National Insurance Contributions: Healthcare

Baroness Merron Excerpts

Tuesday 19th November 2024 Lords Chamber

[Lord Kamall (Con)]

My Lords, unintended consequences have plagued policymakers and Governments for many years. I am interested in whether the impact on primary care providers, hospices and care homes was a deliberate or unintended consequence of the recent rise in employers’ national insurance. Did the Government conduct an impact analysis of the cost to primary care providers, hospices and care homes before the Budget? If not, have they conducted one since or do they intend to do so? Can the Minister assure non-state providers of primary care, hospices and care homes that this was not a deliberate measure to squeeze them out of the health and care space and that the Government will consider appropriate measures to ensure that they can continue to be financially viable and invest in facilities, staff and front-line services?

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

I assure the noble Lord that there is no intent to squeeze out any providers, which are much valued and appreciated. We will continue to listen to their concerns and consult them as we make allocations, which is, as he knows, the usual practice for every Government. On the Budget settlement for the Department for Health and Social Care for 2025-26, I assure him that the Chancellor considered the impact of all the changes in the Budget.

[Lord Scriven (LD)]

My Lords, the net cost to the already struggling community pharmacy sector from the national insurance changes is roughly £50 million. One community pharmacist told me last week that this means that they either reduce services to patients by closing for the equivalent of one day a week or make one and a half members of staff redundant. What advice would the Minister give to that community pharmacist and many others in her situation?

[Baroness Merron (Lab)]

What I would say to each sector, including pharmacists, about the services they provide and what is expected in return from any contract is that, as in previous years—I emphasise that it is business as usual in this respect—employer national insurance contributions are dealt with as part of the process. We are very appreciative of the pharmacy sector’s contribution, not least because it will assist with one of the three pillars in moving from hospital to community services. I encourage all pharmacists to work with us to achieve what I believe they and we in government want: a service that is fit for the future.

[The Lord Bishop of St Albans]

Can the noble Baroness help us understand the huge impact this is having on the hospice movement, which is an extraordinary sector? We get an incredible service from it but, ironically, while we are having a national debate on assisted dying—some of us prefer to call it assisted suicide—this will make it even more difficult to provide this much-valued service. Is there not a case to be made for special support for those independent hospices which have to raise massive amounts of money from charitable sources, so that we are not penalising them?

[Baroness Merron (Lab)]

As the right reverend Prelate is very aware, most hospices are indeed charitable. They are independent organisations that receive some statutory funding for providing NHS services. As we discussed in a recent debate in your Lordships’ House, the amount of funding that charitable hospices receive varies by integrated care board area, and that will depend in part on population need and the breadth and range of palliative care and end-of-life care provision within the ICB footprint. With NHS funding being provided on a tariff basis, as is usual every year, there is NHS planning guidance, a local government finance settlement and consultations with independent providers. That will happen this year as it has every single year under every previous Government.

[Baroness McIntosh of Pickering (Con)]

My Lords, the Minister is aware of my interest with the Dispensing Doctors’ Association. The idea that allocations will be made in due course simply will not wash. GP practices, care homes and pharmacies will close their doors if the Government do not act urgently.

--- Later in debate ---

[Baroness Merron (Lab)]

Under previous Governments, including her own, this was exactly what happened, and it will continue to happen. There are established processes on NHS guidance and the national tariff system, and there will be consultations on primary care contracts, which will play out in the normal—and what I regard as a fair and open—way. I make that point in respect of all Governments, not just this one.

[Lord Clarke of Nottingham (Con)]

My Lords, the root of this problem is that, in an election that the Labour Party was bound to win, it made a promise that it would not raise income tax, national insurance or corporation tax. The taxes it promised not to raise provide 70% of the Government’s income and are the basic toolbox of any Chancellor in any Budget. They sometimes go up or down according to the economic needs of the nation, and they are the broadest-based and fairest taxes. Now that the Government have imposed these rather damaging taxes to raise revenue in this last Budget and have gone for the choices they have, can I have the Minister’s assurance that this promise is not good for the next five years? It will confine the Government’s ability to raise revenue when they need to, so they will go into more areas and will do unintended damage to employment or particular sectors of the economy.

[Baroness Merron (Lab)]

I appreciate hearing the view of the noble Lord, with his considerable experience, but this is a place where I know the current Chancellor would beg to differ. I gently point out that I believe the root cause is something rather different: this Government inherited a £22 billion black hole.

[Noble Lords]

Oh!

[Baroness Merron (Lab)]

Noble Lords may wish to groan and comment, but it is a fact. The deficit that the previous Government ran up in my department alone would mean 20,000 fewer appointments per week. That compares very unfavourably with the 40,000 more appointments that this Government are promising.

[Lord Foulkes of Cumnock (Lab Co-op)]

Does my noble friend agree that we are all getting a bit fed up with the groans from those on the other side when we take the time to remind them of the appalling debt we inherited? It is a truth that has been independently verified that we inherited this £22 billion. They are unwilling to admit the truth. Does she also agree with the noble Baroness, Lady Taylor of Stevenage, that we are putting forward proposals that they, understandably, constantly attack, but that they will not put up alternative proposals for dealing with the debt we have inherited?

[Baroness Merron (Lab)]

I certainly agree with the comments of my noble friend Lady Taylor, who set out the government response very clearly in the last Question. I also share the view of my noble friend Lord Foulkes that it is important to be honest; I believe we have taken that on board as a new Government. That is why, for example, we commissioned the independent review by the noble Lord, Lord Darzi, to find out the state of the NHS in order that we could move forward. What the noble Lord found did not make for pretty reading, and it is our job to put this mess into a rather better shape than it is now.

[Baroness Fox of Buckley (Non-Afl)]

My Lords, what has been described as “groans” might, in another language, be described as holding a Government to account. The Government are in charge now and have to answer the charges as put.

If the Minister is correct that the Treasury evaluated what the changes to employers’ national insurance contributions would be, the Government will have known that this was going to affect not just big nasty bosses but a wide range of employers—hospices, care homes and all sorts of charities. The hairdressing sector is being decimated as we speak. I just went and stood in the rain for two hours at the farmers’ demonstration, where tenant farmers pointed out that these national insurance changes will mean they will have to sack farm workers. This is having a wide decimating impact. If the Government are going to be honest, I hope they will talk to each and every one of the sectors and tell them that this is going to be resolved one way or another.

[Baroness Merron (Lab)]

This Government are very committed and are indeed talking to all sectors, including in my own department. As to the point the noble Baroness rightly raises about holding Governments to account, I welcome that. It gives me and my noble friends an opportunity to set out the plans, responsibilities and concerns of this Government. We will take them seriously and continue to work to get consensus wherever we can.

Type 2 Diabetes: Continuous Glucose Monitors

Baroness Merron Excerpts

Tuesday 19th November 2024 Lords Chamber

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

My Lords—

[Noble Lords]

Hear, hear!

[Baroness Merron (Lab)]

I could get used to that reception, but I am not sure that I will get used to three Questions and a repeat UQ. However, I thank your Lordships’ House.

More than 200,000 eligible people living with diabetes currently benefit from real-time CGM, or continuous glucose monitoring. CGM data-reporting systems are being developed to aid the delivery of rollout by integrated care boards. Alongside this, the data is collected as part of the national diabetes audit. From 2025-26, NHS England plans to publish that data routinely on the audit’s quarterly dashboard, which will provide the insights that ICBs need, including data on CGM uptake, variation and health inequalities.

