Mental Health In-patient Services: Improving Safety

Baroness Bennett of Manor Castle Excerpts

Monday 3rd July 2023 Lords Chamber

[Lord Markham (Con)]

I thank the noble Lord for his commitment in this area over the years. With regard to the first question about past evidence, clearly the HSSIB will be looking at what evidence exists. As the noble Lord said, some investigations go back 30 years, so there will not always be circumstances where it can pick out that evidence, unfortunately. However, where there is that information, we are trying to make sure that we pull it out and learn from it. That is very much the direction of travel. Clearly, if part of the HSSIB’s findings is that we need to make sure that every death in such circumstances is investigated under a certain pathway, then I am sure that will come into its recommendations. In terms of the other questions, I think it is best that I write to the noble Lord, if I may.

[Baroness Bennett of Manor Castle (GP)]

My Lords, the Statement includes a number of themes which it is expected the new Health Services Safety Investigations Body will consider. Not included in that list, however, is the growing role of private provision in NHS mental health care services. This is something that patient groups and others are expressing considerable concerns about. Take, for example, the Priory, where the Care Quality Commission reported that the number of deaths at its sites rose nearly 50% from 2017 to 2020. One of those was the tragic death of 23 year-old Matthew Caseby. An inquest jury concluded that his death was contributed to by neglect, and the coroner issued a prevention of future death report because of continuing risks.

The Priory Group earns more than £400 million from the NHS, and much more from social services. It is now owned by a Dutch private equity firm after it was sold by its former owner at a loss and is financed by a sale and leaseback deal of 35 properties with rents subjected to annual inflation-based escalators. Through the mechanisms in this Statement or others, are the Government going to consider the risks presented by private ownership—particularly private equity ownership—of mental health care services?

[Lord Markham (Con)]

As noble Lords are aware from some of my previous answers, I think the key thing is the quality of output rather than the ownership of an institution. Around the House, we have very good examples of where we believe the Government need the help of the independent sector to increase supply and capacity. That always needs to be done with the right quality of regulatory regime, and that is what we have put in place. From my point of view, I am always going to be looking at the quality of the output and not the ownership of a company.

Lung Cancer: Screening

Baroness Bennett of Manor Castle Excerpts

Monday 26th June 2023 Lords Chamber

[Baroness Bennett of Manor Castle (GP)]

My Lords, I have two questions. My first question is about the timeframe and the role of GPs. The Statement says that, using GP records, current and ex-smokers aged 55 to 74 will be assessed by telephone interviews. Will that require resources from GPs? We all know that there are many different computer systems so where are the resources going to come from? Specifically on GPs, I can well imagine at many GP surgeries tomorrow morning at that terrible time of 8.30 am as everyone frantically tries to hit the dial button that a lot of people will be asking for a scan. Have GPs been equipped to handle that? Do they know what to say and how to manage that kind of scenario?

My other question follows on from the questions about the Khan review. That said that we are grossly underfunding things. Mass media campaigns in particular are funded at 90% under what is needed, while other services are about 50% underfunded. Surely we have to stop these cases happening. Can we see a commitment from the Government within some sort of timeframe to say that we are going to put more money into this?

[Lord Markham (Con)]

I thank the noble Baroness. In terms of identifying the smokers, the telephone is just one way of doing it. The hope is that using the digital data and the app means that more of these things will be on people’s records and identified with them. As ever with these things, electronic means will be the best way to do that, albeit those telephone resources in terms of supporting the GPs are very much part of the plan. It is understood that GPs have a large burden at the moment.

There is not a lot more to add about the Khan review. The ambition is still there to be smoke-free by 2035 and investment has gone behind that. The best example of that, as has been mentioned, is people swapping cigarettes for vapes as one means to do it. Undoubtedly, a lot more needs to be done in that direction as well.

NHS: Performance and Innovation

Baroness Bennett of Manor Castle Excerpts

Thursday 15th June 2023 Lords Chamber

[Baroness Bennett of Manor Castle (GP)]

My Lords, it is a pleasure to take part in this select but very interesting debate, which is small in number but rich in content. I thank the noble Lord, Lord Scriven, for securing it. I will take a different approach from that of other noble Lords so far—perhaps a slightly stereotypical green approach. While we are talking about the current performance of the NHS and innovation, I will focus on the NHS’s environmental impacts.

The noble Lord, Lord Scriven, said that we have a 1940s health service in its structures and systems. We are in the 21st century and in a climate emergency and nature crisis, consideration of which has not been built into the system. I will major on aspects related to the comments made by the noble Lord, Lord Addington, about the centralisation of the system. Indeed, the noble Lord, Lord Crisp, was just talking about that and about how it prevents innovation and people taking action.

