Health and Social Care Act 2008 (Regulated Activities) (Amendment) Regulations 2026

Baroness Merron Excerpts

Wednesday 15th April 2026 Grand Committee

Moved by

[Baroness Merron]

That the Grand Committee do consider the Health and Social Care Act 2008 (Regulated Activities) (Amendment) Regulations 2026.

Relevant document: 54th Report from the Secondary Legislation Scrutiny Committee

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

My Lords, this statutory instrument makes an important change. It will amend the 2014 regulations so that the treatment of disease, disorder or injury, known as TDDI, is brought within the regulatory scope of the Care Quality Commission. This change will be for the treatment of disease, disorder or injury provided in sports grounds or gymnasiums, or under temporary arrangements at sporting or cultural events, where it is delivered for the benefit of those taking part in or attending those activities.

Let me start by clarifying what this is and what it is not. This regulated activity relates not to the task being carried out but to who is doing it. It is the assessment and treatment of physical or mental state when provided by a specifically defined list of healthcare professionals, as per the CQC’s website. The scope of this activity requires those carrying it out to be listed healthcare professionals registered with the appropriate professional body, such as the General Medical Council, the Nursing and Midwifery Council or the Health and Care Professions Council. When a healthcare professional uses their professional title, qualification and skills to assess and treat a person for a disease, disorder or injury, they must be registered with or employed by a company registered with the CQC.

Providers carrying out the treatment of disease, disorder or injury at events may include independent ambulance services that employ paramedics, doctors and nurses, and which are commissioned to attend an event such as a music festival, marathon or football match and be on hand in case anyone there experiences a medical emergency.

Perhaps I can give some context. Members will recall the tragic events of 22 May 2017, when the Manchester Arena bombing killed 22 people and injured more than 1,000 others. The subsequent inquiry uncovered serious failings, including inadequacies in the provision of healthcare services at the arena. The inquiry noted that these shortcomings may have been present at other venues across the country, in part because of the absence of appropriate regulation. A central finding of the inquiry was absolutely clear: the Department of Health and Social Care should consider changes to the law to enable the CQC to regulate healthcare delivered at events. The CQC has itself outlined additional concerns about the quality of care provided at events. It has heard serious allegations of unregulated provision resulting in severe patient harm.

The Government, as noble Lords would expect, are committed to acting on the inquiry’s recommendations and strengthening public safety. I recognise that these changes are overdue, but it was important that they be carefully considered in order to understand the impacts. I am pleased that they have now been laid before us.

To turn to what the amendment will do, the 2014 regulations exempted the treatment of disease, disorder or injury provided at sports venues or gymnasiums or under temporary arrangements from regulation. This SI removes this exemption. It will bring the provision of this treatment at events into line with provision in hospitals, clinics, ambulances, GP surgeries, community services and care homes where it is already registered. This means that any provider delivering the treatment of disease, disorder or injury at an event must register with the CQC and must comply with the same robust regulatory standards that apply elsewhere in the health system. Of course, some of the providers will already be registered to provide this treatment in other settings, which will make the process quicker for them.

I should say to noble Lords that there has been some misunderstanding about what is covered by

“the treatment of disease, disorder or injury”.

It includes a wide range of treatments, from emergency interventions to ongoing care for long-term conditions. I wish to be clear that the treatment of disease, disorder or injury does not include first aid. First aid remains outside the scope of CQC regulation.

By making these changes to the 2014 regulations, the Government will make true our commitment to fulfilling the recommendations of the Manchester Arena inquiry and the drive to improve patient safety. I beg to move.

[Lord Lansley (Con)]

I shall speak briefly to this statutory instrument and ask a number of questions, if I may, to which I hope the Minister will be able to respond. I think that I understand the structure of what is proposed and the exclusion of first aid so that it is not covered, but when I look at the providers that are likely to be affected, I am trying to work out carefully which are the providers concerned. I am assisted by a friend who is part of the Faculty of Sport and Exercise Medicine and who said that it had undertaken a survey.

It seems to me that many of the people who responded to that as healthcare professionals may well be working in registered providers already, so they may be concerned about the need to register in relation to the services that they provide at events but in fact they do not need to register. However, the event organisers themselves may need to register if they bring healthcare professionals on site in order to provide services that go beyond first aid at their event. I am trying to understand how, when the department went out and identified 89, or whatever the number was, potential providers that were not already registered, it ended up with a figure of 36, which seems very low. It certainly bears no comparison to what those who are working in the sector believe would be the number of presently unregistered providers. We need to understand who these 36 are, the character of those providers that the department has identified and why there is such a discrepancy between that and what others have been saying. I would be grateful if the Minister would tell us much more about that.

As a practical example, are all football clubs, or the major football clubs in the Premier League, the Championship and so on, already registered with the CQC? Clearly, they, as organisations, provide continuing healthcare to their players. Do we not need to worry about any of that? Is an event like one of the big festivals that take place already registered, because it has put a team together in order to provide more than simply first aid? Perhaps we are worrying about a need for registration when actually we do not need to worry so much.

I have only one other question. An essential part of the follow-up to the Manchester Arena inquiry was the preparation of an event healthcare standard. Would the Minister be kind enough to update us on that process? Where does it stand and when might we see its publication for consultation?

--- Later in debate ---

[Lord Kamall (Con)]

A number of noble Lords have raised concerns, and I am going just to outline or repeat a few of them. The first is that the department’s own assessment acknowledges that the costs associated with registration and ongoing compliance are estimated, for newly regulated providers, as being between £99,400 and £994,000 per annum. They are quite accurate figures, but let me rephrase that: it could be nearly £100,000 or nearly £1 million. We know that most forecasts are wrong, but a factor of 10 is rather a wide range. I have to admit that that raises concerns about the understanding of these regulations.

But more concerning is the evidence from the Faculty of Sport and Exercise Medicine suggesting that many clinicians working in event medicine may reconsider their involvement if these regulations are implemented as proposed—as the noble Baroness, Lady Grey-Thompson, raised. As other noble Lords have said, events medical providers support the principle of these regulations but warn that they could lead to a reduction in workforce capacity, with the potential unintended consequence of reducing safety. My noble friend Lord Herbert referred to that unintended consequence.

There are also concerns that, where providers withdraw from delivering this regulated medical care, events may instead have to rely on first aid provision, as we have heard from a number of noble Lords. That falls outside the scope of CQC regulation. Well-run events such as Wimbledon, Royal Ascot, the Silverstone Grand Prix and the Glastonbury Festival currently manage most medical incidents on-site. But we could see a shift away from properly staffed medical provision, which risks increasing demand on already stretched NHS services off-site.

Stakeholders, including the Sport and Recreation Alliance, have highlighted a lack of comprehensive engagement with the sector to date. Given the unique characteristics of event medicine, it is essential that any regulatory framework be developed in close consultation with those who deliver care on the ground. However, I have been told by some medical professionals that the CQC is being selective in who it wants. I was told a similar story to that told to my noble friend Lord Markham: when three or four CMOs asked for a joint meeting, the CQC person refused and insisted that they wanted to meet only one of the CMOs. When I hear this, frankly, it gives me no confidence in the CQC or its consultation process. Let me be clear: I do not use those words lightly, but the CQC should be doing proper consultation and not refusing meetings.

I recognise the efforts by the previous and the current Government and the CQC to fix its previously poor reputation. Last year, in the mental health debates, these Benches supported the Government in resisting the appointment of a separate mental health commissioner, because we agreed that the mental health part of the CQC was getting its house in order. Indeed, I met today with some people from the CQC on transitional care, and I was very impressed with them.

However, when I am told that for this regulation the CQC suggested that an additional 36 organisations would require registration, compared to an estimated 25,000 in the survey by the Faculty of Sport and Exercise Medicine, this, as my noble friends Lord Lansley and Lord Markham, and the noble Baroness, Lady Grey- Thompson, said, demonstrates a massive gap in understanding that needs to be addressed. Once again, I am sorry when I say this, but it gives the impression of the CQC being out of its depth.

I am sorry if that is not exactly the ringing endorsement that the Minister was hoping for, but I also know that she has been willing in the past to meet to discuss legislation, and we have worked constructively together in the time we have both been on our respective Front Benches. So, in that constructive spirit, I will make three suggestions, which in fact touch upon those that that were made by other noble Lords.

First, we need to see meaningful CQC engagement with sector representatives, our national governing boards, the chief medical officers in sports groups, the Faculty of Sport and Exercise Medicine and the Faculty of Pre-Hospital Care to ensure that any inspection framework is sector-specific and not simply lifted from the hospital sector. Imposing a CQC regulatory framework suitable for hospitals is inappropriate for pop-up clinics at park runs, cycle races or pitch-side at rugby. Let us be frank: the CQC does not have any existing knowledge of working in these sectors at that level, and it should be listening rather than seeking to impose.

Secondly, we should consider expanding the current employer/employee CQC exemption to athletes, performers and officials whose healthcare providers meet strict occupational health standards regardless of the patient’s contractual arrangement, as other noble Lords suggested.

Thirdly, although I understand that the Secondary Legislation Scrutiny Committee has raised concerns about the time taken to bring forward these regulations, given that the CQC is not exactly inspiring confidence from those who organise sports and other events, could the Government possibly ask the CQC to wait until the event healthcare standard being led by the Faculty of Pre-Hospital Care has been published? In addition, if and when it becomes apparent that the CQC has indeed underestimated the size of this and the cost to the sector, would they be prepared to perhaps extend that December 27 deadline, if appropriate?

However, really to emphasise the point that the Government are listening, I know we have asked for individual meetings, but a much better suggestion would be a round table with interested noble Lords, with the relevant Minister from the department—obviously we would love to have the noble Baroness, Lady Merron, there as we always enjoy her consultations— and the CQC, so it can stop being selective about who it speaks with and can actually listen to CMOs and other medical experts from across the sector. They are not doing this to score points; none of us is doing this for that reason. We agree with the principle, and we want this to work, whichever party and whichever Bench we work on, but we are concerned that the CQC’s approach will lead to the unintended consequence of the withdrawal of appropriate medical provision at these services.

