Health Bill
Debate between Baroness Manzoor and Lord Hunt of Kings HeathTuesday 3rd November 2026
(3 days, 1 hour ago)
Lords ChamberRead Full debate Health Bill 2026-27 View all Health Bill 2026-27 Debates Read Hansard Text Read Debate Ministerial Extracts Amendment Paper: HL Bill 52-II(b) Amendments for Committee (Supplementary to the Second Marshalled List) - (3 Nov 2026)
Lord Hunt of Kings Heath (Lab)
My Lords, following the review by the noble Lord, Lord Mann, I certainly hope that the regulators toughen up their act, and in accepting its recommendations the Government certainly expect them to. I agree with the thrust of where the noble Lord, Lord Blencathra, is coming from. Whether all discretion should be taken away from the regulators, I very much doubt, but it will be interesting to hear what my noble friend has to say on that.
In supporting the amendment tabled by the noble Baroness, Lady Gerada, I want to reflect on two points. First, I repeat what the noble Baroness said, which was striking, arising from the report of the noble Lord, Lord Mann. Drawing on the NHS staff survey, Jewish staff are the only religious group where discrimination from managers and colleagues exceeds discrimination from patients. This is a very serious indication of the stress and pressure on Jewish staff within the NHS.
I am afraid that, so far, the response from management has been pretty poor. We have seen that in relation to what we might call uniform policy. As the noble Lord, Lord Mann, described it:
“Examples such as the brandishing of badges, the display of uniforms on political marches or the co-branding of the NHS by staff or others with third parties has made it unclear what patients can expect from the NHS”.
Patients are entitled to be treated without seeing staff display any political leanings whatever or support for campaigns. Teachers are simply not allowed to do this. One has to ask, what is with NHS employers that they have failed to put across to their staff the behaviour that is expected of them?
The noble Lord, Lord Mann, clearly called for NHS England to review what we might call its uniform policy. It is not the standardised uniform, but what people wear and how they display it. My understanding is that that work is being undertaken, subject to consultation. I hope that, when it comes out, it is not going to be wiffly-waffly, leaving too much discretion to local employers. Now that the Government are taking this over—because I doubt it will be finished before 1 April next year—they should make it abundantly clear to NHS employers what should and should not be expected.
I know that Manchester has been cited as a very good example. As the noble Lord, Lord Mann, said, some trusts do not permit the wearing of political badges, of any item of clothing with a political message or of a uniform to political rallies. We need to see something firm about this so that employers are implementing what is required of them from the centre. For employers, this would be much easier than going through the agony of developing local policies that are subject to consultation and lead to variation. Patients and staff are entitled to be in an environment where somebody else’s political views are not displayed in a way which causes huge upset and concern.
Baroness Manzoor (Con)
My Lords, I understand and support the aims and sentiment behind this group of amendments—particularly Amendment 29 and 258. Any form of discrimination or racism is abhorrent. How one identifies oneself should not be a problem. Antisemitism is not acceptable.
It may be helpful to remind ourselves of some figures as, sadly, racism and discrimination remain embedded challenges within the NHS, affecting both staff and patients, as acknowledged by the noble Baroness, Lady Gerada. It is worth noting that 28.6% of NHS staff in 2024 were from ethnic-minority backgrounds. That was around 450,000 people, yet only 12.7% of senior managers came from those backgrounds. The 2025 NHS staff survey found that ethnic-minority staff were more likely to experience discrimination from managers and colleagues: that is 13.9% of ethnic-minority staff compared with 6.51% of white staff. Some 29.16% of ethnic-minority staff experienced harassment, bullying or abuse by patients and by the public, compared with 23.54% of white staff. It is important to further strengthen legislation as there are gaps.
The Equality Act 2010 prohibits racial discrimination, harassment and victimisation. However, significant weaknesses remain. The public sector equality duty requires organisations to “have due regard to” equality but does not guarantee measurable improvements. The NHS equality standards lack sufficient enforcement and meaningful consequences for persistent institutional discrimination. Will the Minister consider how the Government can strengthen this further, particularly as reporting, investigating and addressing racism remains inconsistent, with inadequate protections and support for whistleblowers? How will the Government address this? There is no sufficiently robust uniform accountability framework ensuring that perpetrators and senior leaders face consequences, as the noble Baroness, Lady Gerada, stated. Will the Government consider developing such a framework on all forms of discrimination? This would also support the 2026 review by the noble Lord, Lord Mann, which reinforces the need for stronger investigations, transparency and organisational accountability.