Let me do a little frame-setting. The NHS is responsible for 5% of the UK’s climate emissions and 40% of public service emissions. NHS England has a large focus on carbon emissions. Interestingly, NHS Scotland is leading on antimicrobial resistance and dealing with that area of environmental impact, and NHS Wales is focused on the environmental determinants of health and taking that approach. Each NHS can learn from the others, and a more joined-up approach is desperately needed. As I will come to, in Europe there is a lead on the impact of general pharmaceuticals on the environment, and we are not joined up with that at all.

The noble Lord, Lord Scriven, approached this in a positive way. I will do the same, in some places by highlighting success stories. The NHS has a net-zero carbon target by 2040. All NHS England estates now use 100% renewable electricity and 99% of waste is diverted from landfill. There are issues around incineration, but obviously there will always have to be some of that. It is worth stressing how much money this has saved the NHS, with a cost saving of £36 million and a £10 million investment in one year in energy-efficient technologies having positive impacts.

Slightly less obvious is an exciting development on which Scotland is leading the way and NHS England is following. Scotland has banned the use of desflurane, an anaesthetic with a global warming potential 2,500 times that of carbon dioxide. NHS England will be banning it in 2024. This is one of the leading ways in which thinking about the negative environmental impacts of medicines is happening. There is also an exciting new plan being developed for reducing the carbon impact from the use of inhalers. Much is happening, but everyone agrees that much more must happen.

I want to focus on an area that I have been majoring on since 2020, when we began debating the Medicines and Medical Devices Bill: the impact of pharmaceuticals on the environment. I saw the noble Baroness, Lady Cumberlege, in her place earlier, who wrote the very important report, First Do No Harm, which still needs to be implemented. When we think about the use of pharmaceuticals in the NHS, we have not thought sufficiently about the harm that they are doing.

What I am about to say draws heavily on a meeting I had recently with the pharmaceutical industry and my British Society for Antimicrobial Chemotherapy senior interns. I also worked with Paul-Enguerrand Fady, who is working with the Foundation to Prevent Antibiotic Resistance, which is based in Stockholm. Paul-Enguerrand is working here in Parliament, and I would urge anyone who is interested in antimicrobial resistance to get in contact. A whole series of events is being held to inform parliamentarians about this, and there is a chance to learn cutting-edge science with that.

From this meeting, I learned about the PREMIER project, a multi-disciplinary consortium of 25 public and private sector groups across Europe, proactively working to manage the environmental impact of general medicines, especially those with limited data availability. It is exploring ways to incorporate environmental considerations early in the drug development process to steer the development of new drugs. It aims to establish a new European standard of environmental protection and reassurance, for patients and society at large, that medicines are increasingly safe for the environment. If the Minister is not aware of this project, can he make himself aware? This is a Europe-wide project. I very much hope that NHS England will be following on and adopting this, not seeking to go it alone in an area where clear leadership is already happening. I do not expect an answer today but can the Minister look into that and get back to me on how the Government are looking at the outcome of that project?

I point out that the PREMIER project is working only on general pharmaceuticals; it is not working on antimicrobials or endocrine active molecules. Potentially, the UK Government could take a lead in ensuring that this project is broadened to include these crucial pharmaceuticals which we know are having a big impact on our environment and our environmental health. It was suggested at this meeting that there is a role for the Government Office for Science in promoting such connectedness in its position as an apolitical, evidence-based organisation. Being cross-departmental, it helps in focusing on systems thinking. The Government potentially have a convening role here to work with a variety of stakeholders. Can the Minister consider how they might take a role in that area?

I said that I would focus on some positives, and I noted that NHS Scotland is very much leading on the impact of pharmaceuticals on the environment. I draw the attention of the Minister to a project in the highlands. NHS Highland got a £100,000 grant from the Medical Research Council to develop a framework to reduce environmental pollution from healthcare practices. This is the first time that this has been done in the UK. Its leader is Sharon Pfleger, a consultant in pharmaceutical public health working with the University of Nottingham and the University of Highlands and Islands. This builds on the work of the cross-sector One Health Breakthrough Partnership, which has a data visualisation tool that helps to understand the link between medicine use and the presence of pharmaceuticals in the environment. I draw the attention of the Minister’s department to that.

Having looked around these islands I see that Wales, as I mentioned, is leading on environmental determinants of health. The Welsh NHS Confederation produced an interesting response to a Climate Change, Environment and Infrastructure Committee consultation on the Environment (Air Quality and Soundscapes) (Wales) Bill. I urge NHS England to contribute to cross-governmental working in this way. It is a very interesting model and we need to see this happening.

