Emergency Adrenaline

Baroness Merron Excerpts

Monday 15th December 2025 Lords Chamber

[Baroness Ramsey of Wall Heath]

To ask His Majesty’s Government what assessment they have made of community access to emergency adrenaline following the authorisation of needle-free delivery methods.

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

My Lords, the Government welcome the approval of needle-free adrenaline delivery methods. In July, the medicines regulator, the MHRA, recommended consideration of changes to legislation to allow the supply of and access to such methods of emergency adrenaline delivery, particularly in schools. The Government are currently considering that recommendation, as well as any changes to regulations that may be required. The Government may assess community access to emergency adrenaline as part of any legislative changes.

[Baroness Ramsey of Wall Heath (Lab)]

My Lords, as the mother of a severely allergic needle-phobic 17 year-old, the authorisation of needle-free adrenaline devices such as Neffy is a potentially transformative development. These products offer families vital peace of mind by enabling life-saving treatment without needles. The Natasha Allergy Research Foundation, for which I am a parliamentary ambassador, is urging better access to such treatments, but Neffy is currently available only privately. Could my noble friend the Minister confirm when it will be accessible on the NHS and whether wider rollout could improve adrenaline availability in public settings?

[Baroness Merron (Lab)]

I very much understand my noble friend’s personal involvement in this area. I congratulate her on her work in promoting the availability of needle-free delivery of adrenaline, and I too welcome its approval. It is down to local area prescribing committees to provide advice to integrated care systems on whether to include new products such as nasal adrenaline and whether they should be included in local formularies. This takes into account available evidence, as well as any relevant guidance. Following this Question from my noble friend, I will seek a view from NICE as to whether it is considering developing guidance in this area, as I know she would find that helpful.

[The Earl of Effingham (Con)]

My Lords, it has been four years since the Commission on Human Medicines first examined widening public access to adrenaline auto-injectors. It is an excellent initiative, but it requires national co-ordination. What progress have the Government made in establishing a national lead for allergy—which some refer to as an allergy tsar—given their previous support for the idea?

[Baroness Merron (Lab)]

We have been focusing our efforts, as I said, on whether changes to the law are required to allow wider access to, for example, adrenaline nasal sprays, which are a welcome development. Our focus is on that, rather than on the appointment of a tsar, to which the noble Earl referred. We will be establishing national clinical directors, and I am sure that this will be considered in that regard.

[Baroness Finlay of Llandaff (CB)]

My Lords, with the disaster of poorly managed allergy, only 24 ICBs have been able to state the extent to which they have services, and none are able to state whether they have a specialist nurse and dietician. Will the Government use the opportunity of the single patient record to provide guidance to ICBs for commissioning, to make sure that those who have serious allergies, such as we have heard about, can get the advice and support they need and be guided to the most appropriate way to manage their allergy in the immediate emergency and in the long term?

[Baroness Merron (Lab)]

I certainly agree with the noble Baroness that the single patient record gives us all sorts of absolutely key opportunities, including in this regard. It is important that we note how common allergies are—they affect nearly one-third of the UK population. Although in most people allergic reactions can be mild to moderate, in some cases they are severe. We need to cut that risk and, in particular, tackle the approximately 50 suspected cases of deaths each year that we currently have. I agree with her contention.

[Lord Scriven (LD)]

My Lords, following on from the previous question, new delivery methods are welcome but we need a workforce to implement them. As the noble Baroness said, it is concerning that not a single integrated care board currently holds the information on whether it has specialist allergy nurses employed in its area. How can the Government ensure that patients have access to these new treatments when local commissioners are failing to track, co-ordinate or prioritise the specialist skills needed to deliver them?

[Baroness Merron (Lab)]

This is an important part of the availability, as the noble Lord has highlighted. The kind of issues under consideration when we look at the availability of these welcome products include, in addition to their ease of use without specialist training in community settings and their use through proper training, suitability for different age groups and the temperature sensitivity of the products. Training will be part of how we look at developing the workforce plan, but I take the point about assessing what training is needed when we think about where they will be available. That is very much part of our consideration.

[Lord Patel (CB)]

My Lords, based on the statistics the Minister just cited about the number of lives that would be saved if emergency adrenaline was easily available in the community, can she say what training would be required? If the drug is given inadvertently to a person who is not in anaphylactic shock, what will happen?

[Baroness Merron (Lab)]

The noble Lord raises a point on the practical and safety concerns that we would need to consider in widening access to adrenaline in the community. I should add that that would be regardless of the administration method. On his point, and following on from the question from the noble Lord, Lord Scriven, it is essential that training ensures safe administration, whatever the formulation, because we do not want to create an unsafe environment. The training will be appropriate to what is needed. However, I must emphasise that we are in the process of considering this, but with a positive outlook and an intent to provide.

[Lord Scriven (LD)]

My Lords, to be helpful to the Minister, I know she will not be able to give an absolute commitment at the Dispatch Box, but with the Government’s 10-year health plan focusing on digital integration, will she commit to embedding a national allergy register within the single patient record, which would deal with many of the issues noble Lords have raised on this Question?

[Baroness Merron (Lab)]

I know that the noble Lord always seeks to be helpful. That is indeed a helpful suggestion, which I will gladly take away, but I will not be able to give a commitment, as the noble Lord is aware.

[Lord Winston (Lab)]

My Lords, I was a little unhappy with the answer to the question from the noble Lord, Lord Patel. My understanding, having seen medical students being given injections of adrenaline during a physiology class to see what would happen—in larger doses than you would probably need in this case—is that they might feel a bit faint. I would have thought that giving a non-injection method is even safer and that the likelihood of side-effects is much lower. Is that not fair?

[Baroness Merron (Lab)]

I am sure that is fair and I certainly bow to my noble friend’s expertise in this regard. I thank him for that, and I thank the noble Lord, Lord Patel, for his question. However, I feel a little inadequate on the medical front here.

Terminally Ill Adults (End of Life) Bill

Baroness Merron Excerpts

Committee stage
Friday 12th December 2025 Lords Chamber

[Lord Kamall (Con)]

As I set out last week and will repeat if noble Lords will forgive me, I completely agree with what the Government Chief Whip said about noble Lords ensuring that they speak to the amendments and do not give Second Reading speeches, but, at the same time, I think it is important that all noble Lords who want to speak to an amendment are given the opportunity to do so.

I thank the noble Baroness, Lady Finlay of Llandaff, for her amendment in this group. It seeks to ensure that someone who currently is or has recently been deprived of their liberty will not be eligible under the Act. This amendment refers to the Mental Capacity Act 2005, which is also the Act underpinning capacity for the purposes of this Bill. I appreciate the underlying logic behind the amendment, which has opened up a valuable discussion of who exactly should have access to assisted dying services. I am sure that all noble Lords would agree, whatever their position, that there should be robust provisions and safeguards in the Bill and that it should be available only to those who are suffering from terminal illnesses who are of sound mind, so that we do not inadvertently open it up to those with issues related to their capacity.

I am also grateful to the noble Baroness, Lady Berger, for her contribution in place of the noble Baroness, Lady Keeley. It is very important that, given the backlog in the system, not just those who have DoLS but those who have made an application for DoLS are deemed not to have capacity when seeking to end their lives. It would be very interesting to hear the Government’s perspective on this and that of the noble and learned Lord.

These questions all fundamentally ask whether the Bill is right to use the Mental Capacity Act 2005 as the basis for defining capacity. I am very grateful to the noble and learned Lord, Lord Falconer of Thoroton, for offering to meet those who have tabled these amendments. That is very constructive and helpful and should be acknowledged. I also look forward to hearing the noble and learned Lord’s responses to some of the issues that have been raised.

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

My Lords, I am grateful to noble Lords for their contributions on this group. To echo the comments of my noble friend the Chief Whip, the Government remain neutral on the principle of assisted dying and on the passage of this Bill. Whether the law in this area should change is a matter for Parliament. As before, any comments that I make will focus on amendments where the Government have major legal, technical or operational workability concerns.

This group relates to deprivation of liberty and eligibility for seeking an assisted death. I thank the noble Baroness, Lady Finlay, and my noble friend Baroness Keeley for tabling the amendments in this group. Amendments 16 and 114, tabled by the noble Baroness, Lady Finlay, seek to prevent individuals who have been deprived of their liberty within the last 12 months under the Mental Capacity Act being eligible for an assisted death. In the case of Amendments 16A and 114A, tabled by my noble friend Lady Keeley, someone would be ineligible as a result of an application for deprivation of liberty having been made, irrespective of the outcome of that application.

Noble Lords may wish to consider that the amendments would introduce a departure from the Mental Capacity Act framework by linking a lack of capacity in one area—capacity to consent to care and treatment arrangements that amount to confinement—to lack of capacity in another area, that being capacity to make the decision to end one’s life. Amendments 16A and 114A go further and would make a person ineligible on the basis that only an application for deprivation of liberty had been made. This may result in a situation where the application was unwarranted, but that person would still be ineligible for assisted death.

Regarding the European Convention on Human Rights—

[Lord Scriven (LD)]

I want to ask what the Government’s view is. This actually changes the whole basis of the Mental Capacity Act. The Mental Capacity Act concerns existing capacity. These amendments move into retrospective or future capacity, which is completely incompatible with the Mental Capacity Act. Do the Government have any views about that significant change of capacity and the test of the capacity of an individual?

[Baroness Merron (Lab)]

I hope that the comments I have made already indicate where we are concerned, rather than going into further areas, but I would be very happy to look at the noble Lord’s point.

I also wish to raise points relating to the European Convention on Human Rights. As before, these are potential risks that I am raising to inform noble Lords’ decision-making, but I wish to be clear that the underlying policies are rightly a matter for Parliament. Noble Lords may wish to note the requirement for an objective, proportionate and reasonable justification to treat those who have previously lacked capacity in a different context differently from others who have not. Noble Lords may also wish to consider whether there is justification for different treatment where an application for deprivation of liberty has been made, but not necessarily completed or approved. In the absence of justifications that are sufficient to persuade a court, the amendments may conflict with ECHR obligations, specifically Article 14 on the prohibition of discrimination, when read with Article 8.

I confirm to noble Lords that, if a court finds that primary legislation is incompatible, it may make a declaration of incompatibility. This does not invalidate legislation. As is usual, the Government would then consider—

[Lord Harper (Con)]

I am grateful to the Minister for making that point, which I think was the question I asked last time. This is very relevant to the question that I posed to the noble and learned Lord, Lord Falconer. It is very important that we put protections in the legislation, so that they are not subsequently unpicked, whether by domestic courts or the European Court of Human Rights. If they are only in a code of practice or guidance, it would not provide protection against those legal challenges. Will the Minister just confirm that what I have said is correct?

[Baroness Merron (Lab)]

I am sure that my noble and learned friend will comment on the noble Lord’s points, but the point I wished to make, which might be helpful, is that it is usual practice for the Government to consider and address these matters. Noble Lords are aware that there is a range of ways of dealing with that: by amending primary legislation, through a remedial order or by a declaration of incompatibility. That is the usual practice.

[Lord Pannick (CB)]

On human rights law, does the Minister agree that, if Parliament forms a considered judgment that there is a basis for a differentiation in this context or any other, it is most unlikely that a court is going to intervene on the sensitive subjects of social policy that we are concerned with here?

[Baroness Merron (Lab)]

I hear the noble Lord, but my role today, as I am sure he understands, is to advise your Lordships on the risks as we see them and for noble Lords to decide how they wish to interpret them with regard to these amendments. But I am grateful for the point that the noble Lord makes.

Noble Lords may wish to note that these amendments would lead to different treatments for those detained under the Mental Health Act from those detained under the Mental Capacity Act. Only those detained under the Mental Capacity Act would be excluded from assisted dying. Noble Lords may wish to consider whether this is justifiable, given that the criteria for detention under both Acts are similar. The decision on which Act to use is largely a matter of professional discretion. Operationally, these amendments could also create confusion for practitioners, because they depart from the principle that capacity assessments are decision- and time-specific, so additional guidance and training would be needed.

Finally, as noble Lords will be aware, these amendments have not had technical drafting support from officials, which means that they may not be fully workable, effective or enforceable in the way that they are currently drafted. However, the issues raised are rightly a matter for noble Lords to consider and decide.

[Baroness Berridge (Con)]

I have heard this outline of the Government’s position. Am I correct in understanding that the Government have no position on ensuring that the Bill is safe for vulnerable groups of people?

[Baroness Merron (Lab)]

I would not make that assumption.

[Lord Kamall (Con)]

The question that a number of noble Lords are concerned about, when discussing this amendment, is that the Mental Capacity Act was passed in 2005. Of course, the guidance has been updated, but it might be helpful to those in the Committee who are concerned that this Act is 20 years out of date to talk about any guidance that has been updated, so that it is not seen as out of date—if that makes sense. This is just to clarify that we are not dealing with an Act that was set in stone in 2005, as things have changed since then.

[Baroness Merron (Lab)]

I am grateful to the noble Lord and feel that this would probably be a very appropriate point to move on to my noble and learned friend.

[Lord Falconer of Thoroton (Lab)]

I will just pick up what the noble Lord, Lord Kamall, is saying. I think he is saying that the Act has been updated over the years and that people have taken account of improvements. He is absolutely right; from my own knowledge of the working of the Act, he makes an absolutely valid point.

I repeat what I said earlier—that we need to discuss this. I will deal with the interventions after I have given my response.

First, the noble Baroness, Lady O’Loan, is right in identifying the risks that arise. That is why I think that the noble Baroness, Lady Finlay, is right that we need to build in some form of enhanced protection.

As far as the intervention from the noble Baroness, Lady Berridge, is concerned, this amendment is limited to DoLS under the Mental Capacity Act; it does not include any exercise of the inherent jurisdiction of the courts on somebody whose liberty has been taken away. The noble Baroness is very welcome to come and discuss that with us, and I will give her notice of any meeting that we have.

As far as the noble Lord, Lord Harper, is concerned, how one provides effective protection depends first on the discussions that take place. I would envisage tabling an amendment on this or maybe agreeing that somebody else tables one. I cannot tell noble Lords the extent to which it will involve the Minister having powers, but it is something that we will discuss.

The points that the Minister, my noble friend Lady Merron, made about discrimination relate to people who have had a deprivation of liberty order in the past, or even those who have one now, who will be excluded altogether from the right to assisted dying. The nature of the Mental Capacity Act is that this should be done on a case-by-case basis. I am proposing that we discuss how to provide enhanced protection rather than excluding.

In the light of what I have said, I hope that the noble Baroness, Lady Finlay, and the noble Baroness, Baroness Berger, on behalf of the noble Baroness, Lady Keeley, feel able to withdraw their amendments.

--- Later in debate ---

[Earl Howe (Con)]

My Lords, this group of amendments covers two distinct but connected questions. The first question, posed by Amendment 17, is, in my judgment, a very helpful one, because the answer will clarify the role—or lack of role—played by a person’s GP in the process being pursued by that person in seeking an assisted death. It seems to me, from reading the Bill’s provisions, that the involvement of a person’s GP in that process, although very likely, is not legally necessary provided that the patient fulfils all the conditions set out in Clause 1(1). Clarification from the noble and learned Lord would be very helpful.

The second question, posed by my noble friend Lady Fraser’s Amendment 62, is also one that I hope can be answered very simply by the noble and learned Lord. Am I correct that it is implicit in Clause 5 that the preliminary discussion between the patient and the registered medical practitioner need not involve a doctor physically situated in England and Wales and need not be face to face? Equally, am I correct that it is unnecessary to state in Clause 1(3)(b) that the steps set out in Clauses 8 and 19 must be taken

“by persons in England or Wales”,

because Clauses 8 and 19 already explicitly provide for this?

