(3 years, 2 months ago)
Lords ChamberI take a personal interest in diabetes; I have two very close family members with diabetes, one type 1 and one type 2. I noticed during the Covid lockdown the different approaches in meeting their clinicians—telephone calls rather than meeting in person, and reviewing their charts and sugar graphs over time, which is regularly done at these reviews. I agree completely that it is really important that we now try to address this backlog as much as possible. I know that the Secretary of State is committed to making sure that, with the uplift, we try to tackle as much of the backlog as possible, including for patients with type 2 and type 1 diabetes.
My Lords, I associate myself with the remarks of the noble Lord, Lord Brooke. I think everybody in the Chamber will appreciate the challenges that my noble friend has faced today with all these questions. My noble friend will probably know that 10% of NHS spending is currently on type 2 diabetes. That is £25,000 a minute, £1.5 million an hour, and rising. He will be aware that diabetes is reversible by diet. I am not sure whether he is also aware that, under the leadership of Jonathan Valabhji, the NHS has now endorsed a 12-week programme which has put many patients into remission rather than having to go on to medication.
I thank my noble friend. I have done my homework and I have read a little about what has been happening up to now, especially about the NHS diabetes prevention programme, which identifies those most at high risk of developing diabetes and refers them on to behavioural change programmes and personalised education to reduce their risk of developing diabetes, including things such as bespoke exercise programmes and learning about healthy eating and lifestyle. The programme achieved full national rollout in 2018 and 2019, with services available to patients in every system in England.
As we know, tackling diabetes is multifactorial. Nevertheless, the NHS long-term plan sets out plans for increased action on diabetes and related issues. I shall mention just a few, including the healthy weight strategy launched in July 2020 to help adults and children maintain a healthy weight, and the restrictions on the promotion and advertising of foods high in fat, sugar and salt, as was mentioned earlier. It is really important with programmes such as this that we look at these studies on a longitudinal basis and look at the evidence. Some of these programmes will work, and some will not. That is just the way the world is. We have to make sure that we tackle unintended consequences first of all, and that any future policy is very heavily based on evidence rather than a wish. That will be the most effective way of tackling diabetes.
(3 years, 4 months ago)
Lords ChamberMy Lords, I speak today in support of the amendment tabled by the noble Lord, Lord Brooke, and, while I have the utmost sympathy for those with eating disorders, to oppose that of the noble Baroness, Lady Bull.
When I came to this House over 10 years ago, my office-mate, my noble friend Lord McColl, was a lone voice asking questions about obesity and its consequences. We talked about it endlessly at our desks. In my case I was motivated as, after 55 years of being overweight, I had finally lost 28 pounds—and I have more or less kept it off. For years I struggled with my weight, so I know how hard it is, but I also know how important it is not only for my own long-term health but for the future—indeed, potentially the survival—of the NHS. Anything that we and the Government can do to help and support others in a similar position, with information that makes it easier to make informed choices, must be tried.
The rise in obesity and its related problems, including diabetes, heart disease and cancers, is a growing problem internationally as well as in this country. The relationship between our environment and health is becoming increasingly clear, and I very much welcome the part 2 of the national food strategy, which joins up the dots so clearly.
In 2017 I chaired a report on childhood obesity for the Centre for Social Justice. If previously I had not been aware of the severity of the crisis, I certainly was by the time that we had done the work and launched the report. Dr Chris van Tulleken’s current work on ultraprocessed foods—seemingly more chemicals than food—which now make up over 60% of the average Briton’s diet, is particularly alarming. He experimented on himself by eating a diet of 80% of these highly addictive foods for a month. What it did to his body was shocking: not only did he put on more than 14 pounds in weight, he suffered many other side-effects such as heartburn, sleep problems, loss of libido and piles. The food even altered his brain. The effect on our children’s health and their growing brains is horrible.
As the Minister said, nearly one-quarter of children in England are overweight or obese when they start primary school aged five, and this rises to one-third by the time they leave aged 11. Childhood obesity rates in the UK are among the highest in western Europe. Obese children are more likely to become obese adults; currently, around two-thirds of adults are overweight or obese, with one in four living with obesity. We know that regular overconsumption of a relatively small number of calories leads to individuals becoming overweight or obese.
