former chief executive of the Leeds Teaching Hospitals, who was in post at the time that this was happening, can then go on to become the chief executive of the CQC? Do recruitment processes need to be looked at, particularly for chief execs who have been leading failing services such as the ones in Leeds?

[Baroness Merron (Lab)]

I note what the noble Lord says and will take his comments back to the Secretary of State.

Human Medicines (Authorisation by Pharmacists and Supervision by Pharmacy Technicians) Order 2025

Baroness Merron Excerpts

Tuesday 21st October 2025 Grand Committee

Moved by

[Baroness Merron]

That the Grand Committee do consider the Human Medicines (Authorisation by Pharmacists and Supervision by Pharmacy Technicians) Order 2025.

Relevant document: 34th Report from the Secondary Legislation Scrutiny Committee

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

My Lords, the legislation before us today is part of a wider programme of common-sense reform to modernise pharmacy regulation and to cut red tape, which will enable pharmacies to thrive and will make pharmacy services quicker and easier for patients to access, as well as maintaining high levels of patient safety.

The Government recognise that the current legislation we have in place is outdated and restricts practice, putting restrictions on the quality of service to the public. So I am very pleased to bring forward today another measure that, if approved, will mean that pharmacists will be able to spend more time delivering clinical care and registered pharmacy technicians will be able to manage more dispensing processes autonomously.

I draw your Lordships’ attention to the fact that these measures are voluntary, and take-up will of course vary across the measures that I will describe.

I turn to the detail of the SI. It proposes to amend the Human Medicines Regulations 2012 and the Medicines Act 1968, using powers under the Health Act 1999. The legislation broadly extends across the UK, but I point out that some of it does not in practice apply to Northern Ireland—I will return to that.

I wish to set out three core proposals. The first covers who must supervise the dispensing of pharmacy and prescription-only medicines. Currently, the situation is that a pharmacist must carry out or supervise all stages of the preparation, assembly, dispensing, and sale and supply. Case law has led to restrictive practice and different interpretations of the law. Many of these activities can and should be delegated to registered pharmacy technicians, who are competent and ready for these changes.

The first proposal will allow a pharmacist to authorise a registered pharmacy technician to undertake or supervise others to undertake these activities without the pharmacist needing to supervise. In giving an authorisation, the pharmacist can set conditions. For example, they may wish to exclude certain categories of drugs and ensure that staff know when to consult the pharmacist.

The law demands that a pharmacist must have due regard to patient safety when giving an authorisation. This means in practice that a pharmacist will be authorising only staff who are trained, competent and confident to undertake a task. The pharmacist will still be expected to undertake a clinical check, which is critical to make sure that a medicine is safe and appropriate for each patient. A further reassurance is that professional standards and guidance will be updated to support the safe implementation of these changes in practice.

The second proposal aims to stop the only-too-familiar situation we will all know about, whereby patients who arrive at a pharmacy find they cannot be handed their medicine because the pharmacist is absent for some reason or another. For example, they may be with a patient or taking their well-earned lunch break. This will be resolved by allowing a pharmacist to authorise any member of the pharmacy team to hand out checked and bagged prescriptions in their absence. This change in the regulations allows the pharmacist to decide who it is professionally appropriate to authorise to hand out medicines in their absence. This is likely to be a pharmacy technician, or a dispensing or counter assistant. Again, the pharmacist is required to have due regard to patient safety and to have already done a clinical check—in other words, they must be content that the medicine is appropriate for that patient and no further consultation is required.

The third proposal relates to how hospital aseptic facilities are managed and run. These are highly specialised services delivering sterile medicines for cancer patients, premature babies and other vulnerable patients. At the moment, the law states that only a pharmacist can run this type of facility. But the reality is that pharmacists are not the only staff capable of running such facilities. There is a cohort of pharmacy technicians who have undergone additional education and training and who are competent and capable of managing these important facilities. So, this legislation will allow registered pharmacy technicians to lead these facilities. The Royal Pharmaceutical Society is updating its 2016 professional standards for the quality assurance of aseptic preparation services. This will define the required knowledge and training for both professions to support and ensure safe implementation.

I turn to the scope and timescales. It is important to note—I made reference to this earlier—that, while the statutory instrument extends across the UK, proposals one and three will not apply in Northern Ireland until pharmacy technicians become a registered profession in Northern Ireland. At this point, we will, of course, work with the Department of Health, Northern Ireland to bring in these measures as soon as possible.

With regard to timescales, we are proposing a phased implementation. The measures relating to the handing out of completed prescriptions in the absence of a pharmacist will enter into force 28 days after the regulations receive royal approval. This means that patients will benefit immediately, thereby taking pressure off already busy pharmacy teams. The aim is to bring the other measures into force following a one-year transition period. This will be enacted by a separate Order in Council. This will allow time for the development and publication of professional standards and guidance and will ensure that these measures are implemented into practice safely.

I hope that I have been able to set out the purpose, alongside a clear rationale on the need for change. I look forward to what will be, I am sure, an informed and constructive debate. I beg to move.

[Baroness Hollins (CB)]

My Lords, some concerns about the order have been drawn to my attention, so I have a few questions for the noble Baroness. Pharmacy technicians, on entry to the register, have an NVQ 3 qualification, which is equivalent to two A-levels. By contrast, pharmacists have a level 7 qualification, a master’s degree, which is a different basic training, with pharmacists obviously having much greater scientific and clinical knowledge. There is a worry that large pharmacy corporations could create pressure or targets which result in pharmacy technician supervision replacing pharmacist supervision for financial gain, which could put patients at greater risk because of the knowledge gap between the pharmacist and the pharmacy technician.

With 16% of 237 million drug errors annually being due to dispensing errors, I ask the Minister, who will, after all, be legally responsible in the event of any patient harm, why supervision is not defined in legislation or in the draft SI. I could not find any evidence of definition. The noble Baroness said in her introduction that pharmacists would be required to make a clinical check, but I cannot see that in the order.

I understand that, in the government consultation, 58% of all respondents and 76% of pharmacist respondents opposed allowing pharmacists to authorise pharmacy technicians to supervise the preparation, assembly, dispensing, sale and supply of prescription-only medicines in pharmacies. Also, 51% of respondents and 65% of pharmacists disagreed with allowing pharmacy technicians to supervise the preparation, assembly and dispensing of medicines at hospital aseptic facilities in the way that pharmacists do under current law.

That generates a few questions. First, what is in place to prevent any one pharmacist—for example, one working centrally across a chain of stores—writing an authorisation for large groups of pharmacy technicians on the register to supervise medicines preparation, assembly, dispensing, sale and supply from, potentially, every pharmacy on the register, implying indirect supervision en masse? If this cannot be done in a single authorisation, could any one pharmacist write multiple authorisations to the same effect? Is it correct that an authorisation can be made without the explicit consent of the technician, and that, once made, it can be withdrawn or varied only by the pharmacist who gave it? If that is correct, individual pharmacists in pharmacies would be powerless to withdraw the authorisation if they were not the one who gave it, even if they were the pharmacist on the premises and had concerns. It seems that, even if the on-site pharmacist was not the one who issued the authorisation, they might be liable for something that occurred but which they were powerless to prevent. It just does not seem clear enough; that is the reason for my questions.