[Baroness Merron (Lab)]

My Lords, I thank noble Lords for their contributions to this debate. As I have said, I will keep my comments limited to the amendments on which the Government have major legal, technical or operational workability concerns.

On Amendments 17 and 309A, in the name of the noble Lord, Lord Beith, and introduced by the noble Baroness, Lady Fraser, Amendment 17 is a probing amendment that seeks to establish whether people who are registered with a GP in Scotland but live in England would be excluded from eligibility for an assisted death under the Bill. Noble Lords may wish to note that Amendment 17 would have limited effect as it amends only Clause 1, which is largely descriptive. Without further amendments to Clauses 10 and 17, which contain duties to assess eligibility criteria, Amendment 17 would not impact those criteria and would introduce conflicting provisions.

Amendment 309A would amend the corresponding eligibility criteria in Clause 10 to include a person registered as a patient with a general medical practice in England, Wales or Scotland. It would not amend Clause 17, which contains the assessment by the panel. Therefore, Amendments 17 and 309A would require further consequential amendments to ensure that the Bill is coherent. This would include amendments to ensure that data recording obligations and the associated criminal offences apply to Scottish GPs. These consequential amendments would likely require consultation with the Scottish Government, as the noble Baroness, Lady Fraser, referred to, in line with the guidance for Private Members’ Bills.

I thank the noble Baroness, Lady Fraser, for tabling Amendment 62. The purpose of this amendment is to establish why the Bill requires only the actions set out in Clauses 10 and 11 to be undertaken by people in England or Wales, and not the preliminary discussion under Clause 5. Our understanding is that the reference to the preliminary discussion in Clause 5 is not mentioned in Clause 1(3) because Clause 5(3) already requires that a person wanting to have a preliminary discussion must be in England and Wales. Amendment 62 would require steps under Clauses 8 and 19 to be taken by persons in England or Wales. As drafted, the Bill requires that most of the steps in Clauses 8, 10, 11 and 19 will already have to take place in England and Wales.

In addition, Amendment 62 would have the effect that, when the Secretary of State makes regulations under Clause 19, the Secretary of State must be in England and Wales at the moment they sign the regulations. This could lead to the regulations being improperly made and challenged should the Secretary of State not physically be in England or Wales at the time of signing the regulations. This raises a practical issue of workability, as I am sure the noble Baroness understands.

On the points raised by the noble Baroness, Lady Fraser, and the noble Lord, Lord Shinkwin, relating to Scotland and guidance that the Government have provided to the sponsor, as I am sure noble Lords will understand, and I have reiterated, we are providing technical and workability support to the sponsor on devolution issues, including those that have been raised. This is an evolving situation that will continue throughout the passage of the Bill.

[Lord Falconer of Thoroton (Lab)]

I am grateful to everybody who has taken part in this short debate. I pay particular tribute to the noble Baroness, Lady Fraser of Craigmaddie, who discussed the issues with me yesterday and was incredibly clear in the way that she raised them today. She also raised the concerns of the noble Lord, Lord Beith.

I will deal with three issues: first, where the GP practice has to be to satisfy the eligibility requirements; secondly, whether the Clause 5 conversation has to take place with an England and Wales GP, or whether it can take place with a Scottish GP; and thirdly, how we will deal with the clashes between Scotland and England. I am aware, because the noble Baroness, Lady Fraser of Craigmaddie, told me about it, of the deposit return scheme and how that went wrong. I am conscious of that as an issue.

First, the noble Lord, Lord Beith, asks with his amendment whether the GP to whom you have to be a member of the practice can be in Scotland. The answer is no under the Bill at the moment. The Bill is clear that you have to be in a GP’s practice in England or Wales. Everybody has said to me that it is perfectly normal for a person living in England in the border areas to have a GP in Scotland, and asked why cannot we change the Bill to say that your GP could be in Scotland, because that reflects how people actually live.

I am sympathetic to that, but the noble Baroness, Lady Fraser of Craigmaddie, legitimately points out that, if that happened, I would need to make various other changes. For example—and the noble Baroness made this point—under Clause 7, where there is a preliminary discussion it has to be sent to the GP, and the GP has to keep a proper record of it. How can I enforce that unless I expand the provisions of the Bill to allow Scottish enforcement, for which I would need Scottish agreement? My view in relation to the point made by the noble Lord, Lord Beith, is: let us see whether we can make it work, but it will require discussions with Scotland.

--- Later in debate ---

[Earl Howe (Con)]

My Lords, the noble and learned Lord has already been very helpful in the undertakings and clarificatory comments that he made earlier in the debate, so I shall be very brief. In following up those comments, I will return to the question that I raised on the previous group. The Bill seems consciously to steer clear of insisting that a person’s GP must always be involved in the process being pursued by that person in seeking an assisted death, other than the GP having a duty to note in the patient record that the preliminary discussion has taken place. The entire process, in other words, could be conducted by the patient in conjunction with hospital-based medical consultants.

Do I understand correctly that the noble and learned Lord is willing to look closely at ways of making sure, by whatever means, that the crucial judgments made by clinicians about a patient’s capacity, about coercion and about that person’s settled wish to end their life are firmly and soundly based? The route to achieving that may well be the GP practice and the multidisciplinary team within it, but, as we have heard, that source of information may not be practical or useful in every case. Will the noble and learned Lord therefore ensure that he will consider more generally in the round possible safeguards that will forestall the possibility of superficial or cursory assessments being made—especially, perhaps, assessments by hospital consultants, who may have enjoyed only a brief acquaintance with the patient?

[Baroness Merron (Lab)]

My Lords, I thank noble Lords for their contributions on proposed safeguards relating to general practice. I will keep my comments limited to the amendments on which the Government have major legal, technical or operational workability concerns. On that basis, I draw noble Lords’ attention to the operational workability concerns in relation to Amendments 19, 20, 21, 29, 30B, 265A and 443A.

--- Later in debate ---

[Baroness Lawlor (Con)]

I beg the Minister’s pardon but she is referring to my Amendments 30B, 265A and 443A, not those of the noble Baroness, Lady Hollins.

[Baroness Merron (Lab)]

I am most apologetic and grateful for the clarification. I hope that the noble Baroness, Lady Hollins, will forgive me, too.

I will continue. The GP must also have seen them at least six times in face-to-face appointments during those two years. Noble Lords may wish to note that these amendments introduce requirements that may result in people seeking GP appointments that are not clinically necessary. This may have an impact on wider access to GP services. Noble Lords may also wish to note that, even if a person has seen their GP the required number of times over the two-year period, their GP could still refuse to provide the explanatory letter, as they are not under any duty to participate in the provision of assistance, as per Clause 31. This would result in the person being unable to access an assisted death.

Lastly, Amendment 220, tabled by the noble Baroness, Lady Foster, seeks to add an additional step in the assisted dying process. It would not be a compulsory step; therefore, it would not have a major impact or be unworkable. However, this amendment has not had technical drafting support from officials and, although the issues raised are rightly a matter for noble Lords to consider and decide, would likely require further consideration in order to be made fully workable, effective or enforceable.

[Baroness Lawlor (Con)]

If there are on average 3.5 consultations a year face to face, with calls and so on bringing it up to 8.7, it would not necessarily make for additional unnecessary appointments for a person with such a condition. That is my first clarification. My second is about a letter being required and the doctor concerned not wanting to assist in the process. The letter is not about the process. The letter would go into the person’s history over the two years they have been consulting the doctor. It has nothing to do with the process of seeking an assisted death.

[Baroness Merron (Lab)]

Acknowledging that the amendments that I was referring to were tabled by the noble Baroness, Lady Lawlor, I have nothing to add to the points that I have already made, other than to say that the noble Baroness used the word “average” and therefore there is a question about workability. Therefore, our interpretations on the noble Baroness’s second point do differ.

[Lord Falconer of Thoroton (Lab)]

My Lords, I indicated my position in my intervention. I will summarise my understanding of the amendment, what my response is and next steps. All the amendments in this group seek a requirement in addition to having a GP before you can have an assisted death. My noble friend Lord Rook suggests having a GP for at least 12 months and having seen him twice before the first declaration. The noble Baronesses, Lady O’Loan and Lady Grey-Thompson, refer to having an “established relationship” with a GP. The noble Baroness, Lady Finlay, refers to one consultation and a home visit before the application. The noble Baroness, Lady Lawlor, refers to a two-year relationship, an average number of visits face to face and then a letter that relates to the medical condition, the treatment and the state of mind of the patient.

As I have indicated, the GP, in the structure of the Bill, is not somebody who has to be involved. The noble Earl, Lord Howe, encapsulated perfectly that the GP is somebody who is receiving information. All these provisions for making it necessary to have a better relationship with your GP than just having a GP do not touch the safeguards. Quite separately from that, I support what the noble Lord, Lord Deben, and the noble and learned Baroness, Lady Butler-Sloss, said. These provisions have an air of utter unreality if you are saying that a condition of an assisted death is a particular relationship with a particular GP. I do not think that any of these safeguards work or reflect the current drafting of the Bill.

It is clear from listening to the debate that people who are concerned with the care should form a basis for the decision. It may not necessarily be making the decision—a lot of people would say that they should not be making the approval—but their input is vital. That was the insight of the noble Baroness, Lady Gerada, which was very much reflected around the Committee. I am willing and keen to reflect that insight in the Bill. But the route is not through newness in relation to the GP. It is reflecting the proposition that the multidisciplinary team dealing with the patient must have some input. I do not know whether that satisfies the question asked by the noble Earl, Lord Howe, but that is the purpose of what I am taking away from this very valuable debate.

As for the right reverend Prelate the Bishop of Gloucester, we are going to speak about prisoners on the next group. Can I reserve my position in relation to prisoners to avoid there being too much duplication?

In those circumstances, I invite the noble Lords not to press their amendments.

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[Lord Kamall (Con)]

I have never been so popular; it will not last, I know.

I thank the noble Baroness, Lady Grey-Thompson, for her amendments. I pay tribute to her for her sincere and long-standing commitment to protecting the most vulnerable in society. If we cast our minds back to Second Reading, many of the contributions made and concerns raised were regarding those who are the most vulnerable in our society. I remember at Second Reading being particularly touched by the words of the noble Lord, Lord Rees—he is not in his place now—who raised concerns about the vulnerability of some ethnic-minority communities, particularly those from disadvantaged communities as well.

Let us quickly rush through some of the points. On Amendment 22, which would make prisoners ineligible for end-of-life services as envisaged by the Bill, I completely understand the underlying principle. Many have spoken, rightly, about the vulnerability of prisoners. While for some it might seem wrong, as the noble Lord, Lord Farmer, has suggested, that a prisoner who has a terminal illness may have a way of cutting short their sentence by means of this Bill, as my noble friend Lady Coffey alluded to, others may say “Good riddance”. I also recognise the argument that prisoners with a terminal illness should be treated with the same compassion and care at the end of their lives as other terminally ill people subject to the Bill, as my noble friend Lord Markham recognised.

We also have to recognise some of the concerns over moral hazard. I do not know how large the incidence of this would be. Would it really encourage those who are terminally ill to commit crime? No studies have been done, but I am open to that concern. There is also the idea about higher levels of suicidal ideation, as raised by the noble Baroness, Lady Fox. These are really important points that we have to take account of.

The right reverend Prelate and my noble friend Lord Deben spoke about the pressure of reducing the prison population, while the noble Lord, Lord Carter, spoke about the higher rate of suicide among male prisoners. These are all reflections that should give us cause for concern, and things we should take account of as we consider what we will do between Committee and Report.

I thank the noble Baroness, Lady Grey-Thompson, for raising the issue of those who are pregnant. As the noble Baroness said, this was not debated in the other place, so I am grateful that the noble Baroness was able to give us the opportunity to debate it. I am also grateful to the noble Baroness, Lady Berger, for sharing statistics about expectant mothers. It was important that we heard those stats. I cannot begin to imagine the difficulty an individual in those circumstances may face. I understand the concern that it does not seem right that the safety of an unborn child may be endangered under the provisions in the Bill. I also understand that there might be precedence in other legislation. I wonder what the noble and learned Lord’s reflections on that are, given his expertise.

I note the amendment tabled by the noble Lord, Lord Farmer, on access to this for those who are awaiting trial. Once again, I would be very interested in the noble and learned Lord’s legal experience on whether that seems relevant and should be within this Bill. During the debates on the Mental Health Bill, my noble friend Lady Berridge was assiduous in spotting gaps in legislation or inconsistencies between different Acts. My noble friend has done the same thing here by raising concerns over the vulnerability of those with education, health and care plans. I think this needs further consideration.

I also thank the noble Baroness, Lady Grey-Thompson, for her amendments relating to those who are homeless or who live in insecure and temporary accommodation. I welcome the experience of the noble Baroness, Lady Gray. I still remember a conversation I had with one homeless charity that we are all one or two unlucky events or bad decisions away from homelessness. I heard from homeless people who told me that they had a great job and a great family life and that everything was going their way. They lost their job, which then led to them losing their marriage. After incidents of sofa surfing and testing the patience of their friends, they ended up homeless. It could happen to anyone. It is important that we do not dismiss the homeless as people who cannot be bothered or are idle. It could happen to anyone. Any noble Lords who have met those in homeless communities will know that some people had been incredibly successful but, after two or three bad decisions or unlucky things that happened in their life, they suddenly found themselves homeless. They are also judged by the way they look when they are homeless.

I remind all noble Lords that the Bill relates only to those who are suffering from a terminal illness and those who have been given an expectation that they will not live for longer than six months. We have to be very careful that, although we have sympathy for the homeless and prisoners, the Bill relates only to those who have a terminal illness. I know there are concerns that the Bill may be widened beyond that, but that is the debate at this stage. We should be quite clear that we are focusing on those with a terminal illness. So, much like on the question of prisoners and others, I recognise the arguments on all sides, but this is an opportune moment, not only because of time but because of the noble and learned Lord’s legal experience, to hear his reflections—after the Minister, obviously.

[Baroness Merron (Lab)]

I am most grateful.

My Lords, I thank all noble Lords for their contributions to the debate on this group. As is my consistent introduction, my remarks will focus only on issues where the Government have major legal, technical or operational workability concerns. Many of the points that follow relate to the European Convention on Human Rights. These are risks that I am raising to inform noble Lords’ decision-making, as I said on the first group. I wish to be clear that the underlying policies are a matter for Parliament. I say to noble Lords who referred to my ministerial colleagues in the other place that it is the role of Ministers, whether in your Lordships’ House or in the other place, to flag the risks to the Bill, including potential legal challenges. As I said, policy decisions remain a matter for the sponsors. Decisions in this regard rest with Parliament.

I begin with Amendment 22, tabled by the noble Baroness, Lady Grey-Thompson, and Amendment 30C, tabled by the noble Lord, Lord Farmer. These amendments would make prisoners, a defendant on remand, a defendant on bail or those detained by a hospital order ineligible for assisted dying services, even if they have a terminal illness and meet all other criteria. Aside from the right to liberty—Article 5—the ECHR requires that prisoners, a defendant on remand or a defendant on bail should have the same rights as those who are not. The rights engaged by this amendment are Article 8 on the right to respect for private and family life and Article 14 on prohibition of discrimination. Noble Lords may wish to note the risk that making these groups ineligible for assisted dying would, on the face of it, lead to a difference in treatment, which would need to be objectively and reasonably justified in order to comply with ECHR obligations.