It is quite clear that all noble Lords support the goal of improving public safety at events. All noble Lords have heard the concerns from public events medical experts, and all noble Lords hope that the Minister has listened to their concerns and will agree to the modest requests they have made in today’s debate.

[Baroness Merron (Lab)]

My Lords, I am most grateful for the debate today. I will make a few general points.

I very much welcome the points and the concerns that noble Lords have been willing to outline. I also want to acknowledge that I have heard the understanding of why we are doing this. I know that we all understand the intent, and I understand the numerous questions— I make that as a comment, not as any criticism—trying to understand the workability. I very much welcome them. What I take from this debate and what I will share with Minister Ahmed as the Minister for Patient Safety is that clearly there is considerable concern. To refer to what the noble Lord, Lord Addington, said about fault lines, I think this is about fear of fault lines, but even fear of fault lines is fear enough, so I absolutely take that point.

Let me say at the outset that, if noble Lords had not asked for it, I would have suggested having a round table for interested Peers. It will indeed include officials from the department and the CQC. Ministerially, because it is Peers, I would want to be there in any case. I am sure that Minister Ahmed would want to be there too, but my anxiety is to get on with the meeting, so I will happily have a discussion with him, but I certainly want to be there. If noble Lords remain concerned about a lot of the points, we can tease them out there.

--- Later in debate ---

[Lord Markham (Con)]

If I may, I hope this may be helpful: the confusion that I have heard is over whether a doctor, for a CQC registration at their GP surgery, can use that to volunteer on a point-to-point racecourse, as an example, or whether they have to separately register with the CQC to be a volunteer on the racecourse and pay the £1,000. Again, if that comes in the letter, that is fine, but that is one of the main points of confusion.

[Baroness Merron (Lab)]

On all these areas, as I said, I am happy to meet with noble Lords in person. To be honest, I think that that would be more helpful, not least because we are talking about scenarios and we have a note of the questions that noble Lords are raising. I would be delighted to go through them. Again, in the responses today, I am probably going to be repeating some of what I said earlier and I am not sure that that will take us forward, so I would rather that we held those points for a meeting, if noble Lords are agreeable.

With that, I thank noble Lords. This has been a very valuable debate. It shows the work that needs to be done and we will be pleased to do that. I thank all noble Lords for their considered contributions and support of the principle of why we are here.

Motion agreed.

NHS Adult Gender Identity Clinics

Baroness Merron Excerpts

Wednesday 15th April 2026 Lords Chamber

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

My Lords, 5,624 patients under 25 were referred to adult gender dysphoria clinics in 2023-24, 6,355 were referred in 2024-25 and initial figures show that 6,167 were referred in 2025-26. There are strong safeguards within the existing service provision and specification that was agreed following public consultation, including with the medical royal colleges. These include specialist assessment, accounting for complex co-morbidities and care delivered by a multidisciplinary team with a wide range of expertise, including in neurodiversity and endocrinology.

[Baroness Maclean of Redditch (Con)]

I thank the Minister for that Answer, but I wonder if she has had a chance to review the landmark study from Finland recently, which suggests very strongly that gender medicine actually has a very negative impact on vulnerable young people with complex needs and, far from actually helping them, in fact is harming them. Can I urge her to expedite one of the most important recommendations from the Cass Review, which is to bring in a separate set of services for 17 to 25 year-old young people who are experiencing gender dysphoria? She will know that, currently, the adult clinics operate an affirmative model; that can be very worrying because young people can access life-altering and irreversible hormones after only two appointments. For young people with a whole set of complex needs, I do not think that is right.

[Baroness Merron (Lab)]

My Lords, we are indeed committed to developing services for 17 to 25 year-olds, and I certainly recognise that this is a potentially very vulnerable time in a young person’s journey, as was clearly outlined in the report by the noble Baroness, Lady Cass. I can say to the noble Baroness that we recognise changing patient demographics, and therefore a holistic biopsychosocial assessment framework is being developed for use across all services, including a complexity measure to support understanding of the impact of any co-occurring conditions, as the noble Baroness refers to.

[Baroness Cass (CB)]

My Lords, we know that the 18 to 25 year-olds have many of the same complex problems as the under-18s and, as the Minister has said, they need similar holistic wraparound care, although that is not necessarily yet in place. However, Dr Levy’s review had a narrower remit than mine, focused on quality improvement rather than the model of care, so as a next step would the Minister agree to ask departmental and NHSE colleagues to convene a group, which should include independent experts, representatives of professional groups and representatives of the new children’s and young people’s services as well as service users, to consider how we best understand and, importantly, improve clinical outcomes for this group of young adults?

[Baroness Merron (Lab)]

My Lords, I remain grateful to the noble Baroness for her work and her expertise in this area, which I know has been acknowledged both by the previous Government and this Government. I will certainly take on board what she has said and ask my officials to discuss this further with NHS England.

[Baroness Thornton (Lab)]

My Lords, I would like to seek some clarification from my noble friend the Minister about this matter, because the Mental Capacity Act 2005 presumes adult capacity and the Care Act 2014 defines safeguarding thresholds, which my noble friend has outlined in some detail already. Can my noble friend the Minister confirm that adults aged 18 to 25 referred to gender identity clinics are treated as autonomous patients without additional safeguarding measures beyond those which she has already outlined and apply to any competent adult?

[Baroness Merron (Lab)]

Yes, I can assure my noble friend that patients are treated as individuals and their care is personalised. It is important, as my noble friend says, to recognise that the law presumes that patients aged 16 and over have capacity to consent to medical treatment. I can also give the reassurance, acknowledging as I have already that patients may have co-existing conditions that warrant additional safeguarding measures, that this will be determined on a case-by-case basis.

[Baroness Burt of Solihull (LD)]

My Lords, if the Government are concerned with safeguarding those aged 18 to 25, can the Minister set out what assessment has been made of the documented harms caused by multi-year waiting lists, including serious impacts on mental health, physical well-being and life outcomes? Given the evidence that regret or detransition among those accessing gender-affirming care is rare, can the Minister clarify what specific risk this proposed safeguarding framework is intended to address?

[Baroness Merron (Lab)]

It might be helpful if I speak in general terms. The Levy review highlighted multi-year waits for adult gender clinics. We recognise that waiting times are too long, and that is why we have increased the number of adult gender services from seven to 12 and we will be establishing a national waiting list. Dr Levy’s report did not make specific reference to concerns about safeguarding, and it is important to see it in that context. I emphasise once again that, where there are additional safeguarding matters, they will be dealt with on an individual basis as is right and proper.

[Lord Kamall (Con)]

My Lords, this is a highly sensitive topic, and I think we have to be very careful about how we talk about it. Evidence published in the BMJ shows a fiftyfold increase in recorded cases of gender dysphoria among children and young people between 2011 and 2021. While we should show compassion and not generalise about individuals presenting with gender dysphoria, what assessment has the Minister’s department made of the drivers for this rise in presentations? It is a sensitive issue, as I said, but are the Government assured that there are sufficient safeguards in place to ensure that the most vulnerable young adults are not irreversibly medicalised, only for some, even if just a small number, to regret it later?

[Baroness Merron (Lab)]

The noble Lord makes a number of points. Let me be quite clear that surgical interventions are only for adults—that is for those aged 18 and over. As I said in my answer to the noble Baroness, Lady Maclean, I also refer to the fact that the strong safeguards in place include, among a whole range of others, specialist assessment, access to a multidisciplinary team and assessment of capacity. These are strong safeguards, and it is right that this is the case in order to support patients to get the care that is appropriate to them and which they need.

[Baroness Fox of Buckley (Non-Afl)]

My Lords, NHS England’s Levy review catalogued failings in relation to a lack of data and tracking outcomes from gender dysphoria clinics. Can the Minister explain how the NHS can offer any treatment without such evidence relating to efficacy, benefits, harms, regret and detransition? Can the Minister also comment on the criticism that clinicians are reluctant to correct patients’ unrealistic expectations, often those of young women, about medical transition. They believe that hormones and surgery can change biological sex; they cannot. That is a scientific fact and surely NHS doctors should explain that.

[Baroness Merron (Lab)]

I am not quite clear about the questions I am being asked. However, I return to the point about safeguards and say to your Lordships’ House that I have already outlined the strong safeguards, the professionalism and the medically informed evidence. Contrary to what is being suggested, there is no casualisation at all about decision-making.

Learning Disabilities: Health and Social Care Access

Baroness Merron Excerpts

Thursday 26th March 2026 Grand Committee

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

My Lords, I am pleased to respond to this Question for Short Debate, and I congratulate the noble Lord, Lord Scriven, on securing what, as we have heard, is a very important debate. I also congratulate him on his commitment to improving outcomes for those who have a learning disability. Personally and publicly, I also want to acknowledge—I will use the noble Lord’s words—how raw this is for him. As well as giving my condolences on the death of his nephew Myles, I can only say that I genuinely believe that, as Myles’s uncle, he pays the greatest tribute to the memory of his nephew as he strives to improve services. It is a mission with which I fully associate myself and the Government.

I also want to acknowledge the other losses of the bereaved—not just those of noble Lords sitting here in the Room but those outside too. I have listened to the debate closely and if I am honest, what I am about to say can only in part meet some of the very real questions, and a number of the proposals too. I will do my best and I commit to raising the points made with my honourable friend Minister Zubir Ahmed, in whose portfolio this sits. I know he will welcome, as I have done, the contributions today.