The government website states:

“Although the presence of a pharmacist in retail pharmacy is not explicitly stated in law, section 70(2) of the Medicines Act 1968 requires that a responsible pharmacist must be in charge of what happens at a retail pharmacy. This means, in law, the ‘physical presence’ of a pharmacist is inferred”.


Can the Minister confirm whether this inference is drawn from the responsible pharmacist regulations 2008, which have been revoked? The General Pharmaceutical Council’s rules are expected to allow for a pharmacist to be absent from a pharmacy, and for a pharmacist to be responsible for more than one pharmacy and, therefore, not physically present in all of them. How will authorisations be tracked so that a local pharmacist can know whether a given authorisation is current or has been withdrawn orally or in writing or varied? The authorisation could have been given by a different person, on a different date and on different premises.

It looks as if a pharmacy technician can hold two or more different authorisations—one of which could be oral, which may be useful in times of emergency or great pressure—but this order requires either verbatim recording or video recording at the time, stating either a date of expiry or that this overrides the previous authorisation. What happens if authorisations conflict? How will a conflict be resolved if, for example, one pharmacist allows the supply of certain drugs and another prohibits it?

This brings me briefly to the Terminally Ill Adults (End of Life) Bill, which, in its current form, provides sweepingly extensive powers for the Secretary of State to amend the entirety of the Human Medicines Regulations 2012 and to make regulations regarding the preparation, assembly and supply of lethal substances —particularly in Section 37(4). This could allow pharmacy technicians to supervise, prepare, assemble and supply highly toxic lethal mixtures. Many medicines are incompatible when taken together, which is a concern.

I apologise for the complexity of the questions and the confusion that this order has provoked.

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I conclude by repeating that these Benches support the aims of the legislation to modernise pharmacy supervision and enable the workforce to operate at the top of their licence. But we want to see, as all noble Lords have said in this debate, that these reforms are implemented with clarity and equity and with safety at their very core. I look forward to the Minister’s responses.

[Baroness Merron (Lab)]

My Lords, I thank all noble Lords for their valuable contributions to today’s debate. I noted the discussion between noble Lords about whether they could agree with several noble Lords at one time; the answer is yes because I can do so, too. I feel that the questions asked will shine a useful light.

I am grateful for the support that this order has received and for the understanding that it is about releasing capacity and meeting what people need these days, as compared to the situation in 1933—or, indeed, at any time since then. This is about our move from hospital to community; our reliance on and welcoming of the whole pharmacy sector; and what that sector can bring to us. This sector is a tremendously important part of our National Health Service and allows us to provide services when, where and how we need them; I add my thanks to pharmacists, pharmacy technicians and their professional bodies for their work in this area. I hope that, overall—I picked this point up—noble Lords will see that this order is about supporting pharmacy services, supporting patients and cutting the red tape that frustrates both the sector and those who use it.

I turn to the specific questions asked by noble Lords; I will of course be glad to write if I do not manage to address any of them. The noble Baroness, Lady Hollins, my noble friend Lady Ritchie and the noble Lord, Lord Scriven, raised concerns about the order, particularly in respect of pharmacy technicians’ qualifications. Let me say at the outset—this is quite a good framing, really—that pharmacists are of course absolutely critical in delivering pharmaceutical services, but the fact is that they cannot deliver without a dedicated team. That is what we are building on.

Pharmacy technicians are ready for these changes. Their training and expertise enable them to take responsibility for many activities that would previously have been the sole responsibility of the pharmacist. I can certainly say that post-registration training and professional guidance will be supporting these changes into practice. I say this to noble Lords: the answer to a number of the questions that have been legitimately asked is the professional guidance, because, as I know noble Lords will understand, this cannot all be laid out in legislation.

The noble Baroness, Lady Hollins, and the noble Lord, Lord Kamall, asked about definitions in respect of clinical checks. Let me start by talking about the professional guidance, which will set out what the pharmacist’s role is to be—including when and how there will be a need for a clinical check. It is important to say that the sector wanted pharmacy technicians to be able to work autonomously; that falls outside what “supervision” traditionally means. Therefore, we are introducing a second form of delegation, which will allow pharmacists to authorise a pharmacy technician to undertake or supervise dispensing activities without the need for direct supervision by the pharmacist. We are aware that we need to give the sector the legal clarity that noble Lords have asked for with regard to what “supervision” means in this context; I can refer noble Lords to a detailed annexe that was published alongside the consultation, but the point is well made.

The noble Baroness, Lady Hollins, my noble friend Lady Ritchie and the noble Lord, Lord Scriven, raised various questions in respect of what I will refer to as indirect supervision en masse and the need for a responsible pharmacist. So let me give the reassurance that these proposals do not remove supervision or change the legal requirement that a responsible pharmacist must be signed in at a registered premises when dispensing activities are taking place and when open to the public. We have stressed at every stage of formulating this policy our commitment to maintaining the legal requirement that noble Lords are rightly concerned about, whereby every community pharmacy must have a pharmacist on the premises.

The noble Lord, Lord Scriven, asked why there is a reference to “any member of staff”. The reason is that pharmacists will be able to authorise any member of staff to hand out checked and bagged prescriptions but they must be authorising only staff who are trained, competent and confident to undertake a task. There will be updated professional standards and guidance to ensure that good governance supports the safe implementation of these changes in practice. Therefore, it could not be, for example—the noble Lord might have had this in mind—an assistant in a supermarket who happens to be working in the pharmacy. That would not meet what is required. Again, that is an important point.

The noble Baroness, Lady Hollins, asked how authorisations will be tracked and what happens if there is conflict. I go back to my opening comments that practice matters cannot be set out in law. They will be addressed in professional standards and guidance, as I have said. That will be set by the regulators and professional leadership bodies to support the implementation of these changes into practice, and we look forward to working with those bodies. That should include professional expectations for record-keeping requirements when an authorisation is given. Training is to make clear to all staff—I return to the point raised by the noble Lord, Lord Scriven—that they need to follow standard operating procedures for when the authorisation is given, when they should consult the pharmacist and when a supply should not go ahead. That will all be part of that.

My noble friend Lady Ritchie and the noble Lord, Lord Kamall, asked about matters relating to Northern Ireland. As I mentioned, when pharmacy technicians become a registered profession in Northern Ireland, which is expected by April 2027, we will work with the Northern Ireland Department of Health to enact the other changes as soon as possible.