I have praised Wales and Scotland, so I should find a project in England to praise and focus on. Some work is happening in Cornwall. I draw here on the work of Roberta Fuller, who is head of hospital reconfiguration at the Women’s and Children’s Hospital at the Royal Cornwall Hospitals NHS Trust. Ms Fuller is working on how to ensure that a new hospital meets the best possible environmental standards. Drawing on the comments of the noble Lords, Lord Addington and Lord Crisp, I quote a paragraph from Ms Fuller’s reflections:

“What will it take to move away from traditional top-down funding allocation towards the kind of cross-industry partnering and thought leadership needed to meet these extremely challenging climate goals?”


Empowering people must be at the heart of tackling the issues that I am talking about, but of course there are so many other issues.

Finally, I will reflect a little on innovation. We have heard the word a great deal from the Government in recent weeks. I am afraid that, very often, when we hear members of the Government talking about it, they are talking about inventing new products that people will make profits from, usually involving shiny new things and, indeed, new pills. Of course, we know that the kind of innovation that I and pretty much all speakers in this debate have been talking about is about doing things differently and more smartly, and operating in ways that acknowledge the One Health paradigm: that our health is entirely dependent on the health of our environment. I would love to see more analysis and understanding from the Government that this is innovation. Innovation may, dare I say it, less directly involve GDP: you are not selling things but improving the public health of the population. We all know about the productivity crisis, the labour shortage and all the problems arising from the absolutely parlous state of public health in the UK at the moment.

In that light, I want to take a step away from the environment side to focus on an issue raised by the noble Lord, Lord Parekh, about the problems of obesity and the threats that it presents to our health. We have been talking about obesity, and it has been almost impossible recently to open a newspaper without seeing talk of the new Wegovy and these other weight-loss drugs. Newspapers have been quoting NHS sources suggesting that, eventually, 12 million people might be treated with Wegovy and similar weight-loss drugs in the NHS. I find that statistic truly horrifying. These are very new drugs, and we have very little idea of how long people might have to take them and what the long-term effects are: they simply have not been around for very long.

Yet, at the same time, we have Dr David Unwin in Southport. He has been an absolutely huge pioneer, starting from the grass roots up, in working to reverse type 2 diabetes. This was thought impossible until recently. What is interesting is that, reading accounts from him, he credits the initial impetus as coming from one patient who said to him, “Why have you been prescribing this drug for me for 10 years when I went off, researched for myself and found that I could change my diet?” Through diet reversal, this patient no longer had type 2 diabetes. We had one patient talking to one doctor, who started to innovate. This is starting to be rolled out around the NHS, but why are the Government not trumpeting it from the rooftops? When we hear the Prime Minister talking about innovation, would it not be great if he were talking about innovation in terms like this? This is a home-built, British innovation done in the grass roots—not based in a university, nor based in Oxbridge, and perhaps that is why we are not hearing about it. But we need to hear far more about this kind of innovation and empower much more of it.

On which line, I will finish with a reflection. I have talked about this ever since I came into your Lordships’ House, virtually. This is a request for innovation in government rather than directly in the NHS, and the Minister has heard it from me before. I am sure that he and all other Members of your Lordships’ House have noticed the strong media focus in recent weeks on the health impacts of ultra-processed foods, which are very clearly causing massive costs to our NHS. The Government have continually declined to acknowledge ultra-processed foods as a category, despite the fact that the Welsh Government, the WHO and many other groups around the world do. My request to the Minister is not to give me a total government turnaround today, but I will ask him whether he will commit to going back to the department and talking about where the latest science is on ultra-processed foods. This media focus has come from the publication of one book, but there are new peer-reviewed research articles coming out every week about the issue.

Sodium Valproate

Baroness Bennett of Manor Castle Excerpts

Monday 5th June 2023 Lords Chamber

[Lord Markham (Con)]

I thank my noble friend. Yes, the number of cases of people of childbearing age—this is a key criterion—taking sodium valproate has reduced by 33% over the past five years. The number of pregnancies has reduced by 73% but clearly that is not zero so more work needs to be done. I was speaking to Minister Caulfield this morning about the Patient Safety Commissioner. We are expecting her report shortly and from there we hope and believe that there will be a lot more we can do on regulation.

[Baroness Bennett of Manor Castle (GP)]

My Lords, I refer to the work of Dr Hughes, the Patient Safety Commissioner, and the initial Question from the noble Baroness, Lady Cumberlege, which referred to where sodium valproate is prescribed in different numbers of pills from the number that come in a packet, so the excess pills are taken by the pharmacist and put into plain paper packaging. The Patient Safety Commissioner has identified this as a real issue because sodium valproate must not be dispensed without the appropriate safety labels, but that is clearly happening. What are the Government doing to stop it?

[Lord Markham (Con)]

The noble Baroness is correct. First, the MHRA is working on guidelines which say that you must always dispense in the original packaging, come what may. In the meantime, secondly, all pharmacists should absolutely be putting leaflets in, whatever the packaging. Thirdly, everyone should have to sign an acceptance form so that they are going into this with their eyes open and understand the risks. Every year they are supposed to renew that acceptance form to make sure that, while it may be necessary in some cases, everyone goes into it with their eyes open to the risks.

