The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord O’Shaughnessy) (Con)
My Lords, I start by congratulating the noble Baroness, Lady Walmsley, not only on securing the debate but on opening it in a way I had not previously experienced—through the voices of children. I must say that if every debate started that way, this would be both a happier place and a more informative one. I genuinely thank her for the approach that she has taken and the time that she obviously took with those children. I thank all noble Lords for their, as ever, wise and challenging contributions and will attempt to answer as many questions as I can.
I do not disagree with the characterisation of what we are discussing as an epidemic, because childhood obesity is undoubtedly one of our top public health challenges. We have heard some data about the prevalence rates, but the simple fact is that a quarter of children entering primary school start off overweight or obese—I am conscious of the distinction that my noble friend Lord Balfe makes—but that rises to a third by the time they leave. Something is happening during those years. There is also a generational aspect to this. Cancer Research UK has shown that the millennial generation is on course to be the most overweight in history. Given the lack of housing and other things they are grappling with, we must address this issue.
As my noble friend Lord Balfe said, there is some encouragement and hope in the plateauing of obesity rates: it is not a cause for despair. However, the evidence shows that, as several noble Lords have mentioned, there is a deprivation gap and this is increasing. The costs of this are mental as well as physical. My noble friend Lady Mone and the noble Baroness, Lady Benjamin, talked about the mental health impacts, including depression, that come from obesity. Other risks that we face are type 2 diabetes, heart disease and an extra likelihood of common cancers such as bowel and breast cancer. It is also a major risk factor for non-alcoholic fatty liver disease. These represent a cost, not just to individuals, but to all of us as taxpayers. The figures used today talk about a cost to the NHS of £5 billion annually. The cost to society is perhaps between five and 10 times that amount.
We all know the scale of the problem and agree that it is complex. It will not be solved overnight. The noble Baroness, Lady Thornton, spoke about the importance of urgency. We need urgency, but it will take time to see results. I am pleased that the mood of this debate is a determination to work together to solve the problem.
What have the Government been doing? As several noble Lords have referred to, we launched our childhood obesity plan in 2016, informed by the latest evidence and research in the area. At the heart of the plan is a desire to change the nature of food that children eat and make it easier for families to make healthier choices. The plan poses challenges for us all to play a role in reducing childhood obesity levels: national government, local government, business, the NHS, schools and families. Some of the key measures that have been talked about today include the soft drinks industry levy, the sugar reduction and wider reformulation programme—which I will return to—and helping children to enjoy an hour of physical activity every day.
Real progress has been made since the plan was published. The soft drinks industry levy has come into effect and PHE has formulated a comprehensive sugar reduction programme with the aim of a 20% reduction in sugar in key foods by 2020, including a 5% reduction in year one. Industry has responded to these frameworks and that gives us cause for hope. There is sometimes a sense that industry will not respond, but companies such as the makers of Lucozade and Ribena, Kellogg’s, Waitrose and Nestlé have been leading the way by removing millions of tonnes of sugar from products. Through my noble friend Lady Neville-Rolfe, I commend the action of Tesco. We enjoyed the services of Tesco Extra in the Isle of Wight over the weekend. Its offer of free fruit for children was extremely welcome; it stopped them fingering packets of Haribo and other things instead. These little things do make a difference.
We now expect almost half of all drinks that would otherwise have been in scope of the sugar levy to have been reformulated as a result. That is a cause for celebration. We know that there was scepticism about the levy when it was introduced, but I think most people would agree that it has been a success. We believe that there is a philosophical reason for acting in this way. Children do not always make their own choices and they certainly do not always make choices with a full suite of information. Government has a history of intervening to protect them; insisting on children using car seats is one example. Children need protecting from the effects of sugar and obesity, for their current and future health. It is right to act to develop good habits. I reassure noble Lords that we believe that to be the case. We do not have an ideological problem with acting in this area to tackle obesity.
An area that I thought might be touched on this evening which I want to highlight is the consumption of energy drinks. These often have a high sugar content and are linked to poor sleep. Again, this is an area where we have seen industry responding positively as regards restricting sales. I have personally seen the havoc that these drinks can wreak in schools and in diets. We are continuing to focus on this area. Therefore, these are a number of areas we are taking forward under the banner of reducing the impact of sugary soft drinks.
On the other things we are doing now, I will just step outside my brief and stress the role of schools. First, the levy is funding a doubling of the primary school PE and sport premium, and providing £100 million in 2018-19 for a new healthy pupils capital fund, with appropriate distribution for the DAs under the Barnett formula. I can reassure the noble Baroness, Lady Grey-Thompson, and other noble Lords that regardless of the income from that levy, the funding is guaranteed for the coming year; off the top of my head, I think it is £320 million. I will ask for confirmation from the DfE about what the plans are for that. However, it is not a true hypothecation, so that funding is there regardless of the income that comes in.
