NHS: Winter Preparedness

Lord Kamall Excerpts

Tuesday 16th December 2025 Lords Chamber

I am proud of the way that the NHS team has pulled together through strike action in the past, and I know they will move heaven and earth to keep patients as safe as they can this winter. I am just appalled that they are having to do so without the support of their colleagues in the BMA”.

[Lord Kamall (Con)]

My Lords, I want to ask the Minister about two cohorts in respect of which there are concerns about vaccination levels. The first is front-line health workers. Is the Minister aware of what percentage have been vaccinated and what action is being taken to improve the uptake of vaccinations, particularly among those front-line health workers? I know that there are stories and concerns expressed in the press about the rate of vaccination. On the second cohort, will the Minister tell the House which socio-economic or ethnic groups have the lowest update? What targeted plans does the department and NHS England have to increase uptake rates in these groups?

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

First, we have started earlier and done more than ever before to prepare for the winter pressures. The good news is that the flu vaccines are working well to protect people against severe disease, and they are certainly working well in comparison to how they used to. In fact, we are the first country in the world to show vaccines working this well. On the uptake of vaccinations, 60,000 more NHS staff have been vaccinated this year than last year, which is extremely welcome. We have delivered over 17 million flu vaccines, which is tens of thousands more than we had delivered this time last year. We have a particular programme of communication and support and availability to those groups which are less likely to take up vaccinations. Vaccinations are our best line of defence against RSV and flu. I will be pleased to provide more detailed information to the noble Lord.

Women’s Health Strategy

Lord Kamall Excerpts

Tuesday 16th December 2025 Lords Chamber

[Baroness Merron (Lab)]

The noble Baroness is absolutely right, and we are taking every opportunity to find the right ways to communicate with women about their healthcare. If I had to give a big message, it would be, “Don’t not put up with it”. That is a basic challenge to get across, because so many women do put up with health challenges when they should not. Many women’s health challenges have become normalised—“It’s just part of life, it’s your age” and so on—and I am very keen that, in the renewed women’s health strategy, we will take on that myth and also take on the services to match that.

[Lord Kamall (Con)]

My Lords, I thank my noble friend for this Question and pay tribute to her consistent championing of women’s health issues. I also thank her for discussing the particular concerns behind this Question with me. I am sorry to return to gynaecology, but the Royal College of Obstetricians and Gynaecologists has raised concerns that cervical screening coverage remains well below NHS targets. Cancer Research says that low attendance is particularly evident in particular groups: the youngest as well as the oldest age group, and women from poor socioeconomic and ethnic minority backgrounds. Can the Minister update the House on how we can reach those women and encourage them to come forward for screening, particularly by working with local charities and community organisations that understand their communities far better?

[Baroness Merron (Lab)]

This is a very important point. The 10-year health plan restated the aim of eliminating cervical cancer by 2040 through the improved uptake of cervical screening and HPV vaccination. To the specific point, which is such an important one, in June—not many months ago—we announced that screening providers can offer home testing kits to underscreened individuals in the exact groups that the noble Lord refers to. I believe this will help tackle deeply entrenched barriers that keep some people away from life-saving screening. I am sure the whole House will reflect on the wise words and advice of His Majesty the King in imploring us all to take up the screening opportunities that there are. I certainly agree with that.

Resident Doctors: Industrial Action

Lord Kamall Excerpts

Monday 15th December 2025 Lords Chamber

The power to end these strikes now lies in the hands of doctors. Resident doctors face a choice: to continue the damaging industrial action in which everyone loses, or to choose more jobs, better career progression, more money in their pockets and an end to strikes. The deal that is on offer would mean emergency legislation to put our own homegrown talent first; to increase the number of extra specialty training places from 1,000 to 4,000, with a quarter of those places delivered now; to reduce the competition for training places from around four to one to less than two to one; to put more money in doctors’ pockets by funding royal college exam fees, portfolio fees and membership fees, with exam fees backdated to April; and to increase the less-than-full-time allowance by 50% to £1,500. It is a chance for a fresh start, to end this dispute and look ahead to the future with hope and optimism—a chance to rebuild resident doctors’ working conditions and rebuild our NHS. I urge every resident doctor to vote for this deal, and I commend this Statement to the House”.

[Lord Kamall (Con)]

My Lords, the announcement of further industrial action by resident doctors is obviously deeply concerning. These strikes, which we now know will go ahead after all, will have a serious impact on the capacity of our health service to function at precisely the time of year when demand is at its highest. Resident doctors make up almost half the medical workforce, and NHS leaders have already warned that action will cause significant disruption.