Childbirth: Black Women

Baroness Bennett of Manor Castle Excerpts

Wednesday 3rd May 2023 Lords Chamber

[Lord Markham (Con)]

My understanding is that since the task force was set up, which was little more than a year ago, it has had as many as four or five meetings. If that is incorrect, I will correct it. The latest meeting was on 18 April. Again, if noble Lords look at the actions that have come out of it, they will all agree that it is actions that count the most. The task force has been very thorough, and Minister Caulfield is very committed.

[Baroness Bennett of Manor Castle (GP)]

My Lords, the Minister has referred a number of times to socio- economic disparities—indeed, the noble Lord, Lord Sikka, referred to the issues of poverty. The MBRRACE report and others have shown the disparity in death rates that sees black women dying in childbirth four times more often than white women. Will the Minister acknowledge for the record that there is a tragic difference here—a higher number of deaths—that cannot be fully accounted for by pre-existing health conditions and socioeconomic disadvantage?

[Lord Markham (Con)]

As I have said, this is a complex area. I do not think we understand all the underlying reasons. Underlying health is a reason, and access is another. What the statistics show is that there is a difference, which is why we are so focused on addressing it and making sure that everyone has excellent standards of maternal care.

Junior Doctors’ Strikes

Baroness Bennett of Manor Castle Excerpts

Monday 17th April 2023 Lords Chamber

[Lord Markham (Con)]

I thank my noble friend for her questions and the wise points borne out by her own experience. The impact this is having on patients is a regret to us all. On derogations, the history has been that the unions have sat down and made sure that life is protected. It is a regret that the BMA junior doctors have not done that in this instance, and that the RCN is saying right now that it is not considering derogations in its new strike. I hope that this position will change. I do not think anyone in this Chamber would want to see life threatened in this way. I know that we are doing everything we can on our end—as I say, offering more than devolved Governments—to solve this situation. I ask for good will on all sides so that we can protect patients first.

[Baroness Bennett of Manor Castle (GP)]

My Lords, in following on from the last question, I point out that the rising percentage of GDP spending reflects a fast-ageing population and the fact that we have terrible levels of public health, terrible housing and terrible diets. All sorts of other issues that are putting huge pressures on our NHS are at historically high levels.

I want to focus on the junior doctor situation in particular. There are currently 9,000 NHS doctor vacancies. The rate of departure of doctors from the NHS is twice what it was a decade ago. Does the Minister acknowledge that the situation of doctors in particular—and, in fact, that of all medical professionals—is rather different from other professions in the sense that we have a huge global shortage of medical professionals? We are seeing many doctors voting with their feet over their current terms and conditions and leaving the NHS, and the Government are not in what you might call a normal industrial situation of saying, “Well, we’ll just have to play tough and negotiate”. There is a huge risk that we are going to lose a whole generation—or generations—of doctors from the NHS who are irreplaceable. The Government have to look at this in a co-operative way to find a way forward, rather than setting out a confrontational approach to the strike action.

Social Care

Baroness Bennett of Manor Castle Excerpts

Thursday 30th March 2023 Lords Chamber

[Baroness Bennett of Manor Castle (GP)]

My Lords, I agree with the noble Baroness, Lady O’Grady, that social care jobs—indeed, all jobs—should pay a real living wage. It should be a foundation of our social contract. I thank the noble Baroness, Lady Andrews, and her committee, for this report, which shows great compassion and sense, as does the report from the Archbishops’ Commission on Reimagining Care. We can hope only that the Government will follow their lead. There is little that I could disagree with in the intentions of either report, but as Greens we always aim to go further, so I particularly acknowledge the interrelationship of other policy natures and the nature of our society, rather than looking at social care as a stand-alone unit or looking simply to join it up with healthcare. This is really systems thinking.

First, I give a personal reflection. The noble Baroness, Lady Barker, referred to the 1 million people who do not have children. This is personal to me, since I am one of the 18% of women of my age, and most ages now since those born in the 1950s, who do not have children. I have no brothers and sisters—no living relatives at all. That reflects the position of increasing numbers of our society, something that we are entirely unready for. Civil society is generating solutions. I note particularly the Older Women’s Co-Housing project in north London.

The Government do not need to direct these, but they must do far more to enable them to happen, for we have now a society that does not care for the vulnerable. Any of us could be left in that situation, at any time. That is why Green Party policy is free social care to all who need it. Provision of free social care must be central to any green new deal. When you hear that phrase, you might think of hard hats and solar panels, but you should equally think of a person caring for someone and meeting their needs—someone holding another’s hand when they need it.