The problem is clear: it is likely that eating out frequently, including eating takeaway meals, contributes to this gradual overconsumption of calories. Research suggests that eating out accounts for 20% to 25% of adult energy, and that when someone eats out or eats a takeaway meal they consume, on average, 200 more calories per day than if they eat food prepared at home. This all adds up. Data also tells us that portions of food or drink that people eat out or eat as takeaway meals contain, on average, twice as many calories as equivalent retailer own-brand or manufacturer-branded products. Some 96% of people eat out, and 43% do so at least once or twice a week—a huge increase on even a decade or so ago.
There is strong public demand for calorie labelling in the out-of-home sector. People want information so as to make better choices. Nearly 80% of respondents to a survey by Public Health England said they think that menus should include the number of calories in food and drinks. This thirst for information also applies to alcohol. An experiment conducted by the RSPH in 2017 showed that, on an evening out in the pub, those drinking with calorie labelling on the menu drank 400 calories fewer than those who were not aware of what they were drinking. The problem is huge, and every tool in the toolkit has to be used to tackle it. There is no time to waste.
(3 years, 5 months ago)
Lords ChamberThat this House takes note of the steps taken to improve women’s health outcomes.
My Lords, it is an honour to be introducing this debate on a topic so close to the hearts and other more intimate body parts of 51% of the population—and some men too, of course.
In my International Women’s Day speech this year, I departed from my usual topics of either women in Parliament or the reality of women’s and girls’ lives in the developing world to talk about women’s health. This change was a result of the Government’s very welcome launch of the first ever consultation and call for evidence to improve the health and well-being of women in England, designed to use women’s voices and experiences to write a new women’s health strategy. For the first time in years, I pondered a woman’s life cycle in terms of health, and I am grateful for the chance to expand on those thoughts today. What I found then, and again now, brought home to me all too graphically the experience of millions of women at different stages of their lives.
Let us start with puberty. It is a confusing time for any child but it is especially so for girls, who are entering puberty about a year earlier than they did back in the 1970s according to global data of 30 studies on breast development. Studies also show that early menstrual bleeding, the last clinical sign of puberty for girls, is associated with a higher risk of obesity, type 2 diabetes, heart disease and allergies. During this period—excuse the pun—I thank journalist Emma Barnett for her book, Period: It’s About Bloody Time, which asks why we are so uncomfortable talking about, and clam up about, menstruation—girls have their first introduction to expensive sanitary products, starting for many period poverty, which affects their school attendance. Estimates vary, but around one in five women of childbearing age suffers from painful, irregular or heavy periods, many to a truly debilitating extent.
Endometriosis manifests itself around this time as well. It is a long-term condition where tissue similar to the lining of the womb grows in other places, such as the ovaries and fallopian tubes. The main symptoms are back and stomach pain, increased period pain, pain during or after sex, pain when peeing or during a bowel movement, feeling sick, constipation, diarrhoea, blood in pee and difficulty getting pregnant. There is a seven-year wait to get diagnosed, with 40% of women needing 10 or more GP appointments before being referred to a specialist.
At this age, social media pressure and social contagion start to have an impact on teenagers’ body image, including anorexia and self-harming. Since 2016, there has been a 45% increase in labiaplasty operations, a female genital cosmetic procedure flippantly referred to as “designer vaginas”. This coincides with a time when vulnerable girls are groomed on the internet and the effects of porn not only are felt on their mental health but lead to this irreversible surgical procedure.
I turn to STIs and birth control. Syphilis and gonorrhoea have almost doubled in the past five years in school-age girls. While chlamydia is decreasing thanks to the screening programme, it remains a problem because of the irreparable damage to girls’ fertility and chronic pelvic inflammatory disease. Avoiding pregnancy is still largely seen as a girl’s responsibility. Boys should be taught that using a sheath not only prevents unwanted pregnancies but also reduces STDs for girls.
I now move to the stage of planned pregnancies and hoped-for motherhood. One in four pregnancies ends in miscarriage, and these women feel let down. There is insensitivity and a lack of empathy in healthcare and arrogance among healthcare professionals, mainly male doctors, who will not and do not listen to patients. My friend had six miscarriages and finally visited a male Harley Street IVF doctor, who put her on a standard protocol for getting pregnant despite her arguing vociferously that getting pregnant clearly was not her problem. She got pregnant again and endured another avoidable miscarriage because she was not listened to. She then went to a female consultant and had a live birth on the first round of tailored treatment.