We on these Benches agree with the Secretary of State for Health and Social Care when he says that the BMA has clearly chosen to strike when it will cause maximum disruption, causing untold anxiety at the busiest point of the year. We agree with Rory Deighton, the acute and community care director of the NHS Confederation, who warned that, with the winter now upon us and rising levels of flu and staff sickness, pressure on services will be intense, with the likely consequence of

“thousands of cancelled appointments and operations”.

The impact of these strikes is compounded by the fact that NHS England has warned that it is bracing for an unprecedented flu wave this winter. In London alone, there are three times as many people hospitalised with flu compared to last year, with an average 259 hospital beds occupied each day, compared to just 89 a year ago. It is in this context that the CEO of the NHS described the BMA’s decision to strike in the run-up to Christmas as

“cruel and calculated to cause mayhem”.

There is a wider concern, shared by patients and families across the country. When the Government caved in to the BMA last year with an unconditional 29% pay settlement, noble Lords on all Benches warned that this would only incentivise the BMA to come back year after year with more demands. At the time, the Secretary of State brushed off these concerns and criticised those who raised this obvious observation, claiming that there would be no further strikes, no more cancellations and no more disruption. While we agree with the Health Secretary that this action by the BMA is cynical, strong words alone will not keep operating theatres open or ensure that patients receive their care in a timely manner. Appointments will still be postponed or cancelled, operations will be postponed and patients will suffer.

Now that the BMA membership has rejected the latest offer and is pressing ahead with further strikes, will the Minister lay out the Government’s plan? What additional resources have been made available to mitigate the serious disruption that these strikes will inflict? Given the combined pressures of flu and RSV, what steps are being taken to ensure that those who are eligible for vaccination actually receive it?

It appears that we are stuck in a downward spiral. Strikes are threatened, offers are rejected, strikes happen, misery is inflicted and then it is threatened all over again. If the Government do find a way of ending the threatened action, will they please do a couple of things? Will they make sure that it is conditional on updating work practices, to ensure that we have a more efficient health system? Many people who work in the health system know that some practices are out of date and have not moved on since the 1940s. Will they make sure that it does not incentivise the BMA to pocket any settlement and return next year threatening more strike action? The very uncertainty surrounding future militancy by the BMA is deeply damaging. It should be a matter of grave concern to the Government that the public seem not to have any confidence in the Government’s ability to keep doctors at work and keep the health service functioning.

As part of this, does the Minister recognise that the Government’s Employment Rights Bill risks making matters significantly worse next year? Will they think again about their rejection of minimum service levels to protect patients in the future? Finally, we know that the OBR has said that the cost of industrial action is a major risk to health spending. What estimate have the Government made of the cost of strike action in December, and will costs be paid using existing NHS budgets? As we know, the Chancellor often says there is no more money.

We are clear that these strikes must end and that the behaviour of the BMA is indefensible, but we must remember that it is not Ministers, unions or negotiators who will bear the cost of this action; it is patients and their families and loved ones. They deserve better. I am sorry to say that we are not yet convinced that the Government are on top of this and working to end the threat of these damaging strikes now and avoid incentivising future strikes in future years. I really hope that the Minister can reassure noble Lords that the Government have a plan.

[Lord Scriven (LD)]

My Lords, I thank the Minister for putting the Statement before us, but do so with a measure of frustration—a feeling shared by countless citizens. This frustration with the ongoing and deeply damaging resident doctors dispute is directed at both parties, the Government and the British Medical Association leadership. We are witnessing a breakdown in negotiation, a failure of common sense and, critically, a failure of duty towards the patients who rely on the National Health Service.

First, let me address the actions of the Government. The manner in which this dispute has been handled is, frankly, not best practice. We have seen periods of silence followed by 11th-hour media interventions by the Secretary of State. This pattern suggests not a serious negotiation but a high-stakes, last-minute political gamble, PR approach. The way the reported details of the last-minute offer were put before the public and resident doctors serves only to deepen this suspicion. This approach disrespects the process and the professionals involved. Given that the issues addressed in the Government’s 11th-hour offer have been known since the general election, why did the Government choose a high-stakes, last-minute intervention, rather than presenting the offer within a calm, realistic timeframe that could have facilitated constructive consideration by resident doctors?