[Lord Rennard (LD)]

Many more people with type 2 diabetes could benefit from this technology. People living in deprivation and people of black and south Asian ethnicity are more likely to develop type 2 diabetes, are less likely to receive essential diabetes care and experience worse health outcomes. However, according to Diabetes UK, only 24 of 42 integrated care boards in England have a policy for continuous glucose monitoring for people with type 2 diabetes that is in line with guidance from NICE. How will the Government ensure equal access to such monitors for people with type 2 diabetes?

[Baroness Merron (Lab)]

The noble Lord makes a very fair observation. Work is going on in a wider equality monitoring programme exploring how to keep an eye on equality repercussions, including ethnicity, by reference to protected characteristics in the Equality Act 2010. Importantly to the point he raised, the review includes consideration of how NHS ethnic group categories can be updated. The outcome of the review—this is the point I really want to emphasise—will ultimately guide a process of reducing inequalities, but I accept his challenge and his point.

[Lord Patel (CB)]

My Lords, there is a strong link between body mass index, BMI, and type 2 diabetes. People with a body mass index of 25 to 30 have an 8% chance of developing type 2 diabetes; those with 30 to 40 have a 20% chance; and those with a body mass index of 40 or over have a 40% chance. One way of monitoring long-term glycaemic glucose levels is to measure haemoglobin A1C. It might therefore be an idea to use haemoglobin A1C levels to diagnose early type 2 diabetes, initially in people with a BMI of 40 or over, as a screening tool. It might be an idea to ask NICE or the screening committee to evaluate that likelihood.

[Baroness Merron (Lab)]

The noble Lord makes a helpful point. I can tell your Lordships’ House that diabetes testing is included as part of the NHS health check. If a person is identified as being at high risk of type 2 diabetes, they should be offered a blood sugar glucose test or a fasting glucose test. NICE produces guidelines on preventing type 2 diabetes in people at high risk, and that includes recommendations on risk assessments, including blood testing, which can include people with a high BMI. His point is extremely valid, some of that is in place and we will ensure that it continues.

[Baroness Foster of Aghadrumsee (Non-Afl)]

My Lords, I am sure the Minister agrees that access to a GP is critical, whether that is in detecting and monitoring diabetes or, in relation to the first Question, detecting and monitoring cancer. Would she be surprised, therefore, that in Northern Ireland it is almost impossible to access a GP at present? Indeed, it is at an all-time low. Will she consider doing a comparative study across the United Kingdom to look at access to GPs because, unfortunately, I believe it is not a very good story at all.

[Baroness Merron (Lab)]

I hear what the noble Baroness says and I am glad to report that I met the Northern Ireland Health Minister recently, along with colleague Peers, to discuss a range of matters including differences across the nations. I will consider the point that she makes.

[Lord Kamall (Con)]

My Lords, while the original Question was about type 2 diabetes—as the noble Lord, Lord Patel, said, type 2 diabetes can be due to lifestyle and can sometimes be reversed—I want to ask the Minister about type 1 diabetes. Its exact cause is unknown and people can get it at any time of their life, yet there is no cure, so in some ways the need for CGM is more critical. The charity Breakthrough T1D, which represents type 1 diabetics, finds that black, Asian and minority ethnic groups in England and Wales and lower socioeconomic communities are much less likely to get access to or use these technologies. Closing that gap was one of the issues that we grappled with in government, so can the Minister tell the House what plans there are to ensure that as many type 1 diabetes patients as possible across England receive access to continuous glucose monitoring?

[Baroness Merron (Lab)]

It is probably important to say at the outset that type 1 diabetes, as the noble Lord knows, is not related to lifestyle issues, and at this point cannot be prevented, so it is a case of management. The technology that is available now is quite remarkable— not just the CGMs that the noble Lord, Lord Rennard, inquired about, but also hybrid closed loop systems, where the CGM is paired with an insulin pump, so it is administered automatically without the person having to calculate. I think that is incredibly helpful. It is only available to those eligible, with type 1 diabetes, but the rollout began in April 2024. The noble Lord makes a good point, as did the noble Lord, Lord Rennard, about access and inequality in access. That is something we continue to work on, ensuring that everybody can fairly access these wonderful technology advancements.

[The Lord Bishop of London]

My Lords, women with type 2 diabetes face a higher risk of miscarriage, stillbirth, neonatal deaths and birth defects. As we have heard, women who live in areas of high deprivation as well as women who come from black and minority ethnic groups are more likely to be impacted by type 2 diabetes. This compounds the existing inequalities in the maternal mortality rate. What steps are the Government taking to support integrated care boards to build relationships with these women who are most likely to experience these impacts, to ensure that they have the best maternity care and diabetic care, including ensuring they have access to continuous glucose monitoring where necessary?

[Baroness Merron (Lab)]

The right reverend Prelate is quite right in what she says, including that responsibility for CGM implementation rests with integrated care boards. It is their responsibility to ensure that the technologies we are talking about can be accessed by all eligible patients regardless of their ethnicity or their indices of multiple deprivation. I assure the right reverend Prelate that achieving that equality of access in all diabetes technology is an absolute priority. We will continue to monitor progress and encourage ICBs to do that by the NDA quarterly dashboard in 2025-26. In other words, we will give ICBs the tools to do the job they need to do.

[Baroness Humphreys (LD)]

My Lords, the use of CGMs makes diabetes easier to manage, as they give not only instant information about blood sugar levels but also indicate whether levels are rising or lowering. The DVLA, however, insists on two-hourly glucose monitoring by the traditional finger pricking method when driving on long journeys. Does the noble Baroness envisage a change in this guidance in the near future?

[Baroness Merron (Lab)]

I must confess that is something that I will need to look into—it may be with my ministerial colleagues in the Department for Transport. But I will look into it, and I will be pleased to write to the noble Baroness.

[Baroness Ritchie of Downpatrick (Lab)]

My Lords, as part of ongoing research, would my noble friend talk to her ministerial colleagues about possible research that is required into the causes of type 1 diabetes, and if more updated research could therefore provide new types of technologies and treatment? There is no particular cure at this moment in time, and people live with it on a daily basis, hour by hour.

[Baroness Merron (Lab)]

Through the National Institute for Health and Care Research, £206 million was awarded to diabetes research in the last five years through its research programme. The NIHR and Diabetes UK have developed a joint strategy which will inform diabetes research in the UK. I hope that can get us to the place that my noble friend refers to.

National Carers Strategy

Baroness Merron Excerpts

Tuesday 19th November 2024 Lords Chamber

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

My Lords, we are committed to supporting unpaid carers through our renewed vision for adult social care and the 10-year plan for the National Health Service. We have already taken action to increase the carer’s allowance earning limit, meaning that carers can earn around £2,000 a year more without affecting their entitlement. We have heard the calls for a national carers strategy and will continue to work collaboratively across government to ensure that unpaid carers are visible, valued and supported.

[Baroness Keeley (Lab)]

I thank my noble friend the Minister for that reply, particularly on cross-governmental working, because I think that is one of the most important aspects. The Labour Government’s first national carers strategy was launched in 1999 by the Prime Minister, Tony Blair. The second strategy in 2008 had the support of Gordon Brown and seven Secretaries of State, because evidence from unpaid carers had shown that support for carers could not be solved by one government department but needed work across several. Sadly, Conservative Governments after 2015 did not continue with the national strategy, preferring a much less effective carers action plan. Carers are partners in care, so will my noble friend the Minister consider the strength of feeling among carers and their support organisations that they need and deserve a high-level strategy across government departments to support them?