Antenatal care is inconsistent. Every woman should have the option of the same midwife throughout, up to their delivery. I wish my noble friend on the Front Bench today—she is probably very uncomfortable in her last two weeks—luck and an easy, quick birth, although I am afraid that there is no such thing as a pain-free birth. I also wish her access to the pain control that she wants and, ideally, no episiotomy. I am afraid that nothing can prepare her or other new mothers for the post-birth challenges of getting her body back to a reasonable condition, breastfeeding, disrupted sleep and so called “baby blues”, possibly followed by postnatal depression, which affects between 10% and 20% of women.
I come to motherhood next. In the vast majority of cases, women are the lead parent, combining most child- care with work, usually at a greater career cost than the father. This in turn leads to tension at home and often a relationship breakdown, leaving the mother as the major childcare provider, which in turn leads to increased mental health issues—I think other colleagues will talk about this—or the use of drugs or alcohol as crutches, which I think the noble Lord, Lord Brooke, may raise.
I turn to the eventual emptying of the nest, which is another time of stress in a relationship and often comes at the same time as caring for elderly parents. This is close to my heart because last year we lost my mother, whom we lived with, aged 96.
I now move on to the menopause, which is a “big one”. Some 34 years ago, I ran the Amarant Trust, a menopause charity funding ground-breaking research into HRT with the team at King’s College Hospital, which also ran our self-referring clinic. Women attended in droves, largely because of hostile, and in some cases misogynistic, GPs. I was pregnant at that time so my own hormones were in turmoil, although not lacking in oestrogen and the myriad of miserable symptoms that so many women experience at that time. I can still remember the distress that so many patients suffered in silence and how debilitated they were by the onslaught of flushes, sweats, sleeplessness, vaginal dryness, discomfort during sex and problems with memory and concentration.
A couple of years ago, I attended a round table with the then Women’s Health Minister and campaigners. I was astonished to find that the situation for menopausal women is no better than it was all those years ago when I was actively involved. Indeed, 23% of women who visit their GPs with symptoms are prescribed antidepressants instead of HRT. I was one of the lucky ones—I sailed through—but those suffering symptoms should of course be given the informed option of taking HRT, a transformational drug that makes life worth living again for so many women. I give a big shout-out to James Timpson, who wrote in last weekend’s Times of the need to
“stop the menopause hijacking careers”.
One newish MP told me that, before she was prescribed HRT, she thought that she would have to give up her job as an MP because it was impossible for her to do it properly. I am delighted to be a founder member of the new APPG for the menopause and look forward to its forthcoming inquiry.
In between all this, we have a miserable list of prolapses, cystitis and thrush. Although I have been comparatively lucky in my own health journey, the latter two caused hours of itching and discomfort, including of course painful sex. This is not always easy to discuss with a partner.
Then we have the female cancers. Cancer Research’s most recent figures, from 2015 to 2017, report about 75,000 new cases of breast, cervical, uterine and ovarian cancers. The Government’s sustained good work with the introduction of HPV vaccination is very welcome. Since then, infections of HPV in 16 to 18 year-old women have reduced by 86% in England. Considering that around 80% of all cervical cancers are caused by HPV, we hope for big reductions in that cancer in the years to come, but let us keep the pressure on for improving the treatment and life expectancy of women suffering these diseases.
I turn to the final countdown, once we have passed the period of caring for aging parents and the move towards osteoporosis, leading to life-changing fractures caused by brittle bones, and then finally dementia.
Even with the generous 12 minutes that I have today, I can only touch the surface of women’s health issues. I pay credit to Health Ministers for taking our problems seriously and, in particular, to Nadine Dorries for driving this agenda, and whose own personal challenge with having an IUD fitted 36 years ago—which in the end she failed because of the intensity of the pain—was laid bare in the Daily Mail earlier this week. Many women are unable even to have a cervical smear because of the agony, but they now feel emboldened to speak out because of other women talking publicly, including the campaigner Caroline Criado Perez.