Likewise, making ineligible hospital in-patients who are under a hospital order would lead to a difference in treatment. Without sufficient justification for the discriminatory treatment, this may be a breach of the ECHR, which could lead the courts to issue a declaration of incompatibility.

The noble Baroness, Lady Grey-Thompson, has also tabled Amendments 24, 458, 308 and 347. The purpose of Amendments 24 and 458 is to exclude those who are pregnant from accessing assisted dying, while that of Amendments 308 and 347 is to make persons who are homeless, or living in supported or temporary accommodation, ineligible for assisted dying services. As I have previously noted, the reasons for this difference in treatment would need to be adequately justified to avoid the risk of a successful challenge under the ECHR.

[Baroness Stroud (Con)]

Can the Minister give her perspective on whether the arguments laid out today would be justifiable as reasons for a different form of treatment between the two categories: prisoners and non-prisoners?

[Baroness Merron (Lab)]

It is important I reclarify that that is a policy decision. What I am doing with your Lordships’ Committee is advising on risks, to assist noble Lords to make their decision regarding this policy.

Amendments 30A and 119A, tabled by the noble Baroness, Lady Berridge, would exclude any person with an education, health and care plan from being eligible for an assisted death, except in cases provided for in regulations made by the Secretary of State. As drafted, these amendments could impose unclear and potentially undeliverable legal duties on the Secretary of State and are potentially not aligned with how EHCPs work in practice or in law. The amendments give rise to a number of unresolved operational questions that do not work with other provisions of the Bill and they are not drafted with sufficient specificity. That could lead to confusion for those interpreting the legislation and unintended outcomes.

[Baroness Berridge (Con)]

We are about to have a meeting to outline special additional conditions, so can I clarify that the Minister is not saying that that is not possible and just that the particular conditions outlined in Amendment 119A are not possible?

[Baroness Merron (Lab)]

First, I am referring to the amendments before us. Secondly, I am advising on risk and workability, again for the assistance of your Lordships’ Committee, which, as is correct and proper, will make the decision.

These amendments appear to treat people with EHCPs differently from those who do not have them. This could give rise to potential incompatibility with Article 14 of the ECHR, when read with Article 8, and would require reasonable justification for differential treatment.

Finally, as noble Lords will be aware, the amendments in this group have not had technical drafting support from officials, so the way they are drafted means that they may not be fully workable, effective or enforceable. However, as I have said, the issues raised are rightly a matter for noble Lords to consider and decide.

[Lord Carter of Haslemere (CB)]

My Lords, the Minister referred to a number of articles of the ECHR, but she has not referred to Article 2, which is the duty on a state to protect life. That is why the courts have imposed a duty of care on the Prison Service and the Government to protect prisoners from committing suicide. My question goes back to what I said earlier: how do the Government reconcile that duty with a vulnerable prisoner applying for an assisted death? How does that square with the duty under Article 2 and the duty of care to prisoners?

[Baroness Merron (Lab)]

I refer the noble Lord to the provisions within the Bill. His earlier question was very much about policy. I am sure that my noble and learned friend will also refer to this, but this is a matter of policy and therefore it is for Parliament to decide.

[Lord Falconer of Thoroton (Lab)]

I am obliged to noble Lords for all their questions. I will deal with the four issues that this group raises: prisoners, pregnant women, homeless people and those who are the subject of an education, health and care plan.

Turning first to prisoners, I declare my interest as chair of a prison charity, Liberty Kitchen. I have been involved in prison issues for a very long time; indeed, I was once the Minister responsible for prisons. When I was in that role, every time a prisoner committed suicide, it was deemed a failure of the Prison Service and something that we took incredibly seriously.

As far as prisoners are concerned, I will make two points. First, this is about people who are terminally ill and have six months or less to live. The question that the sponsors address is whether prisoners should be treated differently from the rest of the population. The posit is: if you are a prisoner and get a terminal illness, is the condition of the prison so terrible that you should never allow a prisoner ever to have that right?

Wheelchair and Community Equipment Strategy

Baroness Merron Excerpts

Thursday 11th December 2025 Lords Chamber

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

My Lords, I am most grateful to my noble friend Lord Hunt, not just for securing this important debate on a vital issue, as the noble Lord, Lord Kamall, said, but for his campaigning, along with other noble Lords, groups and individuals outside your Lordships’ House over many years. I am also grateful to noble Lords not just for their contributions but for sharing their experiences, some of which are painful to relate and to hear.

On the maiden speech of the noble Baroness, Lady Gerada, I welcome her experience and approach. I welcome her to your Lordships’ House. The noble Baroness spoke of choosing to speak in this debate because of its featuring, among other things, dignity and fairness. I was touched by her description of what and who a GP really is within their community. I know that we all look forward to hearing more from the noble Baroness. Perhaps I might say that the Government have promised more GPs—and we are delighted to have more GPs sitting on our red Benches.

This has been an affecting debate, not least as people described the impact of services not being, as they should be, in the right place. I am sure we would all agree that there is more work to do, but I will take this opportunity to outline what the Government have done and are doing. We are focused on ensuring that disabled people have access to the services and support that they need to lead a fulfilling life. My ministerial colleague, Zubir Ahmed MP, is the relevant Minister and I look forward to sharing the points and questions raised in this debate with him.

Integrated care boards are responsible, as the noble Lord, Lord Kamall, just quoted, for the provision and commissioning of local wheelchair services based on the needs of their local population. I am glad that the noble Lord, Lord Kamall, recognised the importance of flexibility. However, flexibility cannot be an excuse for not providing—a point I have heard rightly and repeatedly today.

There are no plans to publish a national strategy for wheelchair provision. I know that will be disappointing to noble Lords, but NHS England has developed policy guidance and legislation to support ICBs, which are crucial in this, to ensure the commissioning of effective, efficient and personalised wheelchair services, including the wheelchair quality framework, published in April, in collaboration with the NHS England national wheelchair advisory group.

Local authorities have a statutory duty to arrange for the provision of community disability equipment to meet the assessed care and support needs of people in their area. Our 10-year plan for health gives that freedom and autonomy to serve local people to local commissioners. In this regard, it is important that we are giving systems a greater degree of control and flexibility over how funding is deployed to get this done.

I have heard about delays to wheelchair provision. I say this not as any excuse at all, but the pandemic continues to have an impact on wheelchair services, not least because some providers have not only reduced their services—with the inevitable outcome—but now face a backlog of referrals. I was interested to explore that some services have also experienced lower referral rates during the pandemic. This of course led to a surge in referrals later. It has meant that waiting times for both adults and children have fluctuated, as services have worked to recover.

However, we need action to address waiting times and I absolutely recognise the impact that delays have. To that point, in October, we published the NHS Medium Term Planning Framework, which requires all ICBs and community health services to actively manage and reduce waits over 18 weeks, and to develop a plan to eliminate all 52-week waits.

The noble Lord, Lord Blencathra, rightly referred to the need to focus on measuring outcomes. The community health services situation report will be used to monitor ICB performances against waiting time targets in 2026-27, and currently monitors waiting times for children, young people and adults under wheelchair, orthotics, prosthetics and equipment. These targets will guide systems to reduce the longest waits. Additionally, the model service specification for wheelchairs sets out that wheelchair assessments have to take place in the most suitable environment, including hospitals, the key thing here being that they are based on the need of the individual.

My noble friend Lord Hunt and other noble Lords rightly spoke of delays in discharge being linked to temporary or short-term loan wheelchairs rather than long-term provision. Access to temporary wheelchair provision to support hospital discharge is determined locally by ICBs; it does not fall within the remit of NHS wheelchair services, which provide services to people of all ages with long-term mobility needs. I heard the point made very clearly about the technology and quality of wheelchairs, which is one of the things I will be raising and discussing with Minister Ahmed.

Reducing waiting time is part of improving the quality of wheelchair services, but it is not the whole story. The quality framework, which the noble Lord, Lord Shinkwin, asked about, is very much designed to assist ICBs and NHS wheelchair service providers to get it right. I have heard, from the experience of noble Lords in the Chamber and also from those outside, that this is not always the case, and I understand that. However, the quality framework sets out the quality standards relevant to all suppliers and aligns with the CQC assessment framework. To the point raised by the noble Lord, Lord Blencathra, and the noble Baroness, Lady Brinton, this is about aiming to tackle the inequalities that we know exist—I acknowledge that—in outcomes, experience and access.

NHS England statutory guidance sets out how ICBs should be working with people, communities, key partners and local authorities. That is why each ICB must have executive leads who work closely with local authorities and who promote integrated working for the benefit of people, including those with a learning disability, autism, Down’s syndrome, and children and young people with special educational needs and disabilities.

As was referred to in the debate, NHS England introduced personal wheelchair budgets in 2019 and gave a clear framework for ICBs to commission personalised wheelchair services, focusing on outcomes and also on integrated care, giving people greater choice over the wheelchair provided—and I have heard what noble Lords have said today.

The noble Baroness, Lady Lane-Fox, spoke quite correctly about the impact of the quality of services on the ability to be in the employment market. That is about quality of life as well as the economy, and I share her views.

The noble and right reverend Lord, Lord Harries, and the noble Lord, Lord Rennard, discussed dissatisfaction with services; I heard that mentioned a number of times. NHS bodies and local authorities must arrange for dealing properly with complaints.

The approach of the 10-year health plan identifies disabled people as a priority group. Our neighbourhood health service will support disabled people, and the 10-year plan focuses on choice and control over their care. I have heard what noble Lords have said, and I will take that back. I hope the steps we have made will make a difference, but I recognise that there is so much more to do.

Terminally Ill Adults (End of Life) Bill

Baroness Merron Excerpts

Committee stage
Friday 5th December 2025 Lords Chamber

[Lord Kamall (Con)]

My Lords, I hesitate to rise as I want to ensure that everyone feels that their voice has been heard in this debate. We do not want to make law on a basis on which people look back and say that we did not properly debate a particular issue. If all noble Lords who wish to speak in this debate have spoken, I am very happy to make my contribution, but if there are any other noble Lords who wish to make their point, I should give way.

Well, that answers that question; I tried my best. I want to make that point clear. It is really important that everyone who feels they want to speak can do so, but I also say to noble Lords, including my noble friends, that it is also important to respect the rules and conventions, to speak to the amendments and not to repeat Second Reading speeches or make wider debates. I hope we can get that appropriate balance. I have taken time making those points, so I will try to be brief.

I pay tribute to the noble Baroness, Lady Berger, especially for the way in which she delivered the Select Committee process that preceded our deliberations in Committee. The evidence submitted to that committee will be invaluable to noble Lords as we continue our work to scrutinise the Bill.

Without making a long speech, I will reflect on the specific amendments on changing the minimum age. I was talking to a noble and learned friend about this, and he said that, frankly, the law around age is a mess—and that has come out in some discussions. Sometimes we are speaking from our own experience. My two children are in their 20s, and I wonder whether they would really have the capacity to make this decision. But at other times, I sit in awe of them and the decisions they make. They express maturity way beyond 20 years, and, in fact, more maturity than much older people.

It very much depends on the individual in these cases. We have to look at whether there is a way to achieve that right balance; otherwise, we will just be making another age limit. You can join the Army at 16 but you cannot serve in combat until you are 18. The Government are talking about reducing the voting age to 16, but then we are hearing debates on neurological competence and capacity. It is important that we understand and express these points.

The point that came out for me in this whole debate about neurological development is that there is no such thing as “the science”. Science is contestable. We heard this from noble Lords who are experts in their field. We must be very careful about saying that “the science says this”. It also has implications for other decisions.

I turn to a couple of points which may already be treated in the Bill. I want to check the understanding of the noble and learned Lord, Lord Falconer of Thoroton, on what is in the Bill. The noble Baroness, Lady Hollins, asked: what happens if a new treatment is available? Clause 2 says

“which cannot be reversed by treatment”,

which probably takes care of that point, but I would like the noble and learned Lord, Lord Falconer, to share his interpretation and say whether it addresses her concerns. The noble Baroness, Lady Hayter, said that we should think about these young people who will be suffering and in pain, yet nowhere in Clause 2 are the words “pain” or “suffering”. We must be very careful to read what is in the Bill when we are making these points.

I welcome the intervention by the noble and learned Lord, Lord Falconer, that while he is quite clear about 18, he is sympathetic to the idea of cognitive development and maturity between 18 and 25, and there might be some discussion. Who knows—I cannot speak for the noble and learned Lord, who has looked into this issue very deeply—but perhaps in those discussions he may be persuaded. He is saying 18 at the moment, but clearly he is open to enhanced measures for those aged between 18 and 25. That is something that I hope the whole Committee will welcome.

There are many other points that I could make, but it is important to hear from the Government and what the noble and learned Lord believes in response to the points that have been raised.

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

My Lords, I am grateful to noble Lords for their contributions to this debate on the age of eligibility for those who are provided with assistance under the Bill. I have made it clear previously, and reiterate, that I will keep my comments limited to the issues on which the Government have major legal, technical or operational workability concerns.

The amendments tabled by the noble Baronesses, Lady Berger, Lady Lawlor and Lady Hollins, seek to raise the age at which an individual would be eligible for the provision of assistance under the Bill. The points that I wish to raise here relate to the European Convention on Human Rights. There are potential risks that I am raising to inform the decision-making of noble Lords, but the underlying policies are rightly a matter for Parliament. Under the convention, the amendments in this group could give rise to legal challenge; for example, that excluding people who are under 21 or 25 from accessing assisting dying may not be justified under Articles 2 or 8 of the EHCR, or that this amounts to unjustified discrimination under Article 14.

Noble Lords will be aware that differential treatments, such as raising the age of eligibility, may be lawful if it is possible to persuade the courts to agree that the age limit is justified, necessary and proportionate. There would need to be a reasonable justification for restricting access to assisted dying to people aged either 21 and over or 25 and over. Noble Lords will want to consider this in relation to these amendments.

[Lord Harper (Con)]

Can the Minister be clear? If we decided to limit—whether by age or in some other way that the noble and learned Lord, Lord Falconer, might decide—and put that into primary legislation, is that then not the law of the country? All that the European court could then do is say that it is not compatible but remains the law—or is the Minister saying something different? If we pass primary legislation, that is the law of the land, is it not?

[Baroness Merron (Lab)]

The point that I was making just before I sat down was that noble Lords will want to consider the points that I have raised in relation to these amendments. I am sure that they will take into account what the noble Lord has just said too.

[Lord Falconer of Thoroton (Lab)]

My Lords, I am grateful to everybody who has contributed to the debate. I have made my position moderately clear in relation to what we should do—and I sense that the Committee is happy that we should take that course.

I completely understand the points about people aged 18 being impulsive and often emotionally immature. On the point made by the noble Baroness, Lady Stroud, that is why the Sentencing Council refers to it. However, it is a different question here as to what the age limit should be. If people are emotionally immature, they will not have a settled view about what to do in these circumstances, but some people will. The noble Lord, Lord Kamall, asked: what happens if there are new developments in medicine that would extend life? The answer is that you would not have six months or less to live, which I think was the answer that he was giving in relation to it.

I have made my position clear. I invite the noble Baroness, Lady Berger, in the light of where we have got to, to withdraw her amendment so that we can move on to the next issue.

--- Later in debate ---

[Lord Wolfson of Tredegar (Con)]

My Lords, I can be extremely brief, because of the confirmation given by the noble and learned Lord and also knowing that the substantive issues of domestic abuse, interpreters and various other matters will be dealt with in their appropriate place.