It is also important to say that as a consequence of the levy we are also investing £26 million in breakfast clubs. These are particularly focused in about 1,500 schools in opportunity areas, which are areas that have been targeted for government action because of poverty. An important issue that has come out of this debate, highlighted by the noble Lord, Lord Addington, the noble Baronesses, Lady Grey-Thompson and Lady Thornton, and my noble friend Lady Mone is the direct link between poverty and obesity. As I said at the beginning, the gap is still growing. We are therefore conscious, as my noble friend Lady Jenkin said, that this is an issue of social justice and that there is a need to act. The breakfast clubs have been focused in the opportunity areas because that is one way we are trying to address that issue.
We have said that schools are well-placed to support action. After a coalition policy we introduced free lunches in reception, year 1 and year 2. I have to disappoint the noble Baroness, Lady Benjamin, that at this point there are no plans to extend the free lunches for all pupils beyond those year groups, but of course children on benefits are able to get free school meals throughout their school life. We have other routes by which we can encourage good habits. I focus on PSHE, for example, and cooking classes, and in the primary curriculum lessons on healthy eating. The children of St Joseph’s had obviously taken on board many of those lessons.
One of the things we also have to do is to provide education about personal responsibility. My noble friends Lady Neville-Rolfe and Lord McColl made the point that this is about taking responsibility based on information. As a child, you are inevitably impulsive, but becoming an adult is about developing good habits, and schools have a critical role to play in this. They also have a role in educating parents, and the best schools get parents in to give them these kind of lessons to make sure that they are able to support their children as well.
The noble Baronesses, Lady Walmsley and Lady Thornton, talked about advertising. There has of course been a ban on adverts and I know that there is a call for further bans on advertising across all media. Any policy must be evidence-based. We are of course always open to that evidence, and it is important to view these kind of actions as one way in which we can help parents. I reassure noble Lords that we are keeping it under consideration. The noble Lord, Lord Berkeley, asked about swimming. It is part of the national curriculum, so I can assure him that we consider it important.
I also stress that the obesity plan is not just about school-aged children but about the early years foundation stage, when children not only learn about healthy eating—play is a key part of that. For smaller children going to formal childcare settings, that will become more part of their everyday life. We have been clear that we have considered a number of different policies, we will continue to consider other policies, and we will focus on those which will have the biggest impact on childhood obesity. I stress that we want to follow an evidence-based approach.
My noble friend Lady Jenkin talked about the work that she has been doing with the CSJ. I thoroughly commend her for that work and for the elucidation she has brought to what is happening in Amsterdam, which I believe she visited with my honourable friend the Parliamentary Under-Secretary of State for Public Health. We are trying to learn the lessons from that.
One of the opportunities that we have here concerns devolution. We recently passed a statutory instrument to give more public health powers to Manchester as part of its devo deal. Manchester is often in the lead in these kinds of issues. We see an opportunity at a city-wide level—mirroring the Amsterdam example—to get all the agencies around the table to act. Greater Manchester has introduced #GMMoving: The Plan for Physical Activity and Sport 2017-21. It involves the Greater Manchester Combined Authority, the NHS in Greater Manchester and Sport England. It is exactly that kind of partnership that we need to see more of.
Partnership working is of course at the heart of what we are doing, and I pay tribute to the many organisations that are active in this area—not just the ones that have sent briefings to noble Lords but those that are spending a great deal of money to raise the salience of these issues, such as Diabetes UK, Cancer Research UK and others.
I want to finish by touching on a couple of other issues that noble Lords have raised. The reports and data that we publish on progress will be open to scrutiny. We will be absolutely transparent in the work that we are doing, including Public Health England’s assessment of progress on the sugar reduction policy, which will be published this spring. We are also funding a new obesity policy research unit and will be publishing the details of its projects. That will give us the evidence base that we need to act.
Many other issues were raised. I thoroughly recommend Malcolm Gladwell’s “Revisionist History” podcast, which deals with a fantastic set of issues concerning how fat became the enemy and sugar the friend, and how that has driven changes in eating policy, probably for the worse. I also thoroughly recommend a book called Why We Sleep. This radically transformed my attitude towards sleep. It would not surprise me if at some point in the not-too-distant future we had a government sleep strategy—and I am not just referring to me droning on as a way of helping people to get to sleep. The consequences of poor sleep are very dramatic and, frankly, terrifying. We do need to get more sleep.
On the basis that we want to get home and get some sleep, I shall finish by saying that we are continuing to act in this area. We should focus on smoking. We have not banned it but we have had a thoroughgoing and comprehensive policy which has reduced smoking on a voluntary basis. It is that attitude that we need to take towards obesity, and the Government will continue to work on many fronts to do that. I look forward to working with all noble Lords so that we can start to reduce childhood obesity.