Health Bill
Debate between Baroness Manzoor and Lord Hunt of Kings HeathWednesday 28th October 2026
(1 week, 2 days ago)
Lords ChamberRead Full debate Health Bill 2026-27 View all Health Bill 2026-27 Debates Read Hansard Text Read Debate Ministerial Extracts Amendment Paper: HL Bill 52-I(Rev)(a) Amendments for Committee (Supplementary to the Revised Marshalled List) - (28 Oct 2026)
Lord Hunt of Kings Heath (Lab)
My Lords, the noble Baroness, Lady Tyler, and the noble Lord, Lord Patel, made some important points about cross-government working. I was thinking back to what the noble Lord, Lord Patel, said, basically that what started under Tony Blair was continued under Gordon Brown. It was backed up by, first, a specific Cabinet committee, which underpinned the inequalities work, and, secondly, by what were called PSA targets, which tied different departments in. I think that was a good mechanism. In defence of the Government, though, the important work that is being undertaken in relation to health inequality by Alan Milburn, working with different government departments, is going to be pivotal because it embraces the terrible outcomes for so many people who come under the NEET category. It is also looking at the dreadful mental health support for children and adolescents, which goes to the heart of many of these issues. If we can pull this off, we can start to achieve some of the equality issues that we have been talking about.
Like the noble Baroness, Lady Tyler, I am here to say a few words about coastal health because the noble Lord, Lord Patel of Bradford, told us we must. Five years ago, the Chief Medical Officer devoted his 2021 annual report to health in coastal communities. He identified high levels of poor physical and mental health, an ageing population with increasingly complex needs and serious challenges in recruiting and retaining the healthcare workforce. The noble Lord, Lord Patel, basically has three asks, on which I want to reinforce what the noble Baroness, Lady Tyler, said. Five years after the CMO’s report, we have no strategy. First, will the Government publish a substantive account of progress against his recommendations? Secondly, how will the Government ensure that coastal populations are separately identified? Unless we do that, we do not have the data on which to plan and strategise and see whether improvements can be made. Thirdly, will the department work across government to develop and test commissioning prevention workforce models suited to the distinctive geography and needs of coastal communities? I would be very grateful if my noble friend would agree to meet the noble Lord, Lord Patel of Bradford, to discuss this further, because it is an important consideration.
My Amendment 11 relates to the terrible distribution of GPs in England currently and asks for a much more equitable distribution. I am grateful to the noble Baronesses, Lady Gerada, Lady Hodgson and Lady Manzoor, for their support. Last week I was very fortunate to have a meeting with Minister Dame Diana Johnson and her officials, which I found extremely helpful, and I was grateful to her officials for the way they have been prepared to communicate on this.
This morning, the RCGP published the State of General Practice 2026 report. Chapter 4, about fair and sustainable general practice care—equitable care—makes clear that action is needed. One area where I believe we need action is what the noble Lord, Lord Darzi, described as
“huge and unwarranted variations in the number of patients per GP”.
Data from the NHS general practice workforce team shows that the national average list size of fully qualified full-time equivalent GPs hovers at around 2,200 patients. John Gooderham, a retired civil servant who once worked for me, undertook a number-crunching exercise showing that the differences in average list sizes are almost unbelievable. His evidence, which was published by the Institute of Health and Social Care Management, showed at least 20 areas with an average list size ranging from 8,300 to 4,400 patients, almost four times as many as the national average. All of them are clearly severely underdoctored. At the other end of the scale, there are 20 areas with an average list size ranging from 1,000 to 1,444 patients.
The trouble is that there seems to be no approach or system to rectify this. We used to have the Medical Practices Committee, which was set up by Nye Bevan in the 1946 Act and lasted until 2001. I have to confess that I took through the legislation abolishing the MPC. Mea culpa—it was a mistake. At the time, the line that I took—I looked it up—was that area health authorities would sort it all out. Where are area health authorities? They did not, and none of their successors has. I think we need to go back to a system that identifies areas that are overdoctored or underdoctored to consider how we can justify this situation. It cannot be allowed to continue. I know that officials feel that the kind of MPC system we had is not fit for today’s more modern circumstances, but one way or another, either through financial incentives or through some restrictions, we have to do something about this. I hope the Government will be sympathetic.