Further, I must express my dismay at the tone sometimes employed by the Secretary of State. Using rhetoric that seeks to divide resident doctors from the public is counterproductive. This dispute will not be solved through grandstanding but through respect and meaningful compromise. The Government must reflect on their tone and timing.

However, the frustration I feel over the Government’s handling is matched in equal measure by my frustration over some of the tactics and demands employed by the BMA leadership. The pursuit of this round of strike action, especially scheduled at the most challenging time of the year, is, in my view, deeply irresponsible. The BMA has a singular responsibility that transcends typical union negotiations. Their members are the direct custodians of people’s health. We are currently grappling with two severe pressures on the NHS: the rising tide of flu and the deliberate scheduling of this strike to coincide with the Christmas period. To choose this time, when hospital rotas are already thin and the NHS is under maximum strain, is totally unacceptable. It shows a disregard for the welfare of the most vulnerable patients. We on these Benches wish to thank the consultants, those resident doctors who decide to go into work, and the other dedicated staff who will keep our NHS safe during this unnecessary strike, for doing the right and decent thing.

The core demand pushed by the BMA leadership is full pay restoration. While I acknowledge the significant financial pressures facing resident doctors, a demand for full restoration to a prior decade’s real-terms value is neither achievable nor reasonable in the present economic climate. By focusing the entire dispute on this single maximum pay demand, the BMA leadership is allowing the Government to ignore the far more crucial systematic issues that genuinely plague resident doctors and threaten the future of the NHS workforce.

This failure is a stain on both parties. The Government must return to the table with a genuine commitment to a multi-year funded plan that addresses the systematic non-pay issues, and the BMA leadership must immediately reassess the morality of its current strike schedule and shift its focus from an unrealistic pay demand to achievable reforms in training and conditions.

I have two further questions for the Minister. The recent offer included a promise to create up to 4,000 extra speciality training posts. However, the BMA leadership has claimed that these posts are simply being cannibalised or repurposed from existing locally employed roles. Will the Minister confirm categorically that these 4,000 places represent genuinely new, funded training opportunities that increase the total number of doctors retained in the NHS career structure and are not merely a reclassification of existing roles?

Given that the pay restoration demand is deemed unachievable, how will the Government—outside of pay—guarantee fundamental reforms to the working time directive enforcement, the quality of training rotations and the rota planning to ensure that resident doctors are used efficiently for patient care and for the development of their skills, thereby making a medical career in the NHS sustainable and attractive?

Our healthcare system cannot afford this deadlock. I urge both sides to put down their political weapons, swallow their pride and focus on the real-world issues before the consequences become truly tragic.

Terminally Ill Adults (End of Life) Bill

Lord Kamall 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—

--- Later in debate ---

[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.

--- Later in debate ---

[Noble Lords]

Front Bench!

[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.

Wheelchair and Community Equipment Strategy

Lord Kamall Excerpts

Thursday 11th December 2025 Lords Chamber

[Lord Kamall (Con)]

My Lords, I thank the noble Lord, Lord Hunt of Kings Heath, for securing this valuable debate. I also thank all noble Lords who have shared their own valuable experiences. I also welcome the noble Baroness, Lady Gerada—I hope I have pronounced that correctly—who, in her maiden speech, shared her valuable background, which we know will contribute hugely to this House.

At its heart, this is a discussion about people’s freedom, dignity and independence. Wheelchairs are, for many, the difference between participating in daily life or being excluded, by enabling people to leave their homes, to see loved ones and to access work and education. However, the reason for today’s debate is that the current system faces serious problems. NHS England’s 2025 wheelchair quality framework recognises this, while the APG for Access to Disability Equipment describes the system as being “in crisis”.

We welcome and acknowledge NHS England’s initial steps to improve wheelchair services, such as a national wheelchair dataset and personal wheelchair budgets. These steps are welcome and should be acknowledged, but data from the British Healthcare Trades Association shows that only around 80% of users received a wheelchair, or a much-needed modification, within 18 weeks, which is below the 92% national target, while people with complex needs can wait significantly longer. A delay in receiving a wheelchair is not simply an inconvenience or a statistic; it is a barrier to living a fuller life.

Also, we find that where a person lives determines how their wheelchair services are assessed, whether they qualify, their level of support, how clearly the process is explained, and what kind of equipment they ultimately receive. NHS England’s own national dataset shows significant regional variation between integrated care boards in meeting the 18-week standard. There is also a wide variation in eligibility criteria. In north Bristol, the threshold for regular use is at least 4 times weekly, on a regular basis. In Oxford, regular use is defined as at least three days per week. In Wirral and west Cheshire, regular use is worded as “more often than not”. For powered wheelchair assessment, we find that in west Suffolk a person must demonstrate indoor need and appropriate home accessibility, get GP clearance and pass a driving assessment, while north-west London uses a tiered categorisation system of need, with detailed thresholds and criteria for the effects that denying access to certain items could foreseeably have.