I am not alone among women in wondering whether, if these debilitating conditions afflicted men, better treatments would have been found by now. Less than 2.5% of publicly funded research is dedicated solely to reproductive health, despite the fact that one in three women in the UK will suffer from a reproductive or gynaecological health problem. There is five times more research into erectile dysfunction, affecting 19% of men, than into premenstrual syndrome, which apparently affects 90% of women.
Women are underrepresented in clinical trials even though biological differences between males and females can affect how medication works. The general assumption is that women do not differ from men except where their reproductive organs are concerned, and data obtained from clinical research involving men is simply extrapolated to women. This has important implications for health and healthcare. I understand that over 100,000 women have responded to the Government’s consultation and that they are currently unpacking the data. On behalf of women everywhere, I thank the Government for the initiative and for the forthcoming sexual and reproductive health strategy.
Noble Lords may not be aware that instances of domestic abuse increase by 26% when England play football and by 38% if they lose. So those who may not be looking forward to Sunday’s game will be especially welcoming the actions that the Government are taking on violence against women and girls.
I look forward to hearing from my noble friend the Minister about how these initiatives will improve life for millions of women who are suffering in at least some of the ways that I have described today.
My Lords, I thank all noble Lords who have participated in this debate and used such a wide variety of their experience to educate us and to plead their different causes—particularly the seven male noble Lords who have supported us. I rather like the idea of it being the seven ages of woman; I will stick with that one. I particularly thank my noble friend the Minister, not only for his comprehensive reply to us today but for his deeply moving description of his and his mother’s experiences. I challenge anyone not to have a lump in their throat hearing this very moving story. He has always been a great supporter of women and of the causes I have supported, and I am extremely grateful to him for that.
I will touch on a couple of the topics we have discussed; they have all been run through by other noble Lords. Like the noble Baroness, Lady Ritchie, I have participated in a clinical trial; it happened to be about endometriosis. I have no idea whether the drug we were testing is currently on the market, but it was a very long time ago so the answer is probably not yet. One of the lessons Covid has perhaps taught us is that clinical trials can be sped through and happen more quickly than we originally thought. I am very glad that other noble Lords raised this as an issue.
A number of noble Lords talked about mental health. The fact that so many people talked about it made us aware of what a big issue it is. Although the noble Baroness, Lady Cumberlege, is not with us today, I suspect that a large number of people—probably more people than are listening to this debate—heard her on the radio this morning. I was very struck by the dignity of the victims: the mother of one victim spoke particularly eloquently and with such dignity about her experience.
A number of noble Lords talked about Sir Michael Marmot and his work on inequality. It is a massive wake-up call for all of us, and the theme of inequality is so clear in the work that he does. It is tempting to think that this debate has been a rather miserable litany of bad experiences, but I think it was my noble friend Lady Bottomley who said—as the Minister has just said—that there have been massive improvements in so many areas. We must not forget that.
I return to the point I mentioned at the beginning. I changed my usual topic of International Women’s Day, but the noble Baroness, Lady Nicholson, raised the hideous plight of so many women across the world. We must remember to count our blessings that we live in such a wonderful country, where we have access to healthcare that is so much better than in so many places across the world.
I will end by again wishing my noble friend Lady Penn good luck. With her typical efficiency, she is actually due on the day we rise, two weeks today—and with her typical efficiency, she will probably have the baby on that day or the day after.
I know the Government are serious about this agenda, and they know that we will be watching them.
(3 years, 7 months ago)
Lords ChamberThe right reverend Prelate makes an extremely valuable point. He is spot on; these comorbidities are related and dealing with them is complex. It is possible to exacerbate one while trying to cope with another. That is one reason why we are putting so much investment into the cross-governmental effort and why this agenda will be led by a cross-departmental ministerial board, to ensure that that kind of co-ordination happens.
My Lords, as the country and the NHS emerge from crisis mode and we understand better that we were disproportionately hit because of the country’s general poor health, I urge the Minister to ensure that the Office for Health Promotion will focus on helping and supporting individuals attain a healthy lifestyle. Will he confirm that, despite what I know to be intensive lobbying, the Government will not water down proposals in the obesity strategy on, for example, advertising on social media and before the watershed and will stick to calorie labelling for alcoholic drinks, restaurants and other food outlets?