[Baroness Merron (Lab)]

I certainly agree with the emphasis that my noble friend is putting on the need for cross-government working. I know she has been a champion of that for many years in the other place and that she will continue in your Lordships’ House to ensure that unpaid carers are properly supported and recognised. I can tell my noble friend that Minister Kinnock, as the lead Minister for unpaid carers, regularly engages with those with lived experience, the organisations that represent them and—importantly to the point my noble friend is making—with Ministers from other government departments, most recently the Department for Work and Pensions. We will be formalising our cross-government working with relevant departments and NHS England.

[Lord Laming (CB)]

My Lords, if the Government are going to achieve their ambition to delay admissions to hospital and get people out of hospital more quickly, does the Minister agree that we have got to have proper support for carers? In particular, we should enable them to feel valued for what they are doing on behalf of their family and society as a whole.

[Baroness Merron (Lab)]

I agree with the comments and observations of the noble Lord. I would like to put on record, as I know many Members of your Lordships’ House would want to do, my thanks for and acknowledgement of the role that unpaid, as well as paid, carers play. They are the difference between quality care and less than optimal care. Their support is greatly valued, so I thank the noble Lord for making that point.

[Baroness Fraser of Craigmaddie (Con)]

My Lords, I declare an interest as chief executive of Cerebral Palsy Scotland. Disabled adults of working age tell me that one of the reasons they have to fall back on family and unpaid carers is the dire shortage of availability of good PAs to help them work and live. Can the Minister confirm that the national carers strategy will look at access to PAs for working-age adults?

[Baroness Merron (Lab)]

I do have to say to the noble Baroness that I have not committed to a national carers strategy. However, in our joined-up approach, we will certainly be looking at what is needed. That will be very much part of our considerations on the workforce strategy, which Minister Karin Smyth will be leading on. It is crucial to the delivery of services.

[Baroness Pitkeathley (Lab)]

My Lords, would my noble friend agree that one of the major problems suffered by carers is recognition, not just by other people but by themselves? They say, “I am a wife”, “I am a husband”, “I am a mother”, “I am a daughter” or “I am a son”, not “I am a carer”. Therefore, a very high-profile national strategy led from the very top—previously, two Prime Ministers took this on board—would be extremely useful in helping carers recognise themselves and therefore putting them in touch with services that could support them.

[Baroness Merron (Lab)]

My noble friend, who is a very impressive campaigner on the rights of carers, is right to talk about recognition. Of course, if one does not understand that one is a carer, it is hard to access support. I certainly agree on that point. There is guidance, for example, to support GPs in recording which of their patients are unpaid carers, to ensure that they get access to the support they need. Importantly—this has been raised a number of times in this House—in respect of young carers, there is guidance for GPs and it has recently been added to the school census, so young carers can be identified in order that there can be an assessment of needs. So it is true that we need to identify in order to support. Part of that is people recognising themselves as carers.

[Lord Kamall (Con)]

My Lords, I also pay tribute to the work of the noble Baroness, Lady Pitkeathley. I learned much from her when I was the Minister. The Minister may recall that, in April 2023, the previous Government set out the better care fund framework. This included £100 million to accelerate digitisation in the social care sector. This would enable the Government and NHS England to collect valuable data about the state of social care and identify gaps if the Government decide to deliver a national strategy. What plans do the Government have to continue and expand this vital process of digitisation across the care sector, hopefully in delivering a national strategy?

[Baroness Merron (Lab)]

It is indeed the case that using technology and digital advance is key in all the areas where we are working, and the noble Lord will know that in the 10-year plan one of the three pillars will be, for example, going from analogue to digital. On that point, plans for going forward in dealing with social care, which is much needed in this country, will be set out in due course. I assure your Lordships’ House that it will be done through a cross-party approach, involving those with lived experience and the many voices and organisations that are part of the social care sector. We are keen that it is something that we can all get behind.

[Baroness Burt of Solihull (LD)]

As the Minister has said, the carer’s allowance was increased in the Budget by what can only be described as a modest amount, but it remains at one of the lowest levels for any benefit in the UK today. No help has been given to any carer who inadvertently overclaimed, even by £1. If the Government chose, they could stop collecting the overpayments while the independent review that they have commissioned takes place. Carers saddled with returning this money are struggling and suffering now. Why cannot the Government give them a break?

[Baroness Merron (Lab)]

I understand the point that the noble Baroness is making. Certainly we recognise that overpayments have caused people great anxiety. That is why it is important to review the circumstances independently, so we can find out exactly what went wrong and make things right, so it does not happen again. The main message I would give is to urge anyone in receipt of carer’s allowance to inform the DWP of any change in their circumstances in respect of the earnings limit, so that overpayments can be avoided. But we are seeking to work constructively to ensure that this is not an ongoing problem.

[Baroness Lister of Burtersett (Lab)]

My Lords, a key element of any carer’s strategy, or non-strategy, must be to make it easier for carers to combine caring with paid work. As well as long-overdue reform of carer’s allowance, there is wide agreement that carer’s leave needs to be paid if it is to be effective. Will the Government therefore consider introducing it, at least in principle, as part of the Employment Rights Bill, rather than leaving it to a review?

[Baroness Merron (Lab)]

The Government are committed to reviewing the implementation of carer’s leave—and also examining the benefits of introducing paid carer’s leave. As my noble friend said, the Employment Rights Bill includes provisions that will support all employees to support a better work/life balance by making flexible working the default, unless it is not reasonably feasible. That gives us an opportunity to make a particular difference for those combining work with unpaid care. Certainly, we are looking at the benefits of introducing paid carer’s leave, and I look forward to updating your Lordships’ House.

Cancer: Older People

Baroness Merron Excerpts

Tuesday 19th November 2024 Lords Chamber

[Baroness Ritchie of Downpatrick]

To ask His Majesty’s Government what steps they are taking to ensure a UK-wide approach to improving outcomes for older people with cancer.

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

My Lords, sadly, the risk of developing cancer increases as a person gets older. Health is a devolved matter, as your Lordships’ House will know, and the department is working with the NHS in England to improve outcomes for people of all ages with cancer. On my noble friend’s specific point, we are working to bring England in line with other nations by delivering a new national cancer strategy next year following the publication of the 10-year health plan.

[Baroness Ritchie of Downpatrick (Lab)]

I thank my noble friend for her Answer. I am sure she is aware that the UK’s cancer burden is projected to rise by around one-third by 2040, and 60% of those cancer diagnoses are expected to be among those aged 70 and above. Yet there is evidence that older people’s cancer care is not always provided to the level that it should be. Therefore, what assurances can she give me of actions the Government will take as part of the forthcoming cancer plan and the 10-year NHS plan to address these health inequalities in cancer care and treatment throughout the UK?

[Baroness Merron (Lab)]

My noble friend is quite right that the incidence of cancer is expected to rise across the UK, especially in older people. I agree that older people can face specific barriers when accessing care. Following on from the independent review by the noble Lord, Lord Darzi, I assure my noble friend that the 10-year health plan and the subsequent cancer strategy for England, both to be published next year, will help us do more to prevent cancer, identify it early and treat people quickly. They will have regard to older people.

[Lord Patel (CB)]

My Lords, I am delighted to hear that we will have a new cancer strategy. I have tried to get a debate in this House on that for two or three years now. Maybe the Minister will use her influence with the powers that be so that we can have a government-led debate on the cancer strategy. However, one of the reasons why our outcomes are poor is late diagnosis of cancer. Only 54% of cancers are diagnosed at stages 1 and 2. What plans do the Government have to improve early diagnosis of cancer?