When noble Lords discussed this topic last month, the Minister said that

“integrated care boards are responsible for the commissioning of local wheelchair services based on the needs of the local population”.—[Official Report, 24/11/25; col. 1089.]

I appreciate the need for such flexibility, reflecting local populations, but could the Minister tell the House whether the Government believe there should be better co-ordination on eligibility and communicating the criteria, and what plans they have for achieving this?

The noble Lord, Lord Hunt, shared an article from Paul Sagar about his home experience. While he was on his hospital bed, distressed and worried about his future, he was phoned by the wheelchair service when he was obviously unable to speak. He assumed that he would be called back. Instead, a letter was sent to his home address: an upstairs flat which he would never access again. I thought that showed just how Kafkaesque a situation some users find themselves in. What is the recourse for patients where local ICBs offer such poor and unempathetic services? What is the accountability mechanism for that and, while respecting local differences, what is the department’s thinking on making them accountable for allowing such poor services? Do the Government have any plans for regular reviews of wheelchair service providers to make sure that they are all meeting standards?

I appreciate that noble Lords have asked a lot of questions, but I hope the Minister, who we know cares deeply about patients, will appreciate that we see this not as a party-political issue but as one which all Benches can agree touches directly on people’s independence, dignity and everyday lives.

Terminally Ill Adults (End of Life) Bill

Lord Kamall Excerpts

Committee stage
Friday 5th December 2025 Lords Chamber

[Noble Lords]

Front Bench!

[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.

Tobacco and Vapes Bill

Lord Kamall Excerpts

Committee stage
Monday 17th November 2025 Grand Committee

Moved by

[Lord Kamall]

175: Clause 135, page 76, line 29, leave out from “smoke-free” to end of line 3 on page 77 and insert “any place in England that is—
(a) an NHS property or hospital,(b) a public playground,(c) a provider of early years education, or(d) a school.”Member’s explanatory statement
This amendment restricts the Secretary of State’s power to designate smoke-free places to only hospitals, children’s playgrounds, providers of early years education and schools in England.

--- Later in debate ---

[Lord Kamall (Con)]

My Lords, Amendments 175 and 179 in my name and that of my noble friend Lord Howe propose restricting the Secretary of State’s power to designate smoke-free places to a clearly defined and limited set of locations: NHS property or hospitals, public playgrounds, and providers of early years education and schools. As it stands, Clause 135 gives the Secretary of State extraordinarily wide powers to add new areas and designations to the list of smoke-free places: in effect, to designate almost any space or area regarded as open to the public smoke-free by regulation. While well intentioned, it is a sweeping power that merits careful scrutiny.

Therefore, the purpose of these probing amendments is to seek to understand how the Government intend to use this sweeping power and whether they will act responsibly in exercising it. The four categories proposed—NHS property or hospitals, public playgrounds, early years providers and schools— are all spaces where there is a clear public health argument for restrictions and, indeed, support for these restrictions. They are environments that the Government have consistently said they wish to protect. However, the Government intend to designate additional places through delegated powers. Therefore, we are probing the Government on the level of discussion, scrutiny and accountability for any such changes. Will this be by way of the negative procedure, draft affirmative procedure or made affirmative procedure? We hope that the Government, in seeking to augment or change this list, will return to Parliament and make the case openly, thereby ensuring that the Secretary of State’s power in this area is clearly defined, appropriately limited and exercised with the scrutiny and responsibility that Parliament expects.

The other amendments in the group address in different ways the question of how far-reaching the Secretary of State’s powers under Clause 135 ought to be and what safeguards should accompany them. Amendment 176, tabled by the noble Baroness, Lady Walmsley, which proposes that the Secretary of State can act only where there is evidence that smoking in a given place is causing harm to non-smokers, is a reasonable and proportionate test, but this evidential safeguard should be in addition to, not instead of, clear and meaningful parliamentary oversight. Amendment 177 from my noble friend Lord Udny-Lister is welcome, since it seeks to ensure that Ministers are not handed sweeping authority to alter well-established rights, such as the ability to smoke in open, uncovered hospitality venues, without the explicit oversight or approval of Parliament. This also appears to be a sensible and proportionate check to ensure that government powers are exercised within a clear and democratically accountable framework and, when combined with Amendment 176 from the noble Baroness, Lady Walmsley, would ensure that any extension of bans is justified by evidence.