That would be central to what the most reverend Primate referred to as a fulfilled life, which we should be offering everyone. Care must be provided, as the noble Baroness, Lady Andrews, said, in a way that is “not transactional, not contractual”. That is our vision, and why the Green Party says that the profit motive has no place in any form of care provision—health or social. The terrible state of our care system owes a great deal to privatisation, which has taken public and individuals’ money and often put it into the hands of hedge funds and other tax-dodgers, while exploiting our workers and providing terrible care.

A study this week from the Guardian showed that the five largest private care chains are taking £150 million a year in taxpayers’ money for places in elderly care homes rated as “inadequate” or “requiring improvement”, including some classed as “not safe”. The leading earner from public funds is HC-One, a chain of 285 care homes majority-owned by a US private equity company. It was paid £50 million, the Guardian calculated, by town halls in 2022 for homes in the two lowest CQC categories.

Many noble Lords have referred to unpaid carers. Another Green promise is a universal basic income—a foundational, secure payment to every member of our society. If they chose to be a carer, we would top that up. This is a system in which everyone would have the security to care without fear of poverty. That truly is system change.

As the noble Baroness, Lady Barker, alluded to, we are that point in the electoral cycle where parties are drawing up their manifestos. I am not expecting other parties to adopt wholesale the Green vision—although I would be happy if they did—but I will offer a couple of smaller-scale policies that I would be very happy if any party wanted to steal.

First, I was speaking earlier today about the concessionary bus travel scheme. How about we extend free public transport to family carers? That would be a modest acknowledgement of the contribution they make to our society. Secondly, young carers are far too often ignored. They often start at a terribly young age, with huge responsibilities. The pupil premium should be applied to them to help their schools support them. Thirdly, on housing, we were talking this week in the levelling-up Bill about the need for vastly better housing, both newbuild and refit, and every new home should be built to lifetime homes design standards. That would mean that people could stay longer in their own homes.

I have a final thought on technology. There is no doubt that it can help a lot, particularly in medical care, by providing security and reassurance and notification of when help is need. But please, let us not assume that a robot, no matter how snazzy, can actually provide human care—the comfort of a human touch, the thoughtful listening to a cry of pain. If noble Lords are tempted by the technological care vision, I point them to the Isaac Asimov novel The Naked Sun. There is a great deal of robot “care” in that, and I promise you it is a dystopia.

Covid Pandemic: Testing of Care Home Residents

Baroness Bennett of Manor Castle Excerpts

Monday 6th March 2023 Lords Chamber

[Baroness Bennett of Manor Castle (GP)]

Following the question asked by the right reverend Prelate about what is happening today, I actually agree with part of the Government’s response, which referred to selective snippets of WhatsApp conversations. That is what we are hearing today. While we are waiting for the official inquiry, which will give us a clear, independent view of what happened, it is clear that there were big problems in our care homes. What are the Government doing today to look at the problems that continue in our care homes, particularly those associated with excessive profit taking and privatisation, particularly in homes under the management of hedge funds?

[Lord Markham (Con)]

I know that that is something in which Minister Whately is very engaged. The House has already seen some of the plans around social care and there is further work on discharge going on as we speak. I have spoken many times in the House about the need to resolve this, not just to make sure that the right care is in place for those involved but to free up hospital beds to improve the performance of the whole system.

Communications Act 2003 (Restrictions on the Advertising of Less Healthy Food) (Effective Date) (Amendment) Regulations 2022

Baroness Bennett of Manor Castle Excerpts

Monday 27th February 2023 Lords Chamber

[Baroness Bull (CB)]

My Lords, I support the regret Motions from the noble Lord, Lord Allan of Hallam, and the noble Baroness, Lady Merron. At the noble Lord’s invitation, I will kick a slightly different ball into the open goal.

I share the Government’s concerns about levels of obesity in the UK, but the failure to adequately explain or justify both the delay to and the rationale for these regulations is further evidence that the Government’s strategy to tackle obesity is disjointed, partial and careless of unintended consequences, and that it falls far short of the integrated public health approach that will be required if we are to meet this major public health challenge.

Research in obesity and eating disorders has often followed separate paths, but it is increasingly recognised that eating and weight-related problems need to be seen on a spectrum that goes from diagnosable eating disorders, through to disordered eating behaviours such as fasting, vomiting or laxative use, to body dissatisfaction, binge eating, being overweight and obesity. Studies show that individuals often present with more than one problem concurrently or move between different problems at different times in their lives, so eating disorders and obesity cannot be seen as separate and distinct issues. There is a raft of risk factors common to both: poor body image and low self-esteem; weight-related teasing; the modelling of poor eating behaviours at home; the stigmatising attitudes of teachers or sports coaches; and the socio-cultural norms around body shape that underpin everyday life. Any of these can increase the risk of both eating disorders and obesity in adolescence and adult life.

