Covid-19: Government Response
Baroness Neville-Rolfe Excerpts(4 years, 6 months ago)
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Lord Bethell
The Government’s commitment to isolation is spelled out clearly in guidelines published by Public Health England, and it is promoted every day with the Government’s “stay at home” slogan. On the 200,000-test aspiration, we have put in place a remarkable platform for testing. We have strong partnerships with important companies, we have sourced new supply chains of critical reagent swabs and other supplies that are in short measure, and we are making the logistical arrangements necessary for a massive expansion of testing. I believe that those will take us to whatever is necessary to meet the testing needs of the country.
Baroness Neville-Rolfe (Con)
My noble friend has described a situation that is still worrying. The rate of deaths and of new infections is still much higher than we wish, and we may soon be faced with a situation where the rules in different geographical locations or in different institutions vary, so we need more information. To enable us to seek optimum changes, could he please publish more information—for example, on how many cases came from hospitals and where, how many involve hospital or care workers, and how many involve other key workers, overseas visitors, self-isolators and the like?
Lord Bethell
The Government have gone about the Covid crisis with a great amount of transparency; a very large number of figures are published every single day. I am afraid that some of the questions my noble friend asks are beyond the reach of measurement in our statistical accountability at the moment, but I completely take on board and celebrate her call for transparency. We are working as hard as we can to get as many numbers out to the public as possible.
Queen’s Speech
Baroness Neville-Rolfe Excerpts(4 years, 10 months ago)
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Baroness Neville-Rolfe (Con)
My Lords, I thank the noble Baroness, Lady Greengross, and other noble Lords who spoke on social care, but I will go elsewhere. I declare my business interests in the register.
I last spoke in a debate on a Queen’s Speech as recently as October. Then, I criticised the Labour Party’s declared plans to attack property rights. Fortunately, that threat has abated for the foreseeable future. It is also clear—I pay tribute to the Prime Minister—that Brexit will happen, allowing realistic plans to be made by the Government and economic actors right across the UK. With victory, however, comes responsibility. The country will expect the Government, with their comfortable majority, to get things moving again after the Brexit-induced paralysis of the past three years.
On public services, I very much welcome the new money for schools, surgeries, police, road and rail improvements, and especially GPs, as well as the multiyear settlement for the NHS and schools. We apparently face a major shake-up in government and the Civil Service. When I moved to business in 1997, I learned things that government lacked: lean thinking; innovation; customer focus; long-term forecasting based on dynamics and demographics; and how to lead, manage and motivate. While some of this toolkit of a successful global company can be adapted to government, the latter is of course more complex and requires a wider range of skills.
My concern about the direction of travel as reported in the press is that No. 10 may try to grab too much power and use it unsatisfactorily rather than ensuring that departments are fit for purpose and able to progress under effective Ministers. The truth is that Downing Street—I have worked there—does not know enough to run the country on its own.
To be a successful nation at a time when possibly as much as 40% of GDP is knowledge-based requires a first-class education system. It was a wake-up call when I discovered in 2014 that we were 24th in the PISA tables for maths, and not much better in reading or science. Mainly thanks to the brave Gove reforms, we are now 18th in maths, ahead of France, Germany and the US. My noble friend the Minister and the noble Baroness, Lady Bull, touched on PISA. I add that England consistently ranks above the higher-spending Scottish and Welsh systems. To compete, especially in Asia, we need to do more. We need good education for everyone from the most to the least talented. Our vocational education, including our apprenticeship system, continues to lag woefully behind many others.
The wrong sort of taxes can also be an issue, for example, business rates, where the tax is badly designed and its effects have been especially malign for retail. Given the prospect of more job losses, I was delighted to see the promise to bring forward fundamental change. Radical, rapid reform is essential.
Brexit gives us a wonderful opportunity to simplify our rule book. We need to make our bureaucrats more business-friendly rather than cautious and obsessed with obtaining and using new fining powers. Looking at the proposals on financial services, I worry that there seems to be more on regulatory protection than is compatible with the stated intent of supporting the UK’s competitiveness and its position as an international services centre.