[Baroness Merron (Lab)]

I am sure the powers that be heard what the noble Lord said about a debate. On the point he raised, I absolutely agree that diagnosing cancer earlier, at stages 1 or 2, improves outcomes and survival. I refer again to the report by the noble Lord, Lord Darzi: we need to do more to diagnose people at an early stage. Work is already being undertaken to improve cancer screening uptake. We will continue to roll out targeted interventions such as the lung cancer screening programme, which has a particular effect and impact on the most disadvantaged areas. Members of your Lordships’ House will know that the Budget also committed to £1.5 billion of capital funding for new surgical hubs and diagnostic scanners, which will increase capacity.

[Lord Kamall (Con)]

My Lords, I will carry on the thread of questioning that the noble Lord, Lord Patel, started about early diagnosis. As the Minister said, it is very important that we look at early diagnosis. Noble Lords who are interested in diagnosis were looking forward to a follow-up report to the 2020 community diagnostic centre review by Sir Mike Richards. That was due to be published before the Budget, yet the Health Service Journal has reported that it has been shelved. Is this true? If so, can she explain why?

[Baroness Merron (Lab)]

It is important that we concentrate on the biggest ever NHS consultation, because that will lead us to the 10-year plan, and all that we are doing will sit within that. As the noble Lord will know, we are committed to getting the NHS to diagnose cancer earlier, treat it faster and improve waiting times. One of the announcements in the recent Budget, which also shifts the dial, is that we will deliver an extra 40,000 scan appointments and operations every week. The 10-year health plan will set out our approach for shifting healthcare from sickness to prevention, including reducing the incidence of cancer.

[Baroness Burt of Solihull (LD)]

My Lords, my mother-in-law died riddled with cancer that was not diagnosed until the very end of her life. We know that older people often suffer from several conditions and that frailty may minimise the treatment options available. The comprehensive geriatric assessment is the gold standard for the assessment of older patients and can make a real difference in outcome and cost, but cancer is not embedded in that assessment. Will the Minister find out from clinicians whether that might be possible?

[Baroness Merron (Lab)]

I give my sincere condolences to the noble Baroness and her family. Yes, I will raise that. It is a good point to look at, and I thank her.

[Baroness McIntosh of Hudnall (Lab)]

My Lords, what plans do the Government have, if any, to include older people in routine screening programmes, particularly given all the statistics that we have heard in the course of this Question and others? I have asked this question before. I have never heard an answer that I found entirely convincing. I am confident my noble friend will be able to help on this occasion.

[Baroness Merron (Lab)]

I thank my noble friend for her confidence, and I will do my best. Decisions on screening, including the age ranges at which they operate, are made by the UK National Screening Committee. They have an upper and a lower age limit, which are based on evidence and kept under review. Current evidence does not support making changes to these ages. For breast screening, for example, self-referral is available for those over the age of 71 and for bowel screening it is available for those over 75. I confirm to her that this is all evidence-based, and we always keep an eye on the continuing evidence.

[Lord Lansley (Con)]

My Lords, I declare an interest in that I am a happy statistic of having survived more than five years after cancer treatment. But I know that I am not alone and that many others of the near 2 million cancer survivors have chronic conditions resulting either from cancer or from its treatment. Will the cancer strategy recognise and offer support to the many cancer survivors who have continuing chronic conditions resulting from their cancer?

[Baroness Merron (Lab)]

I am glad that the noble Lord is, as he describes himself, a happy statistic. We are all grateful for that. I certainly share the view that there are a number of ongoing chronic conditions and impacts on other aspects, such as people’s mental health. The cancer strategy needs to look at this in its development, and I am grateful to him for highlighting it.

[Baroness Pitkeathley (Lab)]

My Lords, as another happy statistic, I ask whether my noble friend thinks that older people are perhaps more reluctant than our younger friends to mention symptoms and are more inclined to say, “Oh, it’s nothing; I’ll get over it”. Would more public education programmes be useful in this regard?

[Baroness Merron (Lab)]

I am glad that my noble friend is also a happy statistic—although I see all noble Lords as more than just statistics. She makes a very good point but it is not just about those who are older; many people are reluctant to consider taking action when they have symptoms. My request to them is that they do not wait and that they act. That is how we get things diagnosed earlier, to provide the right support and care. There is a lot of embarrassment about certain symptoms and I make the plea that people should not be embarrassed. Certainly, as she suggests, the new cancer strategy will take account of how we educate people as well as diagnose and treat them.

Support for Infants and Parents etc (Information) Bill [HL]

Baroness Merron Excerpts

3rd reading
Friday 15th November 2024 Lords Chamber

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

My Lords, I thank the noble Lord, Lord Farmer, for bringing this Bill to the House and for meeting me to discuss it. I have no doubt whatever that he will continue to advocate for children’s health with his customary passion and dedication. I am also thankful to the noble Baroness, Lady Berridge, for enabling today’s debate.

This Government are committed to raising the healthiest generation of children in this nation’s history. However, as I expressed at Second Reading, while the intentions of the Bill are good, we need to be able to deliver a package of support for infants, children and families that is comprehensive rather than piecemeal. Through our mission-led approach, the Government will drive long-lasting and sustainable change for babies and children. As the Prime Minister has confirmed, in the coming weeks, we will publish clear ambitions for each mission, putting the health and well-being of our children at the heart of everything we do.

While we cannot support the Bill of the noble Lord, Lord Farmer, I can assure your Lordships’ House that we will continue to work tirelessly to improve the lives of babies and children right across the country.

A privilege amendment was made.

Diets: Fat

Baroness Merron Excerpts

Thursday 31st October 2024 Grand Committee

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

My Lords, I thank the noble Lord, Lord McColl, for bringing this important issue to the fore. He is a doughty campaigner and I know he has many strong views, to which I have listened not just on this occasion but on many occasions. I welcome the airing that we are having today. I thank other noble Lords, too, for their contributions. As ever, there is a fair amount of common ground and quite a bit of divergence in the opinions about how we tackle what is an obesity crisis. I particularly thank noble Lords, including my noble friend Lord Mitchell and the noble Lord, Lord Rennard, for sharing their very personal experiences; that always assists us.

As many noble Lords have said, there is no doubt that obesity is significant in our country—and not just our country. As the noble Lord, Lord Kamall, observed, over 28% of adults are living with obesity, which puts them at risk of a whole range of health conditions. Obesity is also estimated to cost the NHS more than £11 billion per year, with total costs to the UK of £74 billion per year. The noble Baroness, Lady Jenkin, rightly referred to children’s obesity. It is shocking to realise that children with obesity are five times more likely to be living with obesity as adults. In other words, the seeds sown at the beginning are reaped in a none-too-positive way later on down the line. As mentioned by a number of noble Lords, obesity is particularly concentrated in the most deprived areas, with prevalence for children in the most deprived areas being more than double that in the least deprived areas. That gives some idea of what we are up against. As the noble Lord, Lord Krebs, and other noble Lords indicated, it is absolutely clear that we have to take action.

I share the view expressed that the challenge before us is complex. It would be wrong to see it any other way. Indeed, I share the view that obesity is primarily caused by the consumption of excess calories. We have a food environment where unhealthy foods have become cheaper and more readily available. The noble Lord, Lord Krebs, made a point about a local fitness centre display in his own area. I certainly echo his sentiment that this is not an appropriate way to assist people’s fitness. If the noble Lord has not already, I encourage him to complain to his local authority, because we need a cultural shift as well as a number of practical shifts.