--- Later in debate ---

[Baroness Merron (Lab)]

My Lords, as we have heard, all the amendments in this group seek to limit the powers in the Bill to make additional places smoke-free in England. On Amendment 176, tabled by the noble Baroness, Lady Walmsley, we know that passive smoking, whether indoors or outdoors, poses a risk to health. The rule of thumb is: if you can smell cigarette smoke, you are inhaling it. This is particularly important for children, pregnant women and those with pre-existing health conditions such as asthma or heart disease, which may not be visible to the smoker.

However, despite these well-known and very well-evidenced harms, trying to ascribe specific harms to locations is somewhat challenging, as this debate shows. For example, as the noble Baroness, Lady Walmsley, mentioned, in a large children’s play area it is difficult to evidence that exposure to second-hand smoke has caused a specific harm in a specific place. I can assure noble Lords that we are extremely mindful of this. Therefore, the test referred to in the amendment is overly restrictive, technically very difficult to do and not necessary, given the extensive evidence of harm to vulnerable people. It would also likely lead to a scenario in which we are unable to protect the most vulnerable in society from the harms of second-hand smoke.

Similarly, on Amendment 178, tabled by the noble Lord, Lord Kamall, as I mentioned, we know the harms of passive smoking. There is strong indirect evidence but, as I said, it can be difficult to demonstrate this evidence in specific locations. Again, this restrictive test would prevent areas where there are harms of second-hand smoke to children and medically vulnerable people from becoming smoke-free. Furthermore, as this amendment would apply in England only, it would leave England with more restrictive smoke-free provisions than the devolved nations. 

Amendments 175 and 179 were tabled by the noble Lord, Lord Kamall. As we have made clear but I would like to reiterate, in England we plan to consult on extending smoke-free places as and when. In the first instance, it would be to the outdoor areas of schools and early years settings, children’s playgrounds and healthcare settings. I can assure the noble Lord, Lord Kamall, and the noble Baroness, Lady Walmsley, that all proposed smoke-free locations will be subject to consultation both now and into the future and that regulations will be subject to the affirmative procedure. We will be guided by public health advice. The noble Baroness, Lady Bennett, rightly observed that the powers within the Bill allow us to respond to evolving evidence at a later time, particularly where there is evidence of clear harms to children and vulnerable people.

On Amendment 177 tabled by the noble Lord, Lord Udny-Lister, we have made it very clear—I am glad to take the opportunity to do so again, not least because the noble Lord, Lord Kamall, raised this—that outdoor hospitality settings will not be in scope of the consultation on smoke-free places. We fully recognise the balance that is needed to protect the most vulnerable as well as ensure that businesses are not financially impacted. We are confident that we have the balance right in deciding the places, which I have already outlined, on which we plan to consult.

However, the powers in the Bill, as has been observed, allow for additional places to be designated smoke-free in the future, subject to further consultation and parliamentary debate. The landscape may change significantly on tobacco legislation, as it has done over the years. Evidence and attitudes may also shift, again as we have seen over the years, so it is sensible to ensure that the Bill is future-proofed and can respond to evolving evidence. I therefore ask the noble Lord to withdraw this amendment.

[Lord Kamall (Con)]

My Lords, I am grateful to the wide range of noble Lords who spoke on these amendments. These are clearly intended as probing amendments, at this stage, to understand—as the Minister herself agreed—these wide sweeping powers to designate additional spaces as smoke-free. We are grateful because we were concerned about the level of scrutiny there would be. The Minister assured us that there will be consultation and that any changes will be by regulation following the affirmative procedure. We are very grateful for that and that perhaps answers some of the probing amendments that we have in future groups. For now, I beg leave to withdraw the amendment.

Amendment 175 withdrawn.

Learning Disabilities Mortality Review Reports

Lord Kamall Excerpts

Thursday 13th November 2025 Lords Chamber

[Baroness Merron (Lab)]

Again, I certainly accept the important points that the noble Lord is making. It is unacceptable that there are health inequalities and poorer life outcomes. Indeed, action could be taken. That is why our 10-year health plan recognises these inequalities and identifies particularly those with disabilities as a priority group for more of that holistic, ongoing support. Key to that will be the development of neighbourhood services, where such groups will be prioritised.