The interactions between the two mean that any strategy to address them needs also to be integrated. This is especially important when it comes to messaging. Many campaigns position being overweight and obesity as issues of personal responsibility and choice, shaming and stigmatising people, rather than acknowledging and addressing societal and environmental factors, as well as the powerful impact of genetics, epigenetics, metabolism and biology.

In 2020, 100 obesity specialists from around the world signed a statement in which they explained:

“The assumption that body weight is entirely under volitional control, and that voluntarily eating less and/or exercising more can entirely prevent or reverse obesity is at odds with a definitive body of biological and clinical evidence developed over the last several decades.”


Yet that same year, just months later, the Government produced an obesity strategy underpinned by the assumption that everybody is able to make the choice to modify behaviour and change their weight status. Not only does this stigmatise those who cannot, it can have negative consequences for people for whom the message is not intended. It can cause or exacerbate incipient or established eating disorders, promoting unhealthy dieting or inducing body dissatisfaction.

Children and adolescents are especially vulnerable to this kind of messaging, particularly those who are prone to anxiety. The simplistic portrayal of foods as good and bad, healthy and unhealthy, is risky for children, because they may not yet be at the developmental stage needed to appreciate the nuances involved. Many pre-adolescents report healthy eating initiatives at school as the trigger for an eating disorder, internalising messages such as “fat is bad” in a literal way, impervious to the importance of fat in their neurological development—of course they would be impervious to that; they are children. Children have a degree of cognitive inflexibility, and it can lead them to adhere very strictly to rules. In susceptible children, this can result in obsessive preoccupation with reducing calories, avoiding foods or increasing exercise to burn off what they have eaten.

The current obesity strategy, developed at speed as the links between Covid and obesity became clear, is far from the integrated approach that is needed to address these complexities. Its policies focus mainly on physical activity, diet and weight control and seem to have been designed in consultation with experts in obesity but with little or no input from specialists in eating disorders or body image. In my conversations with officials and Ministers about food labelling regulations, I was astonished at the levels of disconnect between eating disorder and obesity research, policy and clinical practice, and I found it hard to avoid the conclusion that concerns from an eating disorder perspective had been sacrificed to the perceived greater needs of the obesity crisis.

It is completely understandable that the Government have focused their attention on tackling obesity, given its increased prevalence, the long-term health consequences and the burden to both the NHS and the public purse. But it is regrettable that so many aspects of the strategy were not thought through: the complex interactions with other weight-related or eating-related issues; the particular risks to children; and, as the Secondary Legislation Scrutiny Committee has highlighted, the practicalities of implementation and the impact of this further delay on young people’s health.

Obesity is a major public health challenge, and it requires an integrated public health approach, one that balances risks and benefits and focuses on better education, healthcare and policies that modify the environment in ways that support healthier behaviours. The current patchwork of policies, with its partial focus and unexplained delays, is not going to be the answer.

[Baroness Bennett of Manor Castle (GP)]

My Lords, it is a pleasure to follow the noble Baroness, Lady Bull, who set out so clearly that we have to get away from blaming individuals for the fact that we have, as a society, a deeply damaging and disastrous relationship with food. Perhaps going even further than the noble Baroness, I stress that what is behind that is a broken food system—that what is supplied into the system is deeply unhealthy and damaging in all kinds of ways. It is both what is presented to people and what comes into the system that are problems.

It might be fairly said, as the noble Baroness just did, that tonight we are talking about partial, inadequate measures—and I offer the Green group’s support for both these regret Motions—but they are, at least, measures to do something. We can look at another partial, inadequate measure that has come into effect and we are starting to see the results of: the Soft Drinks Industry Levy Regulations 2018. It is very small and partial, but a recent study published in PLOS Medicine showed that we have seen an 8% reduction in obesity in girls aged 10 and 11 as a result of that. There is a gender aspect that I do not think anyone yet fully understands. It is a limited state of progress, but it is better than heading in the opposite direction.

Looking where we are now, here is one figure that is truly shocking: last year, 660 under-fives were admitted to hospital with obesity given as the primary cause of their admission. That is what our broken food system is doing. Restrictions on advertising were hard fought for and much discussed during the Health and Social Care Bill, and I remember sitting in your Lordships’ Chamber over what I suspect was many hours. Yet here we are today, and I cannot help reflecting on an earlier discussion in your Lordships’ House in which it was suggested that the Scottish Government were bringing in the bottle return scheme far too quickly. That was a three-year delivery from the regulations being passed to them being implemented. That was something Westminster could not imagine.

Looking to the general public, one of the things I have found again and again on that issue and issues tackling obesity is that people say, “We heard the government announcement, but it does not seem to have happened.” People think that once the Government have announced something it is happening, and the Government use that, announcing things again and again that never get delivered. It really is past time that we should be seeing the delivery here. I will finish with a question to the Minister: what is the higher priority here, the health of the nation or the profits of broadcasters?