I will pick up as many points as I can in the time that I have. All noble Lords, including the right reverend Prelate and the noble Lord, Lord Crisp, made the point that the health inequalities faced by people with a learning disability are totally unacceptable. I certainly align myself with that. We are committed to driving change. The 10-year health plan gives me hope in this regard because it outlines our ambitions to tackle health inequalities and speaks to the point the noble Lord, Lord Crisp—not exclusively but particularly—made about the need to see the whole person. That is what is missing generally, and it is what the 10-year health plan seeks to tackle, including driving that critical shift from treatment to prevention. The two issues that are presented by this debate are inseparable. I am grateful to the noble Lord for the way he has presented that.

I therefore say at the absolute outset to the noble Lords, Lord Scriven and Lord Addington, that a near 20-year life expectancy gap is not acceptable under any point. I also thank the noble Lord, Lord Addington, for saying that the shortcomings and concerns we are debating have been going on for many years, and what is important is that commitment to change. The noble Lord, Lord Crisp, who spoke of the experience of his brother-in-law Gareth, also spoke of good practice in Derbyshire. We should commend all those who do this and learn from it.

To the point about reasonable adjustments, there are clear legal requirements on health and care organisations and their staff. I hear what noble Lords say clearly: yes, that is all very well but it is not happening. But it is worth reminding ourselves that, under the Equality Act 2010, public sector organisations are required to adapt their approaches in a very practical sense, as the noble Lord, Lord Addington, called for, so that their services are accessible to disabled people as well as to everybody else.

I am grateful to my noble friend Lady Ramsey for bringing Patsy into the Room again. NHS England is rolling out a reasonable adjustment digital flag, as we have spoken about here. That will continue and it is to ensure that, in the way that she rightly demands, key information about a person and the reasonable adjustments needed for their care and treatment are to be recorded in care records. I say to my friend the noble Lord, Lord Addington, that a new information standard was published in December 2025, such that all publicly funded health and social care service providers must be able to share, read and write reasonable adjustment data by 30 September. Training on this digital flag is freely available.

Turning to the safety of people with a learning disability while accessing health and social care, the NHS learning disability improvement standards provide a framework to support NHS trusts and organisations in assessing the quality of their services, because we have to see consistency and improvement across the NHS. There is guidance available on the use of health and care passports to support personalised care for people with a learning disability, and for autistic people.

I say to the noble Baroness, Lady Hollins, that I am deeply saddened by the tragic circumstances of the death of David Lodge. I send my condolences to David’s friends and family. In response to the noble Baroness, who called for a way forward, and the noble Lord, Lord Scriven, who raised whether this can all be a tool for change, because it is not currently—I heard him say that—I know that the noble Lord recently met the Minister for Health Innovation and Safety, Zubir Ahmed MP, as I mentioned. I understand that my colleague the Minister has agreed to work with the noble Lord, Lord Scriven, to continue to hear insights from those with lived experience and wider stakeholders. The Minister is currently working with officials to explore options to improve the process, because we know there is a lot further to go to get ICBs to meet the expectations they have upon them. All these points have rightly been raised on ensuring accountability, reducing inequalities and preventing avoidable deaths. That work will absolutely continue, and I look forward to noble Lords taking part in it.

The noble Baroness, Lady Hollins, asked whether there are any plans to establish a specific inquiry or committee. Currently, there are no plans to do this; however, as I have said, the Minister is very much on the case. On wider action to improve health outcomes, I absolutely hear the points made by the noble Baroness not only in your Lordships’ House but to me personally before this debate, for which I am grateful. If we are talking about those with learning disabilities, we are talking about not just episodes of care but building relationships to enable the correct care for that person; I use the word “person” very definitely in this regard.

Reference was made to the Health and Care Act 2022 and the requirements that it contains. The Government have published a code of practice setting out their expectations on training delivery, and we continue to roll out the recommended Oliver McGowan mandatory training package. I can tell the noble Earl, Lord Effingham, that more than 3 million people have completed the first part of the training, and funding has been provided to support greater uptake this year.

On the point about health checks, the Secretary of State recently wrote to all GPs to emphasise the importance of identification, recording and the quality of the checks themselves.

A number of very pertinent points have been made. I assure noble Lords that they will all fed into the move towards improving the situation for those who have learning disabilities. We owe them nothing less.

Migraine Care: 10-year Health Plan

Baroness Merron Excerpts

Monday 23rd March 2026 Lords Chamber

[Lord Londesborough (CB)]

My Lords, in begging leave to ask the Question standing in my name on the Order Paper, I declare my interest as a migraine sufferer.

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

My Lords, the Government are committed to improving migraine care through the 10-year health plan. We are strengthening neurological services by expanding community-based care and community diagnostics for earlier identification, widening the availability of effective treatments, such as calcitonin gene-related peptide inhibitors, and enhancing the NHS app. NHS England’s neurology programmes are also expanding specialist capacity, reducing avoidable A&E attendances and helping people with migraine to remain in work and maintain their well-being.

[Lord Londesborough (CB)]

I thank the Minister for engaging on a subject that has been raised just once in this House since 1961—which is extraordinary, as we have 10 million migraine sufferers in the UK, more than half of whom have no diagnosis or access to preventive medication. Migraines cost the wider economy more than £10 billion per annum in lost productivity and tax revenues, with hundreds of thousands of capable people unable to work due to lack of treatment, so does the Minister agree that there is a compelling economic as well as compassionate argument for better GP training, more neurologists and including migraine in the NHS Pharmacy First scheme?

[Baroness Merron (Lab)]

I agree with the noble Lord. I appreciate the conversations we have had prior to this Question and acknowledge that he is one of the millions of people suffering from this condition. There is certainly a substantial economic and NHS impact from migraine. I am glad my department is working with the Department for Work and Pensions on a number of initiatives, including the WorkWell programme and the individual placement and support in primary care initiative, which are all focused on supporting those with migraine to stay in work and get back to work.

[Baroness Winterton of Doncaster (Lab)]

My Lords, the approach that my noble friend the Minister has outlined regarding migraine care is very welcome. The 10-year plan also talks about cholesterol management due to its links to cardiovascular disease, but the plan can quite often be confusing for the patient in terms of the care that is provided. A simple example would be suggesting that cheese is bad for cholesterol but good for osteoporosis. HEART UK has therefore raised the fact that there should be a holistic approach to the patient. Can my noble friend make sure this happens in the 10-year plan and the delivery of it?

[Baroness Merron (Lab)]

I can indeed say to my noble friend that a holistic approach is exactly at the core of the 10-year plan, as is the enhancement of care through expanded community diagnostics, better prevention and the use of personalised digital tools, including the NHS app. All these will be helpful in the way my noble friend seeks. The workforce plan, which we will see shortly to support the 10-year health plan, will also acknowledge the need to see people holistically and to staff up accordingly.

[Lord Scriven (LD)]

My Lords, there has been a more than 20% increase in the number of emergency hospital admissions since 2021 due to this condition. Will the Government include and fund migraine in the Pharmacy First scheme and empower pharmacists to prescribe for this high-volume condition?

[Baroness Merron (Lab)]

We constantly review and discuss with pharmacists the range of conditions they cover. It has been one of the highly successful ways of making community-based care available, and we certainly want to continue to work with pharmacists. It is also important to note that more modern treatments are available now on prescription, which will all also support people to manage their condition and will reduce unnecessary A&E admissions.

[Baroness Manzoor (Con)]

My Lords, as has already been mentioned, over 10 million people in the UK suffer from migraine, and it is highly prevalent in women. It is also linked to anxiety and depression. I welcome what the Government are doing in extending women’s health hubs and emphasising mental health in the 10-year plan but, unfortunately, there are no systematic gateways for migraine care in the 10-year plan. How can the Government address this in the light of the significant problem that there is? I am also sorry to hear that the noble Lord, Lord Londesborough, suffers from migraine.

[Baroness Merron (Lab)]

It is important that we acknowledge that this is a debilitating condition. The noble Baroness is right that it is one of the most common neurological conditions, affecting one in five women and one in 15 men. Indeed, it is a major cause of disability. The 10-year plan sets out the main pillars. For example, there will be an updated adult neurology service specification, which will come into being just next month. It was published in August, and I believe it will take account of the points the noble Baroness rightly raises.

[Lord Hunt of Kings Heath (Lab)]

My Lords, my noble friend the Minister, very welcomely talked in her first response about widening access to treatment. My understanding is that NICE guidelines can be very tight for some of those treatments. As part of the work she has put forward, can my noble friend ask NICE to review its guidelines to make sure they are absolutely up to speed?

[Baroness Merron (Lab)]

As I know my noble friend is well aware, the eligibility criteria are set independently by NICE. They are based on clinical evidence and cost-effectiveness, rather than being set by Ministers. However, it is worth saying that the introduction of oral CGRPs, which do not require specialist initiation, will significantly widen access through primary care and reduce the bottlenecks in the system. We are very keen that people can access effective drugs, and I take on board the point my noble friend made.

[Lord Kamall (Con)]

My Lords, I thank the noble Lord for the Question, because although many people think that migraines are just bad headaches, they are in fact a distinct, complex neurological condition. They are responsible for 43 million lost working days each year and are estimated to cost the UK economy up to £4.4 billion. The Minister rightly talked about calcitonin gene-related peptide therapies, but apparently only about 29% of trusts allow access to CGRPs. I welcome what the Minister said about increased access via primary care, but I note that these drugs prevent migraines by targeting a molecule involved in pain transmission. What specific steps is the Minister’s department taking to increase access to these treatments in addition to the primary care initiatives?

[Baroness Merron (Lab)]

We very much recognise the concerns that people may face unnecessary hurdles when trying to access CGRP treatments. NHS England is working with integrated care boards to ensure that the pathways being followed are consistent and timely. It would perhaps be helpful for me to mention some of the national tools, such as NHS RightCare’s headache and migraine toolkit and the Getting It Right First Time recommendations; they also speak to the clearer referral rates that the noble Lord called for and reduce variation. We want people to receive appropriate treatments; we do not want them to be delayed.