At the risk of underlining my reputation as a legal geek, I invite the noble and learned Lord’s attention to his Amendment 350, and in particular the Member’s Explanatory Statement. I understand the amendment, but I do not understand the statement. The amendment leaves out from “to” to end of the line and inserts “section 12(4) and (7)”, which are about “sharing of specialists’ opinions”. The Explanatory Statement says:

“This is a drafting change (consequential on subsection (4) being added to clause 12)”.


Now, Clause 12 already has a subsection (4), and the noble and learned Lord’s amendments to Clause 12 are to subsections (5) and (8). I do not know whether the Explanatory Statement has confused me and in fact the change is not consequential on a new subsection (4) being added but just stands in and of itself. It may be that I am confused unnecessarily, but if the noble and learned Lord could just clear up that minor point, I would be grateful.

[Baroness Merron (Lab)]

My Lords, I, too, shall be brief. All but three of the amendments in this group have been tabled by the Bill’s sponsor and, as has been discussed, they make a series of drafting changes to the Bill, including making sure that terms are consistent throughout and removing ambiguity and duplication.

The Government are neutral on all the policy choices reflected in these amendments, as they are on the Bill as a whole, but have as usual provided drafting support to make the Bill legally workable. As a part of the discussion today, it is of course for the sponsor and for Parliament to determine whether any of the amendments that the sponsor has chosen to table have changed the intent of amendments that were debated in the other place.

Amendment 7 in this group, tabled by the noble Baroness, Lady Coffey, seeks to amend Amendment 6 by changing a reference in Clause 1(2)(b) from “a preliminary discussion” to “their first preliminary discussion”. It does not make any wider changes to the Bill to provide for more than one preliminary discussion to take place, so this may lead to uncertainty. As with all amendments that have not had technical input from the Government, noble Lords may wish to note that the current drafting of this amendment may require further consideration to make it fully workable, effective and enforceable.

Amendments 8 and 9, on which I raise no major workability issues, appear to be trying to achieve the same purpose as Amendment 6, tabled by the Bill’s sponsor. But I would note that Amendments 8 and 9 have not had the technical drafting support from officials and therefore may not be fully workable, effective and enforceable.

[Lord Falconer of Thoroton (Lab)]

My Lords, I am grateful for all the interventions. These changes are only drafting changes. Some legitimate points were made, particularly by the noble Baronesses, Lady Finlay and Lady Lawlor, but they did not really go to the drafting points.

I go to the concerns various Members have expressed. Amendments 6 and 7, tabled by the noble Baroness, Lady Coffey, would prevent doctors having a conversation with people—I am not saying this in a bad or a good way, but that is what she wants to do—particularly before they reach 18. There is a point there, but it is nothing to do with the change I have introduced in my Amendment 6. My amendment would simply make it clear that there has to be a preliminary discussion before you can go ahead to assisted death. I have done that to make it clear that it is one of the eligibility conditions; it says nothing about what should be talked about or whether such a conversation should take place under the age of 18.

In fact, as the noble Baroness, Lady Coffey, said, Clause 6 states:

“No registered medical practitioner or other health professional shall raise the subject of the provision of assistance in accordance with this Act with a person under the age of 18”.


I do not think that the noble Baroness’s amendment would add to that protection. The key point is that all Amendment 6 is doing is saying that you have to have a Clause 5 discussion.

The next point, raised by a number of Peers, is that I am watering down the protection in relation to domestic abuse. That, as a matter of drafting, is wrong. It is only a matter of convenience that, having defined domestic abuse as including everything so defined in the Domestic Abuse Act 2021, you get coercion, control and economic abuse as forms of domestic abuse. To avoid having to repeat that every time the Bill refers to training, I have simply referred to domestic abuse, and that is then defined at the top of page 41. I very much hope that people will accept that that is the position.

The noble Baroness, Lady O’Loan, who is shaking her head, raises a different point about the position in relation to abuse that is not domestic. Perhaps your lawyer is exercising undue influence on you. That is a point that I will respond to in writing, but it is not a point raised by my drafting change, because all the restrictions have been in relation to domestic abuse, not to what the lawyers would call undue influence. But it is a perfectly legitimate point, which I will come back to in correspondence with her.

--- Later in debate ---

[Lord Wolfson of Tredegar (Con)]

My noble friend is absolutely right; on that point they do change the policy intention. I am grateful. I would welcome the thoughts of the noble and learned Lord, Lord Falconer of Thoroton, on that.

Finally, in the absence of my noble friend Lord Howe, I have been asked on his behalf to formally speak on his Amendments 301A and 305A. In speaking to those amendments, I want to highlight the threshold which is set for determining whether an individual is in England and Wales at the time of the first assessment. I hope the noble and learned Lord will be able to pick up this point.

As the Bill is drafted, the question as to whether somebody is ordinarily resident in England and Wales rests on what is called the

“opinion of the coordinating doctor”.

My concern is that an opinion without any further evidential requirement may be too low a bar, particularly given the need to guard against the risk of what has been called death tourism. In other parts of the Bill, the noble and learned Lord has used the word “satisfied”, and I think we would agree that that entails a higher evidential bar than merely “opinion”—indeed, that is also higher than “believes” or “reasonably believes”. “Satisfied” is a higher standard. When the noble and learned Lord replies, can he use that opportunity to explain why the test here is only “opinion” and not “satisfied”, as that test is used in other parts of the Bill?

[Baroness Merron (Lab)]

My Lords, I thank all noble Lords for their contributions to this debate on the issue of residency and eligibility criteria. As I have already made clear and will now repeat, I will confine my comments to amendments on which the Government have major legal, technical or operational workability concerns.

First, I turn to the amendments which narrow the residence criteria in respect of eligibility for assistance under the Bill. Amendment 11, tabled by the noble Baroness, Lady Finlay, would change the residence criteria for assistance under the Bill from requiring a person to be “ordinarily resident” to “permanently resident”. Unlike “ordinarily resident”, “permanently resident” does not have a set definition in the context of UK immigration law. It is possible that it would be taken as referring only to those who have citizenship or indefinite leave to remain, which is a much narrower scope than the current wording of “ordinarily resident”.

Similarly, Amendments 23, 309, 300A and 306A would restrict access to assisted dying support to British citizens or people with indefinite leave to remain. This may result in migrants on long-term work or study visas who have resided in England and Wales for longer than 12 months being denied access to an assisted death, thereby potentially giving rise to indirect discrimination based on race. These amendments may be subject to challenge under Article 14 of the ECHR when read with Article 8, on the basis that this may amount to unjustified discrimination. This differential treatment would require an objective and reasonable justification.

In addition, under various international agreements, the UK has an obligation not to discriminate against EU, EEA and Swiss nationals on the basis of nationality, although the agreements do not prevent restrictions on the basis of residency. Since these amendments would prevent individuals from those countries from accessing these services on an equal basis to UK citizens in the same circumstances, they are likely to be contrary to the UK’s international obligations under those agreements.

Amendments 11A, 258A, 306B and 449A, tabled by the noble Baroness, Lady Coffey, seek to change the residency requirement from “ordinarily resident” to “domiciled”. These amendments would add complexity and potential uncertainty to the eligibility requirements. “Domiciled” refers to the determination of a person’s permanent home largely for tax purposes, meaning that a person can be domiciled in a place without being resident there. It is not a familiar concept in domestic law outside of taxation, so it is unclear how it would apply in this context. Further elaboration in guidance would be needed to make these amendments workable. It is also unclear what practical impact this change would have when the Bill would still require people to be physically present in England and Wales in respect of the steps under Clauses 8, 10, 11 and 19.

I will next turn to Amendment 14, in the name of the noble Lord, Lord Moylan.

[Baroness Coffey (Con)]

Before the Minister moves on, Kim Leadbeater specifically introduced this concept of England and Wales, and, in Committee, Stephen Kinnock did not raise any issues with it at all in terms of operability or similar. I am astonished to hear some of the other elements that are now coming out for the first time in the consideration of this Bill.

[Baroness Merron (Lab)]

I am sorry to hear of the noble Baroness’s surprise. I am simply setting out where the Government have particular concerns within the scope to which I referred. My noble and learned friend Lord Falconer may be able to comment more appropriately, if he wishes to do so, on the points that she raises.

Amendment 14, in the name of the noble Lord, Lord Moylan, would widen the eligibility criteria to include UK citizens of pensionable age who are living abroad. There are two main issues with this amendment. The first is that the UK has obligations under international agreements that enable residents of partner countries to receive certain benefits, including some health service provision, in the UK. These agreements are, as I mentioned, with the EU, EEA states and Switzerland. As I set out, these agreements prevent restrictions based on nationality, although they permit those based on residency. Therefore, the amendment would have the effect of opening access to provision of assistance under the Bill to EU, Swiss and EEA residents of pensionable age, provided that they satisfy other eligibility criteria. Widening access only to UK nationals of pensionable age would be contrary to the UK’s obligations under those agreements.

Secondly, by including those who have “moved to live abroad”, the amendment would enable pensionable-age citizens from Northern Ireland or Scotland who have moved abroad to access the provision of assistance, in accordance with the Bill, if they satisfy the other eligibility criteria.

For all the other amendments in this group, on which I make no comment, any workability concerns are less significant. For example, Amendment 10 would remove two eligibility criteria from Clause 1, while Amendment 13 would change the requirements relating to ordinary residence in England and Wales. As Clause 1 is largely descriptive, these amendments would have limited legal effect without corresponding amendments being made to operative provisions later in the Bill.

While these are choices for noble Lords, these amendments may introduce inconsistencies and ambiguity into the Bill. As noble Lords will be aware, these amendments have not had technical drafting support from officials, so the way in which they are currently drafted means that they may not be fully workable, effective or enforceable—but, of course, the issues raised are rightly a matter for noble Lords to consider and decide on.

[Baroness Finlay of Llandaff (CB)]

Given that Jersey and the Isle of Man, if I am correct, are not EEA countries, how is the contract for health service delivery affected by this Bill in the light of the problems that I highlighted right at the beginning of what has turned into quite a lengthy debate? I was trying to look at a carve-out for those countries so that those contracts could continue, but I was told that it was deemed out of scope of the Bill.

[Baroness Merron (Lab)]

I am sure the noble Baroness will understand that I am restricted in the comments that I can appropriately make here. I heard my noble and learned friend Lord Falconer say that all these matters needed consideration, and I am sure that he will expand further on that very point.

[Lord Falconer of Thoroton (Lab)]

I will come to that question when I go through the points.

The purpose of Clause 1(1)(c)—namely, that to qualify you have to be ordinarily resident in England and Wales and have been so resident for at least 12 months—is, as noble Lords have said, to avoid people coming here specifically for the purpose of having an assisted death. It therefore would not be adequate to say that people should be ordinarily resident at the moment they apply, because they would have come specifically for that period. Hence you need a period, and 12 months is taken as a reasonable period in relation to that.

The phrase “ordinarily resident” appears right throughout the statute book in a whole range of settings and reflects the policy choice made by regulations or statutes. It says, “We want to give this right to people who permanently live in this country”, using the word “permanently” not in a legal sense but in an ordinary sense. In applying that phrase, the courts have not generally had any real difficulty as to what it means. It is a reflection of this Parliament saying that we want to give particular rights to the people who live here, and sometimes we say, as we are suggesting here, that we do not care what their citizenship status is—if they live here permanently, they get that right. For example, in relation to the National Health Service we say that if people live here permanently, they get that right.

With the greatest respect to the noble and learned Baroness, Lady Butler-Sloss, the cases have made it pretty clear that you can be ordinarily resident here but have temporary absences abroad—for example, if you go to work as a diplomat abroad, serve in the Armed Forces or take a job that takes you away for two months. The big case is somebody whose family lived here and who went to be educated in India for a period of time, who is still held to be ordinarily resident here. With the greatest respect to the noble Lord, Lord Mackinlay, I do not think that adopting the phrase “ordinarily resident” gives rise either to injustice or to legal difficulties.

I will deal with the points made by individual Peers. I am very sympathetic to the point from the noble Baroness, Lady Finlay, as I made clear in my intervention. I do not think she was putting in the word “permanently” other than to probe the question of those who live on the Isle of Man or Jersey and get all their medical treatment habitually in England. When the doctor in England says, “I will help you go home to the Isle of Man to get an assisted death”, assuming that it becomes legal in the Isle of Man, the doctor there will be committing a criminal offence under the Bill unless there is an amendment.

The BMA has proposed an amendment that, if you help somebody go home for an assisted death—home being, say, the Isle of Man or Jersey—and it is legal there, that should not be a criminal offence. I talked to the BMA about that. We need to work together to see whether we can get an amendment that satisfies the point that the noble Baroness, Lady Finlay, has made. I would welcome her input in relation to this.

Supply of Blood and Blood Products

Baroness Merron Excerpts

Wednesday 3rd December 2025 Lords Chamber

[Baroness Hayman]

To ask His Majesty’s Government what steps they are taking to ensure the supply of blood and blood products this winter.

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

My Lords, NHS Blood and Transplant has expanded donation capacity to meet the nation’s needs, opening three new donor centres and additional mobile sessions, adding 3,900 weekly appointments. However, blood stocks remain fragile, and we urgently need more donors, with 71,000 appointments still to fill over the festive period. I urge everyone, including noble Lords, to donate. Noble Lords will have the opportunity at tomorrow’s dedicated parliamentary session in Portcullis House to help to ensure a resilient and reliable blood supply this winter.

[Baroness Hayman (CB)]

My Lords, I am grateful to the Minister for that encouraging reply, and particularly for the reinstatement of the parliamentary donation service. However, as she says, this is a very heavy winter season for the NHS. It is a heavy flu season and a heavy holiday season, which puts pressure on donors. Is she confident that she will fill those extra donor slots and that there will be security of supply for the winter? Is she looking at specific campaigns aimed at those of black heritage and younger people, because it is important to get people early? She might remind Members of this House that you can start being a blood donor in your 60s but, if you start earlier than that, you can go on for a while longer.

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[Baroness Merron (Lab)]

I certainly echo the noble Baroness’s comments. It is thanks to the generosity of donors—including the noble Baroness herself, who is I know is approaching her 50th donation—that overall blood stocks are at target levels, but she is right about the extra pressures coming through because of winter. The launch of the national campaign to highlight the constant need for blood in this season and to recruit new donors was set under way last month. We also have targeted media campaigns; for example, in areas of the country with larger black heritage communities to highlight the urgent need for more donors from that group.

[Lord Evans of Rainow (Con)]

My Lords, I confess to 120 donations and thank the Minister for all the work that she is doing on this, particularly for tomorrow’s session, but she is absolutely right that only a tiny proportion of the population are blood donors. Talking personally, it is not always straightforward for working people to get those appointments. The noble Baroness is right that we are very short on black and ethnic-minority donors. With that thought in mind, would it be possible to look at artificial intelligence to make it easier for working people, particularly from ethnic minorities, to make those appointments during the working day?

[Baroness Merron (Lab)]

The noble Lord is also to be congratulated, of course. As he said, despite our having some 790,000 regular donors, only 2% of the population gives blood, so we are not full up and we look forward to more donors. To the point that the noble Lord raises, which is important, we are increasing capacity for appointments to donate, but we are also looking at additional digital and logistical improvements, including in how people can book appointments. We are also piloting a new appointment reminder and better communications. There is room for improvement, and we are taking those steps. The noble Lord makes very good points in this regard.

