Cardiovascular Illnesses

Baroness Merron Excerpts

Thursday 12th June 2025 Grand Committee

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

My Lords, I associate myself with the congratulations to the noble Lord, Lord Booth, on securing such an important debate. I am very grateful to him for doing that on the back of his personal experience. It shines a light and, while I realise that it is difficult, what he has done is worthwhile. Many of us will be affected by cardiovascular disease, either directly or indirectly, which is why we heard the noble Lord’s message so clearly.

As we have all said, too many lives are cut short by CVD. In 2023, an estimated 6.4 million people were living with cardiovascular conditions and almost a third of CVD-related deaths in England occurred among the under-75s, which gives us the scale of the challenge. Over 1 million people report cardiometabolic conditions as being the main or secondary reason for being out of work due to long-term sickness. This is a challenge on so many levels.

I thank the noble Lords, Lord Kamall and Lord Weir, for understanding that this requires a systematic approach across government, which we seek to have. In seeking to build a health and care system that is fit for the future, we are shifting the focus of our NHS from sickness to prevention. That is supported by the investment and direction of the Chancellor’s spending review of just yesterday. It is also why our health mission sets out an ambition to reduce premature mortality from heart disease and stroke by a quarter within a decade.

It is important to go straight to the points that have been raised. Many noble Lords rightly raised prevention. As they are aware, around 70% of CVD cases are linked to preventable risk factors such as obesity, high blood sugar and smoking, to mention but a few. The noble Lord, Lord Moynihan, talked about the importance of exercise and I certainly share his view on that. I assure him that we work across government on this and I take his point that this is not particular to my department. We work very closely with the DCMS to ensure a joined-up approach.

I remember hearing the noble Lord’s solution some years ago, I think on the Health and Care Bill. We have not committed to it, but the principles behind what he says are absolutely right. For example, we are working on better health resources, which include free evidence-based apps, websites and other digital tools, which will help people make and sustain improvements to their health. To take one example, I know the popularity of Couch to 5K. We will continue this work.

The noble Lord, Lord Rennard, referred to the landmark Tobacco and Vapes Bill that is progressing through your Lordships’ House, which will help deliver our ambition for a smoke-free UK. We need to remember that smoking still claims some 80,000 lives every year. It is a cost not just to individuals and their families and communities but of some £3 billion to the economy, yet this is a preventable cause of death. Noble Lords will have heard in yesterday’s spending review that we are investing at least £80 million per year in tobacco cessation programmes and enforcement to support the Bill.

The noble Lord also referred to obesity. There is a wide range of weight management services, from behavioural support in the community to hospital-based specialist services. This year, we will extend the NHS digital weight management programme to people living with obesity and awaiting knee and hip replacement surgery, which picks up on his point about preparation for treatment where necessary.

The noble Lord, Lord Rennard, expressed disappointment in the Government’s response to the Lords committee report on food and nutrition, which I very much welcomed. I am sorry that he is disappointed, but I have drawn to the attention of his noble friend the noble Baroness, Lady Walmsley, that, just this week, following a recent Question in the Chamber, there was a change in the advice given by the department on the use and appropriateness of prepared baby foods, which she was rightly concerned about.

A number of noble Lords talked about the NHS health check. It supports people to manage their risk through referral to weight management or smoking cessation. It is free and aimed at those aged between 40 and 70. It prevents around 500 heart attacks or strokes a year. It is about identifying early.

I absolutely accept the points made by my noble friend Lady Winterton and the noble Lord, Lord Kamall—I am particularly interested in this matter—about the National Audit Office report and the Health and Social Care Committee’s inquiry on doing more to extend engagement with and take-up of the check. One of the things is a new development that will be piloted from this summer: a new NHS health check online, which people can complete at home. It will be piloted through the improved NHS app and, specifically, we will be independently evaluating the impact on equalities to inform the development and rollout.

We have also engaged community pharmacy by investing heavily in blood pressure checks. Nearly 3 million checks have been delivered in over 9,000 pharmacies in the past year, and we are also embarking on new trials. So we are looking at ways in which we can engage better and, if I may say so, improve the NHS check as well.

The noble Lord, Lord Weir, rightly raised the great potential of AI and technology. I can tell him that a considerable announcement on this was made just this week when I was in Cambridge. We are slashing red tape that currently inhibits innovation while protecting patient safety and encouraging innovation—something for which the industry and many others have been calling for some time. We are also getting the regulatory regime in the right place and investing in research, innovation and being up to date. Some years ago, we could not have dreamed of regulating AI but, now, we are absolutely right to look at how we do that. As the noble Lord said, technology and AI are absolutely key.

I turn to the points on inequalities made by the noble Lords, Lord Weir and Lord Kamall, and my noble friend Lady Winterton. Our approach is called Core20PLUS5 and it is a national approach to support the reduction of healthcare inequalities at both the national and the local system levels. One of the five clinical priorities in that framework is the treatment and management of high blood pressure, which is, of course, a key risk factor for CVD. That is just one of the areas.

Noble Lords, in particular my noble friend Lady Winterton and the noble Lord, Lord Weir, asked whether we would commit to a CVD action plan. We have already set the ambition. We are committed, as noble Lords are aware, to publishing a 10-year health plan in the not-too-distant future and to delivering that shift from sickness to prevention. In all of that, we are considering policies—along with, of course, our workforce plan, which will be published in the summer on the back of the spending review, as well as all that will follow from that. We are carefully considering the policies, including those that have an impact on people with CVD, as we develop the plan.

The noble Lord, Lord Weir, rightly raised that men may be less likely to come forward to seek advice. We are in the consultation phase of developing a men’s health strategy, to which I hope he will contribute, and part of that is about recognising the point that he made. We are determined to close the gender gap in care. We also know that, among people with CVD, women are less likely than men to achieve target cholesterol levels. That has to change, so we will pursue it.

I congratulate the noble Lord, Lord Polak, on his work in this area. I believe he introduced me to Hilary in the House. I heard his request for a meeting, and I will pick that up with the department. While I never like to disappoint him, the position at the moment follows the advice given by the UK National Screening Committee, which concluded that introducing population-level screening for sudden cardiac death in young people would run the risk of causing more harm by misdiagnosing some people and by providing false reassurance to those at risk of sudden cardiac death whose risk may not be picked up by screening tests. However, I am sure we will have the opportunity to pursue this further.

A number of other points were raised, which I will of course review. In closing, I say to the noble Lord, Lord Booth, that I absolutely hear what he said about recognition, diagnosis and issues in aftercare. We will address this through the number of future developments that I referred to and the NHS long-term plan that is already in existence. I hope that he will be less disappointed should he or a loved one have to seek treatment, care or aftercare in the future, and I thank him.

Complications from Abortions (Annual Report) Bill [HL]

Baroness Merron Excerpts

Committee stage
Friday 6th June 2025 Lords Chamber

[Lord Sandhurst (Con)]

My Lords, I thank my noble friend Lord Moylan again for bringing to our attention the issue of the reliability of statistics on the complications of abortion. It is absolutely right that, in all healthcare, we have correct and accurate data that health service providers can use to understand the safety of procedures.

It is the usual practice for Committee to include discussion of the amendments that have been tabled to the Bill, but here, of course, there is only the proposition that the only substantive clause should not stand part. This, therefore, has necessitated a general discussion of the underlying principles behind the Bill in a restatement on this side of the Chamber of our positions.

At Second Reading, I said that our view was that the Bill performs “an important service” by highlighting

“the absence of accurate, comprehensive statistics in respect of abortions”,—[Official Report, 13/12/24; col. 1990.]

but I explained in the same speech that improved data collection and reporting does not require legislation for it to be delivered. In short, I do not depart from that view, but this Bill has allowed an informed debate to emerge about data in this field. It presents an opportunity to urge the Government to do more to rationalise data recording and collection, so that proper evidence-based medicine can be implemented. In this respect, I endorse what my noble friend Lady Finn said about data collection and statistics more generally.

In answer to a Written Question asked by my noble friend, the director-general of the Office for Statistics Regulation stated that that office—the OSR—had not completed a compliance check on the abortion statistics collected by the Office for Health Improvement and Disparities since as long ago as 2012. That raises important issues of data quality. I am glad to note that it has now been agreed that the OSR will carry out a long-overdue compliance check on those statistics, but only after the Department of Health and Social Care has been able to update the design of the abortion notification system. This seems, to me and to others on this side, the wrong way round. Surely it would make more sense to complete these compliance checks before making alterations to the ANS. That way, the department will be able better to understand any deficiencies in the system—and we know there are some. I hope the Minister will be able to comment on this and address it.