Financial services is our biggest sector, representing £127 billion of GDP. Many regulatory changes, often Brussels-based, followed the financial crisis and brought in a period during which productivity in the financial sector plummeted. This obviously reflects the destruction of capital but also, I fear, the build-up of control and bureaucracy, especially for smaller players. Indeed, as we heard from my noble friend Lord Hodgson, that is not always effective. A change of leadership at every level is an opportunity. I hope that the new Governor of the Bank of England, Andrew Bailey, will tackle red tape better. He did this brilliantly with his simple regulatory Sandbox for new fintech businesses.
Finally, our regulation should start in our own back yard with HMRC. If well run, this could support business and frustrated taxpayers and actually raise more tax.
There have been many constructive references to climate change this week. I want to make one point. We need to shift from virtue signalling, as epitomised in last year’s Bill on net zero, to action. We have had years of engagement, and during that period, we could have made much more progress with simple plans and encouragement to business.
This is the most wide-ranging of debates. I have not even had time to talk about online harms—highlighted in an amusing speech by the noble Lord, Lord Griffiths—antimicrobial resistance or health data. There is so much to do and to gain. Focus is essential. We have five years and we must use them well.
Restaurants: Calorie Labelling
Baroness Neville-Rolfe Excerpts(5 years, 4 months ago)
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Baroness Blackwood of North Oxford
I know the noble Baroness has raised issues around baby food on several occasions. The reformulation programme taking place under the obesity plan takes account of sugar in a number of different products. So far, I do not think baby food has been one of these, but the Secretary of State has commissioned the CMO to urgently review what can be done to help the Government meet their ambition of halving childhood obesity by 2030. The report is due for publication by September and I will pass on the noble Baroness’s comments.
Baroness Neville-Rolfe (Con)
Does my noble friend agree that two other policies on obesity are not adequately focused on? The first is helping parents to teach self-control and good eating habits. The second is increasing physical activity—for example, through the daily mile and school sports. I was horrified to learn from the Diabetes UK briefing that only 18% of children in the UK reach the recommended target for physical activity so vital to lifetime health.
Baroness Blackwood of North Oxford
I thank my noble friend for her question; she is absolutely right that increasing physical activity is a key part of the childhood obesity plan. That is exactly why the revenue from the soft drinks industry levy is being invested in improving childhood health and well-being in this way, including doubling the primary PE and sport premium to £320 million a year. This has included a commitment to every school in the country including the daily mile, or something similar. We are particularly pleased about that, but we also believe that work needs to be done in supporting parents, and PHE is working on that.
NHS Long-term Plan
Baroness Neville-Rolfe Excerpts(5 years, 4 months ago)
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Baroness Blackwood of North Oxford
It is very important to pay tribute to the extraordinary work that NHS staff are doing across the system and in the wider healthcare system—we should thank them for that. The noble Lord is right that there is great financial stress in the system. A lot of work has gone into trying to alleviate it. That is why the NHS is one of the few parts of the public health system which received a significant increase in the £22 billion increase.
As for the public health system, training and the capital and social care investment, this will be part of the SR negotiations. I am sure the noble Lord will be aware that the Department of Health and Social Care will be making a strong case for increasing those parts of the system, because we believe it needs to increase just as much as he does.
Baroness Neville-Rolfe (Con)
My Lords, I have two questions for my noble friend. First, I very much welcome the inclusion in the plan of a section on improving productivity. My experience is that the best way to improve productivity is the intelligent application of additional capital, and not just, to quote from page 29, “its better use”. Picking up on some of the comments already made, may I ask the Minister how the NHS will make a step change in providing or attracting, and using, capital within the system?
Secondly, a huge medium-term threat is antibiotic resistance, which gets the briefest mention on page 15. Is there a plan to nail this as part of the approach to improving the NHS?
Baroness Blackwood of North Oxford
I thank my noble friend for a very important question. We have just published our new plan to tackle antibiotic resistance; it is an incredibly sophisticated proposal. We have already had some success in bringing down antibiotic use in humans and animals, but there is still a significant way to go, as antibiotic-resistant infections within the system are still rising. That is why we cannot relent in our ambitions, and why it is so important that the commitment to implement that strategy is in the long-term plan and the implementation plan. Although it has a brief mention, there is a whole strategy that it refers to, and it is comprehensive, so I am optimistic about that part.