My Lords, as my noble friend knows, the publication of the consultation on advertising is due soon, and I look to it very much. She is entirely right that obesity, seriousness of illness and death from Covid are clearly related; this has been a wake-up call and we are stepping up to the challenge as of now.
(3 years, 7 months ago)
Grand CommitteeMy Lords, as another of the commissioners, albeit a rather absentee one, I am grateful to the noble Baroness for instigating this debate and to all those who participated in the report either as witnesses or by taking evidence. Its findings were powerful and worrying.
The noble Baroness, Lady Finlay, and I worked together in 2011 to persuade the Government to legislate for compulsory sobriety tagging for alcohol-related crimes. The alcohol abstinence and monitoring requirement, which checks offenders’ intake every 30 minutes, was piloted successfully and is now rolled out across the country. There is a clear connection between problematic alcohol consumption and crime, particularly heavy drinking or binge-drinking and violent crime. The most recent findings, from the Crime Survey for England and Wales in 2018, estimate that the proportion of violent incidents where the victim believed the offender to be under the influence of alcohol was 39%. The estimated total social and economic cost of alcohol-related harm in 2018 was £21.5 billion.
Reducing alcohol-related crime will mean fewer victims, save taxpayers’ money and have a positive impact in communities and on individuals. The legislation to introduce this solution to alcohol-related crimes took more than 10 years from conception, when Boris Johnson as Mayor of London first asked for it, to final implementation. It is a common-sense, effective, value-for-money solution. Why did it take so long?
In the time I have left, I, like others, commend the Government for their commitment to calorie labelling of alcoholic drinks as part of the obesity strategy. Polling shows that the UK public are overwhelmingly supportive of health and nutritional information on alcohol labels. It is clearly absurd that alcohol-free beer, for example, shows nutritional information but ordinary beer does not. This has to change. It is another common-sense, effective policy and I urge the Government to stick to their plans.
(3 years, 7 months ago)
Grand CommitteeMy Lords, I am grateful to the noble Lord for introducing the debate. BMI is used globally as a tool to assess a person’s size. It is a quick and cheap way to make estimations about an individual’s potential risk of disease or poor health. However imperfect a measure of health it is, I doubt that our discussion here, or the Select Committee’s report, will change the way doctors measure their patients and the risks to their health. The overall message of the report, however, drawing attention to the damaging nature of weight stigma and the consequences it can bring, is of course important.
Whatever measure used, what is also important is for healthcare professionals to feel able, without embarrassment, to discuss patients’ health and weight with them and, by using appropriate language, explain the long-term consequences of an unhealthy lifestyle. People need knowledge, support and encouragement, as well as a healthier environment, to make the changes necessary to improve their own lifestyles and thus take pressure off the health system.
Excess weight is one of the few modifiable factors for Covid, and our high obesity figures are one of the reasons why this country has been so badly hit. But even before the virus, it was clear that the unhealthy lifestyles so many in this country now lead were resulting in preventable diseases such as type 2 diabetes, liver disease, heart disease, some cancers, arthritis, the wearing out of hip and knee joints, and the discomfort of general ill health. Many of these conditions can be reversed by changing to a healthy diet. People need—and polling of up to 80% approval shows that they want—informed choices. The Government’s population-wide Better Health agenda is crucial to providing this. I commend them for the bold approach in the obesity strategy and urge them to stick to it.
Advertising works. If it did not then the food industry, particularly the ultra-processed and fast-food industry, would not do it. A KFC “Mighty bucket for one”, apparently the perfect meal for one person, contains 1,155 calories—over half the suggested intake. It is currently advertised everywhere. Young people are bombarded by paid influencers via social media. This needs to stop for their health’s sake.
Calorie labelling is crucial to success. Most people are unaware and polling shows that they want to know. Surveys show that 80% of adults do not know the calorie content of common drinks, which is substantial. A large glass of wine, for example, has around 200 calories, about the same as a doughnut. Unless people are supported and encouraged to move to a healthier lifestyle—and BMI is an important tool in the journey—with a better diet, a healthy weight and regular exercise, it will not just be Covid which affects them because the NHS, already under strain, will be unable to cope with the tsunami of obesity-related health issues coming down the track.
(3 years, 7 months ago)
Lords ChamberWhat plans are being put in place for flu and Covid vaccine booster shots for the winter?