Overall, my noble friend has raised an important concern. I suggest that the Government must now take steps to ensure that the data are gathered on a more reliable and consistent basis.

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

My Lords, I thank the noble Lord, Lord Moylan, for tabling this Private Member’s Bill and my noble friend Lady Thornton for tabling an amendment. I very much appreciate the contributions made by a number of noble Lords.

The stated main purpose of the Bill is to impose a legal duty on the Secretary of State to

“publish and lay before Parliament an annual report on complications from the termination of pregnancy in England under the Abortion Act 1967”.

The purpose of such an annual report, as I understand it, would be

“to inform policy and safe practice regarding the termination of pregnancy”.

I know that noble Lords appreciate that this Government are entirely committed to the priority of patient safety.

--- Later in debate ---

[Lord Moylan (Con)]

For clarification, is the Minister saying that the digitising and adapting of the abortion notification system that her department plans to carry out will be done in collaboration with the Office for Statistics Regulation? Or is the intention that the department does the work in its own box, so to speak, and then the Office for Statistics Regulation comes in and checks it? She seemed to hint that, for the first time, it might be the former, which would be quite encouraging.

[Baroness Merron (Lab)]

As I said, we are developing work with the OSR. As with all ways of developing work, that means working in a way that will get us to the place we wish to get to. I do not quite recognise the latter way forward that the noble Lord referred to, but I will be happy to write him further on this matter.

I can assure the noble Baroness, Lady Finn, that our focus in the women’s health strategy is on turning those commitments into action. I draw the noble Baroness’s attention to the provision of free of charge emergency hormonal contraception at pharmacies from October this year. We are also setting out how we will eliminate cervical cancer by 2040 through the new cervical cancer plan, we are and taking urgent action to tackle gynaecology waiting lists through the elective reform plan. Those are all tangible improvements to women’s health. I assure the noble Baroness that the women’s health strategy is very much kept under review to see how and where it can be improved.

The noble Baroness, Lady Finn, asked about the linking of records. It is not currently possible to link the abortion notification system with wider health records data, because of the unique identifiers on the abortion notification system data. However, as I said earlier, we are reviewing the wording of the form so that it will be easier for clinicians to complete, which will, I hope, bring about some improvements.

I say to the noble Baroness, Lady Freeman, that the Government are focused on moving the NHS from analogue to digital across all areas of healthcare, in order to provide the improved data collection that many noble Lords have called for during the debate.

The noble Baroness, Lady Bennett, called on the Government seriously to consider the implications of money flowing in from the USA with a view to obtaining influence—a point also referred to by the noble Baronesses, Lady Brinton and Lady Barker. I can confirm that this matter is being considered more widely across government.

As noble Lords may remember, the Government have expressed reservations about the Bill as legislation is not required to produce an annual report. We believe that the aims of the Bill can be achieved through existing routes, thereby rendering further legislation unnecessary. In 2023, the department published a report on abortion complications and could choose to do so again. However, it has no plans to publish ongoing separate additional annual reports on abortion complications as there is no operational need to do so. I hope noble Lords will understand—some have made this point—that we have to uphold a duty of care not to legislate when other reasonable processes are available, as there are in this case.

Clause 1 agreed.

Preterm Birth Committee Report

Baroness Merron Excerpts

Friday 6th June 2025 Lords Chamber

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

My Lords, I am sure I speak for all of us when I say that it feels somewhat overwhelming at the end of a debate such as this, not least because noble Lords have been very generous and open about their personal experiences and those of their friends and families, and I am grateful to all noble Lords for being willing to do that. Of course, I join in all the thanks to the noble Lord, Lord Patel, not just for his expert chairing of the committee, which has given us the quality of report that we have got, but for his introduction today. My thanks are also due to all members of the committee; I am sure they are proud of the report.

I heard that this is a report that should not sit on a shelf, and I quite agree. It has shone a light on many of the challenges. As the noble Earl, Lord Effingham, said, no one action on its own will make a difference. Having given evidence to the committee, read the report and overseen the response of the Government, I feel that that the more we look into this, the greater the complexity we find.

We have sought to take each item as best we can. Is there more to do? Completely. Do we start in a difficult place? Yes, we do. So I am grateful for the report. I also associate myself with the thanks that were given to all those who provided evidence. I am sure it will have been an extremely affecting experience to hear from parents and others who have been affected in this way. What the report is about, and what I wish to be about, is protecting the most vulnerable—the babies, the women and their families—and I know that everybody has come from that place today.

I say to the noble Baroness, Lady Wyld, that, as she knows, I welcome the challenge that she and the committee make to the Government, and I will seek to be as helpful as possible today. I know I will not be able to provide every answer, but it is right that the questions are answered. If there are particular areas that I do not get to address, I will of course pick them up afterwards.

I say to the noble Baroness, Lady Brinton, who I know was deeply affected by the words she shared, that she affected us all. I am sure it was hard for her, but the noble Baroness brought into the Room exactly why we are here.

What is the scale of the problem before us? In 2023, the year for which we have the most recent figures, there were almost 4,600 preterm births. That is just over 8% of all births, a very considerable amount. I share the view that rapid improvements are needed to improve not only outcomes but the experience of women and their babies.

We have heard today about the many risks that contribute to preterm birth, which include pre-existing health conditions such as high blood pressure and diabetes, multiple pregnancy, factors such as smoking and obesity, maternal age, and assisted reproductive technology such as IVF. We also know that preterm birth is more prevalent for women from black and Asian groups and for those women living in the most deprived areas, and that situation cannot be allowed to continue.

The impact of being born pre term is significant, as we have heard. Not least, preterm babies are more likely to die in their first 28 days or their first year of life, and in fact the number of child deaths from prematurity rose between 2019 and 2023. We know the scale of the challenge before us. Preterm birth increases the risk of chronic conditions, and babies born pre term require more hospital-based care in infancy and childhood. I was interested to hear put on record by noble Lords, including by my noble friend Lady Goudie, that preterm birth can place significant emotional, financial and logistical stress on families. I welcomed and was glad to support the launch of the Create Health report that shone a light on many of those matters.

This is an important point to make, and it was made to some extent in the debate, but in some cases preterm birth is medically appropriate—this is something I can recall discussing with the committee—because, in that instance, it is safest for mother and baby. One of the difficulties with the target from the previous Government, I felt, was that it did not make that distinction, so it is important that we get any further targets right.

So what actions are under way? My department works with NHS England and across the sector, including with the charities referred to by the noble Earl, Lord Effingham, and I add my thanks to those charities and third-sector organisations. We are working on a range of actions for now and into the future to tackle some of the deeply entrenched issues.

The noble Lord, Lord Patel, and others made positive reference, which I share, to the Saving Babies’ Lives care bundle. This has been co-developed with clinical experts and professional societies, and it draws very much on front-line learning and experience to provide a package of interventions to reduce variations in care, which we know are out there, and to improve neonatal care quality and outcomes. The implementation of the care bundle is one of the conditions required to ensure compliance with safety requirements.

The noble Baroness, Lady Brinton, raised the point that, as of May this year, some 97% of maternity services were fully compliant with the care bundle. That figure has increased by 10% since last year. I assure her that the remaining small percentage is nevertheless significant, and we are following up with them to ensure that they will become fully compliant. The elements of the care bundle address the committee’s recommendation, but we seek to go further.

Noble Lords, including the noble Earl, Lord Effingham, raised the two-year and four-year assessment checks for children who were born pre term. They are extremely important and we are looking at what further actions are needed to ensure that children receive those follow-up assessments, because of their importance.

All 150 maternity and neonatal units in England are taking part in the NHSE perinatal culture and leadership programme. A number of noble Lords, including the noble Lord, Lord Patel, and the noble Baroness, Lady Wyld, were absolutely right to highlight the importance of the maternity and neonatal estate in supporting parents being fully involved in their babies’ care. So I am glad that, just last week, the allocation of some £750 million through the estates safety fund was announced. This is to start tackling—it can only be a first step—the maintenance backlog. The £750 million will support 400 hospitals, mental health units and ambulance sites. I say very specifically that it includes over £100 million for maternity units to enable better care for mothers and their newborns. I know that the noble Baroness, Lady Seccombe, is rightly exercised about this.

I say to the noble Baroness, Lady Wyld, and other noble Lords that I understand the frustration about the time that has been taken for NHS England to publish the findings of the maternity and neonatal estates survey. Noble Lords will not have to wait much longer for that, and I too look forward to seeing it.

A number of interventions rightly centred on the workforce. There are still shortages across the workforce. Overall, the refreshed workforce plan, which will be published in the next few months—in answer to the questions—will seek to transform the services over the next decade to ensure better care for patients.

