Domestic Violence and Brain Injury

Baroness Bull Excerpts

Monday 23rd October 2023 Lords Chamber

[Lord Markham (Con)]

It is a good point, and there are already some very good examples, such as in Cambridge, where the ICB has a single front door to make sure that all facilities, whether it is neurologists, psychologists, physios or speech therapists, are there and available. The noble Baroness is correct: there are lessons we can learn and roll out straight away, and we are looking to do that.

[Baroness Bull (CB)]

My Lords, research projects in Glasgow and at Drake Hall prison in Staffordshire have shown a very high percentage of female prisoners to have traumatic brain injuries that have been sustained as a result of domestic violence. Is it now routine to screen female prisoners for brain injuries as they enter the Prison Service?

[Lord Markham (Con)]

My understanding is that it is not routine at the moment. I know there is some conflicting research as to how much screening should be used as a regular tool. I must admit that I do not fully understand the reasons behind some of that, so I was not quite persuaded as to why that was. It is something on which I want to do more research to understand. I will happily write to the noble Baroness to give her more information.

Food: Two-For-One Offers

Baroness Bull Excerpts

Wednesday 19th July 2023 Lords Chamber

[Lord Markham (Con)]

To me, that is a great example of how working in co-operation to allow people to make the right choices is the best way. For instance, 78% of shoppers have said that they are in favour of not having unhealthy items at the till because they know that they give in to pester power. That is why this has been focus of what we have done.

[Baroness Bull (CB)]

My Lords, notwithstanding the interesting “legal but harmful” point made by the noble Lord, Lord Naseby, I think that most of the House would agree that reducing high-fat, sugar and salt content is a good idea. However, the Minister has at least twice mentioned reduction of calories. Does he acknowledge and recognise that while one way to address obesity is calorie reduction, it is not an appropriate message for everybody and it certainly is not the sole cause of obesity across this country?

[Lord Markham (Con)]

The noble Baroness is correct; this is a complicated area, and a number of measures need to be taken. The best thing is the promotion of healthy foods, and the fresh fruit and veg initiatives that we have talked about today are perfect examples of that.

Long Covid

Baroness Bull Excerpts

Tuesday 25th April 2023 Lords Chamber

[Lord Markham (Con)]

I take issue with the statement of failure to deal with it. We pioneered this space. We set up 90 specialist adult centres and 14 specialist centres for kids. We have invested £314 million and 80% of people are seen within eight weeks of being referred. That shows that we are taking this seriously. The noble Lord is absolutely right that we want to ensure that we get as many people into work as possible. In the case of long Covid, we are definitely doing that.

[Baroness Bull (CB)]

My Lords, the Minister will know that evidence shows that the risk of long Covid increases with each subsequent reinfection, and that most adults were last vaccinated in the autumn, which means that their immunity is waning and that they are vulnerable to new infection. For many, this will be their second or even third case of Covid. Given that the living with Covid strategy is to manage Covid like other respiratory illnesses, what consideration have the Government given to adopting a similar vaccination strategy as they do for flu, in that those not eligible for free vaccinations could be offered the option to buy a vaccination? Have the Government made any assessment of the impact that such a strategy would have on the number of reinfections and therefore the rates of people suffering with long Covid?

[Lord Markham (Con)]

I thank the noble Baroness. I think we all accept that this is a complex area where, naturally, we are being guided by the science. Our vaccination strategy has been focused on the highest-risk groups. On allowing other people to pay over and above, as with flu, I think it is best that I come back in correspondence.

Stroke Rehabilitation and Community Services

Baroness Bull Excerpts

Wednesday 22nd March 2023 Lords Chamber

[Lord Markham (Con)]

During the pandemic this was one of the areas that probably did not get enough time, for all the good reasons that we understand. Therefore, I am pleased to see that these pathways are being set out so that we can get back to the standards that we need. I believe this is something that we will see happening now.

[Baroness Bull (CB)]

My Lords, the Minister will know that stroke survivors, once in the community, face challenges with long-term rehabilitation and higher levels of depression, anxiety and loneliness than the rest of the community. What assessment have the Government made of arts-based therapies—I declare an interest as I am an adviser currently with King’s College Hospital—to address the whole patient as they recover from a stroke?

[Lord Markham (Con)]

We are very much believers in the importance of social prescribing. I was at a reception just yesterday given by the Alliance of Sport, talking about the importance of active lifestyles for people’s mental health and recovery, and in the criminal justice system. It is something that we agree on the importance of. I will come back in more detail on the arts.

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

Baroness Bull Excerpts

Monday 27th February 2023 Lords Chamber

I hope that the Minister will, after the obligatory defence of the Government’s tardiness for reasons beyond their control, wish to explore this modest proposal. I beg to move.

[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?