[Lord Patel (CB)]

My Lords, migraine as a symptom is a manifestation of a whole spectrum of different diseases, both neurological and vascular, and some are based on allergies. The important aspect of treating migraines is correct diagnosis, and advances in diagnostic techniques, including some of the treatments that the Minister mentioned, are now making that easier. Does she agree that, in addition to having a community-based service, it is important to train the right people to make the right diagnoses, so that patients can get the right treatment at the right time, no matter who dispenses or prescribes it?

[Baroness Merron (Lab)]

I certainly agree. NICE’s headache guidelines and the Royal College of GPs’ training modules support that better recognition and management.

[Baroness Blower (Lab)]

My Lords, speaking as a person who was identified as possibly prediabetic and having a significant heart and cholesterol problem, I can tell the House that, when I looked at the charts of what I might be able to eat from both of those sources, it seemed I was left with kale and cucumber. A holistic approach for this is very important, and I am pleased to say that I am very healthy and do not eat only kale and cucumber.

[Baroness Merron (Lab)]

I am sure your Lordships’ House is, like me, delighted to hear that about my noble friend.

Terminally Ill Adults (End of Life) Bill

Baroness Merron Excerpts

Committee stage
Friday 20th March 2026 Lords Chamber

[Lord Wolfson of Tredegar (Con)]

Causation is denied. My noble and learned friend can read it in Hansard, and I spoke to her outside. It is a testament to her dedication that she has been following this on TV. I do not know whether that shows how poor daytime TV normally is, though those of us who were here on Wednesday will remember that your Lordships’ House is very late night TV as well.

I spoke on the amendments when we first touched on this topic in Committee, right at the beginning. As my noble friend Lady Coffey said, those amendments interrelate with what has been discussed today. The Front Bench is focused on the question of making sure that we do not end up with a situation where different citizens and residents in the United Kingdom have substantially different rights in areas as important as this. I listened carefully to what the noble Baroness, Lady Smith of Llanfaes, said about what actually happened in the Senedd. The phrase “voting in the dark” was a stark one, which I think we ought to remember.

On the question of what the Bill actually does, I am reminded of when I studied private international law, where you have something called the characterisation question—something that lawyers often like. It basically goes like this: in order to get the answer you want, you rephrase the question to focus on the bit of the problem which you want to focus on. In this case, you ask the question, “What does this Bill do?” The noble Lords, Lord Pannick and Lord Carlile of Berriew, rightly say, as a matter of form, that the Bill amends the criminal law and therefore is a competence of Westminster. In reality, assisted dying will not be provided by the criminal justice system. In practice, it will be provided by the health service. That is why I listened carefully to what the noble Lord, Lord Stevens of Birmingham, and the noble and learned Lord, Lord Thomas of Cwmgiedd, said: in practice, this is a Bill which touches on health, which is a devolved competence.

That brings me to the wider and more important point. Earlier this week, the noble and learned Lord, Lord Falconer of Thoroton, raised Jersey, Guernsey and the Isle of Man—the Crown dependencies—in the debate on the Crime and Policing Bill. We also learned this week that the Scottish Parliament has chosen not to proceed with the version—and it was a different version —of this Bill proposed there. If this Bill were to receive Royal Assent, we would therefore end up in a position where substantially different rights would exist for different residents and citizens in the United Kingdom.

That raises an important point of principle, on which I would be interested to hear the noble and learned Lord’s view. Does he see it as a success of devolution that, on an issue as significant as this, people living in different parts of the United Kingdom—and for the purposes of this group of amendments, Wales—might have different rights in law, or does he have a potential solution to create a situation where, as close as possible, people have the same or substantially the same rights?

I respectfully ask the Minister to respond on this point as well. Frequently, we have heard from the Front Bench the phrase, “We are neutral”—that the Government are interested only in workability and will look at these issues as and when they arise. However, this is a deep constitutional issue. The Government cannot be neutral on the point of whether they are content in principle that people in England might have different rights on assisted dying from people in Wales. The Government ought to have a stance on that fundamental constitutional position. The Government also ought to have a position on the point raised by my noble friend Lord Deben as to whether, if this Bill were to go through, with palliative care being such an important part of the overall process, they would equalise funding to make sure that residents of Wales have the same access in practice to palliative care as those of us who live in England do.

For those reasons, I look forward to the responses of both the noble and learned Lord and the Minister.

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

My Lords, I am grateful for the views that have been expressed today. As usual, I will keep my remarks to those amendments that raise significant legal, technical or operational workability concerns. I very much associate myself from these Benches with the welcome to the noble and learned Baroness, Lady Prentis. We were delighted to see her return to your Lordships’ House and look forward to hearing from her.

I turn first to the amendments tabled by the noble Baroness, Lady Coffey. Taken together, they would restrict eligibility for assisted dying to England only and exclude people resident in Wales, registered with a Welsh GP or who have recently moved across the border. They would remove the powers of Welsh Ministers to issue regulations and guidance and limit the commissioner’s monitoring functions to England. Individually and as a group, the amendments could have complex effects, risk significant unintended consequences and lead to a lack of clarity about eligibility and the effect of the law across the England-Wales border.

Restricting the Bill to England, as we have heard, would also create a divergence in the criminal law of England and Wales. The protections in Clause 32 would not apply in Wales and the Suicide Act 1961 would continue to apply there as it does at present. It would therefore be an offence to take steps in Wales to assist access to an assisted death in England even where lawful under the Bill in England. That would represent a significant divergence in homicide- and suicide-related offences and run counter to the current devolution settlement.

Amendment 887 would remove Clause 57(2) and (3), preventing certain provisions from extending to Scotland and Northern Ireland, including those on approved substances, advertising, and employment protections. This would risk parallel and potentially conflicting regulatory regimes; may allow advertising of services in Scotland and Northern Ireland, contrary to restrictions in England and Wales; and could leave health professionals who, for example, live in Scotland but work in England and Wales without the same employment protections as someone in England.

There are a number of further amendments in this group concerning powers in the Bill relating to the provision of an assisted dying service in Wales; namely, Amendment 765, tabled by the noble Lord, Lord Goodman, Amendment 764, tabled by the noble Baroness, Lady Finlay, and Amendments 742, 743, 844, 903, 905 in the name of the noble Baroness, Lady Smith. I bring to the attention of noble Lords that these amendments may alter or impinge on the devolution settlement. Any such changes would usually be made following consultation across the UK Government and with the Welsh Government to explore the wider implications. Further, the Senedd would be expected to consider material changes that affect devolved competence.

Amendment 762, tabled by the noble Lord, Lord Goodman, would require the Secretary of State to specify which organisations will provide assisted dying services in Wales, within one month of the Act passing. This raises workability concerns as it requires clarity on who provides services before key implementation decisions have been made. This could be an interference with the ability of the Welsh Ministers in the devolution settlement to exercise their powers in a devolved area. As regulations under Clause 42 are made using the affirmative procedure, this amendment would also require parliamentary debates in both Houses within one month of the Bill being enacted.

Amendment 767A, tabled by the noble Baroness, Lady Coffey, appears to seek to limit the power of Welsh Ministers to make regulations related to private services only and would make Welsh Ministers unable to establish a publicly commissioned service. As currently drafted, the Bill leaves this as a decision for Welsh Ministers. This amendment would therefore have devolution impacts and, if passed, the Welsh Government would need to be reconsulted and the consent of the Senedd would need to be sought for this provision.

I make no comments on the other amendments in this group. As noble Lords are aware, those amendments have not had technical drafting support from officials. Therefore, any further revision and corresponding amendments may be provided to provide consistent and coherent terminology throughout the Bill.

[Baroness Finlay of Llandaff (CB)]

My Lords, may I question the Minister? The 49th report of the Delegated Powers and Regulatory Reform Committee drew attention to the very unusual nature of the clause in the Bill that allows the delegated powers to be used to do anything that an Act of Parliament can do and drew attention to the fact that this is extremely rare. Is the Minister saying that that is acceptable in this Private Member’s Bill and therefore potentially sets a major precedent in relation to other legislation? Can she clarify whether the Government, simply in relation to that, not to any other part, dispute the Delegated Powers and Regulatory Reform Committee’s conclusion?

[Baroness Merron (Lab)]

I am sure that all noble Lords welcome that report and its comments but, as the noble Baroness is aware, it is a matter for the sponsor to decide the response to that rather than the Government.

[Baroness Smith of Llanfaes (PC)]

What is His Majesty’s Government’s approach to the legislative consent Motion process and making sure that the Sewel convention is kept to? What intergovernmental discussions have this Government had with the Welsh Government on the constitutional implications of this Bill in particular?

[Baroness Merron (Lab)]

As noble Lords will be aware, engaging with the devolved Governments is a matter for the sponsor, not the Government.

[Lord Empey (UUP)]

My Lords, we have heard talk in this debate about respecting the devolution settlement. No, we do not. It is not that long ago, for instance, that the Northern Ireland Assembly voted against abortion but got abortion, and everybody on both Front Benches voted for it. So let us not fool ourselves that we have this great commitment to devolution and respect the views of the relevant assemblies. No, we do not.

[Baroness Merron (Lab)]

I note the comments that the noble Lord has made.

[Lord Falconer of Thoroton (Lab)]

I express my personal pleasure at seeing the noble and learned Baroness, Lady Prentis, back in the House. She was an extremely successful Attorney-General because she was wise and knew the law. I am very glad that she is back here to keep us in order.

On issues in relation to Wales, we have understood throughout the importance of complying scrupulously with the devolution settlement. The people of Wales have to be respected and the devolution settlement has to be respected. On two propositions here, there is no doubt.

First, this is about the criminal law. If a Bill were passed in the Senedd that sought to change the Suicide Act under the existing devolution settlement, it would have no effect because it would not be within the Senedd’s power to do it. That has to be dealt with by this Parliament.