On intelligent application of capital and ensuring that it increases productivity, my noble friend is right. That is partly why there is such a focus on ensuring that there is a radical reshaping of how the NHS delivers health and care using technology: so that services and users can benefit from the advances, and so that we can have a democratisation of information, which will be one of the key ways that we will manage demand and ensure that the NHS is sustainable.
NHS: Healthcare Data
Baroness Neville-Rolfe Excerpts(6 years, 2 months ago)
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Baroness Neville-Rolfe (Con)
My Lords, I thank the noble Lord, Lord Freyberg, and congratulate my noble friend Lord Bethell on his excellent speech.
The scale of expenditure on health and social care—some £180 billion together—makes this a very important debate. Because of the ageing population and the growing sophistication of medical intervention, health and care now absorb 21% of public expenditure and account for over 10% of GDP: more than twice the percentage of 25 years ago. This scale, however, means that the opportunity to deliver benefits through digital change and intelligent use of data—in all its forms—is quite enormous. I was delighted that Matt Hancock’s first move as Health Secretary was to dedicate £475 million to enhance technology in health and care. Perhaps the Minister could kindly confirm whether that is new money and the timescales involved for it.
I should start by declaring an interest as a recent Data Protection Minister, a new director at Health Data Research UK and a NED at Capita. Of course, the use of data to advance medicine has a distinguished history. In 1854, in the context of a devastating epidemic in Soho, John Snow showed that cholera was spread by water, after research into the wells from which those afflicted drew their supplies. In 1847 Dr Semmelweis showed, after examination of records in Vienna’s hospitals, that puerperal fever was spread by physicians who had examined corpses and then women in the delivery room, without washing their hands.
From my relatively inexpert position, I shall add three thoughts to the debate. The first is on data as a feedback mechanism. My work in Downing Street on the Citizen’s Charter and my 17 years in retail taught me the value of customer feedback in improving services and outcomes. I often feel that the NHS is not listening to and taking advantage of feedback. I remember turning up to an appointment at Guy’s with a needless cancer scare. When I went in to see the consultant, it turned out that the attachment to the doctor’s letter was missing. She said, “Oh, it happens all the time”, arranging cheerfully for me to have another expensive test. Why not place power in the hands of the patient, as when one is pregnant, and share all test results and reports with them on paper or on an app? I have also been struck by the value of wearables such as Fitbits, which certainly encourage me to get more sleep—an area that has the potential to improve health outcomes and reduce dementia.
Secondly, on digital delivery, we all see how public services fail—often through a lack of incentive—to join up the dots. Providing patients with their health data would help as they could talk to family and friends and ask questions about persistent conditions. The House has done some trailblazing work on AI, which can help with the testing of drugs by repeating checks and variations at a stupendous speed, as I learned from the Motor Neurone Disease Association. It is better than humans at checking routine results like back-of-the-eye tests and X-rays. The disciplined application of digital information can enormously reduce dispensing error. I spotted this in use first in drug administration to the elderly in a BUPA care home.
However, training in and discipline with the medical process is vital. At a recent update with a consultant after a five-year gap, I could not quite believe the graphs of my various tests. Then I saw that the latest data had not been entered and my hard-achieved efforts to reduce weight and improve health had been totally missed, so initially the doctor was completely on the wrong tack. How often may that be happening? Then there is the use of digitisation in online booking, automated patient lists and patient flow, which is displayed so well, for example, at St Thomas’. This should be applied at every hospital and GP surgery in the land.
Thirdly, I want to comment on the public’s trust in the handling of data. I should start by saying how delighted I was at the appointment of Dame Fiona Caldicott, the former principal of my college, Somerville, as the first National Data Guardian for Health and Care.