[Baroness Ritchie of Downpatrick (Lab)]

I thank my noble friend Lady Merron for that helpful information. Initially, up-and-running pharmacy technicians were to be registered by 2025. Why the two-year delay in terms of Northern Ireland? Maybe she would be so good as to ask Minister Nesbitt.

[Baroness Merron (Lab)]

I cannot give a specific answer, but I will be pleased to write to my noble friend and other noble Lords about the timetable rather than land Minister Nesbitt in it in any way, which I would never wish to do. But I can give the assurance to noble Lords that officials are in regular contact with their counterparts in Northern Ireland, and the measures we are talking about have been developed in collaboration with the devolved Governments and the four chief pharmaceutical officers across the UK. I hope that will be helpful.

The noble Baroness, Lady Bennett, asked about a focus on improved training before the regulations. Pharmacy technicians undertake two years of focused training in clinical settings, and they can provide clinical and dispensing services that are appropriate to their level of training at the point of registration. However, additional post-registration training is widely available to support technicians to prepare for these new roles. Assurance is also provided by the annual revalidation for all pharmacy technicians across the country. If we combine this with robust standard operating procedures and professional guidance, it will provide a clear frame- work to ensure that pharmacists can be confident to authorise pharmacy technicians to carry out, or to supervise others carrying out, activities while ensuring patient safety, which is at the heart of this, as well as service.

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[Baroness Hollins (CB)]

Given the high number of drug errors due to dispensing errors currently, will there be some monitoring of the frequency of drug errors to see whether they increase or decrease as a result of the changes?

[Baroness Merron (Lab)]

It is important to keep all matters under review—and I would want more than that—because we need to see how things are going. Certainly, the monitoring will continue. However, I would counsel a bit of caution: increases may not be directly related. As the noble Baroness well knows, it is always a complex situation, but certainly monitoring will continue. We will want to see how these reforms are working.

On training, I say to the noble Lord, Lord Scriven, that initial education training is assured by the regulator. Post-qualification training is a responsibility of NHS England. No pharmacy technician should be acting outside of their competency, and pharmacists have the responsibility that I outlined of ensuring that they are delegating tasks appropriately.

On accuracy errors, which the noble Lord, Lord Scriven, raised, pharmacists and pharmacy technicians remain professionally accountable for their actions. There is no change to that. On the question from the noble Lord, Lord Scriven, about a patient having a question about their medication, the pharmacy technician, or the other professional handing out the medication, will be trained to refer this back to the pharmacist. So, again, that assurance can be given.

I make reference to pharmacy funding because the noble Lord, Lord Scriven, raised it. We have been quite clear that funding community pharmacy is a priority. The new community pharmacy contractual framework, which has been secured by this Government, is the first step in rebuilding community pharmacy as part of our plan for change. There is a £3.1 billion deal; it is the largest uplift in the funding of any part of the National Health Service, which shows, I believe, our commitment to supporting community pharmacy and building a service that is fit for the future.

[Lord Scriven (LD)]

I know that the sector welcomes the commitment from the Government to the uplift—that is not in doubt—but that fact is that, even with the uplift, dispensing fees are still below cost. The question was quite specific, because it is causing a bit of worry in the sector: can the Minister assure the sector that, because this measure is enabling and not mandatory, the Government will not use a skill-mix change as a way of trying to reduce dispensing costs?

[Baroness Merron (Lab)]

I will be pleased to write to the noble Lord in greater detail, if he will allow that, because his question raises a whole range of points, and I would like to be accurate in my response to him.

I move on to the points made by the noble Lord, Lord Kamall, about the transition period. I hope that it is helpful for me to say that, following the approval of the Privy Council and royal approval, provisions on handing out checked and bagged prescriptions in the absence of a pharmacist will apply, as I mentioned earlier, some 28 days later. The other measures will be brought into force after a one-year transition period, which will be enacted by an Order in Council to be agreed with the Privy Council. This will allow time for the professional regulations and guidance that are absolutely crucial to making this work to be updated; we cannot do this without that time.

Noble Lords have made extremely helpful and important points today. I know that there is more work to be done to ensure that the sector is fit for the future so that we can deliver the change described in the 10-year health plan. I am grateful for noble Lords’ support for innovating and modernising the regulatory framework, because pharmacy services must be sustainable, deliver quality services and deliver the outstanding patient care that we all deserve. I thank noble Lords for their contributions and questions.

Motion agreed.

HIV: Testing and Medical Care

Baroness Merron Excerpts

Monday 20th October 2025 Lords Chamber

[Lord Black of Brentwood (Con)]

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

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

My Lords, HIV testing rates in sexual health services increased last year by 3%. After nearly a decade of cuts, we increased the public health grant to over £3.8 billion in 2025-26, which funds HIV testing and sexual health services. This year we invested £27 million in HIV opt-out A&E testing, identifying undiagnosed and untreated HIV and increasing re-engagement in HIV care. The new HIV action plan, which will be out before the end of the year, will include HIV testing and care actions.

[Lord Black of Brentwood (Con)]

My Lords, while progress is greatly welcome—I applaud the Government’s efforts and commitment in this area—does the Minister agree that, unless we move much more quickly, we have no chance of meeting the target of eliminating new infections by 2030? Last year, there were still over 3,000 new diagnoses—a stubbornly high figure—while HIV rates among black African heterosexual men are, in fact, increasing and there are up to 12,000 individuals lost to care; they are aware that they have the virus but are not accessing life-saving drugs that would stop them passing it on. Will the Government act in two very important areas to try to bring this infection rate down? The first is to make sure that PrEP is available outside sexual health clinics and the second is to ensure there is a dedicated team of caseworkers in every HIV clinic who are laser-focused on finding those who are lost to care and getting them back in treatment.

[Baroness Merron (Lab)]

I will certainly take those very helpful proposals back to the department. As the noble Lord acknowledged, we are developing the plan, which must be ambitious. If it not, exactly as he says, we will not meet what I think is a very correct target. I am sure the noble Lord welcomed the news on 17 October of the NICE publication of a recommendation on the use of cabotegravir, an injectable option for those who cannot have oral PrEP. It is important to look at the reasons why people do not access care and treatment and to find solutions, rather than leaving them as they are.

[Lord Fowler (CB)]

My Lords, I entirely support the case made by the noble Lord, Lord Black, but I urge the Government to go further. About 9 million people in the world who need HIV treatment are not receiving it at present. That position is being seriously worsened by the American Government’s regrettable decision to cut healthcare provision in so many programmes. Will the Government now lead a new international effort to increase funding to counter this new threat, which is becoming more and more obvious around the world?

[Baroness Merron (Lab)]

As I am sure the noble Lord is aware and welcomes, alongside South Africa, the UK is leading the campaign to raise investment for the Global Fund’s next three-year funding cycle. I assure him that we will, as he does, continue to champion global health and certainly remain committed to UK support for the Global Fund. UN aid also plays a very important role in the response and our funding has contributed towards preventing new cases in key populations. Long may that continue.