In addition to the food environment that we are in, portion sizes have increased. The noble Lord, Lord McColl, rightly shines a light on this, and we are committed to addressing it. We have made a good start, and our mindset is very much about prevention over cure.

On the question from the noble Lord, Lord Krebs, we have committed to implementing junk food advertising restrictions on TV and online and to limiting schoolchildren’s access to fast food. Our 10-year health plan will also reform the NHS by shifting the focus from sickness to prevention, as noble Lords have already observed.

On the point raised by my noble friend Lord Brooke, as announced by the Chancellor yesterday we will take steps to ensure that the soft drinks industry levy remains effective and fit for purpose. That will be done by ensuring that the levy is uprated to reflect inflation since it came into force and in the future. Importantly for me, the Government will also review the soft drinks industry levy’s operation and structures, to aim to further drive down the sugar content in soft drinks. We will also review the sugar thresholds at which it applies and the exemption for milk-based drinks. I will be pleased to keep noble Lords informed on this development.

I heard the observation by the noble Lord, Lord McColl, that he considers that there is—if I may use this term—a demonisation of fats. I assure him that the dietary recommendations are about promoting a balanced diet. The advice given tells people not to avoid fat per se but—the noble Lord, Lord Krebs, referred to this—to eat foods containing saturated fats less often and in smaller quantities, and to swap to unsaturated fats where possible. The reason for this focus is that there is robust evidence that switching saturated fat for unsaturated fat lowers blood cholesterol and reduces the risk of heart disease by almost a fifth. With more than 150,000 deaths from cardiovascular disease every single year, this is crucial. Indeed, the guidance and the policies, such as junk food advertising, cover both saturated fat and sugar—something of great interest to my noble friend Lord Brooke—so it is not one thing or another, as is often the case when we are speaking about this matter.

Over 12 million people are living with obesity, so we need to provide support for them too—a number of noble Lords correctly outlined the importance of that support. The NHS and local government provide a wide range of services, including behavioural support programmes that provide advice to help people to adapt to a healthier diet.

There are more specialised services for people living with severe obesity and for associated comorbidities. These can prescribe some of the newer obesity medicines as well as offering surgery. However, I emphasise that they should be considered further down the treatment pathway. Exactly what is appropriate for any individual is down to clinicians to advise, in discussion with that patient, and to consider clinical guidance.

The noble Lord, Lord McColl, referred to Ozempic. As he will be aware, it is licensed to treat type 2 diabetes, and healthcare professionals have been reminded in guidance that it should not be prescribed solely for weight loss, although the obesity medicine Wegovy is approved for weight management on the NHS. However, obesity medicines are not a first-line treatment. Other things need to be tried first and other support needs to be in place.

I agree that the primary focus should be on supporting behavioural change, including a healthier diet, and that is confirmed through NICE guidance, but we should acknowledge that obesity medicines can be very effective at helping some people to lose considerable amounts of weight, as my noble friend Lord Mitchell and the noble Lord, Lord Rennard, have described and demonstrated. The losses are considerable—in some cases, over 20% of body weight—and that is a benefit to health.

However, as I said, these medicines should not be given alone, and support on diet and increasing physical activity, which the noble Earl, Lord Caithness, spoke about, are crucial. We need the food environment to be supportive for those managing their weight, ensuring that it is easier for people to eat more fibre, more vegetables and less sugar and salt, and to swap saturated fat for unsaturated.

I turn to the reference to “jabs for jobs”. I am grateful that noble Lords have raised this issue today, because it is an opportunity to address the media coverage. The suggestion is that the Government will somehow target people who are unemployed with such medicines to help them to get back to work. I want to be clear: the NHS continues and will continue to treat people on clinical need. We are not targeting those who are unemployed. The coverage in the media refers to a study funded by the manufacturer of one of these obesity medicines. It will build evidence to increase our understanding about the potential wider value of such medicines, and it will look at the impact on health and healthcare use and collect data on things such as change in employment status.

I turn to some of the other points raised. In answer to my noble friend Lord Brooke, we are indeed looking at incentives for reformulation and considering the balance of mandatory and voluntary measures.

I thank the noble Earl, Lord Caithness, and the noble Baroness, Lady Jenkins, for raising the work of the House of Lords committee. I am glad to see that it has recently published its final report, and I look forward to looking at it and considering the recommendations.

There are a number of specific questions that I have not been able to address, and I will be very pleased to pick up specifics in that regard.

To conclude, obesity medicines are not to be seen as the first thing to turn to—the guidance is clear on that—but they have a place for some people when other options have not worked. We and the NHS are looking at how best to make the medicines that we are considering today available in a safe and effective way.

Hospices: Funding

Baroness Merron Excerpts

Thursday 24th October 2024 Lords Chamber

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

My Lords, I am grateful for the thoughtful and constructive approach that noble Lords have taken to this important issue and for a number of considered proposals, which I will share with my colleague, Minister Stephen Kinnock, who is responsible as the Minister for Care. I know he will be interested.

I congratulate the noble Lord, Lord Farmer, not just on securing this debate but on the way he set out his thoughts, which enabled the debate to be so constructive and sensitive to the issues at hand. I share the thanks given by a number of noble Lords, and take this opportunity to thank all those working or volunteering—as my noble friend Lady Pitkeathley highlighted—in the palliative and end-of-life care sector, including in hospices, for the invaluable support, care and compassion that they provide to people and their loved ones when they need it most.

Like the noble Earl, Lord Effingham, and other noble Lords, I pay tribute to the contribution of Dame Cicely Saunders. She was indeed—and can be regarded very much as—a pioneer. Many people in this Chamber and outside have also played their part, and I thank them too.

Approximately 600,000 people die each year in the UK and that figure is set to increase as we have an ever-ageing population. That will mean an increase in the number of people who need palliative and end-of-life care. As we have heard today, palliative care can help in the hardest of times. It is care that makes a real difference. It can make something that seems quite unbearable a bit more bearable. It can give dignity. I was very interested to hear the noble Lord, Lord Farmer, state his definition of dignity. For me, dignity is crucial at all times and never more so than at the end of one’s life. It also makes it more manageable for not just the person being cared for but their loved ones too.

As a Government, we want a society where every person receives high-quality, compassionate care, from diagnosis through to the end of life. While the majority of palliative and end-of-life care is provided by NHS staff and services, we recognise the vital part played by voluntary sector organisations. Many noble Lords know that it is difficult to quantify how much palliative and end-of-life care is being provided at national or local integrated care board level, because care is provided across multiple settings, including in primary care, community care and hospitals, as well as in hospices. It is delivered by a wide range of specialist and generalist health and care workers, who provide care for a wide range of needs. These include, but are not always exclusive to, palliative care.

I recognise that there are more than 200 charitable hospices supporting more than 300,000 people in the UK with life-limiting conditions every year. As noble Lords have observed, most hospices are charitable, independent organisations that receive some statutory funding for providing NHS services. On the point about funding, in England integrated care boards are responsible for commissioning palliative and end-of-life care services to meet the reasonable needs of their local populations. On the point raised by the noble Lord, Lord Farmer, and other noble Lords, ICBs are responsible to NHS England, which has published statutory guidance on palliative and end-of-life care to support commissioners with this duty. It includes specific reference to ensuring that there is sufficient provision of specialist palliative care services and hospice beds, and future sustainability.

The noble and right reverend Lord, Lord Sentamu, the right reverend Prelate the Bishop of London and the noble Lord, Lord Farmer, raised the issue of variation by ICB area. It is important to note that this is in part—I emphasise “in part”—dependent on what is already available in terms of services, along with local needs. Noble Lords will recall the Health and Care Act 2022, which was a key moment. I remember the noble Baroness, Lady Finlay, being very involved in getting palliative care services added to the list of services an ICB must commission in response to the needs of its local population.