My noble friend Lady Blackstone asked what is happening to understand obstetrics staffing and managing the workforce more broadly. As I say, that will be covered by the workforce plan. However, it is the responsibility of trusts to ensure that they have the right staff in place.

On the workforce, the noble Baroness, Lady Wyld, asked about professional development, and other noble Lords, including the noble Baroness, Lady Sugg, asked about the inclusion of midwifery. I completely agree that it is crucial that staff have the training they need to make sure that they have the right knowledge to provide the right care. The new workforce plan will follow the 10-year health plan and the spending review. Noble Lords will understand that I cannot pre-empt exactly what it will say, but I can say that it will look at the wide range of issues that face the workforce, and that will of course include midwives. Colleagues across NHSE and the department remain committed to delivering on this in respect of the workforce, and I will be very much focused on having the midwifery service that we need.

On the survey, I understand the concerns that were raised about trainee midwives being very worried about their future employment prospects. This was raised by a number of noble Lords, including the noble Baronesses, Lady Bennett, Lady Penn and Lady Sugg, and my noble friend Lady Blackstone. I can share with your Lordships’ House that there is, in some way, a positive position—this is not a way of glossing over the difficulties—in that there are fewer vacancies currently because of improved retention. In fact, the NHS nursing and midwifery workforce has grown in recent years, so we have branches of nursing and midwifery where the new graduate supply is greater than the number of posts available this year. I appreciate the tension, and I assure noble Lords that NHS England is working with educators, employers and regional teams to support newly qualified nurses and midwives in securing employment. This includes developing resources to support learners through the recruitment process and identifying suitable opportunities and support.

The noble Baroness, Lady Penn, asked about NHS England’s abolition and where responsibility will lie. The specifics are being worked through, but the central team leading the change will ensure that nothing is lost in terms of what we need to do. The service that we are concerned about here—provision—will remain a priority. The abolition of NHSE will remove duplication, and I therefore expect to see improvements in this area.

The noble Baroness, Lady Seccombe, made an important point about nurses training to be midwives. I am grateful that the noble Baroness spoke to me about this separately. I agree that nurses who train to become midwives bring a whole wealth of experience, and NHSE offers funding to support this shift. However, I recognise that we may need to go further in order to support nurses to remain on the relevant courses and to take up posts in maternity units. So the funding offer for this will be reviewed later this year.

The noble Lord, Lord Patel, spoke about the importance of community services and health visiting services. Through our plan for change, we will ensure that children and their families are cared for by the right professional. We will strengthen health visitor services.

The noble Baroness, Lady Bertin, spoke very sensitively about mental health issues, as well as a number of other points. Specialist perinatal mental health services are now available in all 42 integrated care systems, and very important they are indeed.

I agree with noble Lords, including the noble Lords, Lord Weir and Lord Patel, on the importance of a woman’s health before pregnancy. More work is required to improve awareness of pre-conception health and pregnancy, taking into account—this is another key point—that many pregnancies are not planned. That is why the point about early education and support is so crucial. The 10-year plan, which we will see shortly, will set out how we will tackle the inequities that lead to poor health.

Research was raised by my noble friend Lord Winston, the noble Baronesses, Lady Owen and Lady Bertin, and the noble Lord, Lord Weir. Since the committee hearing in September 2024, the NIHR has commissioned three new research awards, including research to investigate the prevention of preterm birth as well as interventions to improve health outcomes for preterm babies. Over the last five financial years, research programmes invested in 77 research awards focusing on preterm birth. Again, across their full duration, that was a total of £93 million of funding—and, yes, I totally agree about the importance of research. I will write to my noble friend Lord Winston, following up on his point urging the Government to use opportunities that the biobank presents.

On the important matter of miscarriage, I share the view that my noble friend Lord Winston and other noble Lords set out. We are taking steps to improve data on miscarriage and fill the very considerable current gaps. There is a new digital standard which will record new information on previous miscarriage and baby loss. I am looking at how effectively that is being applied, and I am also looking forward to the review of the Tommy’s graded model of care in respect of miscarriage, so I very much take the points on board.

A number of further actions are being taken to improve maternity safety, including the maternity outcomes signal system, the maternity safety support programme and the avoiding brain injury in childbirth programme. I am pleased to say that all local areas have published equity and equality action plans, which set out tailored interventions for those from ethnic minority backgrounds and those living in the most deprived areas. This will be another important focus for the 10-year plan. Fourteen maternal medicine networks have been set up across England, made up of 17 specialist medical care centres, and high-quality neonatal care is being networked together across England. We are investing £45 million in increasing neonatal cot capacity and assigning care co-ordinators. We are taking further actions to tackle obesity and smoking—and again, that will be referred to in the 10-year plan.

I say to noble Lords, in closing, that there was much richness in the committee report and in today’s debate, for which I am entirely grateful. I look forward to using what has been written, what has been said and further discussions, so that we can provide the service that we all want to see.

Primary and Community Care

Baroness Merron Excerpts

Thursday 5th June 2025 Lords Chamber

[Lord Hacking]

To ask His Majesty’s Government what steps they are taking to support primary and community care settings to integrate in vitro point of care diagnostics.

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

My Lords, we recognise the value of point-of-care diagnostics in enabling earlier detection, reducing avoidable hospital admissions and supporting more personalised care. As part of our 10-year plan, we will ensure that more tests, including in vitro point-of-care diagnostics, take place in the community, which will be closer to people’s homes. Use of in vitro point-of-care testing is encouraged where clinically appropriate, including in community diagnostic centres, and is supported by the development of 27 pathology networks.

[Lord Hacking (Lab)]

I thank my noble friend the Minister for her very positive reply, but I will take it a little further. Do the Government appreciate the enormous potential benefit of in vitro diagnosis for the National Health Service and patients? On the latter, patients would be able to go to their local pharmacy, away from the queues in their GP surgery or local A&E department, and be diagnosed and treated in a matter of minutes. My second question is: what government funding support will be given to pharmacies having to buy the diagnostic machines or boxes, which cost about £2,000 each, and to support the necessary training for pharmacy staff?

[Baroness Merron (Lab)]

This is a good news story, and I certainly share my noble friend’s view of the benefits that he outlined. Community diagnostic centres are now delivering additional tests and checks in 169 sites across the country. They have delivered almost 4.5 million tests, checks and scans since last July, and we have committed to expanding the number of existing CDCs and their opening times. In England, Pharmacy First clinical pathways have been developed closely with various experts, including pharmacists. The funding for the core community pharmacy contractual framework has been increased to over £3 billion, representing the largest uplift in funding of any part of the NHS. We are grateful for the role that pharmacies play.

[Lord McColl of Dulwich (Con)]

My Lords, does the Minister agree that, when we discuss in vitro testing, we should also talk about in vivo testing? That involves taking a history and doing a thorough physical examination of the patient on the spot, but it seems to be going out of fashion. I will illustrate that with the story of a member of staff who had consulted me. He had been investigated at the “St. Elsewhere” hospital for six months, but they had missed the fact that he had ruptured his Achilles tendon. I did an in vivo spot diagnosis. I put my index finger down his Achilles tendon—with his permission, of course—and I could feel the gap in his Achilles tendon where it had ruptured. They had not examined him. Is it not time that we did this inexpensive business of taking a history and doing a thorough physical examination?

[Baroness Merron (Lab)]

I am very glad that the noble Lord asked for permission. I take his point. I know that he understands the value of in vitro point-of-care testing, but he makes the good point that what matters is what is clinically appropriate in the circumstance. We would all expect that to happen for the benefit of the patient.

[Lord Scriven (LD)]

My Lords, I will follow on from the Minister’s Answer. While being supportive of the general trend, what metrics and measures have the Government put in place to ensure that those tests indeed create positive patient outcomes and healthcare efficiency to help future induction of the tests in the NHS?

[Baroness Merron (Lab)]

We will ensure, through our 10-year health plan, that the additional tests, including in vitro point-of-care diagnostics, are taking place in the community. I look forward to being able to provide more information to the noble Lord.

[Lord Kamall (Con)]

My Lords, we on these Benches welcome the Government’s stated commitment to innovation in primary care and the commitment to continue the rollout of community diagnostic centres, which were started by the previous Government. However, unfortunately, last year the Patients Association highlighted barriers to the rollout of point-of-care diagnostics, particularly in rural areas. Is the Minister aware of those concerns, and what plans does the department have to tackle those barriers?