[Baroness Walmsley (LD)]

My Lords, I am afraid I am a weary veteran of discussions about these regulations. As your Lordships know, the House’s Secondary Legislation Scrutiny Committee has absolutely slated them and the information provided with them. It mentions:

“The Explanatory Memorandum (EM) states that in 2019”—


that is a year after the industry was first warned that this sort of ban was going to be implemented—

“under current voluntary restrictions, children were exposed to 2.9 billion ‘less healthy food and drink TV impacts and 11 billion less healthy food and drink impressions online’”.

That is 13.9 billion hits. That was four years ago. In the four years between the measures first being announced and us legislating for the ban last summer, there were 13.9 billion every year, coming to 55.6 billion hits for unhealthy foods, which is an existential scale of influence on children’s food choices. Now we are being told there is going to be another three years of it; at the same rate, that is another 41.7 billion hits to persuade children to eat unhealthily. That comes to 97.3 billion adverts—a figure 12 times the population of the world. There cannot be a child in this country over that period of time who has not seen hundreds and thousands of adverts persuading them to make the wrong food choices.

We are told that the industry needs longer to prepare and the Government need longer to consult. The Government are consulting on simple technical issues that should not take many weeks, let alone another three years. Indeed, I understand there is an idea of changing the definition of these foods, but we already have a clear mechanism for deciding what these foods are. It is called the nutrient profiling model, and the industry knows it perfectly well, because since 2007, it has not been able to advertise those foods around children’s television programmes. So why do we have to wait another three years? How on earth do these delays line up with the Government’s strategy to halve childhood obesity by 2030? These things simply do not match up.

National Health Service (Primary Dental Services) (Amendment) Regulations 2022

Baroness Bennett of Manor Castle Excerpts

Tuesday 24th January 2023 Lords Chamber

[Baroness Bennett of Manor Castle (GP)]

My Lords, it is a pleasure to follow the noble Lord, Lord Hunt of Kings Heath. I thank him for securing this debate and for so clearly setting out the pressing issues around dental treatment. He set out the massive, chronic underfunding—a quarter down since 2010—and the workforce problems. As he said, the regulations we are debating are an extremely modest, if welcome, step to address that to a very small degree.

I will take this opportunity to take a somewhat broader view of dental health and raise a couple of issues that are arising from the crisis of the lack of NHS dental provision. My first point draws on the WHO Global Oral Health Status Report, which was published in November 2022. It stressed that most oral diseases are fundamentally preventable through addressing the social and behavioural determinants, with risk factors such as tobacco, alcohol and sugars that are shared with many other non-communicable diseases. So the first question I put to the Minister is: are the Government really taking seriously the issue of addressing good oral health and public health conditions, which would have so many other positives in terms of issues such as obesity, diabetes, et cetera? Are the Government looking at this in this kind of way?

Secondly, the WHO global strategy on oral health says:

“Achieving the highest attainable standard of oral health is a fundamental right of every human being.”


I will refer here to an article published in the Lancet Public Health on 11 December last year by Winkelmann and other authors, which looked around the world at the different classes of oral health coverage available. There are four: no coverage at all, limited coverage, partial coverage, and comprehensive coverage. The UK, I am afraid, falls in the second of those four increasing levels of coverage: limited coverage. We know that the Government like to claim to be world-leading in many contexts, so do they have an aspiration at least to reach the comprehensive or advanced level of coverage identified in that study, which would mean making dental treatment available to all and ensuing a high quality of preventive public health provision?

My third point is on the issue of dental health tourism. This was prompted to the front of my head again this morning by sitting in a Tube carriage in which I was facing adverts saying, “Get your teeth fixed—go to Turkey”. A couple of days ago, there were a number of horror stories about this across the tabloid newspapers. I am not picking on Turkey in particular, because I do not have the stats on how many people are going where and what problems are arising—but I do not believe that the Government have stats on what is happening with dental health tourism or those problems, either.

As I understand it, there is no reliable source of data on all outbound UK medical tourism, whether it be dental or other forms, but the ONS has estimated that 248,000 UK residents went abroad for medical treatment in 2019. I assume that quite a number of those treatments were probably dental. Indeed, in a recent article the Guardian quoted the editor-in-chief of the International Medical Travel Journal—it is interesting that there is a journal on such a thing—saying that this was going up fast. Are the Government going to collect any stats on both dental tourism and other forms of medical tourism? Are they going to publish those? Are they going to look into whether this is an issue, in which case the stats would clearly be a starting point? Does the Minister agree with me that when these operations go wrong overseas, we will end up seeing the UK dental health system and general health system ultimately having to pick up the pieces?