Secondly, and separately, as a matter of practicality, how assisted dying is to be introduced in the health service and the provision of health in Wales is, in practice, a matter for Welsh Ministers. The approach that we have taken is that this Parliament must deal with the criminal law and Welsh Ministers must be left to deal with the decisions about how it is introduced. It may be that that requires an Act of the Senedd. Because of that possibility, we have included in the Bill the power for Welsh Ministers to give the National Health Service in Wales the power to take steps. That power would normally be given by the Senedd, but so that there could be no doubt about that, and so that it would not wait upon the Senedd, we have included it in the Bill.

Constitutionally, we are allowed to include it in this Bill. Even if there was no legislative consent Motion agreeing to it, we could go ahead without the consent Motion. I and the sponsor in the other place have made it clear, specifically and in writing, that we respect the devolution settlement and that if there is no legislative consent Motion in Wales that consents to this Parliament legislating in an area normally dealt with by the Welsh Senedd then we would withdraw those provisions, because we would not be respecting the devolution settlement. From our point of view, we have proceeded with these provisions only once the LCM has been given. That is our position in relation to it.

I shall now deal with the amendments in that context.

--- Later in debate ---

[The Earl of Effingham (Con)]

My Lords, before I speak to the substance of the amendments in this group, I pay tribute to the noble Baronesses, Lady Nicholson, Lady Berridge, Lady Fraser of Craigmaddie, Lady Grey-Thompson, Lady Hollins and Lady O’Loan, and the right reverend Prelate the Bishop of Newcastle. They have all stood up for a particularly vulnerable group of people, and they are absolutely right to do so. I am sure that the noble and learned Lord, Lord Falconer, is listening most carefully to their arguments.

Individuals with speech, language and hearing difficulties are particularly vulnerable, and it is imperative that they fully understand the process, their rights and the terms of the Bill before they can access the provisions made within it. My noble friend Lord Blencathra said that we really need to know that an individual understands what they are doing, and the noble Baroness, Lady O’Loan, used the phrase “crystal clear”. They are both absolutely right.

Surely how society cares for the most vulnerable of its citizens is an unmovable benchmark. Society must protect people with communication difficulties. The noble Baroness, Lady Berridge, specifically questioned the Government, and His Majesty’s Loyal Opposition believe that it is fair and reasonable to ask the Minister what specific work officials and Ministers have undertaken to establish the core risks posed by the Bill to those with hearing, speech and language impediments. In the view of His Majesty’s Government, how effective are the safeguards currently in place? Can the Bill be improved from a neutral perspective of workability to ensure that no one who faces the challenges we have discussed in this group ends their life without being given the obvious support that they need to fully understand the life-changing decision on which they are embarking?

As the noble Lord, Lord Winston, referenced in the previous group, during the course of the Bill, noble Lords have debated detailed provisions and addressed complex moral issues with a laser focus. However, the question at hand is not a complex one. Those who are not able to understand the situation without proper support must be provided that support if they are to take the decision to end their life. Surely that is non-negotiable.

The noble Lord, Lord Shinkwin, said that we have to think differently and challenged the noble and learned Lord, Lord Falconer, to lead by example. The right reverend Prelate the Bishop of Southwark took the words out of my mouth when he said that he remains hopeful that the noble and learned Lord will agree with this line of thought and commit to engaging collaboratively with all noble Lords whose amendments in this group aim to implement the right and appropriate protections for this vulnerable body of individuals.

[Baroness Merron (Lab)]

My Lords, I am most grateful for the debate that we have had today. In keeping my comments limited to amendments on which the Government have major legal, technical or operational workability concerns, I turn first to Amendments 171A and 174A, tabled by the noble Baroness, Lady Nicholson. The duty outlined within these amendments may prove difficult for doctors to discharge as they are ambiguously drafted and use undefined terms such as “religious, cultural or sex-based” barriers. It is also a mandatory duty that does not afford discretion to the doctor to refuse unreasonable requests.

The duty to appoint an advocate conflicts with Clause 22. It is unclear how these proposed advocates would be appointed or trained, or what their role or responsibilities would be. Furthermore, your Lordships’ Committee may note that where a person has religious, cultural or sex-based barriers, the amendment would also require such a person to be provided with an advocate who has training in and experience of relevant safeguarding issues and must be the same sex as the person seeking assistance. Introducing a more extensive mandatory duty for the provision of adjustments, including an advocate, may give rise to workability issues, as the cohort of advocates meeting these criteria could be very limited and may result in a person being delayed or unable to take part in a preliminary discussion.

--- Later in debate ---

[Lord Wolfson of Tredegar (Con)]

We all know what we are talking about here, but yes, absolutely.

This all goes back to the fundamental point of the Bill. I am addressing this point because the hypothesis is that the person has less than six months to live but, notwithstanding that, we are making sure that this particular group of people have an independent advocate. My point is simply that, if we are going to go down this road, there needs to be consistency: if they are not going to have an independent advocate, they really need to confirm it rather than merely indicate it. I apologise for my slightly loose language; the noble Baroness was quite right to pick me up on that. I hope the noble and learned Lord will consider my point as to whether “indicating” is actually the right test in subsection (2)(b)(ii) of his proposed new clause.

[Baroness Merron (Lab)]

I am most grateful to noble Lords for their contributions to this debate on independent advocates. I will limit my comments to those amendments on which the Government have major legal, technical or operational workability concerns.

I turn first to Amendments 168, 300 and 553, tabled by the noble Baroness, Lady Grey-Thompson. Without further consequential changes, Amendment 168 would result in an internal inconsistency with the framework currently set out in the Bill, which provides an independent advocate only for certain qualifying persons.

Similar concerns arise with Amendment 300, which seeks to establish a new system of advocates for disabled people. It is important to note—not just in reference to these amendments, which I heard the noble Baroness acknowledge are not quite as she might wish them to be, but in relation to the debate—that the Equality Act 2010 definition of disability is very broad. For example, it includes those with cancer. As a result, most people who are terminally ill for the purposes of the Bill would fall within that definition. That means that the amendment could apply to the majority of those seeking an assisted death.

Amendment 300 would require the independent advocate to confirm that the person has been offered

“all practicable social, medical, and palliative supports which are financially supported”.

However, there is no provision to ensure that the independent advocate would have access to the information needed to confirm this, which could make the amendment unworkable.

Amendment 553 relates to young adults aged 18 to 25. People in this cohort are legally adults, so the requirement for parental or guardian consent and to have an independent advocate may raise Article 8 ECHR issues relating to private and family life. To be lawful, these requirements would need to be objectively and reasonably justified and proportionate.

My noble and learned friend Lord Falconer, the sponsor, tabled Amendments 548A, 549A and 862A to address workability issues with the current drafting of the Bill by clarifying the regulation-making powers and parliamentary procedures in Clause 22. The amendments set out when a qualifying person must be informed about independent advocate support and the circumstances in which that support must be provided.

Amendment 544A, tabled by the noble Lord, Lord McCrea, would create a conflict with Clause 22(3), which sets out the role of the independent advocate in providing support and advocacy to a qualifying person. The amendment would remove the definition of “qualifying person”, which would result in confusion about who is a qualifying person and the role of an independent advocate appointed to assist a person who is not a qualifying person.

Amendment 553B, tabled by the noble Lord, Lord Weir, would place a duty on the commissioner to offer the support of an “independent disability advocate” to a disabled person as defined under Section 6 of the Equality Act 2010. As mentioned previously, given the breadth of the Equality Act definition, this duty would apply to most people seeking an assisted death. The amendment is unclear about the duties, training and qualifications that would be required of them.

Amendments 191 and 195 to 199, tabled by the noble Lord, Lord Frost, and spoken to by the noble Lord, Lord Gove, and the noble Baroness, Lady Lawlor, would require the Secretary of State to establish a scheme of neutral advisers to whom a person must be directed in the situation where a registered medical practitioner is unwilling or unable to conduct a preliminary discussion. The amendments are broad, ambiguously drafted and could give rise to significant workability issues.

Amendment 196 in particular would require neutral adviser organisations to make a number of very broad declarations. For example, under the amendment, a neutral adviser must declare that they do not and will not employ

“any person who has taken part in the provision of assistance for assisted dying”.

This could result in a potentially unworkable duty, as it would require the adviser to make a declaration about current and future conduct. These broad declarations could therefore be practically unworkable and create resourcing challenges by excluding significant parts of the workforce, if interpreted broadly.

--- Later in debate ---

[Captain of the Honourable Corps of Gentlemen-at-Arms and Chief Whip (Lord Kennedy of Southwark) (Lab Co-op)]

My Lords, I have noticed that the time now is 5.18 pm. We have no intention of moving on to another group. When this group is finished, I will seek to adjourn the House. I say to any colleagues waiting for another debate that it will not be happening this week.

[Baroness Merron (Lab)]

My Lords, The Government do not have major workability concerns with Amendments 175 and 384, tabled by the noble Lord, Lord Moylan, whom we are very pleased to see in his place; long may he continue to be there.

I will say a few words about clinical practice, which may be helpful in addressing some of the points raised, including those just now by the noble Earl, Lord Effingham. Most of the questions were really about the Bill and are therefore matters for the sponsor, but I will make a couple of points about clinical practice. It is rare for a clinician to base prognosis on a median life expectancy. In addition, explaining the data used is not common clinical practice. I hope that is helpful to noble Lords.

The issues raised are rightly for noble Lords to consider and decide. Of course, that means that the way the amendments are currently drafted may require further consideration to be fully workable, effective or enforceable.

[Lord Falconer of Thoroton (Lab)]

My Lords, can I share everybody’s genuine pleasure that the noble Lord, Lord Moylan, is here? Can I not congratulate him on telling us about it? I would have done, but he told me he did not want it, so I respect his wishes. I thank my noble friend Lord Rooker for being willing to share his experience of the death of his first wife. I also associate myself with my noble friend Lady Royall; from personal experience, one should not feel that one has got some obligation or is in some way defective if one dies quickly of cancer or takes a particular attitude. We should not be censorious one way or the other as to what attitude people take when confronted with a terminal illness. How would we all react when confronted with it? We probably do not know.