[Baroness Burt of Solihull (LD)]

My Lords, today, contracting HIV is no longer a death sentence as it once was, unless it is not spotted and treated in time. Testing is freely available, but we need greater awareness among all the communities affected. The currently growing groups tend to be heterosexual communities, and particularly women and ethnic-minority groups. We will not eradicate HIV if we do not spend the money on telling people about it. Are the Government planning to step up to this challenge and finance the eradication of this terrible blight?

[Baroness Merron (Lab)]

We are currently in the process of reviewing existing mechanisms as well as options for improving retention and re-engagement in care for people who live with HIV. This is a crucial part of the new HIV action plan, for which we will not be waiting very long. The noble Baroness makes an important point: there are all sorts of reasons for disengagement from care. It can be due to complex mental and physical needs but also the fear of stigma, as she referred to, particularly in the most vulnerable population groups, which means that they are disproportionately challenged. However, I assure her and your Lordships’ House that the plan will take account of that. Indeed, the 10-year health plan already makes that commitment.

[Lord Kamall (Con)]

My Lords, does the Minister agree that routine opt-out HIV testing—offering HIV tests to all patients in healthcare settings, such as emergency departments, unless they specifically decline—has proved highly effective, having identified over 1,000 cases of HIV that may well have gone undetected otherwise? Do the Government have any plans to extend this approach beyond the current pilot projects?

[Baroness Merron (Lab)]

I certainly agree that giving people who are attending an emergency department a blood test as part of a routine examination—unless they opt out—has assisted very much in engaging people in care and in identification. We have 79 emergency departments in the programme and they are making a substantial contribution. We will continue to assess where it is successful and how we can extend the success into areas that are not currently benefiting.

[Baroness Bennett of Manor Castle (GP)]

My Lords, there has been a decline in the rate of testing of 16 to 24 year-olds, which is deeply concerning. Are the Government going to tackle that as a matter of urgency, recognising the need to target that group in particular?

[Baroness Merron (Lab)]

As I have mentioned, the plan—which is due to be published by the end of this year—will include a focus on HIV testing and will take account of the groups that are less likely to be tested, because that will be key to our success in eradicating new HIV transmissions by 2030.

[Lord Patel (CB)]

My Lords, every time we have debated this subject, we have acknowledged the difficulty in identifying at-risk people who do not come forward to be tested for HIV. One such group of people are those who go to pharmacies or GPs to get a prescription for PrEP medication. What information do we give them about the need for getting themselves tested for HIV when they approach pharmacies and other sources for PrEP medication?

[Baroness Merron (Lab)]

Although I cannot answer specifically, I would be very happy to write to the noble Lord about what information is in pharmacies. I know the noble Lord will appreciate, as your Lordships’ House has welcomed, the greater use of pharmacies, not least because they are more accessible for those who otherwise would be disadvantaged.

[Baroness Ritchie of Downpatrick (Lab)]

My Lords, HIV testing rates are vital. When the Minister meets the devolved Ministers for the nations and regions, particularly the Minister for Health in Northern Ireland, I ask that she talks to them about this important area, with particular reference to Positive Life Northern Ireland, which is a voluntary body doing enormously good work with those with HIV. It received a shortage of funding, or did not receive funding, from the department this year.

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[Baroness Merron (Lab)]

I certainly can assure my noble friend that, in our discussions with the devolved Governments, we highlight this area and will continue to do so.

[Lord Scriven (LD)]

My Lords, I have a question about regional variations. Some 37% of all community tests were carried out in London in 2023, but only 1.1% in the north-east. What action will the Government take to deal with this regional variation?

[Baroness Merron (Lab)]

The UKHSA supports local areas to improve delivery, not least through data monitoring and reporting, which is vital. Without commenting on specifics, I will say that there will be variation because of incidence and the needs of local populations. We account for this in our funding and direction. What really matters is equality of access and outcome, which will remain a real focus of the plan that I look forward to presenting to your Lordships’ House.

Healthcare Provision: Inequalities

Baroness Merron Excerpts

Monday 20th October 2025 Lords Chamber

[Baroness Pitkeathley (Lab)]

My Lords, on behalf of my noble friend Lady Brown of Silvertown, and at her request, I beg leave to ask the Question standing in her name on the Order Paper.

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

My Lords, the report on the NHS by the noble Lord, Lord Darzi, casts light on a range of health inequalities which are both stark and unacceptable. In response, our 10-year plan for the NHS in England sets out a re-imagined service designed to tackle inequalities in access and outcomes for everyone, no matter who they are or where they live.

[Baroness Pitkeathley (Lab)]

My noble friend Lady Brown’s supplementary is about the experience of women. Last month, the Secretary of State for Health went on record saying that women should have consistent pain relief when coils are fitted. My noble friend has campaigned for 10 years to get proper pain relief for women who are undergoing hysteroscopies. Manchester is piloting a way to deliver this, though many other hospitals are ignoring it. Can my noble friend the Minister assure the House that the Government are seriously looking at this and monitoring what Manchester is doing in this regard?

[Baroness Merron (Lab)]

I can indeed give that assurance, and I am grateful to my noble friend Lady Brown for her voice on the matter of women’s poor hysteroscopy experiences. These are unacceptable and part of a wider issue of women’s pain being normalised. Women must be given the opportunity to discuss pain relief with a clinician before the procedure. While I am glad to say that updated guidelines from the Royal College of Obstetricians and Gynaecologists do emphasise minimising pain, it is clear that more action is needed. I assure my noble friend that we are updating the Women’s Health Strategy for England to address what I believe is a wider issue, and to improve the experiences of women across the country.

[Lord Scriven (LD)]

My Lords, clinical evidence has established that poor health care directly contributes to the current 22-year life expectancy gap between people with learning disabilities and the general population. Why is this unacceptable inequality simply becoming a grim statistic that the Government continue to pay millions of pounds to measure, but are reluctant to take statutory measures to end?

[Baroness Merron (Lab)]

It is an unacceptable situation, as the noble Lord says. However, I refer him to the national approach, which will inform action in communities, including for people with a learning disability and those who are autistic. The Core20PLUS5 informs the reduction of healthcare inequalities among a range of groups; and, extremely importantly, it supports NHS organisations in identifying who might be at risk of poorer experiences, and in addressing this. I agree with the noble Lord that this must include those with a learning disability and those who are autistic.

[Lord Harper (Con)]

My Lords, I support what the noble Lord just said on raising concerns about those with learning disabilities. They have a long-standing issue with access to the health service, and we saw some particularly poor treatment during the Covid pandemic. The last Government took steps to improve training for those working in the NHS in order to improve the situation. Picking up on the Minister’s answer to the noble Lord, what is her ambition in terms of timescale? When might we see some significant improvement in how those with learning disabilities can access National Health Service treatment?