[Baroness Merron (Lab)]

Our commitment to moving towards a neighbourhood health service obviously allows for attention to be given to different circumstances, including in rural areas. It will mean that more care can be delivered locally and that problems can be spotted earlier, including any problems with rollout. We will shortly provide details of a national neighbourhood health implementation programme. We liaise with various groups, including the Patients Association, and I am grateful for their input and for flagging up any difficulties, which we absolutely seek to resolve.

[Lord Patel (CB)]

My Lords, while I accept that in vitro diagnosis at the point of care has great benefits, it is important to address the challenges that we will need to face. They include quality control and the standardisation of equipment used, as well as making sure that the appropriate people are trained, that assessments are made of the results obtained and that proper, good outcomes are delivered. Who will be in charge of delivering this, at the integrated care board level and the national level, to make sure that it is effective?

[Baroness Merron (Lab)]

The noble Lord is right that it is one thing to provide a service; it is another—and so important—to make sure that it is provided appropriately and accurately. ICBs will have their own arrangements. Within that, NHS England is currently responsible for ensuring that this takes place. We will ensure that there are regular updates. If any noble Lord is aware of particular difficulties, I would be very pleased to hear about them; for example, if there is a problem with quality control.

[Lord O’Neill of Gatley (CB)]

My Lords, does the Minister agree that even deeper and wider embedding of diagnostics across the NHS, including more in community pharmacists and GP surgeries, would help in the fight against not only antimicrobial resistance but other infectious diseases? In addition, it would stimulate the venture capital business in diagnostics. All these factors together have the potential to boost NHS productivity dramatically, and would therefore help to boost the country’s growth trend.

[Baroness Merron (Lab)]

I certainly agree with the very strong points that the noble Lord has made. This is obviously a health improvement policy for patients and to support the NHS, but it is also about developing growth and the opportunity for new ways of doing things. We welcome and support innovation.

[Lord Markham (Con)]

Building on a point made by the noble Lord, Lord Hacking, and others, there are many examples where the ideal place to do a diagnostic test is in a primary care setting. Urinary tract infections are a typical example of that, because you can solve it quickly in that setting, avoiding future hospital visits and much pain and suffering. However, that means taking budgets away from secondary care settings and giving them to primary care GPs, pharmacists, et cetera. Are the Government prepared to do that to see these benefits arise?

[Baroness Merron (Lab)]

We are constantly reviewing how best to support where we need to go. In this case, it is about getting tests done closer to home. The noble Lord is right that, for a number of people, the GP practice is a good place to do that, but not in all cases. What matters is doing what is appropriate. We announced an £889 million uplift for general practice in 2025-26, which is the largest uplift to GP funding since the beginning of the five-year framework in 2019, and we have also agreed a new GP contract. The noble Lord will be aware that we recently announced over £1 million to help the quality of the primary care estate, to ensure that we can provide some 11 million further appointments this year. While I accept that this issue is about configuration, I assure the noble Lord of our support for GPs.

Creon

Baroness Merron Excerpts

Thursday 5th June 2025 Lords Chamber

[Baroness Ritchie of Downpatrick]

To ask His Majesty’s Government what steps they are taking to address the shortage of Creon, a cancer medication, reported by the National Pharmacy Association, and what steps they plan to take to prevent similar shortages in future.

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

My Lords, while some supply constraints remain, predominantly with the higher-strength product, Creon stock is regularly being delivered to pharmacies. Alternative products and unlicensed imports are also available. Guidance has been issued to the NHS on prescribing available alternatives and utilising serious shortage protocols to limit quantities dispensed, with actions for integrated care boards to ensure that patients are not left without Creon or an alternative. We continue to work on the long-term supply resilience of Creon.

[Baroness Ritchie of Downpatrick (Lab)]

My Lords, I thank my noble friend the Minister for that Answer, but there are some suggestions that pharmacies are struggling to obtain this important medication, which addresses pancreatic enzyme therapy. Given the struggles that pharmacies are facing, could my noble friend the Minister therefore outline what consideration has been given by the Government to provide a national plan to address shortages and to support patients with alternative care? What approval would be given to highly trained pharmacists to use their professional judgment to supply alternative medicines, where that is medically safe and appropriate, in the event of the prescribed version being unavailable to ensure that patients can enjoy longer, healthier lives?

[Baroness Merron (Lab)]

I can say to my noble friend that serious shortage protocols are a tool that we have and use to manage and mitigate medicine and medical devices shortages. They enable community pharmacists to supply a specified medicine or device in accordance with a protocol rather than a prescription, with the patient’s consent, without needing to seek authorisation from the prescriber. They are used in cases of serious shortage, and we develop those protocols with input from expert clinicians. In addition, we are currently examining options around pharmacists’ flexibilities, including how any risks could be managed, and further details will be set out on this. I hope this gives some reassurance to my noble friend.

[Lord Kamall (Con)]

My Lords, we know that these unexpected shortages occur from time to time, and that this obviously causes patients to worry. As the Minister said, I understand the advice is that alternative therapies are available but may not be sufficient for all patients. Given this, can the Government reassure patients that they are confident that those who cannot turn to alternative therapies will be able to get the appropriate doses of Creon that they require? Also, do the Government have any idea, or have they been given any indication, of when they expect this particular shortage to end?

[Baroness Merron (Lab)]

The supply situation has improved since last year and there is now sufficient stock of lower-strength Creon to meet normal demand. There are still some supply constraints, as I have said, with the higher-strength product stock, but stock is regularly being delivered to pharmacies. As we have discussed, alternative products and unlicensed imports are also available. I totally accept that patients may have concerns, and that is why we have worked closely to keep in communication with patients to assure them that they will not be going without the medication they need. For example, it may be that lower strength in multiple provision can be made, or there are the alternatives that I have described. If any noble Lords are aware of real-life examples of shortages, I would be grateful to hear about them, because we believe that we have made the arrangements, and I can reassure noble Lords that these very important medicines are being provided to those who need them.

[Lord Scriven (LD)]

My Lords, I suggest that the Minister ask her officials immediately to speak to the National Pharmacy Association, which published a survey at the end of last month that said that 96% of community pharmacies were finding problems with getting stocks of Creon and 89% of community pharmacies were having problems with alternatives. In light of that and the bigger picture, what actions are the Government taking to establish new suppliers and manufacturers of enzyme replacement therapy to reduce reliance on a limited number of manufacturers?

--- Later in debate ---

[Baroness Merron (Lab)]

The noble Lord makes a very good point, because the reality is that there are very limited manufacturers of pancreatic enzyme replacement therapy—which applies to a number of people, not just those who have pancreatic cancer—so I do understand that point. It is the case that several non-UK suppliers have expressed an interest in bringing their products to the UK, and they are currently under review with the MHRA. Of course, I hope noble Lords are aware that this Government prioritise UK life sciences, and that is absolutely key. We have established incentives to encourage manufacture, including up to £520 million to support businesses that invest in life-science manufacturing products.

[Lord Spellar (Lab)]

My Lords, may I put it to my noble friend the Minister that there is also an underlying problem, which was also revealed during COVID, that too often the end-use manufacturers are highly dependent on a supply chain that is often in countries that are either unreliable or, indeed, even hostile? These may seem to be basic supplies, but in fact they are enormously important for the final product. Should not the Government in this area, and indeed in others, be looking at this more seriously?

[Baroness Merron (Lab)]

I believe that we are looking at this very seriously. Of course, medicine supply chains are complex, global and highly regulated, so there are a number of reasons why supply can be disrupted and a number of reasons why supply might not be specifically as we would like. Unfortunately, some of those are out of government control. To be honest, we cannot prevent all medicine shortages, but we can take as many steps as possible. I can assure my noble friend that the whole point about increasing resilience of the UK medicine supply chain remains a key priority. We work with industry, we work with the regulator and we will improve the position of the UK as a destination for life sciences and manufacturing in this regard.

[Baroness Bennett of Manor Castle (GP)]

My Lords, the Minister referred to Creon being needed for a number of conditions. In Sheffield, when I was visiting POLARIS, the pulmonary lung and respiratory imaging centre, I met a mother of a cystic fibrosis patient—a young child, quite a small child—and that mother was suffering significant distress at having to spend time chasing around Sheffield to try to lay hands on Creon. The Minister just said that this is out of government control. Does she agree that this is a case where relying on markets to supply essential drugs is not working and that there needs to be more government control in the supply chain?

[Baroness Merron (Lab)]

The noble Baroness puts forward an interesting perspective. There will always be a number of matters that are outside any Government’s control. What is in the Government’s control is what action we can take. In terms of alternatives to Creon, for example, supplies of Nutrizym have more than doubled since last year, and Essential Pharma has also secured additional manufacturing capacity for Pancrex. In May last year, pancreatin preparations—the active ingredient in the medicine we are talking about—were added to the list of medicines that cannot be exported from the UK or hoarded in order to reserve supplies. These actions, along with some of the ones that I have just mentioned and more, all show a very active government position.