I come now to my final point. Your Lordships’ House will shortly be engaging, I suspect at some considerable length, with the Levelling-up and Regeneration Bill. It is worth stressing how much dental health issues are a levelling-up issue. The south-west of England, Yorkshire and Humber and the north-west have the largest shortage of provision of NHS dental services, with 98% of practices in these areas refusing to accept new adult NHS patients, according to the latest figures I have been able to find.

I have raised a number of points, and I understand that the Minister may need to write to me on some of those. We sometimes have this sense that there is health, and then there is dental health. Indeed, the article I cited earlier stressed that the WHO is concerned that dental health is often seen as something that is done by private clinics in private places—but, of course, dental health is crucial to the health and well-being of a healthy population. We have, in so many different areas, a public health crisis in the UK. Dental health is one more of those areas, and it must not be left behind or neglected because of historic structural factors.

[Lord Allan of Hallam (LD)]

My Lords, I am grateful to the noble Lord, Lord Hunt, for ensuring that we have an opportunity to debate this important statutory instrument today. We benefit from his detailed analysis of problems in the dental sector.

The facts are laid bare in the Government’s own impact assessment, which says:

“NHS dentistry was a challenging area prior to the COVID-19 pandemic, with patient access proving difficult in some areas of the country … The COVID-19 pandemic exacerbated problems with patient access and created a backlog of patients seeking access to NHS dentistry.”


There is a recognition in that analysis that people being unable to access NHS dentistry is a long-standing problem. As other noble Lords have said, the statutory instrument is correctly aimed at addressing some aspects of that shortfall, and we would not oppose it as a contribution to solving the problem. However, we would ask the Minister, “Is this all you’ve got?”, given the clear and enormous gap between demand and supply.

The figures are dire. Again, the Government’s own impact assessment shows that the success rate for patients seeking an NHS dental appointment has fallen from 97% in 2012 to 82% in 2022 for people with an existing relationship with a dentist—so one in five of those who already have an NHS dentist relationship are not being seen. But for those trying to get their first NHS dental appointment, this has become almost impossible in many areas, with only 31% of those who had not been seen before successfully getting an appointment, compared with 77% of the same group in 2012. When we drill down into these national figures, we also see significant variation around the country, with some areas having become known as “dental deserts” because of the lack of dentists offering NHS treatments.

Turning again to the impact assessment, we see that it tells us that

“the North West has generally good access (but with pockets of poor access in rural areas), compared to the South West and East of England where access is generally poor, particularly in rural and coastal areas.”

This is a terrible indictment of what is supposed to be a nationally available essential service—one that is likely to have a disproportionate effect on deprived people who often need intensive dental care. The noble Baroness, Lady Bennett, also raised this point, quite rightly, in the context of the levelling-up agenda—or is it the gauging-up agenda? In any case, the agenda to deliver better services to people in historically deprived areas is critical to this understanding of the disparate access to dental care.

These changes are supposed to incentivise better provision of these intensive treatments but I note that again there is no statutory review clause in the instrument requiring the Government to produce data that will show their actual impact. I hope the Minister will want to commit to producing such a post-implementation evaluation in due course, even if that is not a statutory requirement. I am sure he will talk up the benefit of making these changes but the proof will be when we come back in a year or two and we can see whether there has been a change in the number of people able to access NHS dentistry and the number of treatments that were given.

As well as amending the payment scheme, this regulation places new requirements on dental practices to update information about their services for publication on the NHS website. This may seem weird, but I experienced a twinge of fond nostalgia as I read up on this section. It took me back to my first technology job, where I was responsible for producing the directories of primary care practitioners for what was then the Avon Family Health Services Authority. These consisted of papers in ring binders that listed each dental practice and its services for distribution to libraries and other public information points.

That was in the mid-1990s before the massive growth of the public internet, but I managed to get hold of some software called the NCSA HTTPd, an early web server, and I produced an HTML version of our directory for people in the local authority. All of those products are now long discontinued, as indeed is the country of Avon itself, so this is of historical rather than current interest. However, that may have been version 0.001 of the public directory that we now have on the NHS website.

Fast-forwarding to the present day, it will be no surprise that we support improvements to provision of information to the public such as those in the statutory instrument. However, that has to be complemented by improvements to the availability of services or we will simply see increased frustration as people are given better information about what they cannot have. Does the Minister have a response to people who will go to the NHS website and find that there are no dentists taking on NHS patients in their area?

I hope that the Minister will not think it churlish if we say, “Thanks but not enough” in response to this instrument, and that he may have some additional remarks to make about what more the Government plan to do, especially in respect of creating the NHS dental workforce. I emphasise “NHS”; there are many areas where there is no shortage of dentists, but there is a shortage of dentists who are willing to work for the rates that the NHS is prepared to offer them. I hope that by making those improvements, we will be able to move on from where we are today, where seven out of 10 people in this country who try to get into the NHS dentistry system for the first time cannot find anyone to take them on.