[Baroness Merron (Lab)]

In a number of ways—I refer, for example, to the Mental Health Act, which is very significant in respect of the group we are discussing. We have already taken action in that regard in a legislative form.

However, the noble Lord is right. We started in a difficult place, but I am more than hopeful about the whole approach through the 10-year plan. So while I cannot give a month-by-month answer to the noble Lord—much as I would like to—I can say that in the course of the next 10 years, the matters to which he refers will be addressed. I believe that a neighbourhood health service designed around the specific needs of local populations will be a great contributor to this.

[Lord Weir of Ballyholme (DUP)]

My Lords, we have seen in debates across a wide range of medical matters such as perinatal care, dementia and cardiovascular issues that there is widespread geographical disparity within the country, often driven by different approaches taken by different NHS trusts. Can the Minister outline how she intends to use the 10-year plan as a driver for greater uniformity of services, to ensure that there is not that postcode lottery disparity for many patients?

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[Baroness Merron (Lab)]

The 10-year health plan has tackling inequalities at its very heart, and that is the big driver throughout. Health inequalities are strongly associated with deprivation, and it cannot be right that healthy life expectancy at birth for a girl born in Wokingham is 70.8 years, but 52.6 years for a girl born in Barnsley. I think we get a real sense of the challenge.

However, I would not expect every local area to approach this in exactly the same way, not least because the challenges are different. That is why the whole structure of the NHS, including funding, will allow local areas to meet the needs and the challenges, which are considerable in certain areas, in the way that will deliver the best outcome.

[Baroness McIntosh of Pickering (Con)]

My Lords, will the Minister look closely at the inequalities between rural and urban areas in delivering healthcare? The Minister is aware of the work I do with dispensing doctors. Is she aware that community pharmacies and dispensing doctors in rural areas are struggling, as they are not being reimbursed for the national insurance contributions increase announced at the last election? I understand that hospitals are having these reimbursed. Will the Government look at this to ensure that rural pharmacies and GP practices have a level playing field with those in urban areas?

[Baroness Merron (Lab)]

We have discussed national insurance contributions a number of times in your Lordships’ House, and I can only repeat the previous assurance, given not just by me but by other Ministers: that in making the decision, the Chancellor took into account not just the funding available—for example, in the Department of Health and Social Care, which was notable and welcome—but the impact.

In respect of rural areas, the national approach to inform action to improve equality in healthcare does define groups, including those in rural and coastal communities, so I can assure the noble Baroness that this issue does get the attention she seeks.

[Lord Kamall (Con)]

My Lords, to address inequalities we need better data. We have heard from noble Lords about granular data in some areas, but in many areas we still need to collect data and publish it in a much more granular manner, based on region, ethnicity and income, but also other measures. What are the Government doing to improve the collection of data, and particularly its granularity, so that we can address these inequalities?

[Baroness Merron (Lab)]

I agree with the noble Lord about the importance of data. We have discussed this a number of times in respect of racial inequalities. But it is not just about data; it is also about the use of digital services. We must ensure that those in the most deprived areas are not excluded because of their inability to deal with digital aspects. As the noble Lord knows, moving from analogue to digital is another core part of what we are doing. I assure him that we are improving data collection and its availability and use.

[Lord Laming (CB)]

My Lords, one of the groups most disadvantaged and, I regret to say, ignored at times, is unpaid carers—those who have taken on the care of a very disabled child or an elderly relative. Will the Minister continue her work to persuade all the services to be altogether more sensitive to carers and, most of all, to accord them the dignity and care that they need?

[Baroness Merron (Lab)]

The noble Lord is absolutely correct, and I can give him the assurance that he seeks.

Tobacco and Vapes Bill

Baroness Merron Excerpts

Tuesday 14th October 2025 Lords Chamber

Moved by

[Baroness Merron]

That the order of commitment of 23 April be discharged and the bill be committed to a Grand Committee; and that the instruction to the Committee of the Whole House of 23 April shall also be an instruction to the Grand Committee.

Motion agreed.

Alzheimer’s Disease

Baroness Merron Excerpts

Monday 13th October 2025 Lords Chamber

[Baroness Ritchie of Downpatrick]

To ask His Majesty’s Government what plans they have to ensure all people with Alzheimer’s disease have access to a timely and accurate diagnosis to improve access to care and quality of life.

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

My Lords, in the 10-year plan we announced that we would deliver the first ever modern service framework for frailty and dementia to reduce unwanted variation and narrow inequality in diagnosis and care for those living with dementia. It will set national standards and redirect NHS priorities to provide the best care and support, which will be central, along with access to a timely and accurate diagnosis.

[Baroness Ritchie of Downpatrick (Lab)]

My Lords, I thank my noble friend the Minister for that Answer, but I will press her a little further. According to Alzheimer’s Research UK, one in three people in the UK living with dementia currently do not have a diagnosis. Unlike other major conditions, such as heart disease or cancer, dementia does not have national waiting time targets. Therefore, what plans do the Government have to introduce an 18-week referral to treatment target to give those people with dementia, and their carers and families, parity with other conditions?

[Baroness Merron (Lab)]

In our development of the modern service framework for frailty and dementia we are engaging with a wide group of partners, because we need to understand what should be included to ensure the best outcomes. I hope my noble friend will welcome that we are going to be considering what interventions should be supported to improve diagnosis waiting times—which are, I certainly agree, too long in many areas. In addition, we are considering all the options to help reduce variation, including reviewing metrics and targets, as my noble friend refers to.

[Lord Bethell (Con)]

My Lords, having had the analysis of the results of incredibly extensive clinical trials on the use of GLP-1s to treat dementia, particularly Alzheimer’s disease, this is an incredibly exciting potential development. Will the Minister please share with the House what the Government are doing to prepare diagnosis for Alzheimer’s disease, so that those with the disease can be ready for this exciting treatment?

[Baroness Merron (Lab)]

The noble Lord is right to identify what are exciting developments in this area. We are investing in dementia research across all areas. That includes causes and diagnosis, as well as prevention, treatment, care and support, including for carers—I think it is important to identify the wide range. In preparation, we are ensuring that clinical trials are maximised and that reductions in waiting times happen. As I said, through the modern service framework we will be looking at the arrangements as a whole, which will give the useful range of direction that we need to address the point that the noble Lord made.

[Lord Weir of Ballyholme (DUP)]

My Lords, in the light of other positive developments, such as the ADAPT and READ-OUT trials which concentrate on using blood tests to ensure that diagnosis is done more effectively, can the Government outline what steps they are taking to make sure that the NHS is able to adopt such innovations, to ensure that everyone has a right to an early and effective diagnosis?

[Baroness Merron (Lab)]

In addition to the points that I have already made, I add that our work through the life sciences plan will be of great assistance in ensuring that we remove obstacles and make the route to which the noble Lord refers as quick as possible, so that we can move from development to delivery for the people who actually need this. We will ensure that we reduce friction and optimise access to and uptake of new medicines. That includes speed of decisions and implementation, which I am sure will be most welcome.