[Lord Kamall (Con)]

My Lords, since we have a bit of time, perhaps I may be allowed a supplementary. Given that part of the answer is to import unlicensed medicines, what quality-control procedures are there in place to ensure that people can be reassured that these unlicensed medicines are suitable and fit for patients?

[Baroness Merron (Lab)]

It would not be possible to prescribe them if they were not fit and safe for use. I am grateful to the noble Lord for allowing me to make that reassurance. There is very clear information on ordering and prescribing unlicensed imports on the NHS Specialist Pharmacy Service website, should the noble Lord or any other person wish to be reassured of what that means.

Young Children: Convenience Foods

Baroness Merron Excerpts

Wednesday 4th June 2025 Lords Chamber

[Baroness Walmsley]

To ask His Majesty’s Government what steps they are taking to address the nutritional content, labelling and promotion of convenience foods aimed at very young children, including fruit pouches and snacks.

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

My Lords, good nutrition is essential to our goal of raising the healthiest generation of children. Foods for infants and young children have to meet regulations on nutrition, composition and labelling standards. More widely, we are committed to tackling the child obesity crisis and government actions, including the junk food advertising ban, demonstrate the scale of our ambition in this area.

[Baroness Walmsley (LD)]

My Lords, I echo the comment of the noble Lord, Lord Kirkhope, “Oh dear”, because this issue is not new. In 2019, Public Health England drew attention to the fact that these products contain free sugars, they are not advised by the Scientific Advisory Committee on Nutrition for these young children and they are very misleadingly labelled. Every time the Government respond to this, they do what the Minister has just done and say that there are very good regulations about nutritional content and regulation. But does the Minister agree that regulations are only as good as their enforcement, and these are not being enforced? So, when the Government have their many conversations with the food industry, will they please get a grip and stop these companies producing products that are making our children obese, with rotting teeth?

[Baroness Merron (Lab)]

I hope the noble Baroness will be pleased to know that I recognise the view she states. I realise that this has gone on for some time and I am grateful for her work in this area, including through chairing the Lords committee that produced a very helpful report. I recognise that the current situation is not good enough.

On the matter of food regulations and enforcement, it is the responsibility of local authorities in England to enforce legislation where breaches are suspected. Local authorities will liaise with businesses to clarify and, if necessary, agree the action to put it right. It is indeed the responsibility of individual businesses to ensure that they comply with the law, and I assure the noble Baroness that that is a matter we will continue to press, as well as keeping those food regulations under review.

[Lord Farmer (Con)]

My Lords, even natural and additive-free food pouches are processed by heating and blending for shelf life and a texture suitable for babies. Cooking from scratch is increasingly rare, but particularly important when incomes are low. This basic but valuable skill should be included in all Start for Life infant feeding programmes, as baby food, home-blended from nutritious, pre-spiced, pre-salted adult food is of little cost to families. I ask the Minister: are family hubs being encouraged to help parents learn how to cook?

[Baroness Merron (Lab)]

I definitely understand where the noble Lord is coming from and also share the view about where he wishes to get to on this. Cooking lessons have not been specifically included in the programme, as I believe he may be aware, but the Start for Life website and email programme has advice for parents and carers, including healthy recipes and videos on weaning babies and feeding toddlers, and that has recently been updated.

I hope the noble Lord will welcome the fact that the family hubs and the Start for Life programme are central to the Government’s ambition to raise the healthiest generation of children. That is why we are investing approximately £57 million this year, including £18.5 million for infant feeding support.

[Baroness Boycott (CB)]

My Lords, one area that goes under the radar is sponsorship of big sports events. The Olympics has Coca Cola and McDonald’s; many other Olympic sports have things such as Monster. In particular, rugby has Red Bull. The recommended daily allowance of sugar for a child is a maximum of 24 grams. A single can of Red Bull contains not only coffee but 27 grams of sugar. It is completely anti-health, yet we allow these adverts to be all over our televisions. Some 25 years ago, the noble Baroness’s Government took the brave decision to take all cigarettes off any sporting activity. Will this Government think about doing the same for soft drinks that actually make children ill, not healthy?

[Baroness Merron (Lab)]

As the noble Baroness is aware, we continue to support the levy on sugar in drinks. That has actually had success, not least with reformulation. On the point about advertising to which the noble Baroness referred, as I have said, we are committed to bringing in the advertising ban, which will be in place in January. Indeed, industry—TV and online advertising—has already agreed to implement what will be in the regulations earlier than that.

Marketing sponsorship is a much broader point, but again it is one we take very seriously and continue to keep our eye on. I cannot give the noble Baroness the reassurance she seeks today, but I can assure her how seriously we take the impact of advertising and branding and who it is aimed at, particularly where we seek to support better health for infants and young people.

[Lord Brooke of Alverthorpe (Lab)]

My Lords, I welcome the Government’s review of the so-called “fizzy tax” and the consultation that will end in July. Could the Minister tell me whether this extends to and covers these pouches, which are very heavy in sugar? If not, can a review take place to try to apply the same principles we have applied on the fizzy tax to the pouches?

[Baroness Merron (Lab)]

On the matter of new taxation, my noble friend will understand that it is above my pay grade and outside my department. However, we have worked closely with industry in this area. On the matter of pouches, there is already advice that parents should ensure, where children and infants are using them, that it would be better to use the contents through spoons, rather than the item at the end of the pouch, in order to help guard against dental decay. In working with industry, some brands are already taking action to improve their baby food products: for example, the amount of sugar in Heinz creamy rice pudding has been reduced by more than half and Heinz has changed its labelling, which now says pouches are suitable for those aged six months-plus. This is an example of the work we can do. Yes, we have to do more and I am very aware of the danger that sugar represents to the youngest in our community.

[Lord Kamall (Con)]

My Lords, when there are concerns about nutritional content, there are three, perhaps more, possible approaches. First, you could ban the product, although prohibition does not always work. Secondly, you could try nudging consumers towards healthier choices—maybe by taxation or restrictions. Thirdly, you could work with local community organisations. In addition to family hubs and Start for Life, many local community non-state civil society organisations work with local families to help them cook and eat healthily together as a family. Given what has been mentioned already, will the Minister tell us what work the Government are doing with such local community organisations, apart from Start for Life and family hubs, to make sure that civil society is playing its role in educating our children?

[Baroness Merron (Lab)]

On the three ways forward that the noble Lord identified, the approach often has to be a mix of all three. It is the balance that is the point under debate, and it has to be informed by evidence. I certainly share the noble Lord’s view about the importance of civil society and working with community groups. Indeed, my department, but also the Department for Education and other departments, have worked closely with community groups in order to advance the policies and practices we need to improve the health of the youngest in our communities.

[Lord Scriven (LD)]

My Lords, the Scientific Advisory Committee on Nutrition recommends that free sugars are limited for babies and toddlers, yet it reported that our children have excess sugars and 20% comes from snacks aimed at young children. How do the Government plan to ensure that manufacturers are taking actions that do not directly contribute to childhood obesity?

[Baroness Merron (Lab)]

Further to my answer to the last question, we are taking a multifaceted approach. The advice that we give to parents and carers is important, because the noble Lord raises a very important point about not overusing snacks. Although the regulations are roughly the same across the UK and the EU, in the UK we recommend that six months is the point of weaning, whereas across the EU it is four months. So there is some lack of clarity, although we are very clear about where snacks are not needed, which is up to the point of 12 months. We work to ensure not only that people have regulations for protection but that parents and carers are aware of what they should do in terms of providing a healthy and balanced diet for their children.

Health: Ultra-processed Food

Baroness Merron Excerpts

Tuesday 3rd June 2025 Lords Chamber

[Lord Sikka]

To ask His Majesty’s Government what steps they are taking to address health harms associated with ultra-processed food.

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

My Lords, a nutritious diet is key to living a healthy life. Currently, there is insufficient evidence on the extent to which the processing of food itself negatively impacts health beyond poor nutritional content. We have commissioned research to further understand the health impacts of ultra-processed foods. We are focused on taking firm action to reduce the intake of foods and drinks that are high in saturated fat, salt or sugar, which also captures the majority of ultra-processed foods.

[Lord Sikka (Lab)]

My Lords, I thank the Minister. Research shows that ultra-processed food causes disease, disability and premature death. It costs the UK economy £268 billion a year, in the form of additional costs for the NHS and social care, welfare payments, productivity loss and lifelong human suffering. Instead of a free ride, manufacturers of ultra-processed food must bear the true cost of their trade. This could be in the form of a 5% levy on their turnover. Does the Minister agree and, if so, when will the Government introduce it?