However, we should not go over the top on data protection: healthcare is provided in this country free for those who seek it. I suggest that in return data in the system should be used by hospitals and scientists, and in some controlled commercial ways to improve outcomes, and that aggregate anonymised data should be published. The excellent Library Note described the myriad sources that exist. I would add another: housing data, as damp, cold housing costs the NHS billions in preventable illness. I know that experiments in Wiltshire to link GPs to housing ills have been successful. All the sources of data can be brought together much better. It will of course be important to protect the data from hackers and others, by sensible precautions and fierce enforcement—a good use, I would say, for some of Mr Hancock’s money. However, we should not get too distracted by data protection as we promote data use for the good of mankind.
Lastly, I ask the Minister what we can deploy from overseas. There is much to learn from the US but also from Australia, which uses Skype-style hospital consultations to deal with remoteness, and from Singapore, where I saw a pioneering use of sensors built into pillows to monitor patients in hospital and care.
Obesity
Baroness Neville-Rolfe Excerpts(6 years, 4 months ago)
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Baroness Neville-Rolfe (Con)
My Lords, I thank my noble friend Lord McColl for initiating this debate, and I declare my interests in the register. I very much look forward to hearing the maiden speech of the noble Baroness, Lady Boycott, who I remember so well for her achievements in journalism and for her unique food web. My noble friend Lord McColl is always a mine of fascinating doctors’ stories, and I wholeheartedly agree that we need an honest campaign to tackle obesity. It is a problem of plenty, which makes one feel uncomfortable when one thinks of those in parts of Africa, North Korea and even Venezuela where people still suffer from malnutrition.
Obesity poses a serious health risk in the UK. It causes real harm and costs the NHS a fortune in treating diabetes, high blood pressure, heart disease, liver disease, kidney disease and other conditions. It is brought about by the actions of the individuals concerned. In brief, it will occur if, over a prolonged period, intake of calories significantly exceeds calories consumed, so both diet and exercise are relevant. It is not exogenous, like many cancers. Accordingly, an important need is to help those concerned demonstrate greater self-control by reducing consumption, increasing exertion or both. I prefer this approach to indirect actions such as sugar taxes or advertising bans, which are costly in resource terms, limit choice for those not at risk, and are at best scatter-gun.
Our greatest priority must be to tackle the habits of our children. We must teach them self-restraint and the habit of exercise. I believe one of the cheapest and best things we could do is to require all children to run the Daily Mile, and perhaps half a mile for the little ones. There are reports springing up everywhere of its success in terms of weight and health. I heard only yesterday of the impact in my grandchildren’s school as year 4 run a mile round the playground, and we should thank the Daily Mail, INEOS and ITV for giving this initiative real legs. It is also good for children to walk to school, so maybe children should be asked at register whether they have walked as a bit of behavioural psychology to encourage parents and carers from every walk of life.
We should also find some very simple and memorable ways of helping children to eat well. For me, there is simple magic in fresh fruit—five pieces a day if possible and not juice, which is high in calories—salad, freshly cooked vegetables and, indeed, vegetable oil, the fat we need, which can be transformational. Schools should teach cooking and projects should look at how to prevent and tackle obesity.
Our second-biggest priority is to help young adults under 40 not to gain weight, so delaying associated diseases. Essentials here are keeping up daily exercise with simple habits like walking from the bus stop or up the escalator. Employers have a duty to encourage healthy eating habits—for example, in canteens and in public procurement. I have said before that Tesco provided free fruit for children. Diet and health featured strongly on training courses, and I remember publishing a good book on the glycaemic index to help staff with weight problems. Such ideas need to be extended and to become an important part of a firm’s contribution to society and to worker welfare. Above all, the NHS needs to take a grip on its own staff’s issues with obesity. It is not fair on them or a good example to users of the NHS.
Our third priority is to stop the bulge in middle age and beyond in the majority of us who are not naturally willowy. In recent decades, I have found it essential to keep an eagle eye on the scales and to take action when the weight creeps up. I bought a Fitbit so that I walk 10,000 steps a day and get my beauty sleep. As the Minister knows, sleep is positively correlated with slimness and health and negatively correlated with weight gain and with dosing on Twitter, Facebook and Netflix.