Baroness Manzoor (Con)
Noble Lords will know that I am passionate about improving the health of all. The National Health Service is the National Health Service, not the ill service. So many disadvantaged, marginalised groups are not receiving the care or the health that they need. I will not go back into the disparities and the health inequalities. I have put my name to the amendment from the noble Lord, Lord Patel, who spoke very clearly. It is a simple amendment but would be a pivotal, key amendment to the Bill.
I also support the amendment in the name of the noble Lord, Lord Hunt, because without having the first line of defence of GPs, marginalised groups do not have the access to doctors that they desperately need. Everybody knows the effects of inequalities on the economy, the NHS and individuals. The Government have a great opportunity to enhance the Secretary of State’s power and strengthen it, rather than transfer the current power.
As I indicated earlier, in my region we had a duty to bring down inequalities in a deprived area. I worked closely with Alan Milburn and other Ministers, including the then Prime Minister, Tony Blair. It worked when that key emphasis, monitoring, duty and strategy were put in place. We need a health strategy, as the noble Lord, Lord Patel, indicated. I leave the question on the table for the Government. This is a fantastic opportunity. It is not about all the structural change that we have been talking about; this is about making a real difference to people’s lives and to the health of our nation.
Procedure and Privileges Committee
Debate between Baroness Manzoor and Lord Hunt of Kings Heath
Baroness Manzoor (Con)
Of course, for some of us who live further than just outside London, we could not finish at 8 pm and still get home. I just wanted to make that point.
Lord Hunt of Kings Heath (Lab)
My Lords, surely the best way to allow people to get home is to have more reasonable sittings, during sociable hours.
United States: Trade Deal
Debate between Baroness Manzoor and Lord Hunt of Kings Heath
Lord Hunt of Kings Heath
To ask Her Majesty’s Government what assessment they have made of the government of the United States’ negotiating objectives for a future trade deal with the United Kingdom, published on 28 February.
Baroness Manzoor (Con)
My Lords, negotiating an ambitious free trade agreement with the USA that maintains our high standards for business, workers and consumers is a priority. We welcome this demonstration of the commitment by the US to begin negotiations. The UK and US economies are already highly compatible. We welcome the emphasis on state-of-the-art provision in financial services and digital trade, where the UK is recognised as a world leader. We will publish UK objectives for parliamentary consideration ahead of negotiations.
Lord Hunt of Kings Heath (Lab)
My Lords, I think that is a generous interpretation of the aims of the United States Government. It is clear that the price of a trade deal with the US, which this Government will be desperate to achieve, will be high. It will certainly include the possibility of the UK having to pay more for US medicines, of our data protection provisions being swept away, and, with US access to our food markets, of lower standards in food safety and animal welfare. That comes with the added bonus of the US ambassador lecturing our farmers on the delights of chlorine-washed chicken and growth hormones in cattle. In their desperation for a deal, are the Government exchanging so-called vassalage to the EU with subjection to the United States Government?
Baroness Manzoor
My Lords, I do not agree with the noble Lord. As with all negotiations, these objectives mark the starting point for the USA and not the end. They are entirely in keeping with the objectives mandated in US legislation for all trade negotiations and are not surprising. In relation to the NHS, the Government have consistently made it clear that they will continue to ensure that rigorous protections for the NHS are included in all trade agreements. Protecting public services, including the NHS, is of the utmost importance, and the Government will continue to ensure that all decisions about public services are made by the UK Government and not by our trade partners.
NHS: Stroke Care
Debate between Baroness Manzoor and Lord Hunt of Kings Heath
Baroness Manzoor
I thank my noble friend for that question. Reconfiguration of stroke services is very important because there is strong evidence that consultant-led specialist treatments in large, centralised hyperacute stroke services, where geographically appropriate, save lives, improve recovery and can reduce the length of hospital stays, while saving money. Three pilots have taken place in London, Manchester and Northumbria. They have seen a 9% reduction in the length of hospital stays in Greater Manchester and a cost saving of £800 per patient in London.