[Baroness Bull (CB)]

My Lords, the noble Baroness’s Question asked about not just access to care but quality of life. Is the Minister aware of the growing body of evidence that creativity enhances the quality of life of those with dementia, and that of their carers, and provides an effective mechanism for interaction between the two? What is her department doing to explore how creativity can be embedded as part of the treatment to improve quality of life for those with dementia?

[Baroness Merron (Lab)]

The noble Baroness makes a good point. I have been involved personally in a number of discussions about the role of creativity, and I certainly acknowledge it. It is perhaps helpful to refer to the RightCare dementia scenario, which works through the whole of the pathway for those with dementia. It is about not just diagnosing but looking at the best kind of approaches to support people on their journey from diagnosis through to the rest of their lives.

[Baroness Burt of Solihull (LD)]

My Lords, as we know, Alzheimer’s is the main form of a number of types of dementia. Early diagnosis allows for help to identify the specific type of dementia, leading to targeted treatment and access to support services, which have been discussed already this afternoon. However, the expected time from someone presenting at a GP surgery to diagnosis has increased from 13 to nearly 18 weeks. This is going in the wrong direction. What will the Government do to speed up this diagnosis, so that more people can benefit from some of the treatments that the Minister has referred to?

[Baroness Merron (Lab)]

As the noble Baroness says, diagnosis is absolutely crucial. I feel our health system has struggled somewhat to support those with complex needs, including those with dementia. That is why I emphasise the role of the modern service framework in this area; it is the first time we have had one and it takes a whole view, which I think has been sorely lacking. It will be informed by the independent commission on social care next year—so we are looking at next year, not waiting for years. The final point I make is about the dementia diagnosis rate for patients aged 65-plus. The Government are committed to recovering that to the national ambition of 66.7%; at the end of August, it was 66.1%.

[The Earl of Effingham (Con)]

My Lords, the evidence is clear across the board: eating healthily and staying active helps brain health and the prevention of Alzheimer’s. Is it not a huge concern to the Government that more than half the calories the average person in the UK eats and drinks come from ultra-processed foods and fewer than 25% of adults in the age groups most prone to Alzheimer’s are not meeting the Chief Medical Officer’s guidelines for aerobic and muscle-strengthening exercise?

[Baroness Merron (Lab)]

I think the valid points that the noble Earl raises refer to a whole range of health conditions. I refer particularly to our health service’s struggle to support those with complex needs. Clearly, prevention of ill health—one of the pillars of the 10-year plan—is going to be crucial, and that will include good diet and a good exercise and movement programme. I cannot comment on the specific link with dementia. There is so much more work to be done, which is why we are investing so much in research and development.

[Baroness Pitkeathley (Lab)]

My Lords, family members who look after those with Alzheimer’s—often at great stress to themselves, as the House will know—require respite care, which is one of the most valuable ways of helping them. Traditionally, they have looked to the nursing home sector to provide one-week or two-week admissions to give them a break, or perhaps a chance to attend a family event. Increasingly, though, they are finding these more difficult to obtain. Not only are they prohibitively expensive but the nursing home sector is now reluctant to offer short-term placements.

[Baroness Merron (Lab)]

I thank my noble friend for those helpful, although concerning, observations. That is why I very much look forward to the first phase and later phases of the independent commission into adult social care, chaired by the noble Baroness, Lady Casey, not least because it will inform the modern service framework, which will take account of matters such as those that my noble friend raises.

Terminally Ill Adults (End of Life) Bill

Baroness Merron Excerpts

2nd reading
Friday 19th September 2025 Lords Chamber

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

My Lords, I start by thanking all noble Lords for an extensive, passionate and insightful debate. As noble Lords have observed throughout this debate, its quality and its conduct have been exemplary, and I believe that that has allowed the expression of differing and deeply held views. I thank my noble and learned friend Lord Falconer for his work in introducing this Bill to the House, and I know that many noble Lords are waiting to hear from him as the sponsor.

We have all heard the debates across the country, in which campaigners on both sides have made their case with conviction and care. We have also heard the debates in the other place, and we know the previous consideration that this House has given to the topic of assisted dying. Now it is our turn to scrutinise this legislation.

I turn first to the important issue of the role of the Government, which relates in some part to the Motion in the name of the noble Lord, Lord Forsyth, and the amendment to it from the noble Lord, Lord Carlile. The Government are neutral on the principle of assisted dying. It is a matter of conscience. Whether the Bill becomes law is a decision for Parliament, and my role, alongside that of my noble friend Lady Levitt, is to help ensure that, if this legislation is passed, it is legally and technically effective and workable. So, as with any legislation, if Parliament chooses to pass the Bill, the Government will be responsible for its implementation.

The noble Lord’s Motion refers to time being made available for consideration of amending stages. Scheduling is of course a matter for my noble friend the Government Chief Whip, who will indeed keep this under review. The Government have a duty of care to the statute book and, as such, my officials and those in the Ministry of Justice have worked with my noble and learned friend Lord Falconer and the Commons sponsor Kim Leadbeater MP to offer drafting support and workability advice. This will continue throughout the passage of the Bill and is and has been usual practice.

Turning to the Motions in the name of my noble friend Lady Berger—

[Lord Forsyth of Drumlean (Con)]

Can the Minister explain why, despite requests from the sponsors of the Bill, and despite the precedent which has been taken with other Bills which were Private Members’ Bills but matters of conscience, such as capital punishment and abortion, the Government are not prepared to provide time so that this House can ensure that it is properly scrutinised and considered?

[Baroness Merron (Lab)]

I can only repeat the point I made that the Government Chief Whip will listen to the will of Parliament and will review as necessary.

The Motion and the amendment in the name of my noble friend Lady Berger refer to a Select Committee reporting to the House ahead of Committee of the Whole House commencing. The Select Committee should report by Friday 7 November. The outcome of these Motions and any others are indeed a matter for this House to decide on.

To the points that noble Lords have raised over whether this matter should have been for a Private Member’s Bill or a government Bill, I remind us all that, on matters of societal change, the Private Member’s Bill, with government neutrality, has long been used as the right vehicle to handle matters of sensitivity and importance such as this one. On this point of neutrality, I hope that noble Lords will understand my role and why it is not appropriate or possible for me as the Government Minister responding to respond to every point raised during the debate.

I thank the Delegated Powers and Regulatory Reform Committee and the Constitution Committee for their scrutiny of the Bill. As many noble Lords have highlighted, their recommendations will be important in the consideration. The content of this Bill and any delegated powers are a matter for the sponsor and Parliament. I am grateful to both committees because their recommendations will inform the scrutiny of your Lordships’ House. Noble Lords heard my noble and learned friend Lord Falconer’s opening remarks. He has already considered those reports and will continue to do so.