[Lord Kamall (Con)]

My Lords, I thank the noble Lord, Lord Scriven, for shining a light on this really important issue and for repeating the stat that people with learning disabilities and autism in England die almost 20 years younger than the rest of the population. That in itself is shocking, whatever your views.

The charity Mencap has cited a number of barriers that are stopping people with learning disabilities getting good-quality healthcare. These include failures to recognise that a person with a learning disability is unwell and staff having little understanding about learning disabilities in themselves. Could the Minister update the House on what specific steps the Government are taking, and with which partners they are speaking, to address these concerns?

[Baroness Merron (Lab)]

It bears repeating that it is shocking that people are dying on average up to 20 years earlier. As I have said, that is unacceptable. We work very closely with Mencap and other organisations, but what we are doing already is, for example, to the point that the noble Lord raised, improving identification of people with a learning disability on GP registers. In particular, a reasonable adjustment digital flag is being implemented in care records to make sure that support is appropriately tailored. In other words, if we do not know who people are and where they are, we cannot provide the support. That is an unacceptable reason.

Goodmayes Hospital Mental Health Facility

Lord Kamall Excerpts

Thursday 13th November 2025 Lords Chamber

[Baroness Merron (Lab)]

The Mental Health Bill, which is, I hope, within touching distance of Royal Assent, is absolutely crucial. It is a reform of an Act which was 41 years old; it will undoubtedly be crucial. I am grateful to many noble Lords for their participation in getting us to the right place. It will deliver on our government commitment to modernise the legislation. I hope my noble friend is aware that implementation is absolutely key, but there are rightly a number of points within the Bill—which I hope will become an Act—which will take effect only when services are in the right place. It would be wrong to do so without it.

[Lord Kamall (Con)]

My Lords, the incident at Goodmayes Hospital, and others raised by the noble Baroness, Lady Berger, such as the tragic case of Kate Szymankiewicz after her daughter’s death at Huntercombe Hospital in 2022, all raise profound concerns about the treatment of vulnerable patients. Families have described the care that their loved ones received as cruel and more akin to the treatment of prisoners than that of patients. The Minister has spoken of guidance, regulation and new models. Given all these concerns in hospitals such as Goodmayes and Huntercombehlh, I ask the Minister: what conversations is the department having with trusts and ICBs to instil a culture where patients are treated with compassion and dignity and, where it is safe, patients have proper access to their families?

[Baroness Merron (Lab)]

That is absolutely at the core. I will just say, as an example on this particular tragic case, that NHS England still meets regularly with the trust, and the last meeting took place two weeks ago—it conducted a mid-year review. There is also a recommendation for a memorandum of understanding on investigating healthcare incidents where there is suspected criminal activity, which is something we have really got to consider. That will mean that there can be action following incidents such as this, where there is reasonable suspicion. Again, having a handle on it, monitoring it, keeping accountability and having the guidance are key to prevention as well as improvement after these terrible and tragic events.

Telemedical Abortions

Lord Kamall Excerpts

Wednesday 12th November 2025 Lords Chamber

[Baroness Merron (Lab)]

I most certainly can agree with the points the noble Baroness has rightly made. There is a very clear pathway to providing safe care. The provision of telemedicine in this regard came in in 2022, and it has given safe abortions further ballast, so it is nothing other than a safe procedure, as I mentioned earlier.

[Lord Kamall (Con)]

My Lords, I associate myself and these Benches with the kind tributes paid to the noble Baroness, Lady Newlove. She was a fierce campaigner, particularly after the sad and premature death of her husband—in fact, her death could be seen as premature, and we will all miss her greatly.

As the Minister and other noble Lords have said, much of the clinical evidence shows that telemedicine is just as safe as administering medication in a clinic. However, whatever your views on abortion, there are clearly some concerns about the coercion of women. Can the Minister repeat her assurance to the House that telemedical abortion consultations will include robust safeguarding assessments carried out by trained clinicians? Can she assure us that, if there are any concerns about the safety of women, or that women may be being coerced by an abusive partner into seeking an abortion, they are referred to an in-person appointment?

[Baroness Merron (Lab)]

I certainly can confirm that, and I am grateful to the noble Lord for emphasising the point. Two doctors have to certify that in their opinion, the abortion meets the grounds of the Abortion Act. For a telemedical abortion, the doctor must also certify that in their opinion the pregnancy has not exceeded 10 weeks at the time when the first pill is taken. Let me also say that, if there are any concerns, the woman will be asked to attend an in-person appointment.