In addition to the guidance and service specifications, NHS England has commissioned the development of a care dashboard. The relevance of that is that it brings together all the relevant local data into one place and it will help commissioners to understand the needs of their local population and give them the ability to filter the available information—for example, by deprivation or ethnicity. That is meant to enable ICBs to put plans in place to track and address the improvement in health inequalities.

I will refer to the highly sensitive area of assisted dying, which was raised by the noble Lords, Lord Farmer and Lord McColl, and other noble Lords. I reconfirm to your Lordships’ House that, if the will of Parliament is that the law on assisting dying should change, this Government will work to ensure that it is implemented in the way that Parliament intended and is legally effective. I add that, irrespective of whether the law changes on this matter, we will and must continue to work towards providing high-quality, compassionate palliative and end-of-life care for every person who needs it.

I shall briefly look to the future and say to my noble friend Lady Pitkeathley, who raised the matter of research, that through the National Institute for Health and Care Research the department is investing £3 million in a new policy research unit in palliative and end-of-life care. The unit was launched at the beginning of this year and it will build evidence in this area. To respond to the right reverend Prelate the Bishop of London, it will have a specific focus on inequalities, which I very much welcome.

Noble Lords will be aware that this Government have committed to developing a 10-year plan to deliver an NHS that is fit for the future. We will be considering a whole range of policies, including those that impact people with palliative and end-of-life care needs. I say to the noble Lord, Lord Howard, that one of the three shifts that the plan will deliver is around the Government’s determination to shift more healthcare out of hospitals and into the community. The noble Lord referred to a plan by Hospice UK and said it was looking to update it. We will certainly be pleased to hear from Hospice UK on that matter. Palliative and end-of-life care services, including hospices, will play a very big part in that shift from hospitals to the community.

I turn to some of the additional points that noble Lords have made. I say to the noble Baroness, Lady Finlay, who has made such a big contribution in this area, and the noble Lord, Lord Balfe, who has been a strong advocate, particularly in respect of children’s hospices, that we will indeed be delighted to look at the Welsh experience. Just this week I had a meeting with the Welsh Minister, so I will be following up on that.

The noble Lord, Lord Farmer, asked whether there will be a move to implement the recommendations in the APPG report that would ensure that funding flows to hospices. As I have said, we are determined to move more towards community healthcare and we will certainly work with hospice providers to understand their views as part of this work.

I am sure that we were all very moved to hear my noble friend Lord Monks share his experience of the sad loss of his son Daniel; my sincere condolences to my noble friend and to his family and friends. I heard what he and so many other noble Lords had to say about the quality of care received in hospices, and I too will pay tribute.

I will of course take up the points made by the noble Baroness, Lady Berridge, on gift aid with my colleagues in the Treasury.

I say to the noble Lord, Lord Balfe, and to other noble Lords that my colleague the Minister of State for Care has recently had meetings with NHS England to look at a way forward in the whole area of providing services. I know that he also met the noble Lord, Lord Balfe. We are particularly anxious to reduce inequalities and the work going forward will look at that.

I will review the debate and if there are particular questions that I have not answered, I will of course do so. I will also address the comments and suggestions made by the noble Lord, Lord Scriven. I thank all noble Lords, and particularly the noble Lord, Lord Farmer, for leading us in this debate.

Human Medicines (Amendments Relating to Naloxone and Transfers of Functions) Regulations 2024

Baroness Merron Excerpts

Wednesday 23rd October 2024 Lords Chamber

Moved by

[Baroness Merron]

That the draft Regulations laid before the House on 29 July and 15 May be approved.

Relevant documents: 1st Report from the Secondary Legislation Scrutiny Committee (special attention drawn to the first instrument by the Secondary Legislation Scrutiny Committee, 2nd Report). Considered in Grand Committee on 22 October.

Motions agreed.

Human Medicines (Amendments Relating to Naloxone and Transfers of Functions) Regulations 2024

Baroness Merron Excerpts

Tuesday 22nd October 2024 Grand Committee

Moved by

[Baroness Merron]

That the Grand Committee do consider the Human Medicines (Amendments Relating to Naloxone and Transfers of Functions) Regulations 2024.

Relevant document: 2nd Report by the Secondary Legislation Scrutiny Committee. Special attention drawn to the instrument.

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

My Lords, this draft statutory instrument proposes amendments to the Human Medicines Regulations 2012, which will expand access to naloxone, a life-saving medication that prevents death from opioid overdose. In addition, this draft statutory instrument makes amendments to keep the regulations current by updating references to Public Health England and the Health and Social Care Board, following the dissolution of those bodies.

We know the devastating impact that illicit drugs cause. Drugs destroy lives, tear families apart and make our streets less safe. Drug misuse deaths have doubled in number over the past 10 years, and we know that people who die from drug misuse often do so at a tragically young age, often in their 40s. Almost half of drug misuse deaths in 2022 involved opiates such as heroin. These deaths are avoidable. Dedicated drug treatment services provide the path to recovery and this Government are continuing to ensure that treatment is available and of high quality.

However, we also know that over half of people struggling with opiate addiction are not engaged in treatment. These are incredibly vulnerable people who often have multiple and complex needs; they are at increased risk of accidentally overdosing and dying. Tackling this issue supports the Government’s health mission. It will ensure that people can live longer, happier and healthier lives, and it chimes in with our collective efforts to break down barriers to opportunity and create a fairer society.

Naloxone is a highly effective antidote to opiate overdose. It can already be administered quickly and safely by anyone in an emergency, but current regulations specifically enable only drug and alcohol treatment services to supply it for future use without a prescription. That limits the reach of this life-saving medicine.

The draft instrument that we are debating today proposes two key UK-wide changes to existing regulations: first, to expand the list of services and professionals named in the regulations who can give out naloxone without a prescription. That means that professionals such as registered nurses and probation officers will be able to provide take-home supplies of naloxone where appropriate, should they wish to do so.

Secondly, it proposes to establish national registration services across the whole UK. This will enable other services and professionals who are not able to be named in the legislation but who come into contact with people at risk of overdose, including housing and homelessness services, to register and procure naloxone.

There is a positive background to these changes. The Department of Health and Social Care consulted on them at the beginning of this year and received over 300 responses spanning a range of organisations and professionals from across all four nations of the UK. Of these responses, approximately 95% agreed with the proposals that are set out. This demonstrates the level of interest in this important issue and the breadth of support for the changes we are seeking to achieve.

These changes have also been called for by experts in the sector such as the Advisory Council on the Misuse of Drugs in its review of naloxone in the UK. In addition, Dame Carol Black recommended naloxone provision as an important harm reduction measure in her two-part independent review of drugs.

Allowing more services and professionals to supply naloxone will mean easier access to it for people at risk, which in turn will mean lives saved. With the growing threat posed by synthetic opioids, which are often more potent and more deadly, the importance of this work only continues to increase as time goes on.

I want to provide reassurance that, with these changes, there is no compromise on safety. Naloxone is very safe and effective, even when administered by a layperson with no prior experience. It has an effect only if the person has been taking opioids and it is already widely used across the UK and internationally.

We are taking steps to mitigate against any very limited risks associated with wider access. We will provide updated guidance for services in scope, and we will set out robust requirements for training and safeguarding. I reassure the Committee that the intention of these changes is not to create additional burdens for services, particularly as we are aware that many of those in scope will already be facing pressures. These new powers are enabling, not mandatory. They provide an opportunity for increased provision, based on local need, but they do not make any requirements.