Obesity has become rather a gloomy subject characterised by slow progress and huge public health costs. We need a new culture of self-restraint and a less tolerant attitude to obesity in society and in ourselves.
Health: Endoscopy and Bowel Cancer
Baroness Neville-Rolfe Excerpts(6 years, 4 months ago)
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Baroness Neville-Rolfe (Con)
My noble friend has done much to bring the benefits of the digital revolution to the NHS. Are there digital solutions that might help to prevent bowel cancer and other cancers in the fight against this dreadful disease in the coming months and years?
Lord O'Shaughnessy
My noble friend is quite right to point out the potential of digital, particularly the analytical capability of artificial intelligence to look at samples. That was one reason why the Prime Minister recently pledged to have 50,000 more early cancer diagnoses by 2033—a long-term goal—precisely because the NHS is such a good place to use artificial intelligence to improve care.
Childhood Obesity Strategy
Baroness Neville-Rolfe Excerpts(6 years, 5 months ago)
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Lord O’Shaughnessy
There is a single campaign which is exemplified in the document and we need to put that across. I know that the noble Lord is working with broadcasters. I am not sure about the merits of weighing teenagers, but I will look into that and write to him.
Baroness Neville-Rolfe (Con)
My Lords, I declare my interests as set out in the register. I have a few doubts about some of the interventionist proposals in this strategy and therefore I welcome a consultation process on the detail. However, I am keen that people should be able to take responsibility for themselves by helping them to develop good habits, so I congratulate the Government, and indeed the Daily Mail, ITV, INEOS and local authorities on the Daily Mile initiative, which could be transformational.
The Minister and I are both interested in the advances in the science of sleep. We know that poor sleep is linked to obesity. Could the Minister agree to making use of this new science in his strategy?
Lord O’Shaughnessy
My noble friend makes an excellent point and I am glad that she has welcomed the introduction of the Daily Mile initiative, which is an important national ambition embedded in the strategy. I know of the benefits of sleep by its absence, but nevertheless I agree absolutely with my noble friend. This second chapter sets out a lot of good progress and intent. Clearly it is not the last word because this is a developing science, although we know more and more both about the causes of obesity and its consequences. Given that, there is a good opportunity through the consultations to bring the science about the benefits of sleep to bear in this conversation, not only for younger people but for adults as well so that it is properly reflected in the final documents that come out.
Children and Young People: Obesity
Baroness Neville-Rolfe Excerpts(6 years, 7 months ago)
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Baroness Neville-Rolfe (Con)
My Lords, this debate takes place at dinner time, which is an ideal time if I may say so. I congratulate the noble Baroness, Lady Walmsley, on gathering us all together to discuss this important area.
Obesity is a subject that I have grappled with since the early 2000s when, as a Tesco employee, I sat on the foresight obesity panel under the auspices of the business department and its Government Office for Science. This was in an era when, on the positive side, serious research and objective facts generally ruled in public policy. On the negative side, we came up with a report the most striking output of which was a vast spaghetti-style map—which I have with me if any noble Lords would like to see it afterwards. It mapped the causes and avenues of obesity, but it was so complex that it defeated the system and, perhaps as a result, gathered minimal attention.
I made a contribution later with colleagues at Tesco by introducing workplace initiatives such as free fruit and Race for Life—the noble Lord, Lord Addington, is right that mass sport is definitely a positive—and by pioneering traffic-light labels on food packaging. Indeed, broadly the same system was eventually adopted on a national basis by the then Secretary of State, my noble friend Lord Lansley. These labels are used for calorie counting, for avoiding sugar if you are diabetic, for keeping down fat if you have coronary risk and for encouraging manufacturers to reduce salt. I would be interested to hear whether the Minister knows of any evidence of the impact of this traffic-light measure, especially on the vital younger age groups that we are talking about today.