Lord Hunt of Kings Heath (Lab)
My Lords, I remind the House of my membership of the GMC. Coming back to the question about hyperacute stroke services, which have been such a huge boost to patient outcomes, the Minister says this is up to CCGs, but all over the country CCGs have been obstructive to this move. They have defended their own district general hospitals, attempting to keep all their stroke services at the expense of the quality and safety of patient care. The Government have to intervene, surely?
Baroness Manzoor
The noble Lord makes a very valid point. As I said, evidence-based medicine is speaking about a hub-and-spoke way forward. There is the national plan. We have set up a primary board that will look at reconfiguration of services and the workforce planning within it. We hope that some of those challenges can be met head on.
Human Bodies: Commercial Exhibition
Debate between Baroness Manzoor and Lord Hunt of Kings Heath(7 years, 8 months ago)
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Lord Hunt of Kings Heath
To ask Her Majesty’s Government what consideration they have given to updating the Human Tissue Act 2004 to ensure that human bodies being imported into the United Kingdom for commercial exhibitions are governed with the same ethical and legal responsibilities that pertain to bodies originating from the United Kingdom.
Baroness Manzoor (Con)
My Lords, in England and Wales and Northern Ireland, the law requires that people who wish to be displayed in public after death must give written permission. This does not apply to bodies imported from abroad and any change to the provisions would require amendment of the Human Tissue Act. The Government are working with the Human Tissue Authority to consider what more can be done within existing legislation to address any concerns around the display of bodies.
Lord Hunt of Kings Heath (Lab)
My Lords, I am grateful to the noble Baroness. The Human Tissue Authority does a very good job. However, as the noble Baroness said, the key provisions of the Act do not apply to bodies imported from abroad. This means that, when it comes to commercial exhibitions such as the Real Bodies exhibition in Birmingham last year, there is no guarantee that the bodies used are not those of executed prisoners, including prisoners of conscience from China. The noble Baroness said that the Government were prepared to work with the HTA to look at the existing legislation. Does she accept that we need an amendment to the HT Act in order to be able to regulate these commercial proceedings? Will she agree to meet noble Lords to discuss that?
Baroness Manzoor
My Lords, I am always happy to meet noble Lords to discuss this issue. As the noble Lord knows, changes to primary legislation will be required to activate the change that he is seeking. To be clear, the Human Tissue Authority ensured that the Birmingham exhibition met licensing standards and licensed it in line with the law. We have no evidence to suggest that the exhibition contained the cadavers of political or other prisoners from China.
NHS: Accident and Emergency Departments
Debate between Baroness Manzoor and Lord Hunt of Kings Heath
Lord Hunt of Kings Heath
To ask Her Majesty’s Government what is their response to the assessment of the President of the Royal College of Emergency Medicine that removing the four-hour accident and emergency treatment target would have a “near-catastrophic impact” on patient safety in many emergency departments.
Baroness Manzoor (Con)
My Lords, I note the concerns of the Royal College of Emergency Medicine and assure it, and the House, that patient safety remains paramount in any NHS care setting. As I mentioned in the excellent debate that the noble Lord, Lord Hunt, introduced last week, the NHS long-term plan will reform urgent and emergency care, and NHS England’s clinical review of standards will report its interim findings in spring 2019. Until then, we are clear that existing core access standards will remain in place.
Lord Hunt of Kings Heath (Lab)
My Lords, I am grateful to the Minister. She will know that, before the four-hour target was introduced, we had dangerously overcrowded A&E departments, very long waiting times and unsafe care generally. It is clear from the evidence that the chief executive of the NHS recently gave to a parliamentary committee that he wants the clinical standards review to get rid of the four-hour target under the guise of giving greater priority to the most urgent treatments. The problem with that is that most urgent treatments get priority already. There is a real risk that, if you let the four-hour target go, many patients will have to wait longer and longer. The royal college is concerned about patient safety. Is the answer not to invest in more beds and adult social care for frail, older patients and then get a more effective flow of patients through hospitals? In that way, the target could be met.
Baroness Manzoor
My Lords, the noble Lord is absolutely right: performance targets are important. However, we must ensure that the NHS is focusing on clinically appropriate targets. The clinical review of standards is considering standards for both physical and mental health. Following its interim findings, any recommended changes will be carefully field-tested across the NHS before they are implemented. An impact assessment will be published and changes to the NHS constitution will be consulted on, as is legally required.