Finally, addiction is not a choice. It is often fuelled by wider issues, such as trauma and housing instability. This is a complex public health issue and must be tackled as such. We must change the narrative on addiction to one that is about the prevention of drug use, the reduction of harm and enabling recovery. The changes we are discussing here will save lives. On this basis, I beg to move.

[Lord Scriven (LD)]

I thank the Minister for setting out the rationale for this draft statutory instrument so well. I agree that this is a step forward in the ongoing battle against the devastating impacts of opioid overdoses. As she said, opioid overdoses have reached alarming levels, claiming thousands of lives every year. According to the latest statistics, opioid-related deaths have surged alarmingly in most regions. This is not merely a statistic. This is about the loss of lives, families shattered and far too many left to grieve, so it is important to take further action that is effective and wrapped in compassion. The temporary measures taken in Scotland show that the changes outlined in these regulations work and will save lives.

Naloxone, when used in the right place at the right time, is a life-saving medication. This draft statutory instrument will facilitate local supply networks, ensuring a broader distribution system and therefore more effective use of naloxone, empowering, among others, healthcare professionals, the police, prison and probation staff, and people in the youth justice system to facilitate the supply of this life-saving drug.

In response to one of the issues that the noble Baroness raised, a question occurred to me. As this will not be a mandatory provision across the country, how will the Government monitor lives that could be saved but that may not be saved because of a lack of take-up of this in certain towns, cities or regions? It could end up that a life will be saved if one body decides to do this, while a life could be lost in a neighbouring county, city or town if that does not take place.

One of the key provisions in this draft statutory instrument is the move to enable the friends and family of those at risk to administer this drug. Allowing those closest to individuals at risk to carry and administer naloxone creates a lifeline that will, literally, make the difference between life and death.

I listened to what the Minister said about setting up local naloxone providers and supply co-ordinators, and I have read the draft statutory instrument and the explanation—but I am still not clear about what regulatory oversight of these bodies will be in place. Who will be the regulator and what powers will they have to deal with the improvement or, indeed, withdrawal of such a service if it is deemed that the local provider is not carrying out the rules laid down in the draft statutory instrument?

Clearly, the broader implications of these amendments are not merely about the use naloxone but about standing with those who struggle with addiction, and their families. These amendments are an essential evidence-based response to the dramatic increase in opioid use and overdoses. By enabling greater access to naloxone, they will help to save lives.

--- Later in debate ---

[Baroness Merron (Lab)]

My Lords, I am grateful to the noble Lord, Lord Scriven, who I do not believe I have had the opportunity of welcoming formally to his new Front-Bench role. I am delighted to do that today; he is most welcome. I very much look forward to working with him and hope that he enjoys his role. I am also grateful to the noble Lord, Lord Evans, as ever, for his contribution.

I am pleased that both noble Lords, on behalf of their Front Benches, have been so positive in welcoming these regulations. I certainly agree with the closing words of the noble Lord, Lord Scriven: in doing this today, we are standing with those who struggle with drug use and with those around them—the communities, their families and their friends. It is with that motivation in mind that we are doing this.

I will of course write to noble Lords if there are any points that I do not manage to cover adequately. To pick up some of the points, however, the noble Lord, Lord Scriven, asked who will regulate. As part of the legislation, as I said in my introduction, there will be training and data-reporting requirements attached to both routes for new providers. Those new providers could be the emergency services, for example, and they will have to report on levels of prescribing so that effectiveness and safety can be monitored. That will absolutely be required of them.

[Lord Scriven (LD)]

The Minister might not still welcome me to my place now but although I understand that, my point was: what powers do those whom they report to have in ensuring compliance? That is the bit I did not get from reading the regulations.

--- Later in debate ---

[Baroness Merron (Lab)]

That is understood. I am sure that the noble Lord will be delighted to know that this is to be established, but he is certainly quite right to raise that point. I will ensure that, once that detail is established, it is made known.

On the point about a potential additional burden on services, which the noble Lord, Lord Evans, raised, we certainly recognise the fact that there are challenges in the scope of these regulations. Our intention—I stress intention—is not to create any additional burden. I think I was quite clear in mentioning that these are enabling, not compulsory, requirements. That is important, because it means that no service or individual professional will actually be required to give out take-home naloxone as a result of these regulations. That potentially allows a more gradual introduction of this.

For example, I know that the noble Lord, Lord Scriven, mentioned that there may be differences in the level of take-up across the country. I suspect that may well be the case. It will be our job not just to encourage it to be taken up but to work out why it is not being taken up. We will not just bring in this instrument; we will seek to actively promote it. As I said, we are confident that there is a high level of support for these changes and we will continue to work closely with services and professionals to support them with provision.

The noble Lord, Lord Evans, rightly said that the previous Government undertook the consultation. I am most grateful for that because it has informed where we are today. That consultation under the previous Government received significant positive support from the sector, with the overwhelming majority of respondents agreeing with the set-up of the changes.

The noble Lord, Lord Evans, raised a question about costs. There is no direct cost to the Government associated with these changes since, as the noble Lord will understand, this is only an enabling provision. It will be for services to determine whether they use this power and give out take-home naloxone. At the moment, local authorities provide funding for naloxone, which is supplied through drug treatment services based on their assessment of local need. Although local authority public health services will want to support the wider provision of naloxone, I recognise that their resources are limited; I am sure that many of them will tell me that. This will potentially mean that there is an additional call on their resources and they may need to pay for it through their own funding streams. However, we will monitor demand and engage with services and local areas to understand where any pressures may be.

Another point here is that this is not a neutral act. There will be benefits, in relation not just to personal health and saving lives but to costs associated with dealing with overdoses. I hope that will be seen.

The noble Lord, Lord Evans, also asked whether the methods of administration are permitted only by medical professionals. It is already the case under current regulations that naloxone can be administered by anyone. I emphasise the point about high levels of safety and that it can be administered by a lay person.

I think I have picked up most of the points raised, but as I said, if I have not I shall be very pleased to look further into any other points and to write.

To summarise, the changes we are proposing will allow more services and more professionals to give out take-home supplies of naloxone without a prescription. As I said, it can already be administered by anyone but having more services with the ability to supply it will mean easier access for the people who are at risk of overdose. It will support them and those around them, as has been generously welcomed and acknowledged by the noble Lords, Lord Scriven and Lord Evans.

In short, these changes will widen access to a life-saving medicine. I am sure we can all agree that any death from an illicit drug is tragic and preventable, and we should take every step we can to reduce drug-related deaths; that is what we are doing today. On this basis, I hope that noble Lords will join me in supporting these important regulatory changes. I commend these draft regulations to the Committee.

[Lord Evans of Rainow (Con)]

I thank the Minister for her responses. In Australia, Canada and some states in the United States the nasal spray is available over the counter. Does the Minister have any knowledge of any plans to administer it via our pharmacies?

[Baroness Merron (Lab)]

I am waiting for inspiration, as the noble Lord will realise. In fact, I would rather write to him, as he has made an important point and I want to be quite clear on it. I thank him for reiterating the point.

Motion agreed.

Human Fertilisation and Embryology (Amendment) Regulations 2024

Baroness Merron Excerpts

Tuesday 22nd October 2024 Grand Committee

Moved by

[Baroness Merron]

That the Grand Committee do consider the Human Fertilisation and Embryology (Amendment) Regulations 2024

Relevant document: 1st Report from the Secondary Legislation Scrutiny Committee

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

My Lords, these important regulations were laid before the House on 15 May 2024 by the previous Government, and one of my early tasks in post was to approve that this change in legislation be put before Parliament. I am pleased that we have secured this time today and grateful for stakeholders’ patience.