[Baroness Merron (Lab)]

I am interested to hear my noble friend’s suggestion. This Government do not have that as part of their plan. However, on my noble friend’s point about the need for research, I heard what he said about evidence, but that is not the evidence that I have available. I assure your Lordships’ House that the Scientific Advisory Committee on Nutrition repeatedly reviews evidence and assesses the impact of processed foods on health in position statements, and it has made two recent publications on that. We continue to invest in research on ultra-processed foods.

[Lord Krebs (CB)]

My Lords—

--- Later in debate ---

[Lord Krebs (CB)]

My Lords, I declare my interests as recorded in the register. Last year, the author of the best-selling book Ultra-Processed People, Dr Chris van Tulleken, gave evidence to the Food, Diet and Obesity Select Committee, of which I had the privilege of being a member. He said that ultra-processed food

“is not a regulatory tool—I do not know anyone credible who is talking about using that definition to slap labels on things … the regulatory tool, in my view, should be fat, salt, sugar and calories”.

Does the Minister agree with Dr van Tulleken?

[Baroness Merron (Lab)]

I am grateful to the noble Lord for bringing his expertise and commitment to this area. It is indeed the case that the majority of foods classified or considered as ultra-processed foods also tend to be high in calories, saturated fat, salt and sugar, for which there is more definitive evidence, as the noble Lord has referred to. It is the case that many UPFs are already captured by the Government’s considerable programme of work to improve the food environment.

[Lord McColl of Dulwich (Con)]

My Lords, I congratulate the Government in general, and the Minister in particular, on taking such a sensible view about the great red herring that is ultra-processed food. There is no scientific evidence that it specifically causes obesity. Obesity is caused by eating too much of anything, and the answer is to reduce the amount of food that people eat.

[Baroness Merron (Lab)]

I am grateful to the noble Lord for his appreciation of the Government’s efforts in this regard. I believe we have to consider the role of ultra-processed foods, but that has to be based on evidence and scientific truth, rather than speculation. That is why the Scientific Advisory Committee on Nutrition has shown concern but cannot prove a direct link. It is not necessarily about the processing, but we know that high fat, salt and sugar is a problem for healthy living, and that is mostly a very good description of UPFs.

[Lord Rennard (LD)]

My Lords, in February last year, the British Medical Journal reported research involving 10 million people that found evidence highly suggestive of diets rich in ultra-processed foods being linked with the increased risks of premature death, cardiovascular disease, mental health disorders, diabetes, obesity and sleep problems. What is the timescale for the Government’s further research on the dangers of ultra-processed foods? How will reversing aspects of the ban on junk food advertising help?

[Baroness Merron (Lab)]

As the noble Lord will be aware, we are committed to implementing the TV and online advertising restrictions for less healthy foods and drinks. That is one of a number of steps that we are taking to tackle obesity, as per the question from the previous noble Lord. There is a direct link between advertising and intake, particularly with children, so I am glad that we will be introducing regulations to take effect in January—in fact, the industry has agreed to comply in advance of that, which shows a constructive approach. As for further information, the Scientific Advisory Committee on Nutrition will consider evidence again in 2026, next year, and make dietary recommendations. The Government continue to invest in research through the NIHR and the UKRI.

[Baroness Bennett of Manor Castle (GP)]

Further to the regulations that the Minister mentioned that are coming in January, the Labour manifesto promised to prohibit unhealthy food ads online and before 9 pm, which was to come into effect in October. Can the Minister confirm that the rules that are coming in January are in fact watered down and will not forbid the advertising of brands? Does she think that advertising a brand but not a product—say, McDonalds, Kentucky Fried Chicken or Greggs—will promote the consumption of fresh fruit and vegetables?

[Baroness Merron (Lab)]

First, I do not accept that the advertising restrictions represent any watering down. In May, a Written Ministerial Statement set out, to the noble Baroness’s point, that the Government will provide a brand exemption in legislation. The restrictions will come into force officially on 5 January. I realise that the noble Baroness regards this as not the position that she would choose, but I believe that it will provide certainty for businesses to invest in advertising campaigns with confidence and encourage them to develop more healthy products—that is the situation that we want—as well as protecting UK children from the harms of junk food advertising.

[Lord Kamall (Con)]

I thank the Minister for the answers that she has given so far on the evidence, because it is really important that any policy in this area is evidence led. When I looked at the British Heart Foundation website, I saw that it said that additives in ultra-processed foods

“could be responsible for negative health effects”

and that the

“actual processing of the food could … make a difference”.

It also says:

“Another … theory is that … ultra-processed foods could … affect our gut health”.


But what it says overall is that there is insufficient evidence here. We really need more research to be done. We are not sure whether it is something in the ultra-processed foods or the processing itself that makes them unhealthy. The Minister has touched on this already. We have talked about the timeframe for research, but when people are looking for a source to consider the dangers, or otherwise, of ultra-processed foods, are there any particular websites or sources that the Government could point people to, so that people are more aware of and more educated on the research on ultra-processed foods?

[Baroness Merron (Lab)]

The important point that the noble Lord raises is that our role is to encourage people to ensure that they are choosing a healthy diet and can achieve a healthy diet. As the noble Lord said, the word “could” is a bit of a problem. That is why we continue to invest in research and, as I say, work closely with the Scientific Advisory Committee on Nutrition.

[Lord Patel (CB)]

My Lords, several speakers have alluded to the evidence available that associates ultra-processed and processed food with disease or health conditions. Would the Minister agree that all the evidence cited is from observational studies? No studies report as a causative factor a direct link between processed and ultra-processed food and any disease—including the British Heart Foundation, the BMJ and the one that the noble Lord, Lord Sikka, mentioned. It is right that we should fund research that associates the causation of these food processes to disease.

[Baroness Merron (Lab)]

The noble Lord is absolutely right. There is concern, and I am very aware of it, about the effect of ultra-processed foods, but nobody knows whether it is the processing or the content. What we do know is that it is definitely the content. We also know that high-fat, high-sugar and high-salt foods damage people’s health. Our focus is on what we know, and it is important that we continue to do that while researching what other links there may be.

Social Care Reform

Baroness Merron Excerpts

Thursday 22nd May 2025 Lords Chamber

[Baroness Pitkeathley]

To ask His Majesty’s Government what progress has been made in cross-party talks on the reform of social care.

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

My Lords, the Government are facing up to the challenges of adult social care reform. The Prime Minister has tasked the noble Baroness, Lady Casey of Blackstock, to lead an independent commission into social care, a once-in-a-generation opportunity to transcend party politics. The noble Baroness is tasked with building cross-party consensus on her recommendations and is starting a national conversation on what is expected from social care.

[Baroness Pitkeathley (Lab)]

My Lords, history shows us that reform of social care is a contentious issue and political consensus has been notable by its absence—indeed, parties have used proposals as sticks to beat each other with—but there is agreement on two things: first, the system badly needs reform; and, secondly, this is a long-term project that cannot be solved in one Parliament but across several. In view of that, does my noble friend agree that achieving political consensus is a vital part of any reform of social care? Can she tell the House that this will be specifically included in the terms of reference for the review that the noble Baroness, Lady Casey, is carrying out?

[Baroness Merron (Lab)]

My noble friend makes very strong points, which I absolutely concur with. This is an issue that needs to be able to stand the test of time and changes, whether they be in leadership or of Government. That is why we are taking the approach that we are. My noble friend will have seen the terms of reference that have been published. They are deliberately broad because we are tasking the noble Baroness, Lady Casey, to lead the work fully independently, which is particularly important in seeking cross-party consensus. Indeed, the noble Baroness’s review is very much about having the conversations cross-party and seeking to bring people together across parties and across sectors and the many individuals who have an interest in this.

[Lord Forsyth of Drumlean (Con)]

My Lords, is not the truth of the matter that there is a consensus between the parties? The Economic Affairs Committee of this House published a report some five years ago. There was unanimity across the House. There has since been another report. This setting up of commissions and so on is just to appease the Treasury, which refuses to provide the money that is needed for social care and is the key to cutting waiting lists and moving forward in the health service. Should not the Government just have the courage to commit to the resource that is necessary instead of kicking this into the long grass for another three years while elderly people and young people suffer from inadequate services and clog up beds in the health service?