Organ Donation (Deemed Consent) Bill
Debate between Baroness Manzoor and Lord Hunt of Kings HeathFriday 1st February 2019
(7 years, 9 months ago)
Lords ChamberRead Full debate Organ Donation (Deemed Consent) Act 2019 View all Organ Donation (Deemed Consent) Act 2019 Debates Read Hansard Text Amendment Paper: HL Bill 141-I Marshalled list for Committee (PDF) - (30 Jan 2019)
Baroness Manzoor
My Lords, I thank the noble Lord, Lord Morrow, for raising the issue of territorial extent and its application in this Bill. I clarify that that the Bill does not change the rules of consent in Northern Ireland and introduces deemed consent only in England. The reason Northern Ireland is included in the extent is because the Bill amends an existing piece of legislation, the Human Tissue Act 2004, which extends to England, Wales and Northern Ireland. While the Bill has been drafted to have a matching extent to that Act, which is the recommended approach when an existing Act is amended, we are changing the law to introduce deemed consent in England only. Deemed consent will not apply to Northern Ireland.
On the second part of the noble Lord’s amendment, the Bill as drafted ensures that organs removed in England under deemed consent can still be stored and used in Northern Ireland as now, even if Northern Ireland does not have deemed consent. This is why Northern Ireland is included in Clause 2(2) and (3). However, for such a provision to have effect in Northern Ireland, there will be a need for a legislative consent Motion from Northern Ireland.
I hope this reassures the noble Lord that we have not undermined policy in Northern Ireland in any way, and reassures the Committee that this amendment is not necessary. I hope the noble Lord will withdraw his amendment.
Lord Hunt of Kings Heath
My Lords, the noble Lord has asked me to confirm the view of the Minister, and I so do.
Health: Chief Medical Officer’s Recommendations
Debate between Baroness Manzoor and Lord Hunt of Kings Heath
Lord Hunt of Kings Heath
To ask Her Majesty’s Government what steps they intend to take to implement the recommendations in the Annual Report of the Chief Medical Officer 2018, published on 21 December 2018.
Baroness Manzoor (Con)
My Lords, in her most recent annual report, the CMO set out a compelling vision for the future of healthcare by 2040. The Government are carefully considering all the recommendations made in this annual report and, as noble Lords will know, have taken substantive and sustained action on the contents of all previous reports. Indeed, the NHS Long Term Plan is addressing many of the issues that are at the heart of the CMO’s report, such as data, research and prevention.
Lord Hunt of Kings Heath (Lab)
My Lords, I am grateful to the Minister for that Answer. She will know that the CMO’s report was a devastating critique of the state of public health at the moment, showing wide inequalities in health, which have been widening under the current Government. She recommends strong fiscal action to increase taxes on tobacco and alcohol, as well as on foodstuffs with high contents of sugar and salt. The NHS England 10-year plan makes no mention of that. Will the Government accept the CMO’s recommendations?
NHS Long-term Plan
Debate between Baroness Manzoor and Lord Hunt of Kings Heath
Baroness Manzoor
My Lords, I thank both noble Baronesses for their contributions to this Statement. I am very grateful for some of the positive comments that were made from both Benches. I am very proud that this Government are putting £20.5 billion into the NHS. That is an amazing achievement. We must recognise that this is a great achievement for the NHS. The NHS is working closely within itself and with the Government to ensure that we can deliver the outcomes we all want, which are improved care for those who use the NHS and to prevent people from getting ill in the first place. I welcome this. As someone who worked in the NHS in my early days I recognise the importance of this money. We are not being disingenuous in what we are trying to achieve—far from it. It is because we passionately care about the NHS that we are doing this.
A number of points were raised by both noble Baronesses. I hope that they will appreciate that I have only just got this brief, but I will endeavour to do my best to answer all the questions. However, if there are any that I have not responded to, I will of course write to the noble Baronesses and place a copy in the Library. The noble Baroness, Lady Thornton, quite rightly raised the issue of staff. We need staff in the NHS if we are to carry out any plans. They are very important to us. She asked what we were doing. There are record numbers of dedicated NHS staff and they work tirelessly to make sure that patients get excellent care. We support them by training 25% more doctors, nurses and midwives, giving a significant pay rise to over 1 million staff and listening to the issues that matter to them. We know that this is a complex area and we are listening and talking to staff to see how we can bring about greater improvements in workforce planning.