This legislation brings us one step closer to extending the chance to start a family. The Human Fertilisation and Embryology Act 1990 provides the legislative framework for regulating fertility treatments and the use of gametes and embryos in the UK. These draft regulations amend two aspects of Schedule 3A to the 1990 Act, which were inherited from the European Union’s tissues and cells directive 2006/17/EC.

The first issue we are seeking to address in these regulations is where “partner donation” is defined as being between a man and a woman who are in an intimate physical relationship, which excludes female same-sex couples. We are in an age where social attitudes to same-sex couples and family formation are very different and, alongside this advancement in attitudes, assisted reproduction techniques have developed that now allow both female partners to take part in the creation of a child. This is through reciprocal IVF where one partner donates her egg to make an embryo with donor sperm, forming a biological link to their child; then the other partner undergoes IVF, becomes pregnant and delivers their child.

Legislation has not kept pace at all with these advances. Currently, female same-sex couples who undergo reciprocal IVF as a non-partner donation are required to have additional screening for infectious and genetic diseases. This leads to an additional financial burden for female same-sex couples undergoing this treatment. It can cost more than £1,000 when compared to opposite-sex couples undergoing IVF using their own gametes, where there is no clinical reason for the screening.

The second issue we seek to address under the 1990 Act is where a person living with HIV cannot donate their gametes to create a family, unless it is with a partner in an opposite-sex couple. Thankfully, through the advances in the treatment of HIV, such as anti-retroviral therapy, the risk of transmission is now regarded as negligible through unprotected sexual intercourse and by extension, gamete donation.

The proposed regulations would allow people with HIV who meet certain conditions to donate their gametes to known recipients, where certain conditions are met. These are: that they have an undetectable HIV viral load of less than 200 copies per millilitre, shown by two tests prior to donation; that they have been receiving anti-retroviral treatment for at least six months prior to donation; and that the recipient knows of the donor’s HIV diagnosis and provides informed consent.

The proposed regulations will also modify the definition of partner donation to include female same-sex couples, allowing them to undergo the same testing requirements as opposite-sex couples. The regulations also create a new defined term of “partner donated egg” and exempt these donations from the requirement to comply with more stringent screening criteria. These policy changes have been adopted following advice from the Advisory Committee on the Safety of Blood, Tissues and Organs.

--- Later in debate ---

[Lord Evans of Rainow (Con)]

My Lords, when I came here today, I did not think I would be hearing about Enoch Powell. I think that, if he were here today, he would be very interested in what we have been debating. Enoch Powell’s consistency was Wolverhampton South West. In the 2010 election, a colleague of mine of Asian background, a Sikh, won by the same majority as Enoch won it by in 1950. I am glad to say that Mrs Enoch said that Enoch would have been delighted by my Conservative colleague Paul Uppal winning that seat. It shows that people change over time. I wish he were here to hear what I am about to say.

I welcome these regulations laid before us by His Majesty’s Government. They bring forward the plans from May this year that were established by the Conservative Government. Now, as then, we believe that equality under the law is a long-established principle in this country and any improvement towards this end is to be lauded. I am sure that can receive support from all noble Lords.

These regulations mark a further step towards ensuring equal access to IVF services for people living with HIV and for female same-sex couples. It is another stage in the process of ensuring that as many people as possible can fulfil their dreams of parenthood, and it builds on the incredible work done to reduce the stigma associated with HIV, which has for so long prevented people getting tested and seeking treatment. With these changes, we will make it clear that people with HIV can live happy and fruitful lives.

The conditions in these regulations limit donation to those with an HIV viral load of no more than 200 copies per millilitre, meaning that the infection is undetectable and therefore non-transmittable. This requires the donor and recipient to have a personal relationship with one another and ensuring that safeguards are in place to minimise any risks associated with partner donation from people diagnosed with HIV. This will benefit hundreds of couples who have been trying in vain to become parents, and it will also reduce costs relating to IVF.

I hope that His Majesty’s Government will continue in the steps of the previous Conservative Government with efforts to help those living with HIV to have equal access to healthcare services.

[Baroness Merron (Lab)]

My Lords, I am glad to sense not just support for this draft statutory instrument but recognition in this debate. Following the comments of the noble Lord, Lord Evans, I acknowledge the contribution of my predecessor as Minister responsible for this area, who pressed on with the SI and ensured that it was laid. I am glad to be speaking to it today, as I know he is. I am also pleased to note that Adam Freedman from the National AIDS Trust is with us today. He is most welcome to the Committee. He has come to see the statutory instrument debated. He and his colleagues have patiently encouraged the previous Government and this Government in the right direction, and I thank him for that.

On the points raised by noble Lords, the noble Lord, Lord Wigley, asked whether the devolved Governments were content. I delighted to tell him that they are. He also asked about additional costs. A de minimis assessment was carried out, and it estimates £46,000 to £92,000 for the impact on the fertility sector. Obviously, as has been evidenced and described in this debate, there is a hugely positive impact from the measures within this draft statutory instrument.

I note what the noble Lord, Lord Wigley, said. I put down that he, along with the noble Lord, Lord Winston, and other parliamentary colleagues past and present, are veterans of change and of the Acts we are talking about. As the noble Lord, Lord Scriven, said, this is a journey—one that I suspect is not at its end, although I am pleased to take us further on that journey today. I also pay tribute to the contribution in this area of the noble Lord, Lord Winston, over many years, and to the contributions of other colleagues, who have given it their support and professionalism.

The noble Lord, Lord Winston, asked what the case would be if a recipient were HIV positive. The answer is that they will be able to get IVF. They are not actually affected by these regulations, which impact donors, not recipients. I assure the noble Lord that he was far from wasting the Committee’s time with his comments. I heard clearly his comments about counselling and the need for support. I will look closely at that with officials, following his remarks. I clarify that the £1,000 I referred to was not for IVF. It was an estimated cost for the additional screening required for female same-sex couples, which we are now seeking to correct.

On funding and the issue of availability on the National Health Service, as noble Lords will know, funding for IVF is devolved to ICBs. I am very well aware of the differential provision to different groups and individuals. I will consider future policy options, having picked up this part of the brief and spoken to a number of people about their concerns.

The noble Lord, Lord Scriven, also asked about access to IVF on the NHS. In addition to the point about consideration of advice that I will be getting about improving the service, I want to share his comment about this being just one more step in a positive direction. It is about supporting the fact that families come in all shapes and sizes. A family or a household is a family or a household, and parents are parents. They are there to support and bring up their child in a positive way, and we want to support that too.

I finish by thanking the noble Lord, Lord Evans, for reminding us that one thing that these regulations will do is take us a step on another journey—that of reducing the stigma for those who live with HIV. There have been so many medical advances, which is why we are able to bring this instrument forward today. But attitudes continue to be something to be challenged at times, and I am glad that noble Lords recognise the contribution of the legislative change we seek to make.

We want to ensure that those who want to start a family do not face barriers where there is no reason for those barriers. I place on record my thanks to the organisations who have pushed for and supported these reforms, particularly the National AIDS Trust, Stonewall, the Elton John AIDS Foundation and the Human Fertilisation and Embryology Authority. As I said earlier to the noble Lord, Lord Wigley, I thank all those parliamentarians and others along the way who have got us to this place today.

Motion agreed.