GP Appointments

Baroness Bull Excerpts

Thursday 23rd February 2023 Lords Chamber

[Lord Markham (Con)]

I am clearly aware of that. At the same time, I am very aware that we want to make sure that people are able to see a doctor when they need to and are not deterred from that. So we would have to tread very carefully and it is definitely not in our plans at the moment.

[Baroness Bull (CB)]

My Lords, given that a dual system of online and in-person GP interaction is inevitably the future and that virtual appointments are clinically appropriate in some circumstances, what are the Government doing to increase public confidence in virtual interactions with their GP? How will they ensure that all triage systems do not disadvantage those groups who are less likely to vocalise their preference or to advocate for the urgency of their own needs?

[Lord Markham (Con)]

Absolutely. One of the key benefits of the digital approach is the triage system. We all know that a lot of people who call at 8 am for an appointment could probably be well served by a pharmacy, a physio service or nursing. So proper triage through a digital-type system is a big step forward. It will end up with them being able to make an appointment with the pharmacy, physio—or the GP in this case. It will also free up resources so that those people who are not able to access digital services are able to get through at 8 am and speak to a person. So I really believe there is a win-win for both sides and personally I am very excited to take this through the House later in the year and see all the services that will be launched.

Mental Health: Advertising and Body Image

Baroness Bull Excerpts

Thursday 30th June 2022 Lords Chamber

[Baroness Bull (CB)]

My Lords, despite the fact that advertising prescription-only medicines like botulinum toxin to the general public is already illegal, Botox is still widely advertised online by providers of cosmetic procedures. Given the risks of amateur and poor procedures to physical and mental health, what steps will the Government take to improve the enforcement of existing rules so that the online environment is free of these illegal adverts?

[Lord Kamall (Con)]

A range of issues were looked at in the online advertising programme, including advertising on social media, where people get messages from in the first place, and what the most effective method is. What do we ban? What do we give advice on? What do we give warnings to? It is an incredibly complicated issue, but we are looking through lots of evidence that came in as a result of the consultation.

Social Care: Adults

Baroness Bull Excerpts

Wednesday 22nd June 2022 Lords Chamber

[Lord Kamall (Con)]

As the noble Baroness will acknowledge, some of the problems have been in evidence for a long time. Sometimes, we are tackling the legacy of this neglect of the social care system. At the same time, we have to remember that many social care providers are not run by the state; they are private providers. Following the People at the Heart of Care White Paper, we want to make sure that, first, we encourage better conditions for workers. We also want to make sure that local authorities determine a fair rate of pay based on local market conditions. We have seen an increase in the national living wage, which means care workers will get an increase. But we are looking at all this as part of the overview of the social care landscape.

[Baroness Bull (CB)]

My Lords, could the Minister comment on the March 2022 progress report on the Out of Sight – Who Cares? report, which came out in October 2020? It found that of the 17 recommendations, none had been fully achieved and only four had been partially achieved. Can the Minister say when Government will address these recommendations and end the excessive use of the dehumanising isolation, segregation and seclusion within adult social care?

[Lord Kamall (Con)]

On that specific question, I will have to go back to the department and get an answer. I will commit to write to the noble Baroness.

NHS Dental Services

Baroness Bull Excerpts

Tuesday 24th May 2022 Lords Chamber

[Lord Kamall (Con)]

The noble Baroness highlights one of the issues that must be addressed: those areas, particularly low-population areas, but also coastal and some rural areas which are so-called dental deserts. It should also be noted that a person is not necessarily permanently registered with a dental practice. You only have to register for as long as your treatment lasts, and if you cannot get treatment at one practice, you should be able to try other practices. You can try 111. I have heard various reports. Some people have told me that 111 is incredibly effective, while others have told me that there are still dental deserts in their local area.

[Baroness Bull (CB)]

My Lords, maternity exemption certificates provide free NHS dental treatment and check-ups for mothers during pregnancy and for a full year after birth. However, mothers who live in so-called dental deserts are denied this right, exacerbating health inequalities between different regions. Will the Government consider extending the duration of the maternity exemption certificate during this crisis of provision, so that more mothers can take advantage of their right to free dental care?

[Lord Kamall (Con)]

On the face of it, that sounds a reasonable suggestion, so I shall take it back to the department and see if the people there agree.

Health and Care Bill

Baroness Bull Excerpts

Lords Hansard - Part 1 & Report stage
Monday 7th March 2022 Lords Chamber

Tabled by

[Baroness Bull]

143: After Clause 155, insert the following new Clause—
“Social care cap for younger adults
In section 15 of the Care Act 2014 (cap on care costs), after subsection (4) insert—“(4A) The Secretary of State must ensure that regulations made under subsection (4) specify a zero amount for adults—(a) who are under the age of 40 when they first receive care and support to meet their eligible needs, or(b) who have eligible needs which first required care and support before they reached the age of 40.’’”Member’s explanatory statement
This new Clause would ensure that adults entering the care system under the age of 40, or who were under 40 when they first entered it, would have their care costs capped at zero, in line with the Dilnot report recommendation.