First, we have had a debate about the six months, and I am incredibly unkeen to revisit the six months because I do not think that that was the frame within which the noble Lord, Lord Moylan, tabled his amendment. His amendment is about what is to be told to the patient rather than whether six months is right—I am gratified that the noble Lord, Lord Moylan, is nodding. I will focus on the issue: how should the patient be told? His amendment is in Clause 5, which is about the preliminary discussion. It requires the doctor conducting the preliminary discussion to discuss the person’s diagnosis and prognosis. It requires the doctor to refer to any treatment available to the patient, and the likely effect of the treatment, and it requires them to go through

“all appropriate palliative, hospice or other care”—

it is not just palliative and hospice care; it is other care as well—

“including symptom management and psychological support, and offer to refer them to a registered medical practitioner who specialises in such care for the purpose of further discussion”.

It is a detailed discussion about the prognosis, diagnosis and likely effect of treatment.

I was struck by the speech made by the noble Baroness, Lady Watkins. The idea that you are told you have six months to live, and that is it, is extraordinarily unusual. The idea that this happens is very unlikely; that it could happen in this context seems to me to be extraordinarily unlikely. Noble Lords will be aware that, in Clause 7, there must be a record kept of this conversation. The iniquity that one is trying to deal with seems to me to be unlikely to arise.

Should we be putting into the Bill the specific statistical material that has to be given? If you are relying on a median or an average, do you have to say that you are doing that and what the variations are? No, I am not in favour of that. There is a power for the Secretary of State, by codes of practice or guidance, to give indications as to how it should be dealt with. I trust doctors more than many people in this debate. It would be unhelpful to put in words such as those in the amendment into the Bill, so I am against the amendment.

On a completely separate issue, we have debated the question of the prognosis and the reason for the six months. I strongly adopt the words of the noble Baroness, Lady Noakes, that this is not the view of one person; this is the view of two doctors and a panel of three. This is not just a question of one prognosis and it is over. That is an issue that we dealt with previously. I am delighted that the noble Lord, Lord Moylan, was in a position to move the amendment. I am sorry to say that I do not agree with it.

Unpaid Carers: Patient Hospital Discharge

Baroness Merron Excerpts

Thursday 19th March 2026 Lords Chamber

[Baroness Pitkeathley]

To ask His Majesty’s Government what assessment they have made of the extent to which unpaid carers are consulted before a patient is discharged from hospital, and what plans they have to monitor this.

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

My Lords, the Health and Care Act 2022 requires NHS trusts to involve patients and unpaid carers in discharge planning, reinforced by 2024 discharge guidance. However, this is not always done consistently and carer involvement is not monitored nationally. We will support better implementation by commissioning work from the LGA’s better care fund support programme this year. Care transfer hub guidance also promotes best practice by encouraging early identification and involvement of carers in planning.

[Baroness Pitkeathley (Lab)]

I thank my noble friend for her Answer. It was important, though not easy, to win for carers the right to be consulted at the point of discharge. I am sorry that better statistics are not being kept, but I am glad to hear the plans for improvement. The survey from Carers UK shows that the number of carers being consulted is decreasing rapidly. Although I fully understand the pressure on the NHS at the point of discharge and the difficulties of securing proper social care support, does my noble friend agree that it is very short-sighted not to consult carers at this point? If they break down from lack of support, the patient is readmitted and there is further pressure on the NHS.

[Baroness Merron (Lab)]

I completely agree with my noble friend that the involvement of and support to unpaid carers is crucial when a patient is discharged because, as she says, it is vital not just for patient recovery but for the whole healthcare system. I welcome the recent Carers UK report that was published last year, which focused on how government legislation and guidance is or is not being implemented and monitored in practice. That has been and will be very useful work for us to continue with.

[Lord Young of Cookham (Con)]

My Lords, further to the question from the noble Baroness, Lady Pitkeathley, there are 120,000 young carers aged between seven and 18, many of whom are the principal carer for a parent or sibling, accompanying them when they go into hospital. Although many hospitals are good about identifying the young carers, not all of them are. What more can be done to make sure that these young carers are identified right at the beginning of the process and fully consulted about arrangements for discharge?

[Baroness Merron (Lab)]

The noble Lord is right to emphasise the role that many children and young people have as young carers. The Children’s Social Care National Framework is statutory guidance for local authorities, which have duties to identify young carers who may need support and to assess their needs. I am well aware that young carers may not be aware of this, but there is a right to request assessments. Improving joint working between adult and children’s social care services, as well as health services, is key. Lastly, I hope that the electronic patient record would identify where there was a carer, including a young carer.

[Lord Scriven (LD)]

My Lords, I declare my interest as a vice-president of the LGA. The model of unplanned discharge places an immediate burden on unpaid carers. What assessment have the Government made of the financial impact on unpaid carers during this period? Specifically, will they consider a discharge support grant to provide immediate short-term funding for carers for the first four weeks following an unplanned or non-thought-through discharge?

[Baroness Merron (Lab)]

I know the noble Lord will be aware of the better care fund, to which there is a commitment of some £9 billion. It can be used in various ways, including in the way that he described. I look forward to the work of the LGA’s better care fund support programme that we will commission this year so that we can work with NHS and social care partners, because we need to strengthen the approach of not just involving but supporting unpaid carers. Discharge should not take place if carers are not able to fulfil the duties that it is assumed they can fulfil.

[Baroness Andrews (Lab)]

My Lords, it is good to hear that there is real awareness of the issues caused by this. It is one of the most acute problems in the whole provision of social care, and it falls hard on unpaid carers when they do not even know how or who to ask for help. It has been diagnosed many times as a big issue. There used to be co-ordinator discharge people in hospitals who would help with this process. Are there still such posts? The news about the LGA work is welcome in relation to co-ordination when it counts and support for unpaid carers, who are the experts here. They are not passive arbitrators; they need to have their own knowledge and expertise recognised in this process. Is there provision at the hospital level for this?

[Baroness Merron (Lab)]

My noble friend makes exactly the right points. We certainly recognise the vital role that unpaid carers play in supporting those who are to be discharged. Decisions about staffing and the approach—I emphasise that a multidisciplinary approach is clearly needed here—are a matter for local areas, but I can say in addition that there is a regular cross-government meeting, which is really important when it comes to joining up the approach, that looks at providing unpaid carers with the recognition and support that they need, as my noble friend said. We are also working towards publishing a cross-government action plan later this year. So in this area, including the LGA work, the kind of approach that my noble friend talks about will certainly be considered.

[Lord Kamall (Con)]

My Lords, I thank the noble Baroness, Lady Pitkeathley, for being a tireless champion of unpaid carers over many years and successive Governments. She quite rightly pointed out that Carers UK found that only 14% of unpaid carers were asked about their ability and willingness to provide care before hospital discharge. I want to follow up on the previous question from the noble Baroness, Lady Andrews. One of the problems faced by successive Governments is that trusts and what were previously CCGs and are now ICBs are very bad at learning from other parts of the system that do things well. For example, Northumbria has been known to have a really good discharge system: it embeds co-ordinators and works out how to get that discharge going. How can the Minister’s department improve learning across the system where there is good practice, take that best practice and appropriately transplant it into other areas so that we can really tackle this problem once and for all?

[Baroness Merron (Lab)]

The whole system needs to do better, as the noble Lord outlines. It will be helpful that we are also looking at commissioning research in this area to look at best practice, as well as barriers and solutions, regarding the involvement of unpaid carers—I think that has been somewhat overlooked, if I am to be honest with your Lordships’ House. We have regional teams that have issued very practical toolkits to help hospitals implement their legal duties; we should remember that there are legal duties in this response. In addition, that is why we are involving the LGA’s better care fund support programme, as I said, as well as seeking to publish a cross-government action plan. These will be steps in the right direction, but I very much acknowledge that we do not start in a good place.

[Lord Patel (CB)]

My Lords, although the better care fund is a help, its success depends on how hospitals and the LGA work together. Would the Minister agree that the fund is still used to fund short-term gaps, particularly winter pressures, and that the yearly funding cycle does not help for longer-term planning? Could that be improved?

[Baroness Merron (Lab)]

I can see the pressure and difficulties that can bring. There is a range of reasons why discharges do not take place in a timely fashion—not just processes but the interface between health and social care, and capacity. As we look at how we involve carers and improve discharge rates, matters of funding will be key.

[Lord Kirkhope of Harrogate (Con)]

My Lords, we live in a world where we have constant criticism, both of government—rightly, quite often—and of many individuals for their behaviour. But here we have a situation where the health service and, indeed, society are being saved many billions of pounds as a result of the work of people who volunteer to care for their relatives and others—those in the voluntary sector, in our hospice movement and all over the health service. Without these people, we would be in real trouble. Is it not marvellous, and can we perhaps commend them and approve of what they are doing both to save us resources and to show that people are basically good?

[Baroness Merron (Lab)]

I am very grateful to the noble Lord. I and the Government are certainly cognisant of the role that unpaid carers play. That is why, last year, we increased the carer’s allowance weekly earnings limit. This was the largest cash increase ever and means that 60,000 additional carers will qualify. That is part of our recognition, but I share the views the noble Lord has given and the comments about my noble friend Lady Pitkeathley and Carers UK—I am grateful to all.

GP Contract

Baroness Merron Excerpts

Tuesday 17th March 2026 Lords Chamber

[Lord Kamall (Con)]

My Lords, I am grateful to the Government for this repeat. The Minister in the other place pointed to 1.3 million referrals being diverted through something called “advice and guidance”. This means that GPs must seek input from a specialist before making a referral, but some professional bodies have warned that this mandatory approach will risk creating barriers to patients accessing specialist care and may compromise patients’ safety if they are not referred in a timely manner. To address these concerns, can the Minister set out what clinical safeguards are in place where a GP believes a patient needs to be referred directly to a specialist but is instead referred to go through this advice and guidance process? If a patient comes to harm as a result of any delay due to not being referred directly to a specialist, who will bear responsibility for that decision and how will accountability be determined?

