Learning Disabilities: Health and Social Care Access

Lord Scriven Excerpts

Thursday 26th March 2026 Grand Committee

Asked by

[Lord Scriven]

To ask His Majesty’s Government what assessment they have made of (1) the use of reasonable adjustments for, and (2) the safety of, people living with learning disabilities when accessing health and social care.

[Lord Scriven (LD)]

My Lords, I thank all noble Lords who put their names down to speak in this important short debate, which for me is rather a raw one. This debate is not to ask for more of the same; to do so would be to sign death sentences for thousands more individuals with a learning disability. The system does more than fail. It facilitates what Professor Sara Ryan describes as “social murder”. As both a researcher and the mother of Connor Sparrowhawk, whose preventable death occurred a decade ago, she uses this term to describe a state-sanctioned erasure whereby those very institutions aware of the risks to life choose to maintain the status quo rather than dismantle it. People with a learning disability die, on average, 20 years earlier than the general population, and 40% of these deaths are preventable. At current trends, it will take 102 years to close this life expectancy gap. I therefore ask the Minister: does she accept that this century-long wait is a human rights failure?

Saying that tweaks will be made to a fundamentally broken system is an acceptance of the status quo that killed Connor a decade ago, and it is the same status quo that killed my nephew. My nephew, Myles Scriven, died in 2023 at the age of 31. The coroner delivered a devastating judgment of the evidential reality of today’s health and care system. He found a culture stuck in another era where clinicians had only a superficial grasp of regulations and communication was unsafe. Most tellingly, the reasonable adjustments were laid out in Myles’s medical notes: advocates required; mental capacity tests required; a hospital passport required; communication support required. Yet this was ignored by all healthcare staff, despite the trust telling us at the inquest that 98% of staff had been trained. Safeguards existed on paper only; they did not exist for Myles.

Since Myles’s death, hundreds of families have contacted me, confirming that his experience was not an isolated incident. They have shared identical accounts of systemic failure. Reasonable adjustments are being bypassed, parental expertise is being dismissed, and regulators are failing to enforce the very standards that they are sworn uphold. Despite repeated warnings, some providers continue to ignore the very changes necessary to prevent further avoidable tragedy. Myles’s case was no outlier, but a systemic norm.

We see the grim reality of this failure in the superb journalism of Daniel Hewitt of ITV News, whose investigations have exposed a trail of preventable deaths where life-saving laws are treated as optional. We also see it in the timeless reporting of Dr George Julian, who spent a decade at inquests documenting the fatal consequences of diagnostic overshadowing. Her work reveals an ingrained culture that refuses to see the person behind the disability and a culture that sometimes weaponises the Mental Capacity Act, while completely abandoning the legal duty to provide reasonable adjustments.

So why has the machinery of oversight failed so spectacularly? The CQC has become a regulator of process. It audits the existence of policy, not the efficacy of its application at the bedside. With only one prosecution in this area by the CQC, despite hundreds of preventable deaths, I ask the Minister: does she not agree that the regulatory framework is fundamentally broken and requires urgent statutory reform? Similarly, LeDeR is a toothless archive of tragedy. It is a system of learning without much doing. It produces a report with no legal powers to compel change. Can the Minister say what the Government’s plan is to transform LeDeR from an archive of tragedy into a tool for change? Specifically, will they commit to a statutory requirement that makes LeDeR’s findings legally binding on providers?

The system is obsessed with inputs. It measures how many staff attend training, not whether they have learned and changed. It measures the number of annual health checks, yet senior clinicians say that these are frequently tick-box exercises. The quality is dangerously variable, leaving serious underlying health needs entirely unaddressed. A tweak will not save lives. We need a systematic reform of the implementation, accountability and regulatory framework that moves beyond paper policy and puts the actual safety and survival of human beings at the very heart of the system.

First, we need a statutory review of all deaths, ensuring legal accountability for implementing recommendations. Can the Minister explain the Government’s ongoing refusal to support this call and why they believe the current voluntary arrangements are sufficient, when the death toll suggests otherwise?

Secondly, the Government must look to the Netherlands, where a dedicated medical specialty for learning disabilities has transformed outcomes and extended life expectancy. We need senior clinical leaders—consultants who can navigate multiple overlapping health issues with the same authority that we see from clinicians in paediatrics. This is about providing the expert clinical leadership required to break through systematic inertia. Will the Government commit to the establishment of these senior clinical leadership roles across the system? Will they provide the recurrent funding required to ensure that this model delivers the improvement and accountability that are so desperately missing?

Thirdly, we need real leadership accountability. The era of moving on from tragedy to tragedy must end. If a provider fails, the responsibility for reform must personally be held right at the top. Accountability must be triggered where a leader presides over safety breaches and fails to implement documented remedial actions—then they should face a lifetime ban from holding any senior management or board-level position in the health and social care sectors. Government responses to my Written Questions reveal a startling vacuum of oversight. They currently lack the basic data required to identify where the system is failing. How can the Government claim to enforce accountability when they do not even track which safety actions are being ignored?