[Lord Scriven (LD)]

My Lords, following on from the previous question, to address the major barrier of donor inconvenience, will the Government look urgently at consulting employers and unions on a national campaign to encourage the adoption of a “donate time” policy, offering a flexible blood break for employees to attend donation sessions during the working day?

[Baroness Merron (Lab)]

That is part of the potential solution, in addition to where donors go, how they are communicated with and how easily they can make appointments. We will certainly put the noble Lord’s suggestion into the mix; it is certainly something that I have discussed in respect of the Civil Service, and it varies across departments.

[Lord Watts (Lab)]

My Lords, we are seeing reductions in the number of donors, whether it be in blood or in organ donation. Are we not getting to a serious situation where the Government need to think about how they can increase donations to historic levels?

[Baroness Merron (Lab)]

I am not sure that I agree with the reflections of my noble friend, although I do agree that we have a shortfall of some 200,000 donors to shore up and grow our blood supply. As I said, the situation remains fragile, which is why we need more support. We are constantly working to identify gaps and opportunities to strengthen and diversify the donor base through a donor base resilience programme, launched just this year. It is not just numbers; it is also the range of people, as we heard in earlier questions.

[Baroness Watkins of Tavistock (CB)]

My Lords, does the Minister agree that during Covid we used non-traditional venues to encourage vaccination? I will give an example that we talk about a lot: football clubs. In Plymouth, that resulted in people who had never been able to see the football club go and get their vaccination. I believe that if we invested heavily in similar approaches, we would get many more young people giving blood. Will the Minister comment on that?

[Baroness Merron (Lab)]

The noble Baroness is quite right. We have to go to where people are and not just expect them to come to us, and using a whole range of venues is important, as are mobile donation facilities. This is constantly kept under review: the service is constantly reviewing where the most successful places are and looking at new venues and new opportunities to take up.

[Lord Kamall (Con)]

My Lords, to continue on the line of the noble Baroness, Lady Watkins, I remember that when we were looking at vaccine hesitancy, we looked at how we could reach certain communities—they do not like being called hard to reach because they feel they are being patronised. Quite often, it was through faith organisations; sometimes, it was through community leaders. What work has been done on the lessons learned from the vaccine hesitancy campaigns to encourage more people to give blood? I want also to ask about guidelines. I was speaking to a noble friend who said she had volunteered to give blood but was told that because she had passed the age of 66 and had never given blood in the UK before, she was not allowed to donate. Can we have some clear guidelines for those who are willing to give blood, especially Members of this House?

[Baroness Merron (Lab)]

Of course, is the answer to the noble Lord. On his point about reaching certain groups, we have invested across 51 organisations this year that are very much rooted in the community, and 31 of the projects across those organisations have worked nationally to boost awareness, understanding and behaviour change in black, Asian, mixed-heritage and minority-ethnic communities, where we need more people to come forward to donate blood in order that we have the blood we need for the conditions that they are there to meet.

[Lord Wallace of Saltaire (LD)]

My Lords, I should admit that I never decided to become a blood donor. Once, when I was at Chatham House, a van from the blood donor service was due to come to St James’s Square the next week and my secretary informed me that she had booked me in to give a donation. I thereafter donated for 20 years. That shows that there are a lot of us who would sort of get round to it if we thought about it, and taking the caravans to businesses and working with the businesses to encourage their members to donate is one way that clearly helps to get passive potential donors to say yes.

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[Baroness Merron (Lab)]

The noble Lord gives a good example—sometimes we need other people to sort us out to give blood—but the main point he makes is absolutely right: we need to speak to people through our campaigns. Each donation can save up to three lives. We need to tell people the effect of what they are doing too, and I am glad that we are taking innovative steps to raise awareness, including advertising on London buses.

[Lord Markham (Con)]

I thank the Minister for letting me get in just in time. I am interested in plasma. As many noble Lords will be aware, we have been importing 100% of our plasma needs ever since mad cow disease, so it is an area in which we are quite vulnerable and I know the blood services are trying to correct that. Can the Minister give us an update on where we are on that?

[Baroness Merron (Lab)]

We are making considerable progress in diversifying where plasma comes from. We are also making good progress in demand management and ensuring that there is no waste in blood products, which will also greatly assist us. I shall be pleased to write to the noble Lord with a full description of the advances that we are making; it is an exciting time in that respect.

Tobacco and Vapes Bill

Baroness Merron Excerpts

Committee stage
Wednesday 26th November 2025 Grand Committee

[Lord Robathan (Con)]

My Lords, I rise briefly to support my noble friend Lord Kamall on the Front Bench. I have not taken part in these debates before, but I have to say that I find it quite disturbing that we should be making laws because perhaps we do not like walking down a street where people are puffing vapes. I do not, but there are lots of things I do not like that people do, and I am not going to ban them all—well, perhaps I would, actually, but I am not going to.

Similarly, if you cannot be hooked by passive vaping, as my noble friend Lord Kamall said, I am not quite sure why we are taking it so seriously. As I understand it, vaping is not addictive; nicotine is addictive, but vaping itself is a different matter. It also seems to me that we are legislating unnecessarily. I am afraid, to broaden the subject slightly, that this will lead to yet further influxes of cheap and nasty vapes, which may or may not be, as the noble Baroness just said, influenced by other matters.

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

My Lords, I am most grateful to noble Lords for their contributions to this debate. Let me first turn to the opposition to Clause 138 standing part of the Bill, which has been proposed by the noble Lord, Lord Udny-Lister. Clause 138 amends the Health Act 2006 to insert new provisions relating to vape-free places in England. These provisions allow the Secretary of State to designate certain places and vehicles as vape-free, but only where they are also smoke-free.

The noble Lord, Lord Kamall, asked about evidence. The fact is that evidence is developing, as the noble Lord himself rightly acknowledged, but we do know that while vapes are less harmful than smoking, there is a reason why the Chief Medical Officer says:

“If you smoke, vaping is much safer; if you don’t smoke, don’t vape”.


Vapes are not harm-free; there are legitimate concerns regarding the unknown long-term health impacts of vaping. They produce aerosol that exposes people to nicotine and potential toxicants, which poses health risks to children and medically vulnerable people in particular; for example, they can trigger asthma attacks. It is therefore important and right—I say this to the noble Lord, Lord Robathan—that the Government act to protect more vulnerable groups from potential health harms. I should also say that evidence suggests that, in adolescence, the brain is more sensitive to the effects of nicotine, so there could be additional risks for young people compared to adults.

As the noble Baroness, Lady Walmsley, said, many businesses and enclosed public places already have in place, on a voluntary basis, schemes to prohibit vape usage on their premises. We want to introduce legislative requirements to make it clear to the public where it is illegal to use vapes and to enable enforcement agencies to enforce accordingly. I know that noble Lords understand the reasons for wanting to be clear about what is and is not legal, and this Bill and the provisions in it are very much part of that.

Again, as the noble Baroness, Lady Walmsley, welcomed, the main answer to all the questions today— I will continue to go through the various amendments—is that we will be consulting on making indoor settings that are subject to existing smoke-free legislation vape free. The consultation in this area and beyond is crucial, because we also plan to consult on making some outdoor places where children are present vape free—for example, children’s playgrounds, and the outdoor areas of schools and early years settings.

The noble Lord, Lord Kamall, asked about how we will recognise the difference between harms. I can assure him that this is an area we absolutely want to get right. We do want to ensure that adult smokers who are using vapes as quit aids are doing so in appropriate places, such that they do not return to smoking. That is exactly why we will consult before making regulations and carefully consider the responses to ensure the policy seeks the appropriate balance.

Amendment 182A tabled by the noble Lord, Lord Howard of Rising, would mean that some indoor areas, for example nightclubs, would not be able to be made vape free. I am grateful to the noble Baroness, Lady Walmsley, for her views on this. As I have already outlined, vapers pose potential risks to both users and non-users, especially indoors. We had a debate in an earlier group about the workability or otherwise of designating particular areas as able to police themselves. It is quite important to say to the Committee that the vast majority—around 90% of those over 16—do not currently vape. Just because someone is in an over-18 setting does not mean that they are content to be exposed to these second-hand harms.

As discussed, this is a particular concern for medically vulnerable people whose conditions may not be in the least visible to the vaper, who I am sure does not wish to cause harm—for example, those with asthma. Additionally, people who wish to vape will still be able to do so in outdoor hospitality settings—for example, in the outdoor smoking areas of an over-18 nightclub. We have been very clear that we will not be consulting on including those outdoor areas in the scope of vape- free places.

Ultimately, the Bill grants powers to make places vape free and does not itself make any place vape free. The consultation will ask questions relating to areas that should become vape free, any necessary exemptions and any additional evidence on the second-hand harms of these products. Therefore, in our view there is no change needed to the primary legislation.

It is appropriate now to turn to Amendments 181 and 184, tabled by the noble Lord, Lord Kamall, which would seek to limit the locations that can be designated as vape free. As I have already outlined, the current power allows us to respond to evolving evidence at a later time and ensures the Bill is future-proof. The noble Lord asked about the process. I can confirm as I have done previously that the power for vape-free places will be through an affirmative regulation. That will mean, as the noble Lord knows, a debate in both places. The noble Baroness, Lady Walmsley, talked about vape-free areas being specified in the Bill. I hope I have explained why that is not the case. It is particularly important as we talk about evolving evidence that we look to the future. That is why we will be consulting and why we will turn to regulations.

The noble Lord, Lord Kamall, mentioned vape-free schools and asked whether that measure applies to children or adults. I can confirm that it is about the area rather than the people in it. So there are no limitations on people of a certain age; it is the area that would be designated.

I turn to Amendments 182 and 187 in the name of the noble Lord, Lord Udny-Lister, which relate to vape-free policies in schools and colleges in England that are made vape-free places. It is my view that these amendments are not necessary. As I have said, we have already made it clear that we will consult on making schools, sixth-form colleges and early years settings vape-free places. Public consultation will allow us to gather views from a wide range of stakeholders, including those who run education settings. Enforcement officers will have the power to issue on-the-spot fines or pursue convictions where they deem it necessary for the offence of using a vape in a vape-free place. However, we anticipate—this may be helpful to noble Lords—that there will continue to be a role for internal sanctions for pupils found vaping on the premises. Schools are already required to publish a behavioural policy.

In relation to education provisions for pupils on vaping, we have worked closely with the Department for Education to incorporate education on the risks of vaping and nicotine use in the recently updated relationships, sex and health education statutory guidance for schools and teachers; I am sure that the person referred to by the noble Baroness, Lady Bennett, will benefit from that in future.

I appreciate the points made by the noble Lord, Lord Kamall, and his intention in Amendment 183, to which the noble Baroness, Lady Walmsley, also spoke. I agree that it is important that patients receiving care in a mental health setting have access to appropriate smoking cessation tools; that is particularly true given that smoking rates among those with a long-term mental health condition are far higher than in the general population. As I have mentioned previously, in England, we are considering making inside hospitals—but not outside them—smoke-free. I appreciate and am alive to the fact that there are particular considerations in the case of mental health facilities, but I assure noble Lords that we are keen to get things right in this area and are going to follow the evidence. We want to ensure that vapes can continue to be accessible as an effective quitting aid for adult smokers; noble Lords have made strong and important points about this. As outlined, we believe that the details of any exemptions are best explored through the consultation process, although we understand the intention behind the amendment.

I hope that this provides reassurance and understanding to noble Lords that the settings that will be in scope of the vape-free policy will be fully considered by consultation and then considered under the affirmative procedure. I hope that the noble Lord feels able to withdraw his amendment.

[Lord Kamall (Con)]

My Lords, I thank the Minister for her response; I also thank all noble Lords who spoke on this group. I am grateful to the Minister for confirming that any further extension of the designation of vape-free places will be done via the affirmative procedure, which is very welcome.

I have a couple of outstanding questions; I suspect that the Minister and her department were not able to get the answers quick enough, thanks to the power of the internet or whatever, so I wonder whether the Minister could write to noble Lords on these matters. First, is there any evidence yet from studies of passive smoking in outdoor settings? As I said, the studies I looked at were all on indoor settings; nothing has been done on outdoor settings. It would be good to know what evidence the department currently has. I also ask the Minister to share that evidence, with the appropriate links, so that we can all understand it. usbI understand that the consultation is all about seeking further evidence, but it would be interesting to know what evidence the department currently has—on the understanding that the evidence is evolving, as the Minister rightly said.

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[Earl Howe (Con)]

My Lords, my noble friends Lord Howard of Rising and Lord Udny-Lister, who is unfortunately not in his place, are to be thanked for enabling us to focus on the issues around the use of heated tobacco. We have touched on this subject at earlier stages but, when previously discussing heated tobacco, the Minister promised to write to noble Lords about the evidence that her department possesses of the harms caused by heated tobacco. I am sure that is high on her agenda, but the question is crucial in the context of these amendments since, whatever the answer is, it will have a direct bearing on the use of the Secretary of State’s powers to designate locations as heated tobacco-free.

There are various published studies, as she will know. A study published by UCL found that people who switched from cigarettes to heated tobacco had lower levels of exposure to harmful chemicals than those who kept smoking, but higher levels of these toxins than those who stopped using tobacco altogether, which I guess is not a surprising finding. Other studies state that it is too soon to know how using heat—not burn—products will affect someone’s health in the long term, since research looking at these tobacco products is still, I understand, in its early stages and, in the main, funded by the tobacco industry. We therefore need clear evidence, born of independent research, on both the relative harm of heated tobacco compared to burning tobacco, as well as the absolute levels of harm that result from its use.

I am a non-smoker. I understand the concern that heated tobacco should not be a loophole for large tobacco firms to get around the law, but I am also concerned that in the absence of long-term evidence, portraying heated tobacco as being in the same category as cigarettes carries the risk of failing to reduce harm for that small percentage of smokers who wish to quit but have not taken to vapes for one reason or another.

Pending fresh research findings, I think, alongside my noble friends, that there remains a legitimate question about how the Government intend to treat spaces, both indoors and outdoors, where heated tobacco is used, and about whether they believe there is a clear proven case for including heated tobacco in the generational ban. In particular, does the Minister consider uncovered outdoor areas to be different in this context from enclosed spaces, in terms of both health risk and social behaviour? As she knows, the hospitality industry has concerns about extending the indoor smoking ban to outdoor hospitality areas such as pub gardens, and I welcome the assurance she gave on that a few minutes ago. The indication from the Government thus far is that hospitality areas will not be caught by any outdoor ban, but if that is true of smoke tobacco, can the Minister confirm that there is no similar intention as regards the outdoor use of heated tobacco?

[Baroness Merron (Lab)]

My Lords, the amendments in this group relate to limiting the Government’s ability to create heated tobacco-free places in England. I am grateful for all the contributions to the debate.

The noble Lord, Lord Udny-Lister, opposes Clause 139 standing part of the Bill. Clause 139 provides the power to designate certain places and vehicles in England as heated tobacco-free. Places can be designated heated tobacco-free only if they are smoke-free. As I have mentioned, we plan to consult on making heated tobacco-free all indoor places that are currently smoke-free. We also plan to consult on making certain outdoor spaces heated tobacco-free. As with smoke-free places, the consultation will cover children’s playgrounds, the outdoor areas of schools and early years settings, and areas outside healthcare settings where medically vulnerable people may be present.