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

As the noble Lord said, we have seen 1.3 million people diverted since April 2025. Otherwise, they would have been added to the electives waiting list, in clinical terms, unnecessarily. The main thing I can say to the noble Lord on advice and guidance is that I think the figures speak for themselves. That is why we are embedding it into the core contract. We are recognising it as routine practice. It provides more predictable funding and removes annual sign-ups. More generally, I must emphasise to the noble Lord that it does not take away a GP’s right to refer. That remains a matter of clinical judgment and, as in all things, clinical judgment will rule the day.

[Lord Scriven (LD)]

My Lords, the Government have now mandated a cast-iron guarantee that GP practices’ online portals must remain open in core hours, but a portal is merely a digital letterbox, it is not a clinician. Has the department conducted a full clinical risk assessment of the danger of red-flag symptoms being buried in high volumes of routine digital traffic? If so, will the Minister publish those findings today? If not, how can the Minister guarantee that this always-on requirement is clinically safe for patients?

[Baroness Merron (Lab)]

When we develop digital approaches, I have to say again that the figures speak for themselves on, for example, patient satisfaction with general practice: people believe it is finally moving in the right direction. According to the Office for National Statistics, some 77% of people described contacting their GP as easy. That was in January this year, and it was up from just 60% in 2024. I think the public are giving their own view. On development of online access, we always ensure that patient safety is at its heart. I cannot give the commitment to publish that the noble Lord seeks, but I will be very happy to write to him and place a copy of the letter in the Library of the House, giving all the detail about how patient safety is assured. That is core to all our work and developments.

[Baroness Bottomley of Nettlestone (Con)]

My Lords, it is evident all over the country that there is an epidemic of sick notes. Is there anything that the Government are doing to strengthen the arm of GPs who try to resist giving a sick note on simple request?

[Baroness Merron (Lab)]

If I have understood the noble Baroness correctly—forgive me if I have not—the GP contract does not address that directly. That is obviously a more general but important point about GPs’ practices and how they deal with matters. GPs are given advice in their updated training on how to manage those situations, and I expect them to follow it.

[Baroness Gerada (CB)]

My Lords, the new GP contract appears to be baking in access over continuity: my GP, when I want to see him. How will the Government protect continuity of care, which is after all what keeps the NHS safe and provides value for money, and which patients welcome?

[Baroness Merron (Lab)]

We have already said that through our 10-year plan, and this contract very much ties into the main pillars of the plan. We found GP services in a very difficult and challenging state, as I know the noble Baroness will be more than aware. We regard GP services as the front door. We want to see that continuity of care and we expect GPs to organise it accordingly. We all understand that it is not always possible, but clearly the best form of care, whether in the community or in hospital, is on a continuous basis and wrapped around the patient’s needs, not the other way around.

[The Lord Bishop of Manchester]

My Lords, the Statement made in the other place refers explicitly to coastal areas and deprived places, and I welcome that. Will the Minister say something about how we can ensure that there is good access to GP services in rural areas?

[Baroness Merron (Lab)]

The right reverend Prelate is right to raise this. We have been very concerned for some time about the inequalities in coastal areas and areas of greatest need, where healthy life expectancy is the lowest. That includes communities with higher deprivation levels. That is why we began our reforms last year with an independent review of the outdated Carr-Hill formula. That is about the distribution of GP funding, which is fundamental to the point the right reverend Prelate makes. It is based on data that is around 25 years old in some cases, and clearly our population has changed. I look forward to updating the House when that review is concluded.

[Baroness Manzoor (Con)]

I welcome some of the criteria that are going to be used, particularly for deprived communities, in relation to access, but there remains a postcode lottery in terms of access to GPs, particularly in deprived communities. My concern is that, with some of the algorithms and IT being used as a postbox, patients are being referred directly to A&E departments. Will the Government assess in A&E departments which people are being referred that way so, that we can ensure that that loophole is addressed?

[Baroness Merron (Lab)]

It is important to say that online access does not sit alone. There is also in-person access, including telephone access if people prefer that. The intention is not—and it is not the practice—that they are just postboxes. They are dealt with. We constantly keep those approaches under review. Our expansion is about access to GPs. That includes, for example, in answer to some of the points that have been raised today, including by the noble Baroness, repurposing £292 million from primary care network incentive scheme moneys to fund additional GP sessions to create more capacity, because that is necessary whatever way people make contact. That was based on feedback from the BMA, which said this would be a more effective use of funding.

[Baroness Browning (Con)]

Is there any monitoring of when GPs insist on a telephone call rather than a face-to-face meeting, or when things are sent by email to the surgery and they are then triaged by others rather than their normal GP? Is there any identifying of just how many cases they miss of those very serious conditions that subsequently end in serious illness or even death? I am particularly thinking of such things as sepsis, where the symptoms are not always so overt to begin with as they are as the disease progresses. Is there any monitoring of how successful these new systems are in picking up those types of diseases?

[Baroness Merron (Lab)]

All the systems are under constant review. It might be helpful if I point out to the noble Baroness that one of the key things in the GP contract for 2026-27 is the requirement for all clinically urgent patients to be dealt with on the same day. That is not required currently; I think that will make a huge difference. Again, I emphasise that we will not be defining “clinically urgent”: it will be down to practices to use their clinical judgment, and that is the right place.

NHS: In-house Software Capabilities

Baroness Merron Excerpts

Monday 16th March 2026 Lords Chamber

[Viscount Hanworth]

To ask His Majesty’s Government what plans they have for sustaining and enhancing the in-house software capabilities of the NHS.

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

My Lords, NHS Digital services are built and run to rigorous Government Digital Service standards. They are secure, user-centred, interoperable and continually improving. National Health Service England has significantly expanded its in-house engineering and data capability, and it is reducing its reliance on outsourced systems and strengthening operational resilience. These measures ensure that health and care data is available in all clinical settings to improve outcomes for patients, while delivering value for money to the taxpayer.

[Viscount Hanworth (Lab)]

I thank the Minister for that reassuring Answer. The NHS has had a disastrous history of outsourcing its IT technology, which has wasted millions of pounds. A requirement of outsourcing is that there must be sufficient in-house expertise to properly assess the need for outside assistance and the quality of whatever assistance is on offer. In the absence of such expertise, outsourcing can be perilous. Moreover, given the requisite in-house expertise, outsourcing may become unnecessary. At a time when a host of novel IT solutions are becoming available, the IT staff of NHS England are seeing their numbers radically reduced. At the same time, the NHS is becoming increasingly dependent on the services of large American IT corporations. Can we be assured—genuinely assured—that history will not be repeating itself?

[Baroness Merron (Lab)]

My noble friend is right to point out the history. The NHS previously relied very heavily on large, outsourced IT systems that, in some cases, led to inflexibility, high long-term costs and limited NHS control over core platforms and data. I was glad to arrange for my noble friend to meet the chief data and analytics officer at NHS England last Wednesday. I hope that, like me, he was reassured that NHS England has very much shifted its model towards building and operating critical digital services in-house, in line with the standards that I referred to in my initial Answer.

[Baroness Watkins of Tavistock (CB)]

My Lords, cyber security is an essential element in any system, but nowhere more so than when people’s health records are being maintained. Many security breaches are attributed, at least in part, to human error. What investment are His Majesty’s Government making to train front-line staff in the new systems and provide continuous professional development to achieve the 10-year digital healthcare plan?

[Baroness Merron (Lab)]

The straightforward answer is that we are doing exactly that. It is important to say that our front-line digitisation—our move from analogue to digital—is not something for the sake of it; we are doing it because it is improving efficiency and outcomes. For example, a 94% coverage of electronic patient records is expected by the end of this month, and the digitally mature trusts show a 13% lower cost per admission. That is a prize worth having, but we can do it only through the systems and training that the noble Baroness seeks.

[Lord Kirkhope of Harrogate (Con)]

My Lords, I support what the noble Viscount said. The history of software in the National Health Service is nothing less than a disaster. Coupled with that is a very unfortunate situation where some of the companies that have been responsible for these messes in the NHS are still on the Government’s procurement lists and are still getting contracts from the Government. Surely more attention should be paid to that, and we should curb that as soon as possible.

[Baroness Merron (Lab)]

If the noble Lord has particular companies in mind, he is most welcome to raise them with me. It is important that we look at what NHS teams have done: they have designed, built and maintained national platforms. The NHS app is an example; I am sure that many noble Lords will be familiar with it. That is going to be our digital front door to the NHS. In addition, there is the NHS login and core national infrastructure. All these mean full NHS ownership, governance and control. Supported by £2.5 billion of investment in 2025-26, we are, as the noble Lord seeks, expanding NHS in-house digital capability to reduce the reliance on large suppliers.

[Lord Scriven (LD)]

My Lords, last week’s catastrophic attack on Stryker by Iranian-linked actors paralysed supply of some critical surgical equipment across the NHS. Does the Minister agree that our total reliance on vulnerable third-party global medtech platforms is a serious security risk? How will the Government ensure in-house expertise and procurement software so that the NHS can bypass compromised commercial networks during such crises?

[Baroness Merron (Lab)]

Cyber attacks across our whole government are extremely concerning, and that is why we have built resilience. On health and social care specifically, I can assure the noble Lord that, in 2025-26, we invested £75 million across health and social care; that built on the £375 million invested since 2017. When I had responsibility for the blood transfusion service, my own experience was that, where there was a cyber attack, we had the systems in place.