The Minister cannot change the past, but the Government can be the architect of a new era of robust, safe services, accountability and regulatory action that works—or do we continue to defend a system that oversees social murder by another name? Systemic change is more than a tweak; it is a fundamental shift in how we value these human lives. It is the transition from viewing my nephew as a tragic case to seeing him as a citizen, with an inalienable right to safe care and an equal right to long life.

If we do not move to a legally binding new model of improvement, accountability and effective regulation, the Government are effectively saying that a 20-year life expectancy gap is the cost of doing business. Families deserve more than a sympathetic nod. They deserve more than a system that does not work in practice and they deserve a guarantee that “never again” starts today. I look forward to the Minister’s response, not just as a Member of your Lordships’ House, but as an uncle who will not allow his nephew’s preventable death and those of others to be in vain.

Migraine Care: 10-year Health Plan

Lord Scriven Excerpts

Monday 23rd March 2026 Lords Chamber

[Baroness Merron (Lab)]

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

[Lord Scriven (LD)]

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

[Baroness Merron (Lab)]

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

Unpaid Carers: Patient Hospital Discharge

Lord Scriven Excerpts

Thursday 19th March 2026 Lords Chamber

[Baroness Merron (Lab)]

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

[Lord Scriven (LD)]

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

[Baroness Merron (Lab)]

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

GP Contract

Lord Scriven Excerpts

Tuesday 17th March 2026 Lords Chamber

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

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

[Lord Scriven (LD)]

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

[Baroness Merron (Lab)]

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

NHS: In-house Software Capabilities

Lord Scriven Excerpts

Monday 16th March 2026 Lords Chamber

[Baroness Merron (Lab)]

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

[Lord Scriven (LD)]

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

[Baroness Merron (Lab)]

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

Maternal Mortality

Lord Scriven Excerpts

Tuesday 20th January 2026 Lords Chamber

[Baroness Merron (Lab)]

I understand what the noble Baroness is saying and her frustration, which I am sure many of us share. The purpose of the investigation by my noble friend Lady Amos is to pull together all the learning and all the inquiries. She has, for example, given a real voice to those affected, speaking to 170 affected family members. Those voices are what has been missing, and that cannot go on. We are determined to draw a line under where we have unfortunately been and to move forward, while taking direct actions, including, for example, a national programme to support struggling trusts to make improvements.

[Lord Scriven (LD)]

My Lords, recent Health Service Journal investigative journalism has found that the Chief Midwifery Officer wrote to trusts last year identifying gross failures in home births safety, yet the Government have chosen to keep this information private while women are pushed into unsupported births. Is it acceptable for NHS England to hide this evidence of systematic safety risk from the public when the home birth services of 14 trust have effectively ceased to exist, despite the legal duty to provide them?

[Baroness Merron (Lab)]

I am not fully up to speed with the article that the noble Lord raises, but I undertake to look at it and get back to him, because this is a very important matter.

Terminally Ill Adults (End of Life) Bill

Lord Scriven Excerpts

Committee stage
Friday 16th January 2026 Lords Chamber

[Lord Markham (Con)]

Again, it is about whether you put that financial support clarification in black and white and say, “This must be something that someone’s done”, where it might not even be relevant to the circumstances, or where the—

[Lord Scriven (LD)]

The fact that somebody has a terminal diagnosis of six months automatically triggers SR1, so that part of the amendment is superfluous. There are things in amendments that automatically happen but which they would put in the Bill, but they do not need to be put in the Bill by the amendments because they already happen.

[Baroness Finlay of Llandaff (CB)]

My Lords—

[Lord Scriven (LD)]

You cannot intervene on an intervention.

[Baroness Finlay of Llandaff (CB)]

I beg your pardon; I am sorry.

NHS: Winter Preparedness

Lord Scriven Excerpts

Tuesday 16th December 2025 Lords Chamber

[Baroness Merron (Lab)]

I know my noble friend is very familiar with the maternal RSV programme, not least because of her campaigning, for which I pay tribute to her. It only began in September, and it is already proving successful. We want to see more pregnant women being vaccinated; we have updated and made available information resources in 30 languages for better access to vaccinations. We encourage maternity services to have early discussions with pregnant women about vaccination, and we ensure that training is in place to allow staff to have the knowledge and confidence to address concerns and build confidence. I hope that this answer is helpful not just to my noble friend but to the noble Lord.

[Lord Scriven (LD)]

My Lords, I do not believe for one moment that the Minister is complacent. In answer to the question from the noble Lord, Lord Kamall, the reason why the staff vaccination rate is up from last year is because it was at an all-time low of less than 30%, down from 2020 when it was 75%. There are still 750,000 healthcare workers who have not had the flu vaccine and who are unprotected. Based on that figure, what extra steps will the Government take to further incentivise take-up by NHS staff to prevent the crippling of service delivery when it most needed?