Many noble Lords have spoken about the importance of high-quality palliative care for all those who need it. I want to be clear that irrespective of any legislation on assisted dying, everyone must be provided with high-quality compassionate care through to the end of their life. While the majority of palliative and end-of-life care is provided by the NHS, we recognise the vital role played by the voluntary sector in supporting people at the end of their life. That is why we are providing the hospice sector with £100 million of capital funding for eligible adult and children’s hospices, to ensure that the best physical environment for care is available.

We recognise that more could be done to support people who need palliative and end-of-life care, as a number of noble Lords said. We are looking at how to improve the access, quality and sustainability of all-age palliative and end-of-life care, in line with the recently published 10-year health plan, and to make the shift from hospital to community, including making that care part of the work of neighbourhood health teams.

I thank noble Lords once again for their engagement, care and thoughtfulness during this debate. As I have said, the Government remain neutral on whether the Bill becomes law. Should Parliament pass this legislation, I can say to your Lordships’ House that it will be our responsibility to ensure that it can be implemented safely and effectively.

Genome Screening: Newborn Infants

Baroness Merron Excerpts

Thursday 18th September 2025 Lords Chamber

[Baroness Thornton (Lab)]

My Lords, I beg leave on behalf of my noble friend Lord Winston to ask the Question standing in his name on the Order Paper.

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

My Lords, as set out in the 10-year health plan, this Government have an ambition to offer newborn genomic testing as part of routine NHS care, subject to evidence gathered through the Generation Study, which is using whole-genome sequencing to test 100,000 newborns for over 200 rare conditions. With advice from the UK National Screening Committee and appropriate funding, genomic testing could be available for all newborns in the UK by 2035.

[Baroness Thornton (Lab)]

I thank my noble friend the Minister for that Answer, because this is of course a very serious issue, particularly in the case of babies and minors. There are grave difficulties in obtaining informed consent. Every person may be born with hundreds of genetic mutations potentially associated with fatal diseases, but nearly all are unlikely to cause serious health issues in the vast majority of those carrying such markers. Can my noble friend say what plans the Government have for funding and ensuring properly informed consent in screening programmes? I thank my noble friend Lord Winston for informing my question.

[Baroness Merron (Lab)]

My Lords, the Generation Study is particularly designed to inform policy of the type that my noble friend is rightly concerned with. These are extremely important issues, and I am glad to have spoken to our noble friend Lord Winston about these matters. Perhaps I could give the assurance that the study will test only for treatable conditions, where there is robust evidence that the condition is highly likely to develop within the first five years of life, and suspected positive results are then reviewed and confirmed through further tests. If genomic testing is used within future screening programmes, informed consent will still be required.

[Lord Kakkar (CB)]

My Lords, I draw attention to my interest as chairman of UK Biobank. The value of large-cohort studies is not only in the collection of baseline data, and indeed, in this case, the genome sequences of the 100,000 newborns, but in the opportunity to secure the long-term longitudinal follow-up of participants, so that there is a broader understanding of the change in health and health dynamics.

The Minister mentioned the question of consent with regard to genetic testing, but there is another question of consent, with regard to long-term access to the primary care data of those individuals who have participated in the study. Is the Minister content that there are appropriate arrangements in place with regard to consent to ensure long-term access to primary care data for those individuals?

[Baroness Merron (Lab)]

The noble Lord raises a very good point. Certainly, it is part of how we develop the use of data. I am aware that he did not directly ask me this, but perhaps I might use the opportunity to say that data safety, which I know is a matter of concern to many noble Lords, is absolutely paramount here. We also have absolute regard to conducting studies ethically, but the point about primary care data, its use and its value, as well as its safety, is very well made and one which we are certainly developing still further.

[Lord Jopling (Con)]

My Lords, while the screening of genomes in newborn infants is of course very important, it is even more important to find a cure for some of these dreadful hereditary diseases—I am thinking particularly of Huntington’s chorea. Does the Minister have any information as to what progress is being made, with a prospect some time, before too long, of having a cure for this dreadful disease?

--- Later in debate ---

[Baroness Merron (Lab)]

I am grateful to the noble Lord and will be very pleased to write to him on that specific. Part of this work in the programme we are referring to is on treatable diseases. For example, the Generation Study covers hereditary fructose intolerance, which means that babies would not be able to ingest fructose normally. By identifying it, we can then recommend removing fructose from their daily diet, which is a way of overcoming that condition. So, by spotting the condition early, we can take action. As the noble Lord says, there are indeed a number of areas in which further work needs to be done, but I would be very glad to write to him on the detail.

[Lord Kamall (Con)]

My Lords, while genome screening of newborns is welcome and could be an important part of the prevention agenda, it raises a number of ethical issues. I will focus on just one: at what stage do you tell someone who has a high probability of getting a medical condition, say in their 40s or 50s, about the probability or even certainty of developing that condition, without causing undue distress or even premature treatment? Can the Minister briefly tell noble Lords about the conversations that are going on in the department about these ethical issues, perhaps with the medical profession, and perhaps write in more detail later?

[Baroness Merron (Lab)]

As I mentioned to the noble Lord, Lord Kakkar, the matter of ethics is crucial in this development. It might help if I restated— I absolutely understand the noble Lord’s point—that that is why the Generation Study, which is directed at newborns, is for treatable conditions that may develop in the first five years of life, not later on. I understand why that would be of concern, and similarly of concern to my noble friend Lord Winston, so I hope that assurance will be helpful.

[Lord Mohammed of Tinsley (LD)]

My Lords, I just want to return to the issue of data and consent and build on the question from the noble Lord, Lord Winston, that the noble Baroness, Lady Thornton, talked about. Given that a newborn child cannot really provide consent for whole-genome sequencing and that the information collected has lifetime implications, what specific measures will the Government take to ensure that a child’s future rights to privacy and autonomy are protected, particularly concerning the storage and potential reidentification of their genetic data in research libraries?

[Baroness Merron (Lab)]

There were a number of very helpful points in there. To reconfirm and satisfy your Lordships’ House, this is for conditions that may develop up to the age of five. As with all screening, consent is required. As the noble Lord rightly says, a baby of course cannot consent, but the parents can. Around the age of 16, the plan is also to be able to seek that consent again from the young person. On data storage, it is stored securely in a research library run by Genomics England. Access is tightly controlled, overseen by an independent committee and permitted only within a secure environment. If the noble Lord would like more details, I would be very happy to provide them.

[The Lord Bishop of Chelmsford]

When will the House have the opportunity to debate this policy for whole-genome sequencing with all its details, given that it has such weighty and far-reaching implications for healthcare, prevention and a number of ethical issues, as we have already heard?

[Baroness Merron (Lab)]

A debate in this House will be a matter for my noble friend the Chief Whip. Members of your Lordships’ House may seek to encourage such a debate, which I would certainly welcome. I can say to the right reverend Prelate that the sequencing of 100,000 newborns through the Generation Study will be completed by summer 2027. The evaluation part of the study will then be completed and presented to the UK National Screening Committee, which will make a recommendation. Subject to all of this and appropriate funding, genomic testing could be available for all newborns by 2035— so there is a long window of opportunity for the right reverend Prelate.