[Baroness Merron (Lab)]

I understand the noble Lord’s impatience—I am sure we share it—and I hear what he says, but I have to remind your Lordships’ House that the previous Government did not commit funding to their plans, and I am glad the noble Lord agreed with that. I do not accept the characterisation of this. As my noble friend Lady Pitkeathley said, it has to stand the test of time. We are not waiting to take action; we have already put a number of pieces of work in place to lay the groundwork, including additional funding for social care authorities, increasing the carer’s allowance weekly earnings limit and an extra £172 million for home adaptations. We are not just waiting for this report. By the way, I do not recognise the three-year characterisation because the first phase will report in 2026 and then there will be a further report back by 2028. I feel this is the right way forward.

[Lord Forsyth of Drumlean (Con)]

Eight minus five is three.

--- Later in debate ---

[Baroness Merron (Lab)]

I understand that, but the noble Lord said we were just waiting until 2028, and I am not aligning myself with that.

[Baroness Walmsley (LD)]

It is recognised that any meaningful social care reform must deliver for unpaid carers. Will the Minister say what role carer organisations are playing in shaping these talks?

[Baroness Merron (Lab)]

Unpaid carers are key because they provide care and support to those who require care. The needs of unpaid carers will be very much part of the commission. I know that the noble Baroness, Lady Casey, will be speaking to relevant organisations and those with lived experience.

[Lord Turnberg (Lab)]

My Lords, can my noble friend give us an estimate of the number of vacancies in the care workforce and tell us whether there has been an assessment of the impact on the workforce of the restrictions on overseas recruitment for care workers?

[Baroness Merron (Lab)]

I can say to my noble friend that the adult social care workforce is growing. Skills for Care data tells us that there has been an increase of 70,000 filled posts since 2022-23, that staff turnover is reducing and that the overall vacancy rate decreased to 8.3% in 2023-24 from 9.9% the previous year. While the direction is good, there is certainly more to do. As regards international care workers, it has indeed been factored in that we need a workforce, and that is one of the many reasons why the new measures that require care providers to prioritise recruiting international care workers are focused on those who are already in the UK, have visas and require new employment. I am sure we will talk about this as we discuss the Employment Rights Bill and all the directions it is taking to support professionalisation of the workforce and encourage those in the UK to take on adult social care roles.

[The Earl of Effingham (Con)]

My Lords, in July last year His Majesty’s Government scrapped the social care cap and curbed winter fuel payments. Sir Andrew Dilnot, author of the landmark Dilnot commission report on social care, said this was a “tragedy” and that

“we have failed another generation of families”.

With all due respect, the Government are doing a U-turn on the winter fuel payment; can the Minister rule out a U-turn on social care?

[Baroness Merron (Lab)]

Again, I do not recognise the characterisation of a U-turn on social care. The Prime Minister and the Secretary of State have been extremely clear, as I outlined earlier in response to the noble Lord, Lord Forsyth, about why this commission is in place. When it was brought to this House previously, I recall that many noble Lords, although not all, were positive about it because they saw the opportunity—which the previous Government did not, not least because they did not fund its suggestions. This Government are absolutely committed to having a lasting, practical answer that involves everybody concerned and will be supported in the right way. I would have hoped that the noble Earl would welcome that.

[Baroness Watkins of Tavistock (CB)]

My Lords, can the Minister explain how cross-party consensus will be constructed in relation to local mayors and local authorities? For example, the leadership in Cornwall Council has just changed, and there are huge care needs in Cornwall. How will we ensure that other parties—those underrepresented in this and the other House—are involved?

[Baroness Merron (Lab)]

As I mentioned, the terms of reference for the noble Baroness, Lady Casey, are deliberately broad. She will set out how she will involve all those who are affected and have a voice, because she wants to make sure that it is a thorough report.

[Baroness Buscombe (Con)]

My Lords—

--- Later in debate ---

[Baroness Andrews (Lab)]

My Lords, can the Minister tell us what progress has been made on addressing the problem faced by many unpaid carers who have been penalised, through no fault of their own, for having been paid too much because of technical failures in DWP? Are we making progress on addressing those very serious issues?

[Baroness Merron (Lab)]

Yes, the relevant officials and Ministers are working on that. I realise the difficulty it has caused and they, too, are very sensitive to that point. I will reflect my noble friend’s comments to my ministerial colleagues.

NHS and Care Volunteer Responders Service

Baroness Merron Excerpts

Tuesday 20th May 2025 Lords Chamber

[The Earl of Effingham (Con)]

My Lords, the NHS and Care Volunteer Responders service has completed more than 2.7 million tasks and shifts, including more than 1.1 million telephone support calls, over the past five years. It provides volunteering support seven days a week, underpinned by wraparound support and assurance, as well as safeguarding, problem-solving teams and helplines running from 8 am to 8 pm. Volunteers are ID checked, have role guidance, hold DBS checks when required and have their expenses paid by the programme. How will the Government ensure that volunteering in the NHS and social care is encouraged and facilitated, given that the need for volunteers across the country remains acute? When will the new scheme begin operating and can the Government guarantee that existing patients will not be left in the lurch?

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

I start by saying, as I am sure the noble Earl agrees, how grateful we are for the generous contribution made by volunteers. They play a vital role in supporting patients, staff and services in many ways. The national NHS and Care Volunteer Responders programme was first established as part of the Covid response, and the noble Earl helpfully set out its contribution. The fact is that a model that worked well in a national crisis is no longer the most cost-effective option, so there will be a new recruitment portal for NHS volunteers to be fully launched this year. This is all about expanding voluntary opportunities and getting more volunteer hours to further support patients even better than volunteers do already.

[Baroness Walmsley (LD)]

Where will the current funding for this programme go? Will it go into the new scheme the Minister has mentioned, or into community services or support for vulnerable groups, or will this result in some kind of cut to services?

[Baroness Merron (Lab)]

I assure the noble Baroness that there is no intention that this will impact on services. As I mentioned, this is about getting value for money; the previous scheme did so during the Covid pandemic and just after, but we are in a totally different world now. All those who volunteered through the scheme that is being brought to an end will have been sent an email advising them how they can continue their volunteering—we do not want to lose people—and how it will be easier. The launch of the portal will provide a one-stop shop, overseen by NHS England. That is what will be funded. I hope that the noble Baroness and other noble Lords will find the website a much friendlier place through which they can volunteer.

[Baroness Brown of Silvertown (Lab)]

My Lords, can the Minister assure me that we will not use volunteers to plug the gap in NHS services and that people will get an appropriate level of care when they arrive at an NHS facility?

[Baroness Merron (Lab)]

My noble friend makes an important point and I can give her that assurance. For me, volunteering provides a different type of resource. For example, Mid Yorks is advertising for trolley volunteers, ward befriending volunteers and café volunteers. It is about supporting the staff in their efforts, and supporting patients. Volunteers have always had a role, and long may that continue.

[Baroness Coffey (Con)]

My Lords, if the Minister is concerned about the use of volunteers, will she then consider the role of community first responders? Responses by volunteers are included in measuring the response times of ambulances to 999 calls. Based on her logic, she should now exclude that from response times so that we get the required transparency.

[Baroness Merron (Lab)]

This announcement does not affect transparency or services directly provided by the NHS. We are seeking to improve the volunteering offer to make it more cost-effective, and to retain, recruit and better utilise volunteers. I will look at the point the noble Baroness raises, but I emphasise my point to your Lordships’ House.

[Baroness Thornton (Lab)]

My Lords, I declare an interest as a non-executive director of the Whittington Hospital, which is my local hospital. It has a very strong volunteer scheme and is recruiting volunteers all the time. Can my noble friend the Minister assure me that this is about enhancing the work that is done locally, because most volunteers are recruited and most volunteering is done locally?

[Baroness Merron (Lab)]

My noble friend makes a very important point and I can certainly give her the assurance she seeks. Over 50,000 additional volunteers are recruited by NHS trusts, which they then support directly in the way my noble friend describes. Their roles are totally unaffected by the change to this programme. There are many thousands of volunteers who support the NHS directly or indirectly via other local and national voluntary sector organisations, and I pay tribute to them all.

[Baroness Finlay of Llandaff (CB)]

My Lords, I declare an interest as president of Attend. Can the Minister explain how, in the new system, the Government will work with an organisation such as Attend, which provides insurance, legal advice, financial services and networking to a whole series of agencies that provide volunteers across the country, to ensure that there are rigorously high standards and that those who volunteer are protected in their role, and that they benefit in addition to providing maximum benefit to the recipients?

[Baroness Merron (Lab)]

The noble Baroness raises an important point. I am sure there are many, like me, who have volunteered, or still volunteer, and gained as much as they gave, although they did not expect to. It is important to have standards, and to protect volunteers and everybody involved. That will be the case. A lot of local action builds relationships with local organisations, which is a very successful way of harnessing the benefits of volunteers and volunteering.