[Baroness Merron (Lab)]

The noble Lord is quite right. We have to protect our staff, who are under immense pressure and are not just at risk from flu but seeking to tackle the extra pressures of industrial action. We are focused on making vaccines available to staff in the easiest way possible. We will continue to do so. I should add that we are considering options on implementing advice to expand vaccinations to the over-80s and, in particular, older adult care residents to ensure that any change has the best possible impact. It is important that we continue to drive vaccination rates up. That will protect staff who are providing the care. As the noble Lord said, we also have to continue our programme to encourage NHS staff to take up the vaccine.

Emergency Adrenaline

Lord Scriven Excerpts

Monday 15th December 2025 Lords Chamber

[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.

[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.

Resident Doctors: Industrial Action

Lord Scriven Excerpts

Monday 15th December 2025 Lords Chamber

[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.

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

My Lords, the Government have made a comprehensive offer to resident doctors to resolve their disputes. I listened closely to the assessment of the Government’s performance made by the noble Lords, Lord Kamall and Lord Scriven, and it is not a reflection I agree with. This has dominated the agenda, and the Secretary of State has taken a proactive and collaborative approach with the BMA resident doctors committee. For example, he has had 18 meetings and seven phone calls with the BMA; he has sent 10 letters; and there have been dozens of meetings with officials.

I cannot recognise the suggestion of a hands-off, confrontational approach: the Secretary of State has consistently chosen to do everything he can, particularly to cancel the Christmas strikes, which are timed for the most damaging period of the year. The Secretary of State even went as far as to extend the BMA’s strike mandate, giving it time to call off strikes while it consulted its members and an option to rearrange if the offer was rejected. I am astounded that the BMA rejected the offer that was put before it. It was a comprehensive offer to resident doctors to resolve their disputes, providing those currently applying with more training job opportunities, prioritising UK-trained graduates, and it would have put money back in the pockets of resident doctors. Among a whole range of things that noble Lords have rightly acknowledged, the rejection of the offer means that NHS colleagues will be cancelling Christmas plans to cover shifts and patients will have their operations cancelled as the NHS prepares for the worst.

The noble Lord, Lord Kamall, asked: what happens next? In these circumstances, it is a very powerful question. The Government will consider our next steps, with our first priority being to deal with strikes. I reassure noble Lords that the focus of the department and the NHS will be on getting the health service through the double whammy—as has been well referenced by noble Lords—of flu and strikes. We have already vaccinated 17 million people, which is 170,000 more than last year; we will continue to work intensively with front-line leaders to prepare for the coming disruption.

On the offer, the BMA asked us to create more training places, which is what we would have done. The offer would have created 4,000 new speciality training posts for resident doctors over the next three years, with an additional 1,000 for this year. Under this deal, more doctors in non-training roles would have had the opportunity to progress their careers and become the consultants and GPs of the future we all want to see. Sadly, this offer is no longer on the table, thanks to the rejection by the BMA membership. That is why our focus has to be on dealing with strikes and getting through.

Our operational response is to mitigate the impact of any industrial action. We should acknowledge, as we have heard from the Front Benches, that flu rates are the highest they have been in the last five years for this time of year. I am sure that all noble Lords, while recognising legitimate concerns about access to training places, will remain concerned that an offer that would have made a real difference has been wholly rejected and strikes are going ahead. In response to the noble Lord, Lord Scriven, I do believe there was a way out and the BMA membership has chosen not to take it.

On the estimated cost of strike action, the July strikes cost the NHS around £250 million. If those costs repeat themselves for November and December, strike action will have cost around £750 million in this year alone. The cost of the five-day resident doctors’ strike in July could have paid for training for over 1,600 GPs over three years or 28,000 hip and knee replacements. But, again, the Government’s offer has been rejected so we will have to make our first priority dealing with the strikes.

Through the Employment Rights Bill, we want to create a positive and modern framework for trade union legislation; we want productive and constructive engagement; we want to respect the democratic mandate of unions; and we want to reset our industrial relations. For me, this sets us back considerably, sadly, and that has been clearly acknowledged. What do strikes do? They suck up time, resources and energy, and the costs for the NHS, as I have already stated, are around £250 million. While we have made a number of offers and acknowledged legitimate concerns, I do not believe that that has been treated in the way it should have been.

The noble Lord, Lord Scriven, asked about the 4,000 roles. That was in response to the BMA, which asked us to create more training roles, which was a fair request and exactly what we would have done. It would have created 4,000 new speciality training posts for resident doctors over the next three years, with an additional 1,000 this year. It would have meant more doctors in non-training roles having an opportunity to progress. But, as a Government, it is our duty to consider our next steps, and our first priority will be to deal with the strikes.