National Health Service Regulations

Baroness Merron Excerpts

Tuesday 16th September 2025 Lords Chamber

[Lord Pack]

To ask His Majesty’s Government what assessment they have made of the effectiveness of the National Health Service (General Medical Services Contracts) Regulations 2015, as amended by the National Health Service (General Medical Services Contracts and Personal Medical Services Agreements) (Amendment) Regulations 2025.

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

My Lords, implementation of the 2025-26 GP contract changes is still under way. GP practices have recently been issued contract variations, but the changes have not yet taken full effect. The changes, agreed with the British Medical Association for the first time in four years, will improve access for patients and enable local health systems to hire more staff. The Government will closely monitor the impact once the changes are fully implemented in the coming weeks.

[Lord Pack (LD)]

My Lords, my concern is about the degree to which GP contracts are dictated by extremely prescriptive legislation. The recent change to keep GPs’ computers switched on overnight—rightly, to improve data sharing—is a striking example. It did not require just negotiation with GPs or advice from security and privacy experts, as it of course should: it also required Parliament to legislate to change the contract details. Does the Minister not agree that embedding this level of micromanagement in legislation not only is unhelpful but actively stifles innovation in the NHS?

[Baroness Merron (Lab)]

That is an interesting assessment of where we are; it is not one that I was about to speak of, but I hear what the noble Lord says. Let me say that, in implementing contract changes, it is absolutely usual—and, in my opinion, correct—that regulations are important and are consulted on. There is a whole list of things here around transparency. There was consultation with the BMA’s General Practitioners Committee, as well as the laying of the regulations and bringing them into force. This is all quite the usual practice—and actually, I think, good practice. I appreciate that GPs are very much the front door to our NHS and it is absolutely important that we make these changes in order to assist them and their patients.

[Baroness McIntosh of Pickering (Con)]

My Lords, I remind the House of my interest with the Dispensing Doctors’ Association. What assessment have the Government, in particular the Minister, made of the way in which the GP contract will impact on rural doctors—not least the Dispensing Doctors’ Association, which cannot even access the EPS system at the moment, which is obviously disadvantaging its patients?

[Baroness Merron (Lab)]

The expectation is that all GPs, including those in rural areas, will benefit greatly. The premise of the 10-year plan, which was announced recently, is to improve patient access. That is a particular issue in rural areas and is absolutely key, no matter where you are—whether you are appearing in person, are seeking to get online access to your GP or are on the phone. Remember, this is all about, for example, ending the 8 am scramble. Noble Lords have been very critical and I share in their criticism. I think that, particularly in rural areas, where people face various challenges in getting around, these changes will improve things massively for both GPs and patients.

[Lord Harris of Haringey (Lab)]

My Lords, my noble friend has described these changes in terms of the benefits for patients. How will the Government know whether they are of benefit to patients, given the decision to wind up HealthWatch, which itself was less than adequate in terms of patient representation compared with Community Health Councils, an organisation I knew well many years ago? Surely, that is a negative step and there should be a mechanism for local consultation and local engagement with patients through an independent body.

[Baroness Merron (Lab)]

I appreciate what my noble friend says about HealthWatch, which has done a sterling job over the years. However, in assessing where we are in ensuring that we have the right framework in place, including on patient safety—Dr Penny Dash recently published her report saying that the landscape was “cluttered” and it was difficult to hear the patient voice—it is right that we make the changes that we do to improve things. The reform to the GP contract very much assists general practice to be at the heart of a neighbourhood health service, and that is where we are going.

[Lord Sahota (Lab)]

My Lords, when the new Government came in, I heard that they were planning walk-in clinics. How is that progressing?

[Baroness Merron (Lab)]

In terms of development, as my noble friend will know, the 10-year health plan speaks very clearly of a “neighbourhood health service”, which people will find it easier to access. It will be up to local areas how they do that. In a number of areas, as my noble friend refers to, that will mean clinics where all services are under one roof. We would certainly encourage that. I can also give an example of a pilot scheme taking place now with mental health crisis centres. They are 24/7, all year round, and are available without referral for people who need mental health support, as well as advice and guidance: they can access those.

[Lord Kamall (Con)]

My Lords, as the Minister will know, the 2025 amendments to the regulations made several key changes, one of which was to keep online consultation talks open during surgery hours. While these Benches welcome the shift from analogue to digital, we understand that the National Pensioners Convention estimates that between 500,000 and 700,000 older people would not be able to access either the online consultation tool or patient records, either because they are not online or because they struggle to navigate apps and websites. Can the Minister update the House about what her department is doing to work with GPs and, in fact, the whole system of health and care, to make sure that that small minority of people who are not digitally literate, including older people, are not locked out of receiving health and social care?

[Baroness Merron (Lab)]

The noble Lord makes an important point. There is absolutely no intention that people will be disadvantaged in any way. This is about equalising access, which means keeping all forms of access open. That may be online, but it will also be possible to deal with things in person and on the phone. Obviously, if we can take pressure off phone access, or personal access, through the use of online, that will assist the group to which the noble Lord referred.

[Lord Hunt of Kings Heath (Lab)]

My Lords, my noble friend referred to Community Health Councils. I was one of the first CHC secretaries to be appointed in 1974.

[Lord Hunt of Kings Heath (Lab)]

Wait for it, my Lords—I was also the Minister who got its abolition through your Lordships’ House. Mea culpa; I was mistaken. We should bring it back.

[Baroness Merron (Lab)]

My noble friend does himself credit with his honesty, which I too will take example from .

[Lord Kirkhope of Harrogate (Con)]

My Lords, there are concerns about the use of physician associates in many general practices. They are not of course doctors but are now on the front line of giving advice and assistance. Is the Minister satisfied about the way in which these people are deployed? Is she happy that the security of patients is completely safe with the use of these people?

[Baroness Merron (Lab)]

Physician associates often work in hospitals and are there to develop the availability of care. The noble Lord is right to say that there are concerns around physician associates. That is why my right honourable friend the Secretary of State for Health and Social Care announced an independent review to work out where there are problems and what we need to do to make sure that there is no confusion among patients about who is treating them, and also that patient safety standards are upheld.

[Baroness Pitkeathley (Lab)]

My Lords, does my noble friend agree that, from the patient’s point of view, the team around the GP is as important as the GP? As yet, we have no way of applying the regulations to teams. Does she think that this ought to be pursued, in the interests of the patient?

[Baroness Merron (Lab)]

I agree with my noble friend. In the contract changes, we have removed caps on the number of staff recruited. Importantly, we also expanded reimbursable roles to include practice nurses, to do the very thing that my noble friend asked about, which is to increase workforce capacity.