I do not want to go over the ground that others have already covered, but want to make a scientific point and a moral point. On the science of diet, there appears to be more disagreement than one might expect. Too many calories should obviously be avoided, but the relative merits, or demerits, of fat and carbohydrates seem still to be a matter of surprising disagreement—I was interested in what my noble friend Lord McColl said about low fat and sugar. My hunch as a past fan of Elizabeth David is that there is a lot to be said for the Mediterranean diet; that is, lots of fruit and vegetables, of vegetable oil and of fish. However, it would be helpful to be certain about it. These disagreements among experts are not helpful for progress.
My scientific point concerns another area, sleep, which, as it happens, did not appear specifically on our huge obesity map in 2007. There have been some serious advances in the science of sleep in recent years, but the vital point is that there is strong emerging evidence that poor, disturbed or insufficient sleep is a significant contributor to obesity, even if the precise mechanism is imperfectly understood. There are various ways to improve sleep, such as by avoiding white light and wearing a Fitbit-type device—which allows you to monitor your sleep pattern on your phone and go to bed at a more consistent time, apparently a key to success. More publicity about the advantages of better sleep patterns for weight reduction could help many who struggle with weight problems.
We have moved from a world where many people were short of food to one where, outside the most unfortunate countries such as North Korea or some in Africa, people have access to more food than is good for them. This has its own challenges. My moral point is that, whatever the scientific facts, obesity will not be tackled successfully unless those at risk can demonstrate self-control. It is no use blaming others, food manufacturers or the fears that prevent children walking to school, as I did every day from the age of five—it was quite a long way, for our own failings. The main fault, dear Brutus, lies not in others but in ourselves. As far as young people are concerned, we need to convince them that self-control is needed to avoid obesity—and for many other desirable outcomes. This is not a convenient conclusion—it is so much easier to blame others for our own shortcomings—but it is no less valid for that and is very important in tackling the obesity epidemic among our children and young people today.
NHS: Cancer Treatments
Baroness Neville-Rolfe Excerpts(6 years, 10 months ago)
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Baroness Neville-Rolfe (Con)
My Lords, I would like to congratulate the noble Baroness, Lady Jowell, on arranging this debate, and express my extreme admiration for her brave and moving speech. It is an honour to be able to add praise for all she has done and for the battle that she and her family have fought. As a result of her efforts, I believe that she will help many in the future who are less fortunate than her.
My younger sister died of cancer last year. She was a successful novelist with a great capacity to make friends and an extraordinary knowledge of culture and languages. But she had a pain and she did what so many women do, which was to struggle on and delay seeking medical help, with fatal consequences. In spite of the brilliance of the doctors in Dartmouth, New Hampshire, she died within two years of her first pain. So I am speaking today not only to commend the noble Baroness, Lady Jowell, but to encourage everyone to seek medical advice in such circumstances, and to endorse the Government’s scheme for referring possible cancer cases to hospital within two weeks.
Since I have a business background, I want to make two other points. The first is to commend the pharmaceutical sector for its many breakthroughs. Of course university research and development is critical, and we have an extraordinary share of Nobel Prizes in this country, but we also have great firms: AstraZeneca, GSK and smaller innovative sisters which apply capital and data, do trials and create a business model that can help millions of patients and shareholders—for example, our pension funds. These businesses have a real role in the task of finding innovative solutions for hard-to-tackle cancers, including brain cancer, which we are discussing today.
The second is to highlight the role of business-focused corporate responsibility. When I was at Tesco, we created a partnership with Cancer Research UK called Race for Life. Every year we organised 200 or 300 races in parks across Britain, with a lead event in Battersea Park. I ran it 11 years on the trot. They were amazing experiences, with women young and old, from our checkout to David Cameron’s office. There was always a splendid turnout of MPs and leaders like Helen Alexander, who sadly died of cancer herself last year. And there was always a bevy of Baronesses to add a touch of class and shed a few pounds, and some of you are here today. That was fun, but the important thing is that we raised a vast amount of money for Cancer Research UK—over £400 million in that period—and we increased the salience of cancer research through our TV ads and promotions. And on the back of every runner was scribbled a message about a friend with cancer, or a friend who had died of cancer—a very emotional experience. In that era cancer recovery rates accelerated. We were in the right place at the right time. I wish the noble Baroness’s campaign similar success.