[Lord Kamall (Con)]

My Lords, there is always a very difficult balance between keeping something in-house or outsourcing it, and we should not forget the national programme for IT in the NHS in the early 2000s, which ended up costing between £10 billion and £20 billion. My question is on the company Palantir. The Minister will be aware that there are a range of views on Palantir. Some say that it is the best software available and that no one can match it; others say that they are worried that it will lock the NHS in long-term and scrape data for other uses. What specific measures have NHS England and the department put in place so that, in the event that the Palantir contract is not renewed, the healthcare system will be able to move seamlessly to another supplier?

[Baroness Merron (Lab)]

That seamless movement is an important point generally, but the federated data platform does not centralise or sell patient data. Data remains firmly under NHS control, and access is strictly governed. It is fully auditable and used only for approved patient benefit and NHS benefit. Palantir operates strictly under the instruction of NHS England and it does not, as I said, own or control NHS data. That access is tightly governed. In response to the earlier question, I note that the federated data platform to which the noble Lord refers is cyber resilient and subject to rigorous contractual, legal and information governance controls.

[Baroness Bennett of Manor Castle (GP)]

My Lords, my question also relates to the federated data platform. I am sure the noble Baroness is aware that more than 50,000 patients have written to their local trust boards asking not to have their data placed on it. The Greater Manchester ICB, serving 2.8 million patients, has said that this does not present value for money and is a big public trust issue. Palantir is of course owned by Peter Thiel and Alex Karp, who are closely associated with the Trump regime and have very right-wing and anti-democratic views. Does the Minister acknowledge that this association with Palantir is damaging our NHS?

[Baroness Merron (Lab)]

I would first look at delivery: the federated data platform has enabled nearly 100,000 extra operations, removed over 600,000 patients from waiting lists and reduced unnecessary bed days by 15%, as well as driving a 10% improvement in cancer diagnosis—so people are being diagnosed sooner because the system is working more efficiently, and that is important. This is a three-year contract given in 2023. I refer the noble Baroness to the comments I made to the noble Lord, Lord Kamall, about the rigorous contract due diligence for all commercial agreements, including with Palantir.

[Lord Patel (CB)]

My Lords, it is historically true that the NHS wasted a lot of money, but this was partly because the development of digital services was in-house. Currently, things are looking much better, and the classic example is the development of the NHS app. However, I will ask the Minister about the health research data service that will be established. Patients should have confidence in data that is used and collected for research, partly because of the recent report on UK Biobank, where the researchers published the codes they were using to access data for research. It has to be made absolutely certain that the public have the confidence in the data that is used.

[Baroness Merron (Lab)]

Absolutely—public confidence is really important, and the debate around this today perhaps emphasises the need to communicate the realities of what is going on. But giving the NHS greater control and long-term value for money, as well as protecting privacy and improving public trust while improving outcomes, is the way forward. But the noble Lord is quite right, and we will ensure that we seek to build that confidence still further.

NHS: Heart Valve Disease

Baroness Merron Excerpts

Thursday 12th March 2026 Lords Chamber

[Lord McCabe]

To ask His Majesty’s Government what assessment they have made of whether NHS services for heart valve disease support healthy ageing and ensure older adults receive equitable access to timely treatment.

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

My Lords, to accelerate the 10-year health plan ambition to reduce premature mortality from heart disease and stroke by 25% and to tackle unwarranted variation across the country, this year we will publish a new cardiovascular disease modern service framework. It will support consistent, high-quality and equitable care while fostering innovation across the cardiovascular disease pathway.

[Lord McCabe (Lab)]

I thank my noble friend the Minister for her response. The guidelines of the European Society of Cardiology and the European Association for Cardio-Thoracic Surgery suggest that the UK is falling behind in terms of diagnosis and treatment for heart valve disease. Can she give an assurance that the new framework will take full account of these guidelines and pay particular attention to the diagnosis and treatment of older people?

--- Later in debate ---

[Baroness Merron (Lab)]

I am most grateful to my noble friend for his work in promoting the improvement of services for those with heart valve disease. I can say—it might be helpful—that we are driving down cardiology waiting lists. The number of people waiting over 52 weeks from referral to treatment was down 9% between the end of December 2025 and the end of January 2026. Yes, the modern service framework will accelerate this progress to reduce premature mortality and will set standards for the best evidence-based interventions.

[Lord Patel (CB)]

My Lords, management of people with heart valve disease is truly a low-hanging fruit in reducing deaths due to cardiovascular disease. Some 400 people a year die on waiting lists for transcatheter aortic valve implantation. It is simple for people who have breathlessness or suffer from decreased exercise tolerance or chest pain. Even I, within five minutes, could diagnose whether they were at risk of heart valve disease or not—line them up and I will tell you.

[Baroness Merron (Lab)]

I am reassured that the noble Lord can assist within five minutes—we might consider engaging him. The serious point is that early diagnosis is important, and the modern service framework will build on the work that has already been done. I know that the noble Lord is aware of this, but just the use of a stethoscope is the way to make an early and initial diagnosis. We are upping our game here by bringing in AI-assisted stethoscopes, which will be a massive assistance for diagnosis.

[The Lord Speaker (Lord Forsyth of Drumlean)]

My Lords, the noble Baroness, Lady Brinton, is taking part remotely. I invite her to ask her supplementary question.

[Baroness Brinton (LD) [V]]

My Lords, the Resuscitation Council UK, the British Cardiovascular Society and the National Council for Palliative Care have excellent and sensitive joint guidance on the use of cardiovascular implants towards the end of life. My family’s experience in different parts of the country shows that not all cardiac surgeons take account of end-of-life care in patients. In one case, a patient was told that she would not be allowed to leave the hospital until she had a pacemaker, despite the fact that, at 88 years old, she did not want one and, two years on, bitterly regrets finally agreeing. Can the Minister say whether the review that she just mentioned will ensure that surgeons follow the guidance and work not only with patients but with their other clinicians?

[Baroness Merron (Lab)]

I am sorry to hear the experience that the noble Baroness describes. We are indeed seeking to have a whole-team approach to the whole patient. I absolutely agree with her that it should indeed consider where somebody is in their life stage.

[Baroness Browning (Con)]

The noble Lord, Lord McCabe, referenced older people in particular in his Question—he did not say where he drew the line at old, but perhaps I will declare an interest. What happens, for example, when really older people need heart surgery but are considered to be an anaesthetic risk? With new developments in heart surgery, I wonder whether the Minister can tell us what progress there has been in carrying out procedures without necessarily needing to have invasive surgery.

[Baroness Merron (Lab)]

I can privately share with the noble Baroness that I suspect that “older people” covers both of us: it is over 65. The point that she makes is important. The option of what is called a TAVI intervention is far less invasive than a surgical intervention, as she referred to. That activity has grown significantly year on year, with something like a 16% increase on 2024-25. That is a very welcome step forward as we move towards minimally invasive procedures.

[Baroness Andrews (Lab)]

My Lords, it is obvious that early testing for heart valve disease is an exemplary form of preventive medicine, which is where we all need to get to. The House owes my noble friend gratitude for organising heart valve testing through the Heart Valve Voice, which was extremely successful. Does my noble friend agree with me that, because of the absence of routine testing, we should look for opportunities to link heart valve testing with the other sorts of routine testing where there is a captive audience? These could include, for example, occasions when people go for cholesterol testing or possibly even flu vaccination, which are becoming more routine? If we could get that in operation at an early stage, it could make a significant difference.

[Baroness Merron (Lab)]

My noble friend is right and, certainly, as we move through our 10-year health plan, the opportunity to make every contact count is very important. I refer my noble friend to the advances that we have made in services available in community pharmacies, because measuring blood pressure is hugely important. Our pharmacies, I am glad to say, have delivered nearly 4.2 million blood pressure monitoring checks since October 2021. We have more than 7,500 pharmacies now available in our high streets delivering this service. That is the kind of thing that my noble friend is looking for.

[Lord Kakkar (CB)]

My Lords, I declare my interest as chairman of King’s Health Partners. The Minister made reference to AI stethoscopes aiding in the diagnosis of patients with heart conditions. The evidence for this was established in a very large trial—the TRICORDER trial—involving some 1.5 million patients and more than 200 general practices in our country. What it demonstrated was, compared to the use of the ordinary standard of care, a doubling of the rate of diagnosis for heart failure and a tripling of the rate of diagnosis for heart arrhythmias. The problem was that, subsequent to the trial, the diagnostic rate did not increase, suggesting that it is necessary to invest in training and the establishment of new working pathways to ensure that innovation can be properly established in routine clinical practice. Is His Majesty’s Government funding such activity?

[Baroness Merron (Lab)]

The noble Lord is right to make the point that innovation research is one part of it, but it is actually its implementation that matters. However, the faster and more frequent detection of cardiovascular conditions is the key thing and training is certainly a part of that.

[Lord Kamall (Con)]

My Lords, I am grateful to the Minister for giving me time for this question. She will be aware that studies analysed in around 155,000 diagnoses of aortic stenosis in England have found that women were significantly less likely to be referred to specialists and far less likely to receive valve replacement. This also applies to patients from deprived areas and in some ethnic minority groups. What assessment have the Government made of these disparities and what action are the noble Baroness’s department and NHS England taking to ensure that patients have access to heart valve treatment regardless of their gender, ethnicity or where they live?

[Baroness Merron (Lab)]

The noble Lord is quite right: women are underdiagnosed, they are undertreated and some ethnic minority groups face poorer access. That is why I very much welcome the fact that, in the framework to which I referred, dealing with inequalities will be absolutely key. Research, in which we are partnering with the British Heart Foundation, will focus on tackling inequalities in higher-risk groups as well as unequal cardiovascular disease outcomes. Inequalities and tackling them will be at the heart of all our acceleration of progress as well as our research.

Human Medicines (Amendment) Regulations 2026

Baroness Merron Excerpts

Wednesday 11th March 2026 Lords Chamber

Moved by

[Baroness Merron]

That the draft Regulations laid before the House on 29 January be approved.

Relevant document: 51st Report from the Secondary Legislation Scrutiny Committee. Considered in Grand Committee on 9 March.

Motion agreed.