[Lord Balfe (Con)]

My Lords, I in no way denigrate volunteers, but can the Minister confirm that when a volunteer in a hospital comes across information about patients it has the same level of confidentiality as it would if it had been found by a member of staff, and that it is not acceptable for any information gathered by a volunteer to be used improperly?

[Baroness Merron (Lab)]

I share the noble Lord’s view. Various directions are given to volunteers about how to behave when they receive information that may be to do with safeguarding, and where it should go. It is important that volunteers and staff do not keep it to themselves and that action is taken, so I can give the assurance that he seeks.

[Lord Sikka (Lab)]

My Lords, the Air Ambulance Service is a vital part of emergency care. It is a matter of concern and shame that one of the richest countries has to rely primarily on charitable donations, which cannot provide a consistent and stable service. I urge the Minister to ensure that the Air Ambulance Service is properly funded from the public purse.

[Baroness Merron (Lab)]

There is a role for charitable organisations. One example is hospices. As I have been told many times in this Chamber, as well as outside it, many hospices and other charities, including air ambulances, welcome and relish the freedom they have as charities and do not want government funding or intervention. Of course, we very much respect and appreciate the role that the Air Ambulance Service plays. My own brother was saved some 10 years ago, so I feel very connected to this point. He is grateful, as am I.

[Baroness Fraser of Craigmaddie (Con)]

My Lords, I hear what the Minister says—that this is about a new scheme that will encourage volunteers within the NHS. However, sadly, data shows that instances of volunteering are declining across this country. Does the Minister know what measures will be put in place to ensure that all the volunteers who are currently on the scheme that is going to be closed are supported into whatever the requirements are in the new scheme? Having to go through DBS checks again, reapplying or anything like that might just put barriers in the way of supporting people who are already valued into the new scheme.

[Baroness Merron (Lab)]

I understand that point. It is important to retain and develop people’s interest and commitment. The new portal will be a one-stop shop and will be much better at achieving what the noble Baroness and I seek. I know, having heard about it already, that it has functionality that is not there now. I cannot currently put in my postcode and find out what volunteering opportunities there are, which seems ever so basic—we do that on many other fronts. The new portal will allow that. In other words, the potential volunteers will find it much more accessible and will be matched better. The standards of recruitment will be higher and we will retain people. The noble Baroness makes a very good point—it is why NHSE has written to everybody on the old functionality.

Healthy Life Expectancy

Baroness Merron Excerpts

Tuesday 20th May 2025 Lords Chamber

[Baroness Alexander of Cleveden]

To ask His Majesty’s Government what steps they are taking to reverse recent declines in healthy life expectancy, and to address poverty-related inequalities in life expectancy.

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

My Lords, it is unacceptable that who you are or where you live can impact healthy life expectancy. Reversing the decline in healthy life expectancy is a core part of this Government’s health mission. There is a long way to go but we are making good progress—exceeding our pledge to deliver an extra two million operations, scans and appointments by delivering well over three million, and addressing major health risks that particularly impact more deprived areas.

[Baroness Alexander of Cleveden (Lab)]

I thank my noble friend for her Answer. She may be aware that, this morning, the Health Foundation published a new international benchmarking report. It highlights that, in the 2010s, in all parts of the UK outside London, mortality rates increasingly lagged behind progress in the other 21 countries in the study and that, by 2021, mortality rates in the north-east and north-west of the UK were 20% higher than in the south-west. In light of this, will the Government heed the Health Foundation’s call for a new health inequality strategy that has a particular focus on those parts of the country that have faced long-term industrial decline?

[Baroness Merron (Lab)]

My noble friend raises an extremely important point about inequality. The Health Foundation report focusing on the 2010s shines a light on the need to drive action, which we are doing across government through our missions, with a very ambitious goal and the right approach of halving the gap in healthy life expectancy between the richest and poorest regions. Although I am certainly very interested in what the Health Foundation report says, further strategy is not needed at this time because of the approach we are taking. But I assure my noble friend that in addressing health inequalities, including in areas of past industrial decline, we will be driving economic growth and removing health-related barriers to health, wealth and prosperity.

[Lord McColl of Dulwich (Con)]

My Lords, people are not living as long as they were because of the obesity epidemic, which is killing people at an earlier age from a variety of very unpleasant diseases. Does the Minister agree that there are a lot of pseudoscientists around putting out propaganda that people cannot exercise personal responsibility and therefore government action must be taken? Could it be that those people do not want to see the end of the obesity epidemic because they are making so much money out of it?

[Baroness Merron (Lab)]

The noble Lord always has interesting observations that I listen closely to. I certainly agree that obesity is a major contributor to ill health. Some 64% of the adult population is overweight or living with obesity, and it does indeed, as he says, pose a major health inequality issue. The approach has to be on many levels, and there is government action. For example, we have laid secondary legislation on TV and online advertising restrictions on less healthy foods. We got on with that because we thought it extremely important. Equally, we support people not just through policy or medical intervention, but by encouraging them to adopt a healthier lifestyle. The reasons why people are obese are complex, and we approach it in that way.

[The Lord Bishop of St Albans]

My Lords, I welcome His Majesty’s Government’s commitment to bringing forward a child poverty strategy. The interaction between mental ill-health and poverty is well known. Will the strategy address access to vital mental health support services, especially for those in more remote rural areas where they are difficult to access?

[Baroness Merron (Lab)]

The right reverend Prelate is quite right to draw attention to mental health impacts and the inequality of their incidence. As I mentioned, there has to be a cross-government approach because if we address it through health alone, we will not succeed. Factors such as poor housing, low income, worklessness and disability, as well as ill health and many other factors, affect healthy life expectancy. That is why we are approaching it not by a separate strategy, but by a mission-led approach.

[Baroness Barker (LD)]

Through the work of people such as Professor Michael Marmot, the Government know about the different incidences of ill health across the country. Retailers, particularly food retailers and high street pharmacies, know about the incidence of ill health way in advance of that because they have the data on consumption and purchasing behaviours. Will the Government work with them, particularly the large supermarkets, to increase the availability of data in advance, so that we can prevent some of the incidence of ill health rather than getting the NHS to pay for it when it has happened?

--- Later in debate ---

[Baroness Merron (Lab)]

Prevention is certainly the best approach. As noble Lords will be aware, one of the three pillars of the published 10-year plan is moving from sickness to prevention, so that will feature very much in the plan. We work closely with industry to ensure that government can benefit from its information and its approach, and that we can bring industry along with us to ensure that, collectively, we are taking the best approach to making healthier foods available. We also have to make sure that people have the resource to have healthier foods, as well as information. It is, again, a many-pronged approach, but that is why it has to be a joined-up approach.

[Lord Patel (CB)]

My Lords, while accepting what the noble Baroness, Lady Alexander, and the Minister have said about social inequalities in health outcomes, there are other issues. For instance, period mortality affects life expectancy, so a male aged 65 will expect to live another 18.5 years and a female another 21 years. In turn, period life expectancy is affected by mortality rates so if you improve mortality rates, particularly for diseases where the rates are highest, you will improve life expectancy irrespective of social inequalities. That means that we need the health service to deliver high-quality care for those conditions which result in high mortality rates. Any forward plan or 10-year plan should address that issue. Does the Minister think that might be wise?

[Baroness Merron (Lab)]

I do feel that that would be wise, and we as a Government have already shown that trajectory. To give just one example, smoking remains the preventable killer in our country, and the landmark Tobacco and Vapes Bill will deliver the ambition of a smoke-free UK. We will have a smoke-free generation and will gradually end the sale of tobacco products across the country. We have to break that cycle of addiction and disadvantage which is particularly focused on areas of greater disadvantage. As ever, the noble Lord speaks wise words.

[Baroness Stedman-Scott (Con)]

My Lords, as somebody who has embraced the healthier lifestyle and healthy eating—far later than I should have done—I have looked at every strategy in the book and found one that works. I draw the Minister’s attention to the fact that Japan has the highest life expectancy in the world at birth. Multiple studies have put this down to both healthy eating habits and a strong culture of exercise, both of which are reinforced during school. With Committee of the Children’s Wellbeing and Schools Bill beginning today, what steps will His Majesty’s Government be taking to ensure that our children receive better health and exercise education to emulate the success of Japan?

[Baroness Merron (Lab)]

I congratulate the noble Baroness on being an example to us all. She referred to learning from international examples, including Japan, and indeed we do. We know that some 12 million adults and approximately 2 million children are not physically active enough, so we are developing targeted plans to help children build healthy eating habits and embed physical activity support into routines. We will continue to work closely with DfE on this.