The noble Earl, Lord Howe, asked an important question about evidence, and I will write with more detail as soon as possible. However, I reiterate what I said in debates on previous groups and elsewhere: there is no safe level of tobacco consumption and all tobacco products are harmful, including heated tobacco products. I am grateful to the noble Baronesses, Lady Bennett and Lady Walmsley, for their supportive comments. Laboratory studies show evidence of toxicity from heated tobacco and that the aerosol generated by heated tobacco devices, like other forms of tobacco, contains carcinogenic compounds. Recent evidence has also indicated that exposure to second-hand emissions from heated tobacco products is associated with significant respiratory and cardiovascular abnormalities in bystanders.

The noble Lord, Lord Udny-Lister, also tabled Amendment 185. The noble Earl, Lord Howe, asked me to repeat—I am glad to do so—that, as I have made clear, we are not planning to consult on making outdoor hospitality settings in England heated tobacco-free.

Amendment 184A tabled by the noble Lord, Lord Howard of Rising, seeks to exempt areas where it would be reasonable to expect that only over-18s are present from any future restrictions on heated tobacco places. This amendment is similar to the one already discussed in relation to vape-free places, which would mean that some indoor areas, for example nightclubs, could not be made heated tobacco-free.

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[Baroness Merron (Lab)]

My Lords, I am most grateful for this discussion. I say at the outset that, although I do not support accepting the amendments, I have a lot of sympathy with a number of the points made, which I will come on to. However, while I completely understand the pressure on small retailers—I will come on to that—I struggle to accept that the Bill is the fount of all evil, which I feel is the direction we are going in. I certainly agree with the noble Baroness, Lady Bennett, who spoke about the need to see the Bill in its overall context. I associate myself with those comments.

I absolutely agree with the intention behind Amendment 191, tabled by the noble Lord, Lord Kamall, and introduced by the noble Earl, Lord Howe. I hope I can reassure noble Lords that the Government are committed to supporting businesses to implement the measures in the Bill, which much of this discussion has been about. As I have said previously, we will continue —it is a continuing thing that is not in the past—to work closely with retail bodies such as the British Retail Consortium and the Association of Convenience Stores on the implementation of the measures, which will include the development of guidance.

I heard the concern of noble Lords about what guidance will be given. Again, I understand those points but, to say it in other words, we will support retailers through this transition. As the noble Baroness, Lady Walmsley, mentioned, what is being asked of retailers is not unusual for them; they are very familiar with age verification. I will come back to that later. The measures in the Tobacco and Vapes Bill will come into force across a range of dates and therefore it is important that the associated guidance is available at the appropriate time. In other words, there will be time to make this transition and there will be support for that. We are firmly committed to publishing the guidance in a timely manner.

Turning to Amendment 188, tabled by the noble Lord, Lord Kamall, I say to nearly all noble Lords who have spoken that, although I understand the intention of the amendment, it is unnecessary. As noble Lords have acknowledged, the Government are already taking action to tackle the absolutely unacceptable rise in retail crime. The Government will not stand for violence and abuse of any kind against shop workers. Everybody has a right to feel safe at their place of work and we have long championed specific protections for retail workers.

To protect the hardworking and dedicated staff who work in stores, the Crime and Policing Bill introduces a new offence of assaulting a retail worker, which the noble Baroness, Lady Fox, referred to. The Bill also removes legislation which makes shop theft of goods to the value of £200 or below a summary-only offence. That sends a clear message that any level of shop theft is illegal and will be taken seriously. I hope that that is helpful to the noble Lord, Lord Howard.

Alongside legislative action, we are also providing over £7 million over the next three years to support multiple policing bodies to help to tackle retail crime. As I have mentioned, we will continue to work closely with retailers and will utilise the lead-in time to best support them in preparing for and implementing the measures in the Bill. This will include government communications and information campaigns to inform both the public and retail workers.

The noble Baroness, Lady Fox, asked what assessment the Government have made of the impact on small businesses. Page 82 of the impact assessment specifically addresses this. As noble Lords are aware, an impact assessment should be expected and is required for any Bill. That means that the Regulatory Policy Committee also took a view; it published an opinion on the impact assessment and provided a fit-for-purpose rating. This included a green rating for the assessments of small and micro businesses’ assessments. I hope that will be useful.

I turn to Amendment 200A, tabled by the noble Lord, Lord Howard. This would require the Government to create a financial assistance scheme specifically to subsidise the cost of purchasing age-verification technology to enforce on the sale of nicotine products. I heard the comments of the noble Baronesses, Lady Walmsley and Lady Bennett, who spoke against that amendment.

There are no plans to mandate the use of age-verification technologies to enforce the age of sale of nicotine products. It will be for businesses to decide how they ensure that they sell only to people 18 years or over, including whether to use age-verification technology to support them in this. As I mentioned earlier, as did the noble Baroness, Lady Walmsley, checking that a customer is over a certain age is a well-established and well-trodden path for retailers. They should continue to take reasonable steps and exercise due diligence to ensure that they do not sell products to anyone underage. Most retailers already follow recommended practice, and I am grateful to them; they regularly ask for identification from customers to verify their age.

To provide clarity for retailers on the types of ID that can be used, the Bill provides powers to specify in regulations the steps that may be taken to verify a customer’s age and satisfy the age of sale defence. This will include the types of digital identities that can be used, and work will continue with the Department for Science, Innovation and Technology, which is leading on this work. I emphasise that the Government are absolutely committed to supporting retailers through the changes brought in by this legislation, including through the publication of clear guidance in which they will be fully involved.

I hope that I have provided helpful reassurances and that the noble Lord will feel able to withdraw the amendment.

[Earl Howe (Con)]

My Lords, I am grateful to all noble Lords who have spoken in this short debate, including the Minister for her reply. Perhaps I could repeat that my amendment was intended as a probe to raise a set of general concerns surrounding the retail sector. I was reassured by the Minister’s reply, including her references to the provisions of the Crime and Policing Bill. But we need to bear in mind, as we debate the Bill, that retailers are not the source of the problem that the Bill seeks to address—yet they will be the ones to lose out.

The Bill is projected to cost retailers more than £1 billion in profits over the next 30 years, plus what I am sure will be a considerable amount more from the reduced footfall that many will see over time. The noble Baroness, Lady Fox, was right: there is considerable worry in the sector, which is exacerbated by the uncertainty surrounding the timetable for the Bill’s implementation. It would be helpful, perhaps when we reach the next stage of the Bill, for the Minister to give us an idea of how the Government intend to proceed as regards the processes of consultation—consideration of submissions, as well as the actual implementation—and what the outline timetable will look like. The transition needs to be as inclusive and smooth as possible, and practical guidance and support will be essential, especially for small retailing businesses. I have no doubt that the Government have this in mind, but we may need to return to it on Report, just to underline the point. Meanwhile, I beg leave to withdraw the amendment.

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[Earl Howe (Con)]

My Lords, the Committee will be grateful to my noble friend, with his considerable experience in health policy, for the clear and cogent way in which he introduced his amendment. I am very supportive of the principles behind the amendment, as it seeks to ensure that decisions taken after the passage of the Bill are informed by robust, independent evidence and that Parliament is equipped with the relevant and authoritative information it needs to provide proper oversight of the regime for vaping and nicotine products, information that is constantly updated as the body of evidence evolves.

Critically, this principle applies equally to the Government. Proposed new subsection (5) in the amendment would require Ministers, when making regulations under the Act, to have regard to the proposed panel’s reports and recommendations. That is a sensible idea. My noble friend Lord Young of Cookham was right to remind us that there has for some time been a gap in the public health mechanisms regarding the production of such reports. If we were to recreate a mechanism of the kind suggested, the regulatory frame- work would evolve in response to the realities of science and the market rather than outdated information.

It is also important to recognise, as the amendment implicitly does, that although our primary concern here is health, regulation in this space cannot be viewed in isolation from the wider economy. When sales of currently legal products are restricted or prohibited, this inevitably impacts businesses, consumers and, sometimes, wider society, and those economic effects can themselves have unintended consequences for public health and people’s lives. There is also plenty of evidence of unintended consequences and the effectiveness of previous episodes of prohibition. The risk of a rise in consumption of illicit products is an obvious example, as is misinformation propounded on social media. The Government should make and review decisions with as clear a view as possible about those sorts of trade-offs.

For those reasons, I hope the Government will take on board the very sensible suggestion contained in this amendment.

[Baroness Merron (Lab)]

My Lords, I am most grateful for this debate, which concludes the work of the Committee. As I have said before, I certainly share the intention of the noble Lord, Lord Lansley, who tabled this amendment, to ensure that regulations are based on the best available evidence. I appreciate the consideration he has given to the amendment and the reason he put it forward.

I say in response that we continue to monitor emerging evidence, which we have much discussed, on vapes and nicotine products, including commissioning independent research through the National Institute for Health and Care Research. For example, we commissioned a comprehensive analysis of all youth vaping studies—referred to in the debate—which was published recently, and a five-year-long living evidence review that will collate the latest and most robust research into the health impact of vaping. This living evidence review is accompanied by a scientific advisory panel, which includes independent experts, appointed independently from the Government on merit, who the Government can call on for advice on the latest evidence. Further, as the noble Lord, Lord Young, mentioned, earlier this year we announced a landmark 10-year study that will include in its investigations the long-term health effects of vaping on young people’s health.

I agree with the noble Lord, Lord Lansley, that misperception of the harms of vaping is of concern; I take that point. Vaping absolutely can play a role in helping adult smokers to quit, as we have discussed, but children should not be vaping and nor should non-smokers. We are committed to carefully considering the scope of restrictions, to avoid unintended consequences and the misperception of harms, which is an area for further work.

We also fund a vaping expert panel, which provides valuable guidance for trading standards professionals on the enforcement of regulations. Under many of the powers in the Bill there is a requirement to consult before making regulations and, on 8 October, we published a call for evidence on issues where more evidence is needed before we can consult on specific proposals. We will monitor the impacts of measures brought in by the Bill and subsequent regulations. We will also be able to update regulations in future to ensure that policy is responsive to evolving evidence, should this be necessary.

It is our view that we have access to appropriate expert advice, which I know is the noble Lord’s intention, and we will consider the best available evidence in making regulations. I hope that he will feel able to withdraw his amendment.

[Lord Lansley (Con)]

My Lords, I am grateful to all those who contributed to the debate. It is both helpful and timely at the conclusion of Committee to have exactly this debate. In a funny way, perhaps we should have had it at the beginning, because it helped to fill out some of the details of the ways in which the evidence base for the vaping and nicotine product regime will be assessed and understood.

Mental Health Bill [HL]

Baroness Merron Excerpts

Consideration of Commons amendments and / or reasons
Monday 24th November 2025 Lords Chamber

Moved by

[Baroness Merron]

That the House do agree with the Commons in their Amendment 1.

1: Clause 5, page 11, line 22, leave out “by a constable or other authorised person”

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

My Lords, with the leave of the House, I will speak also to Amendments 2 to 21, including Amendments 19A and 19D. It is a pleasure to return this Bill to this House; I very much appreciate the support and engagement of noble Lords throughout its passage.

Let me turn first to the government amendments in the other place, other than the minor and technical amendments, which are there for clarification. We have clarified the duties on NHS bodies to make arrangements regarding advance choice documents, otherwise known as ACDs. NHS bodies must actively inform individuals about ACDs, rather than taking a minimal approach. The Bill requires that information and help are provided to people who wish to make an ACD through discussion with a suitably qualified person. NHS bodies should consider the advantages of making an ACD within 12 months after discharge and aim to provide support. Additional guidance on these duties will be in the revised code.

I thank my noble friend Lady Keeley and the noble Baroness, Lady Barker, for raising concerns about the unequal application of the Human Rights Act. The Government have now made it so that registered private providers delivering Section 117 aftercare or in-patient mental health services, funded by local authorities or the NHS, are treated as carrying out public functions under the Human Rights Act and act compatibly with the convention rights. This amendment will apply UK-wide.

I turn to the amendments made by this House on police powers. I thank the noble Baroness, Lady May, for her constructive engagement and for establishing the review of the Mental Health Act when she was Prime Minister, which has brought us to this place today. We have removed the amendments made to Clause 5 that would have added police and other authorised professionals to Sections 2, 3 and 5 of the Mental Health Act. Extending police and other authorised professionals to these sections would be inappropriate—a view that is shared by the police.

We have removed Clause 50 from the Bill, which would have extended emergency police powers under Sections 135 and 136 of the Act to other authorised persons. Health and care professionals lack the training, equipment and access to rapid back-up needed to use such powers safely, and stakeholders are concerned about staff having the authority to use reasonable force. A blanket extension of powers to multiple agencies would risk confusion and delay in emergencies due to a lack of clarity over who should respond.

There are strong views on either side of this issue, and there are situations where health professionals feel that they do not have the powers they need. That is why I am announcing longer-term plans to launch a consultation into emergency police powers of detention. We will consult on the powers available to different professionals in different situations and settings, in particular—but not limited to—the operation of the emergency powers in Sections 135 and 136. The consultation will seek views on powers and joint working approaches to ensure that health and social care professionals and police have the appropriate powers to act in order to prevent people harming themselves and others when in a mental health crisis. We firmly believe that this is the right approach to a complex issue that requires careful consideration and consultation.

I turn to community treatment orders. Clause 6(3) has been removed from the Bill, as CTOs already comply with the code and have an initial six-month period. The responsible clinician may renew a CTO if there is a risk of serious harm without it and a reasonable prospect of therapeutic benefit. Following positive engagement with the noble Lord, Lord Scriven, and the noble Baroness, Lady Tyler, I can confirm that the Government will review the statutory forms that relate to CTOs, with the aim of strengthening them to ensure a clear audit trail of the reasons for applying a CTO and associated conditions.

Regulations will require that statutory care and treatment plans specify any CTO conditions and their justifications, which will also be clarified in the code. We will work with the Tribunals Service and the judiciary to ensure that the patient’s plan is considered alongside other evidence at tribunal hearings. We will clarify in the code that, where a tribunal recommends that the responsible clinician reconsider CTO conditions as it does not consider them necessary, the responsible clinician should review and, potentially, revise those conditions. The code will set out that the responsible clinician should inform the patient of their decision after considering the tribunal’s recommendation, which should be recorded in writing. We will engage on the code before publication and involve the noble Lord, Lord Scriven, and the noble Baroness, Lady Tyler, in the process. As the tribunal is responsible for considering all relevant evidence, this may include recent recommendations made at past tribunal hearings regarding the conditions placed on the person, including the detail and rationale of any current conditions.

I can confirm that since September 2025 we have increased the quantity and frequency of reporting on racial disparities in key metrics, such as detention CTOs and length of stay by ethnicity. Much of this data was previously published annually but it is now published monthly, allowing for closer monitoring of progress. The data is publicly available on the Mental Health Act annual dashboard and, along with implementation of the patient and carer race equality framework, will be used by the Care Quality Commission as part of its inspection regime.

On the debriefing amendment, I thank the noble Earl, Lord Howe, and the noble Lord, Lord Kamall, for their constructive engagement. We have removed Clause 35, which required independent mental health advocates to consult people about their in-patient experience after discharge. This removes policy duplication and additional strain on advocacy services, whose focus is on supporting detained patients’ rights. The code will clarify the processes of care planning. Supporting someone to make an advance choice document should include the opportunity to reflect on past experiences. The 10-year health plan commits to making patient feedback central to quality improvement.

The Government have tabled amendments in lieu regarding the appointment of a nominated person for a child under 16 who lacks competence, and I am most grateful to the noble Baroness, Lady Berridge, for her continued work on this. The Bill now states that an approved mental health professional, or AMHP, must appoint either

“a person who has parental responsibility … a person named in a child arrangements order as a person with whom the relevant patient is to live”

or

“a person who is a special guardian”.