I am extremely grateful for that perceptive question. We are looking, at this very moment, at our arrangements for the autumn. For the flu vaccine, we hope to double down on our hugely successful efforts from last autumn. We hope to build on the experience of the Covid vaccine to ensure that a much wider range of people have the vaccine, so that we can deal with those who might head towards severe illness, and to stop transmission. When it comes to the Covid vaccine, we are beginning to try to understand whether a booster shot will or will not be necessary to address the threat of VOCs. As I said earlier, we are still at a stage where we do not have the full science at our disposal but, if necessary, we will roll out a vaccine booster programme in the autumn.
(4 years, 1 month ago)
Lords ChamberIn direct answer to the noble Baroness’s question, I am not sure whether any advice was given by the DPP, because there has been no change in the law. Nothing we have done here changes in any way either the 1961 Act or the advice of the DPP. So, from that point of view, the consultation is not necessary. What we have sought to do is clarify travel guidance in a way that does not change the application of the law in the country.
My Lords, the Secretary of State said in the other place that this conversation on assisted dying must happen
“in an evidence-based, sensible and compassionate way.”—[Official Report, Commons, 5/11/20; col. 480.]
What efforts will the Government be making to ensure that we as a House have all the evidence available to us when this important debate next reaches the Chamber?
My Lords, the debate has not been scheduled, but evidence that would be of interest includes evidence from clinicians themselves, many of whom have seen some movement in their attitudes on this subject. There is also an enormous amount of values-based and faith-based evidence from those who have a particular view on this subject. There is also the evidence of the personal choices of those approaching death themselves. There are extremely moving testimonies by individuals faced with very daunting and challenging circumstances. All of these views have relevance and value, and they should all be part of this important and delicate debate.
(4 years, 6 months ago)
Lords ChamberTo ask Her Majesty’s Government what assessment they have made of the number of obese and overweight people dying from COVID-19.
My Lords, Britain is overweight. For too long, obesity has been a huge cost to the health of the individual, the NHS and the economy. Covid is a wake-up call. Initial evidence suggests that obesity may be associated with a higher rate of positive tests for Covid, of hospitalisation, of admission into intensive care and, I say with great sadness, of death. The Prime Minister spoke movingly of his experience. The Government remain committed to halving childhood obesity by 2030 and we are looking at other ways of making a bigger impact on this national scourge.
I thank my noble friend for that Answer. Now that Covid has joined diabetes, heart disease and cancer in targeting the obese, I am glad that the Government are finally taking the obesity epidemic seriously. I encourage my noble friend to look at the measures ready now to be implemented, such as chapter 2 of the childhood obesity plan. What advice is being given to people about how to boost their immune systems to improve their general health but also to be ready to combat Covid if it comes for them?
My noble friend is recognised for her hard work in this area, and we all admire her championing of healthy living. The CMO’s advice is to focus on weight; that is the best way that you can prepare for winter, for the second spike, to defend yourself against Covid.
(5 years, 5 months ago)
Lords ChamberTo ask Her Majesty’s Government what action they are taking to combat childhood obesity.
My Lords, we are delivering a world-leading plan to tackle childhood obesity. Later this summer, we will set out further action through a prevention Green Paper. In addition, the Chief Medical Officer is reviewing what more can be done to help us meet our ambition of halving childhood obesity by 2030. The review, due to report in September, will consider the approaches taken internationally, regionally and across the country, and will make a series of recommendations.
My noble friend will have seen coverage in the weekend’s press of food companies which are continuing to breach the government advice that a child should not be weaned until six months of age. They are also still failing to reformulate infant foods. For example, one portion of baby porridge contains 9.4 grams of sugar in a 24 gram portion. That of course leads to further childhood obesity, dental decay and addiction to sugar. Can my noble friend tell us what conversations and discussions the Government are having with food companies, in particular Heinz, Danone and Nestlé about reformulation and the age at which infants should be weaned?
My noble friend is a great champion on this subject and has been an expert in it for a long period. Through the prevention Green Paper, which is due to be published this summer, we are determined to look at a range of further options to tackle obesity. We have publicly committed to taking action on infant and baby food. She will know that we are making progress on the reformulation section of the obesity strategy. However, we have further to go, and I am grateful to her for her Question on this issue.