To put this into context, there are currently record numbers of doctors, paramedics and ambulance staff, and all HCHS staff. The monthly workforce statistics for September 2018 show that since May 2010, there are over 45,900 more professionally qualified clinical staff working in NHS trusts and CCGs, including 16,500 or 17.4% more doctors, over 6,500 or 2.2% more nurses, midwives and health visitors, and 13,400 or 8.3% more nurses on our wards. We recognise that it is a complicated issue and that there are staff shortages in some areas, and we are actively engaging with staff and looking at solutions as we move forward.
Other issues raised by the noble Baroness, Lady Thornton, related to Brexit and to scrapping the 2012 Act as part of the long-term plan. That was about legislation and I shall deal with legislation first. I think the basis of the noble Baroness’s question was whether we are going to scrap the Lansley reforms. In June the Government asked the NHS to come forward with proposals for legislative reform to support the ambitions of the long-term plan, which have now been set out clearly. NHS England will continue to engage nationally and locally to refine the proposals over coming months. The Government will consider updating legalisation where there is clear evidence that doing so would improve services for patients.
The noble Baroness, Lady Thornton, mentioned performance and the noble Baroness, Lady Tyler, also touched upon it. The Government have been clear that through the long-term plan the NHS must get back on the path of recovering performance. The plan is clear on proposals for updating urgent and emergency care and on expectations to reduce waits for planned operations. We must ensure that we have a health system which focusses on clinically appropriate targets. The ongoing clinical review of standards, which will report in the spring, will be followed by a period of testing and evaluating any new or refined standards. The review is considering standards for physical and mental health.
The public health grant was touched upon by the noble Baronesses. We are already giving local government more than £16 billion for public health services over the current spending review period. The Government recognise the important role played by local authorities in supporting people to live longer, happier lives and managing demand for health services. We have a clear commitment to ensure that public health services continue to do that. Future budgets for PHE and the public health plan, which is part of the financial settlement for local authorities, will be finalised at the upcoming spending review.
Baroness Manzoor
I have a couple of minutes. On the adult social care Green Paper, it was recently announced that the Government will provide local authorities with £240 million this financial year, 2018-19, and £240 million next year for adult social care so that people can leave hospital when they are ready and go into a care setting that best meets their needs. This will help to free beds over the winter. There is a further £410 million for social care.
We recognise that the NHS and social care provision are two sides of the same coin and that we cannot have a plan for one side and not for the other. While the long-term funding profile of the social care system will not be settled until the spending review, we will publish the social care Green Paper soon, ahead of the spending review.
I am conscious that there were a couple of other issues, particularly in relation to the role of the NHS in relation to public health, which the noble Baroness, Lady Tyler, raised. I think I have highlighted it. On going forward and the implementation plan, as indicated in the Statement, the Secretary of State has asked my noble friend Lady Harding about how we move forward, particularly on workforce planning. An implementation plan will go to the Secretary of State by the spring and a more detailed implantation plan will be put in place once the spending review figures are available as part of the spending review framework. There will be a framework in terms of quality. I am conscious that my time is up, so I will write to the noble Baroness on the two other questions on adult social care and the differences in mental care for young people.
Lord Hunt of Kings Heath
My Lords, I apologise to the noble Baroness for intervening. She paused, and I thought she had finished.
I refer noble Lords to the register and particularly to my advisory role with SweatCo.
I turn to public health issues. The plan makes a very bold statement about tackling some of our major public health problems. When it comes to specific government action, it is silent. I refer the Minister to the Chief Medical Officer’s annual report for 2018 which was published just before Christmas. It was very hard talking in some of the recommendations that the Government need to take. I shall cite just one of them. In relation to obesity the Chief Medical Officer recommended that the Government review the use of fiscal disincentives in relation to foods high in sugar and salt and of incentives to increase fruit and vegetable consumption. Why is the plan silent on these issues?
Baroness Manzoor
The plan is an overall strategy. The detail will be filled in over the coming months and years as we work closely with clinicians and people working in the NHS. That is why, looking at obesity, we introduced the sugar tax, which has been very successful. Noble Lords may say that we did not get as much money as we thought we would, but to my mind that is great; it means we have got preventive action because companies are now putting less sugar into drinks et cetera, which is a bonus. The noble Lord is right. That is why we are putting so much more money —£4.5 billion—into the preventive agenda so that we tackle the issues that he has just indicated.