If there is no suitable person willing to act, the AMHP must consider the child’s wishes and feelings when deciding who to appoint.

On the amendment tabled by the noble Baroness, Lady Berridge, to the Government’s Motion, I understand the intention to prevent a parent who has had parental responsibility limited from being appointed as a nominated person by an AMHP where a child lacks competence to make the appointment. The amendment tabled would mean that a special guardian or person named under a child arrangements order as someone with whom the child must live must be appointed. It is not appropriate for legislation to say that a particular individual must always be appointed nominated person. If they are not able, or even willing, to perform the role effectively, requiring them to take this role and ruling out other options risks harming the child’s interests.

As we know, legislation can be a blunt tool. It is far more appropriate to set out nuances such as this in the statutory code to ensure that the child’s individual needs are considered. That is why we previously agreed to set up an expert task force to consider these very complexities. Part of this role includes ensuring that clear guidance is given to AMHPs on who to appoint in a range of scenarios to avoid unintended consequences. At this late stage, in order to get this right, we should not be hurriedly working through these complexities as part of the legislation. We should develop detailed guidance, in consultation with professionals and patients, through drafting the code of practice. I therefore ask the noble Baroness not to move her amendment.

In conclusion, I hope that noble Lords will support our position and pass the legislation without amendment. I beg to move.

[Baroness Berridge (Con)]

My Lords, I will speak to Amendment 19D in my name. I thank the Minister and her officials for the frequency of their engagement on the Bill. I put on record my apology for not spotting possible issues with the Government’s Motion, to which I have tabled the amendment, much earlier. I thank the Minister and her officials for meeting with the approved mental health professionals, the professional group dealing—often late at night or at a weekend—with our sickest children, who do not have the competency to appoint a nominated person for themselves.

I specifically recognise the inconvenience to the Bill team, but this matter relates to the protection of mentally ill children and has been flagged at every stage since the Wessely review in 2018, when a consultation was suggested. In recent meetings with the Minister, I understood that what was to be achieved was that the appointment of nominated persons would reflect existing court orders made by the family court on child protection grounds. The mischief that the approved mental health professionals want to solve is that they do not want to have any discretion to appoint as a nominated person anybody not in accordance with an existing court order. They want to see this achieved through the mandatory appointment of the special guardian in priority to anybody else, the rationale being that special guardianship is usually used to avoid care orders, adoption or long-term fostering.

--- Later in debate ---

[Baroness Merron (Lab)]

My Lords, I thank noble Lords for the thank yous and the appreciation for the whole team, which, as noble Lords have said, is extensive. I also appreciate the welcome for the number of improvements that we have made to the Bill by being able to work together. I am grateful to noble Lords for their contributions, as I said at the outset. We have made significant progress on the Bill. Even today, the amendments and discussions reflect the complexity of these reforms and the shared determination to deliver legislation that will make a real difference.

I will seek to address some of the points that Peers have raised—as always, I am very happy to pick up points outside the Chamber. I turn first to those raised by the noble Baroness, Lady Berridge. She asked about having strong requirements for local authorities rather than special guardians. Stakeholders, including the Office of the Children’s Commissioner, agreed that the main priority should be whether the child is under a care order—that is, the local authority has parental responsibility—and that this should be considered under a separate tier to a special guardian or child arrangements order.

I will now pick up the point that the noble Baroness, Lady Berridge, and the noble Lord, Lord Kamall, raised about why there is no use of the word “or” in the legislative drafting. On this point, I am advised that, by default, the absence of “and/or” on the page means “or” as a matter of drafting. The modern style is to say “and” when you mean “and”, but to leave—I hope that the noble Lords, Lord Meston and Lord Pannick, and some of their colleagues can assist. I will start that sentence again: the modern style is to say “and” when you mean “and”, but to leave “or” silent if the latter is what is intended. This is the key point: we are clear that it must be a single person who is appointed.

On the issue that the noble Baroness, Lady Berridge, raised about the creation of a hierarchy, we simply do not agree that a person with residual parental responsibility should always be blocked from being a nominated person, as the child arrangements order or special guardianship may be in place for reasons other than the parent being a risk to the child. However, we agree with the general principle that the AMHP should be aware of, and consider the implications of, any child arrangements order or special guardianship. In most cases, it is true that they will still appoint those people to be the nominated person, rather than the person with residual parental responsibility. It is considered that allowing flexibility allows judgments to be taken on a case-by-case basis, taking into consideration specific circumstances and what is most appropriate for the child or young person, rather than a blanket exclusion. We will provide clear guidance in the code, following consultation and engagement with experts and professionals. I hope that will allow a way forward to deal with the complexity.

The noble Baroness raised a point about a parent having malevolent intent. I stress that, if the AMHP later finds that the special guardian will be a more suitable person, the legislation allows them to terminate the appointment of the nominated person and appoint the special guardian instead. If there are any outstanding issues that I have not covered either in my speech or in this response, I will be happy to discuss those with the noble Baroness, as I have continued to do. As I said earlier to noble Lords, I believe that this discussion, these questions and the amendment all show the complexity that we are all seeking to resolve.

The noble Baroness, Lady May, asked a number of questions about the consultation. My department will lead the consultation, and we will be working with the Home Office and stakeholders to scope it. While I cannot give an exact timeline for the review, and I am sorry to be unable to do so, I can say again that before launching the consultation we are going to be working closely with the Home Office, the NHS, social care colleagues and the police to consider the options to consult on that support better outcomes for patients and the services. I will be pleased to set out further details on the timetable in due course.

The noble Baroness, Lady May, asked what happens at the end of the review. I am sure she will understand that I do not want to pre-empt the outcome of the process. However, on a future vehicle to implement the review, while obviously we cannot commit to a legislative means to do that, we will be taking forward the consultation results and outcomes when parliamentary time allows. I will be pleased to keep the noble Baroness updated on all these developments.

The noble Baroness, Lady Hollins, mentioned my colleague the Minister, Stephen Kinnock MP, who did a sterling job of taking through this legislation in the other place. She asked about his work with lived-experience groups. I say to your Lordships’ House and to the noble Baroness in particular that, after Royal Assent, our first priority will be to draft and consult on the code of practice. We will be engaging with people with lived experience, their families and carers, and with staff, professional groups, commissioners, providers and others to do this, alongside launching a public consultation. The code will be laid before Parliament before final publication. Realistically, we expect that this process will take at least a year, but the nature of our discussions means that it is important that we get this right.

The noble Baroness, Lady Tyler, asked about confirmation of an implementation timeline. While of course legislation is important, implementation is what delivers the results. We estimate, as the noble Baroness has heard me say, that full implementation will take around 10 years; that does not mean we wait 10 years but, realistically, that is how long full implementation will take, due to the time needed to train the workforce and the need to ensure that the right community support is available. Noble Lords will be aware that this timeframe necessarily spans multiple spending reviews and multiple Parliaments, so we are limited—I hope noble Lords will understand this—in the detail that can be given about future spend and timelines. I quite understand why noble Lords raise this issue.

I acknowledge the dedication and thoughtful engagement shown by Members of your Lordships’ House throughout the passage of the Bill. The amendments made by the Government reflect not only technical refinements but, importantly to me, our response to the concerns and insights that were raised by Peers, MPs, stakeholders and those with lived experience. I believe that those concerns and insights have improved the Bill’s clarity and effectiveness, and I hope that noble Lords will support these amendments. It is thanks to what I regard as exemplary cross-party working that we are in a position to pass the Bill into law and begin implementation. It is about bringing positive change as soon as possible for those whose lives are touched by the legislation that we have debated. I commend the Motion to the House.

Motion on Amendment 1 agreed.

Moved by

[Baroness Merron]

That the House do agree with the Commons in their Amendments 2 to 17.

2: Clause 5, page 11, line 33, leave out “by a constable or other authorised person”

--- Later in debate ---

Moved by

[Baroness Merron]

That the House do disagree with the Commons in their Amendments 18 and 19 but do propose Amendments 19B and 19C in lieu—

18: Schedule 2, page 81, line 25, leave out from beginning to end of line 3 on page 82 and insert—
“(3) If no local authority has parental responsibility for the relevant patient but there are one or more other persons who have parental responsibility and who are willing to act as the nominated person, the approved mental health professional must appoint one of them.”

--- Later in debate ---

Moved by

[Baroness Merron]

That the House do agree with the Commons in their Amendments 20 and 21.

20: Schedule 3, page 92, leave out lines 22 and 23 and insert—
“(c) the patient is not liable to be detained under this Act or any other legislation or by virtue of a court order.”

Brain Tumours: Causes and Treatment

Baroness Merron Excerpts

Monday 24th November 2025 Lords Chamber

[Baroness Mattinson]

To ask His Majesty’s Government what steps they are taking to improve the scale of research into the causes and treatment of brain tumours.

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

My Lords, research is vital to ensure that people get the most effective treatments and the highest quality care. We are committed to furthering investment in brain tumour research: between 2018-19 and 2023-24, NIHR invested £11.8 million and UKRI invested £46.8 million in this area. The new NIHR brain tumour research consortium does promise a step change, with further announcements being imminent. In addition, the national cancer plan will seek to improve every aspect of cancer care, including outcomes for those with brain tumours.

[Baroness Mattinson (Lab)]

My Lords, I thank the Minister for her reply, but I want to press for more urgency to beat this terrible disease. Brain cancer is now the biggest killer of children and adults under the age of 40 in the UK. Behind every statistic is a person, like my old friend Georgie Maynard, a mother of three who received her own devastating diagnosis two and a half years ago. Georgie has co-founded the Brain Cancer Justice group, and she is here today. She wants to know why the UK’s brain cancer survival rate ranks only 22nd out of 29 wealthy nations, why just 1% of the cancer research budget is allocated to brain cancer, and why only 12% of people with a brain tumour are able to participate in trials. In particular, the whole-genome sequencing is vital for brain tumour research, yet just 5% of brain tumour patients can access it.

Last September, the Tessa Jowell Brain Cancer Mission published its recommendations. Will the Minister agree to review these recommendations and meet with the Brain Cancer Justice group to discuss how they can be incorporated?

[Baroness Merron (Lab)]

I thank my noble friend for the opportunity to meet Georgie just before Questions. I am happy to write to my noble friend with answers to all those questions. On the last two, yes, we continue to work very closely in partnership with the Tessa Jowell Brain Cancer Mission to drive further progress against its recommendations. I will certainly speak with the Minister who deals with this area—Ashley Dalton MP, who is currently ensuring that the cancer plan can be published at the beginning of the forthcoming year—about the suggestion of a meeting. We have very much engaged with the cancer community on the cancer plan, and we continue to be keen to do so.

[Lord Patel (CB)]

My Lords, I thank the Minister for promising us a cancer plan by the beginning of next year. I hope it will be forthcoming, because it will be good to look at how cancer care will change. Regarding brain tumours, the problem is that the symptoms are often vague and mild, so early diagnosis is much more difficult. We need more research into the early diagnosis of tumours. Furthermore, we need much more research than the numbers mentioned by the Minister. One of the success stories, one hopes, in 2026 will be drug gene therapy and viral immunotherapy, which will be put through clinical trials early next year to treat glioblastoma, the major brain tumour killer. I hope we will have more funding, because £30 million, £40 million or even £50 million will not do.

[Baroness Merron (Lab)]

I want to convey to the noble Lord our ambition in this area. I completely accept the point he makes—although not all of them—about the challenge of diagnosing rarer cancers, including brain tumours. Research is absolutely vital. Last September, we announced new research funding opportunities, bringing the brain cancer research community together, because we want to drive step change for patients in the way the noble Lord seeks. Funding decisions will arise from this call, and announcements are expected imminently.

[Lord Sharpe of Epsom (Con)]

My Lords, my son survived a brain tumour, but he was lucky, because in the UK between 40% and 60% of brain tumour diagnoses happen after the patient has arrived at A&E, having often been misdiagnosed—to follow on from the noble Lord’s question—earlier. That is a much worse outcome than many for other cancers. As the Minister said, brain tumour cancers are the leading killer of people under the age of 40. Will she therefore commit to a public awareness campaign to explain some of the difficult symptoms the noble Lord just identified, and the seriousness of brain tumours? Such awareness is sadly lacking among the public.

[Baroness Merron (Lab)]

I take the point the noble Lord makes, and I am sorry to hear of his son’s—and of course his family’s—experience. One of the things we are working on is increasing public awareness of brain cancer research opportunities. That is not quite the same as the point the noble Lord made, but extending that through the NIHR’s “Be Part of Research” initiative is important. The national cancer plan will give us the opportunity to review what communications and campaigns we run with the public. That will be a good opportunity to consider the point he makes.

[Lord Scriven (LD)]

My Lords, Georgie’s brother is Charlie Maynard MP, who has been campaigning on this. One of the issues raised is that in the UK it takes significantly longer to open a clinical trial for these patients than in most comparable nations, due to the excessive administrative burden. Will the Government therefore commit to looking at a fast-track designation for trials involving cancers with unmet needs, such as glioblastoma?

[Baroness Merron (Lab)]

We certainly do need to cut more red tape on cancer treatments. For example, we recently accelerated patient access to ultrasound cancer treatment through our innovative devices access pathway pilot. That is just one way in which we will have the potential to help companies, which is crucial to bring game-changing cancer treatments to fruition and to NHS patients even faster.

[The Lord Bishop of Leeds]

My Lords, would the Minister agree that it is important to recognise and praise the treatment that is already available while challenging to do more? I was diagnosed with a benign tumour and the treatment was exemplary. On the real upside of this, I have a lot of documentary evidence that I have a brain.

[Baroness Merron (Lab)]

I have never doubted that about the right reverend Prelate, but I am sure that the whole of your Lordships’ House is very pleased that he is with us. It is absolutely right and proper to pay tribute to all those in the whole system who provide care, treatment, diagnosis, research and so on. It is a team effort, and I am glad that he has benefited so well from it.

[Lord Kamall (Con)]

My Lords, being diagnosed with a brain tumour is devastating not only for the person involved but for their family. As my noble friend Lord Sharpe said, brain tumours can lead to memory loss, cognitive changes and reduced physical ability. Those symptoms are sometimes not picked up beforehand, but even when someone is diagnosed with a brain tumour those very symptoms sometimes lead to misunderstandings among friends and family members, and can lead to isolation. Given this, can the Minister outline what steps NHS England and the department are taking to raise awareness among families and friends of all the symptoms and side-effects of brain tumours, so we can avoid those misunderstandings and ensure that the patient continues to receive care from their loved ones?

[Baroness Merron (Lab)]

It is an important point, as the noble Lord, Lord Sharpe, raised. As I said, the national cancer plan will give that opportunity to address challenges and needs such as those the noble Lord raised. We are also establishing a brain tumour research consortium through the NIHR, which will bring together researchers from different disciplines. The scientific advancements it will drive will be how to prevent, detect—to the point raised by the noble Lords—manage and treat brain tumours. That will also be of great assistance.

[Lord Winston (Lab)]

My Lords, the Government should be congratulated on trying to improve their work on brain cancer. Talking about treatment, one of the issues is that one of the greatest advances and most important areas is brain imaging using magnetic resonance imaging, PET scanning and even electrical recording in a sophisticated way, but access to these important technologies still seems somewhat deficient. Will the Minister say whether the NHS has plans to increase access to brain imaging? It seems a very important area in treatment.

[Baroness Merron (Lab)]

We certainly want to see services properly available across the country and people not being disadvantaged because of where they live or what the services are. Again, from what I know of it—we will soon see it—the national cancer plan will improve every aspect of cancer care, including outcomes for those with brain tumours and access to the services my noble friend outlines.

NHS: Wheelchair Services

Baroness Merron Excerpts

Monday 24th November 2025 Lords Chamber

[Lord Hunt of Kings Heath]

To ask His Majesty’s Government what assessment they have made of the provision of wheelchair services by the NHS and social care authorities.

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

My Lords, integrated care boards are responsible for the commissioning of local wheelchair services based on the needs of the local population. NHS England has developed policy guidance and legislation to support ICBs to commission effective, efficient and personalised services. This includes a Wheelchair Quality Framework, published in April, which is designed to assist ICBs and NHS wheelchair service providers in delivering high-quality provision that improves access, outcomes and experience.

[Lord Hunt of Kings Heath (Lab)]

My Lords, I am grateful to my noble friend, but does she recognise that the work by the Wheelchair Alliance and the All-Party Group for Wheelchairs Users would suggest that, if you leave this to local health bodies and local authorities, they simply will not improve the current inadequate and patchy service? The All-Party Group for Access to Disability Equipment has reported that

“63% of carers and 55% of equipment users said that services are getting worse”.

Given what my noble friend said about the quality framework, which I very much welcome, does she accept that nothing will change unless this is enforced from the centre, with strong performance management?

[Baroness Merron (Lab)]

I accept the observations that my noble friend has made; I know he has been a voice on this for many years. I share with him the impatience for change and welcome the work of the APPG and the Wheelchair Alliance. The NHS Medium Term Planning Framework, which was published just in October, requires that, from 2026-27, all ICBs and community health services must actively manage and reduce the proportion of waits across all community health services over 18 weeks and develop a plan to eliminate all 52-week waits. I expect that wheelchair provision and services will improve through this as well as other means.

[Baroness Watkins of Tavistock (CB)]

Can the Minister comment on whether we keep any statistics in relation to people who have to stay in hospital who avoid discharge because of the length of time taken to get wheelchairs?

--- Later in debate ---

[Baroness Merron (Lab)]

I will be pleased to write to the noble Baroness about the specific data that is available, but we know that, because of issues to do with aids and adaptations, sometimes people’s leaving hospital is not as timely as it should be. That is not in their interests. We certainly expect local authorities, for example, which have a statutory duty, to make arrangements to do so and also for ICBs to make the provision so there are not the hold-ups that the noble Baroness refers to.

[Baroness Manzoor (Con)]

My Lords, as the Minister said, the NHS provides the funding for wheelchair access, but the wheelchairs are mostly necessary in community settings and in the home, and there is a gap between social services and the NHS using different criteria to assess the health needs of the patient. What are the Government going to do to address this so that people get the service that they need?

[Baroness Merron (Lab)]

The provision of the right type of wheelchair is crucial, but we also need to expand care options to boost independent living at home. We have done that in part through an additional £172 million for the disabled facilities grant, which goes hand in hand with people being able to live at home. This could enable around 15,600 extra home adaptations. Introducing care technology standards for those who are using wheelchairs and those who are not will also enable proper care standards and independent living.

[Lord Rennard (LD)]

My Lords, I declare an interest as the conference chair of the National Association of Equipment Providers. As a teenager, I pushed my mother everywhere in a wheelchair; we had to buy it second hand through the Liverpool Echo. Wheelchair provisions have improved greatly since then, but how can the Government work with the Wheelchair Alliance and with trade associations to ensure that retailers have skilled clinical staff who are trained to undertake assessments and prescribe appropriate wheelchairs and other forms of assistive technology?

[Baroness Merron (Lab)]

The points that the noble Lord has raised are crucial—not least that, as I alluded to earlier, one type of wheelchair does not suit everybody. That is why I am keen to see the results of the Wheelchair Quality Framework, which, as I mentioned to my noble friend, was published in April. That sets out quality standards and statutory requirements, including offering personalised wheelchair budgets, which would assist in the circumstances that the noble Lord describes.

[Lord Weir of Ballyholme (DUP)]

My Lords, I declare an interest as a frequent wheelchair user and as a member of the all-party group. Some concerns have been expressed that the competition for contracts for wheelchairs is very limited and that a number of wheelchair providers are not even submitting their names to be considered for those contracts because they feel that it is not worth their while. What action are the Government taking to ensure that there is sufficient choice within the NHS and that the market is large enough to ensure that companies will actually bid for those contracts?

--- Later in debate ---

[Baroness Merron (Lab)]

This is a very important point, not just for the supply chain but also for the technology, particularly if we are thinking about those with more complex needs; the wheelchair has to support and meet those complex needs. We know that there is a lack of investment in new models and that there has been disruption in the supply chain. While I do not seek to blame, that was a particular issue arising out of the pandemic. We are indeed working on better technology in terms of wheelchairs and other aids and adaptations and seeking to iron out difficulties in people making bids for contracts. If the noble Lord has examples, I would be very pleased to hear about them.

[Baroness Pitkeathley (Lab)]

My Lords, can my noble friend comment on the problem, which carers often report, of being unable to return the wheelchair to its source when it is no longer needed?

[Baroness Merron (Lab)]

My noble friend raises a point that applies not just to wheelchairs but to other aids and adaptations. There is indeed a very considerable issue. That is a matter for local services, but it is absolutely something that we will work with them on as part of how we improve services, because it also includes the safe and timely return.

[Lord Kamall (Con)]

My Lords, as well as the concerns raised by the noble Lord, Lord Hunt, about NHS wheelchair services, we know that, in addition, there are over 1 million wheelchair users of different types in the UK, and we know that people still face considerable difficulties in accessing health and social care buildings. Of course we understand that some buildings are old and will have to be retrofitted, but what specific conversations is the department having with charities, expert groups, owners of buildings and developers to raise awareness of the need and how to improve access, particularly for those older buildings?

[Baroness Merron (Lab)]

The noble Lord is right, and his comments about buildings apply not just to NHS buildings either but to the whole range. I can assure the noble Lord that across government we have continuing discussions about this, because it is not, as the noble Lord says, just a matter of getting the right wheelchair; it is also about them being accessible in terms of the buildings. It is also the reason that I mentioned to his noble friend about adaptations to people’s homes so that wheelchairs can be used there too.

[Lord Laming (CB)]

My Lords, does the Minister agree that one of the problems is that the need is often not identified until the person is heading for discharge from hospital, whereas if it was foreseen at a much earlier stage and there was proper co-ordinated planning between health and social care, a great deal of these delays could be reduced? Will the Minister do all that she can to improve the relationship between health and social care at local level?

[Baroness Merron (Lab)]

I would certainly agree that timely provision of wheelchairs and other aids and adaptations does support people not only to remain as independent as possible for as long as possible but to leave a hospital setting if that is in their best interests. We now have the better care fund as a framework for integrated care boards, the NHS and local authorities to make joint plans and to pool budgets for the very purpose the noble Lord mentions, which is about delivering better joined-up care. That can indeed include wheelchairs. That is a very systematic approach, doing exactly what the noble Lord is requesting.

Terminally Ill Adults (End of Life) Bill

Baroness Merron Excerpts

Committee stage
Friday 21st November 2025 Lords Chamber

Nevertheless, given the Bill’s subject matter, there are two watchwords that we should carry in our minds, particularly in the light of the speech of my noble friend Lord Shinkwin. They are “reassurance” and “clarity”. Amendment 3 and others in this group would serve to deliver reassurance through greater clarity. That is why I suggested that the noble and learned Lord, Lord Falconer, should consider these amendments with a sympathetic eye, because they serve to put the Bill’s intentions around coercion beyond any reasonable doubt and they do so without in any way undermining the Bill’s underlying aims.

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

My Lords, I thank all noble Lords who have spoken today for their contributions on these important issues. As I have already made clear, I will keep my comments limited to the amendments on which the Government have major legal, technical and/or operational workability concerns.

On that basis, I will speak about Amendments 118 and 118B. Amendment 118, tabled by my noble friend Lord Hunt, could prevent a person from accessing assistance where there is no clear connection between their individual circumstances and the crime that their close relative is under investigation for or has been convicted of, even if the said crime took place some years in the past. Amendment 118B, tabled by the noble Lord, Lord Farmer, would expand the meaning of “close relatives” to include “friends”. It is not clear who would determine the meaning of “friends” in this context. I should also say that disclosure of personal data engages Article 8 of the ECHR and is regulated by the principles set down in the Data Protection Act. Detailed financial assessment of those connected to a person seeking assistance is likely to interfere with the privacy of those individuals, particularly where there are no signs of coercion. The necessity of doing so is difficult to assess in the round rather than considering this on a case-by-case basis.

I turn to Amendments 222 and 612, in the name of the noble Baroness, Lady Hollins. Amendment 222 proposes a new clause to oblige the Secretary of State to provide specialist psychological assessment and support for persons considering an assisted death and their families. It would also oblige the Secretary of State to establish bereavement support services offering psychological support before an assisted death to all persons concerned. The Bill does not require families to know about an assisted death in advance, so requiring the offer of psychological services to them could create an undeliverable obligation on the Secretary of State.

Amendment 612 would mandate the video recording of a person being assisted to end their own life. The amendment would also require the person to confirm in the video recording their identity, their wish to die of their own free will, their capacity and that they are acting without persuasion or coercion. The amendment would require that this recording is sent to the coroner within 72 hours of death and it would create a regulation-making power for the Secretary of State concerning the practical arrangements for the recording, storing and transmission of the recordings. Requiring that a person’s death be video recorded where they did not wish the event to be recorded could risk being a significant intrusion into their family and private life under Article 8 of the ECHR. Since the Bill includes several safeguards, this intrusion is unlikely to be considered justified, and this amendment could also raise GDPR issues and concerns.

Amendment 460, in the name of the noble Baroness, Lady Finlay, specifies a range of actions the panel must take into account when considering a person’s psychosocial and safeguarding circumstances. It includes a requirement to offer immediate access to safe housing and financial support where abuse is disclosed. As the Bill is drafted, neither the panel nor the commissioner is provided with such a function and it is not clear how this would interact with local authority responsibility for housing provision.

As for the other amendments in this group where I make no detailed comments, although they may be deliverable, some would be challenging to implement. For example, Amendment 47 would require assessing doctors and the panel to assess a person’s state of mind or private thoughts. Amendment 58 would require an assessment of indirect structural disadvantage, including poverty or lack of care. Although I raise specific workability issues with only a small number of amendments in this group, noble Lords will be aware that the other amendments in this group have not had technical drafting support from officials. The issues raised by these other amendments are rightly a matter for noble Lords to consider and decide on, but I note that the way in which they are currently drafted means that they may not be fully workable, effective or enforceable.

[Lord Falconer of Thoroton (Lab)]

My Lords, in this debate we heard deeply personal information from the noble Lords, Lord Empey, Lord McCrea, Lord Watts, Lord Polak, Lord Griffiths, Lord Carlile of Berriew and Lord Shinkwin, and the noble Baronesses, Lady Hollins, Lady Hayter and Lady Grey-Thompson. I express my profound respect for people being willing to share in that way. I make it clear that in nothing that I say do I in any way intend to disrespect any of what must have been quite difficult statements to make. I really treasure many of the things that have been said, whether for or against the Bill.

As all noble Lords engaged in the debate know, at the heart of the Bill—there is no dispute about this—the decision to have an assisted death has to be where the patient, to quote the Bill,

“has a clear, settled and informed wish to end their own life, and … has made the decision that they wish to end their own life voluntarily and has not been coerced or pressured by any other person into making it”.

There is no dispute in the Committee that there have to be appropriate and sufficient safeguards to ensure that there is no coercion.

The current safeguards in the Bill are as follows: first, a doctor has to be satisfied that the person is not being coerced. Secondly, a second doctor has to be satisfied that the person is not being coerced. Thirdly, a panel has to assess that the person is not being coerced. Fourthly, the first doctor—after a period of reflection, in signing a second declaration by the patient—has to be satisfied again that the person is not being coerced. Finally, the doctor providing the assistance has to be at the last moment satisfied that the person is not being coerced.

The two doctors who give the certificate at the beginning must both have had specialist training in domestic abuse, including training on identifying coercive control and domestic abuse, and including identifying the effect of financial control. The panel considering the matter must consist of a psychiatrist, a social worker and a senior lawyer. If either of the two doctors have any doubt about the position in relation to capacity, they have to consult a psychiatrist. Anybody who by dishonesty, coercion or pressure induces the patient to either execute a declaration that they want an assisted death or take the assistance is guilty of a criminal offence. If all that the person does by dishonesty, coercion or pressure is to induce the person to execute a relevant document, the maximum sentence is 14 years. If, on the other hand, if they induce the person to take their own life, then the maximum sentence is life.

The question before the House in this debate is whether those protections are adequate to ensure that there is not coercion. I have before me a number of amendments. Amendment 3 is proposed by the noble Baroness, Lady Finlay: she would like “independent” to come before “decision”. I wholeheartedly agree with her that the decision must be independent, in the sense that it is a free decision made by the person, unpressured or coerced in the way that I have described. I am always influenced by what the noble Earl, Lord Howe, says in relation to that; he said, “Reassure us”. There is no dispute between me and the noble Baroness, Lady Finlay, that it has to be an independent decision. Is it clear enough in the Bill? With the deepest respect to both the noble Baroness, Lady Finlay, and the noble Earl, Lord Howe, I point out that it specifically says that the person should have

“made the decision that they wish to end their own life voluntarily and … not been coerced or pressured by any other person into making it”.

With respect, I say that it is clear enough on the face of the Bill.

I turn to Amendment 45, that of the noble Baroness, Lady Fox, which would insert “encouraged” in addition to “coerced” and “pressured”. I have thought very carefully about this, and I am against putting it in. The reason is that I see the reality: somebody who is thinking about an assisted death will want to talk frequently to those who love them. They may want to talk to the multidisciplinary team which is looking after them. Let us suppose somebody says, “I really, really want to go now. Should I take that opportunity?” If somebody says, “I encourage you to make the decision that is best for you,”, what the noble Baroness is proposing is that that becomes a criminal offence, potentially imprisonable for 14 years or for life. To me, that does not seem sensible.

I turn to Amendment 46. The noble Baroness, Lady Finlay, asks for “influenced” or “encouraged” to be added. I have dealt with “encouraged”. With regard to “influenced”, the multidisciplinary team or the person’s loved ones may well—with the best motives—influence somebody to go ahead with it. I do not criticise them for that if that is what the person wants and if it helps. It seems to me, again, wholly inappropriate to go beyond “coerced or pressured”.

On Amendment 47, the noble Baroness, Lady Coffey, suggests that it should be “external or internally” pressured that one is concerned with. We can understand external pressure—that is, somebody pressurising someone else to do it, and pressure carries with it an inappropriate degree of influence—but how does one in practice deal with an analysis of what would make me, for example, want my life to end? My noble friend Lady Merron also referred to that. The pain, the lack of dignity, the sense that I am not the person that I was in front of my own children is internal pressure. It might include me thinking, “I do not want to go on with this; in part, I’ve only got two or three weeks to live, and I want it to end”. The internal pressure is making me come to that conclusion. It is impossible to ask people, in particular the law enforcement authorities, to investigate what is going on in my mind. I have thought very carefully about that. I reassure the noble Lord, Lord Ashcombe, that I have given each of these amendments very careful thought, because they are important, but, again, I do not think that is a practical solution.