Clinical Commissioning: North Durham

Geraint Davies Excerpts

Wednesday 23rd November 2016 Westminster Hall

[Dr Blackman-Woods]

My hon. Friend makes an excellent point. Indeed, I was shocked and surprised. In fact, when “BBC Look North” presented me with the information, my immediate reaction was of huge concern for my constituents. I did an interview for “BBC Look North” and was then contacted by other news outlets. As a result of those interviews, I was contacted by many of my constituents, some of whom had already been adversely affected by the new referral system, and by GPs who said they were being forced to jump through hoops or to refer their patients unnecessarily to physiotherapy services when they knew that treatment would not help before they could refer to a specialist in a hospital.

I was also contacted by a GP in the area covered by North Tyneside CCG who said that he had referred a patient to a specialist for a skin condition but the referral was overruled by the new scheme, which is called the referral management system. The skin condition turned out to be cancer, but that was not discovered until months further down the line, which meant that far more radical surgery was required than would have been the case if the patient had been seen by a specialist when the GP first referred them.

I therefore have a number of serious concerns about the referral system and the way in which the decision to implement it was made. My first concern is the possible negative impact on the health of my constituents and other people who live in areas affected by the new patient referral management schemes. I am concerned because whether a referral to a specialist goes ahead or not could have a long-term impact on the health of the patient or even result in something more serious, especially if decisions are overturned by About Health. A patient might not receive the treatment they need early enough.

I am also concerned about the financial impact of the decision. I understand that the NHS is under considerable financial pressure, but I doubt whether the scheme will end up saving money in the long run. That is because, as I just set out, in many cases where referrals are rejected the problem does not go away and patients return to their GP or even go to A&E with far more serious problems, which take up more of the NHS’ time and resources. About Health, the private company deciding on referrals, will be paid a basic fee and an additional £10 for each referral letter, which in itself will incur a significant cost. I am therefore not at all sure that the scheme is cost-effective.

My final concern is about the lack of public consultation and information on the decision to implement the scheme. Last October, the Secretary of State for Health announced plans to rate CCGs to make

“the most patient-focused NHS culture ever”,

which would be

“much more accountable to their local population than previously.”

The decision made by North Durham CCG to change completely the way in which GPs can refer a patient to a specialist without any consultation flies in the face of CCGs being accountable to the local population. How are people supposed to hold a CCG to account if they are not aware of changes that are being made?

The North Durham patient reference group meets monthly in Durham city to discuss patients’ points of view and give feedback to the CCG about proposals and issues. The group, which is drawn from members of each GP practice forum across Durham, was informed of the new referral scheme only as it was about to be introduced, and it was not given any opportunity to give feedback on proposals. Despite meeting monthly, members of the group had not even heard about the plans before they were presented with them and told that they were to be introduced imminently.

Similarly, members of patient forums at local GP practices were informed of the decision, rather than consulted on it. I am told that patient forums and the North Durham patient reference group were concerned and opposed the immediate implementation of the proposals, but North Durham CCG decided to go ahead and implement the new scheme immediately in any case.

This is a really important point for the Minister. If a patient goes on to the CCG’s website, what they see does not tell them that their details will be given to a private company; they are simply told that a referral system is in place and that referrals are to “consultants” or “specialist GPs”. I think many patients would conclude from that wording that their medical information is to be sent to a specialist at a local hospital rather than to a private company.

I have written to the CCGs in the north-east to invite them to meet me and other members of the northern group of MPs to discuss this issue. It has been extremely difficult to get them to come to a meeting with us or indeed to get any information from them at all. I have some questions, which I will put quickly, to give my hon. Friend the Member for North Durham time to speak. Does the Minister know of any other clinical commissioning groups in the UK that have implemented a patient referral management service? Does he think that it is acceptable that no consultation was carried out? Will the practice be repeated by other CCGs across the UK—particularly ones ranked as in special measures? How can About Health, or other private companies, be held accountable if decisions result in negative outcomes for the health of patients? Does the Minister agree that the referral system is acceptable at all?

[Geraint Davies (in the Chair)]

Both the Minister and the Member who moved the debate have agreed that Kevan Jones and Julie Cooper may speak, on the understanding that they will speak for under five minutes and two minutes respectively.

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[Mr Jones]

That is absolute nonsense.

[Geraint Davies (in the Chair)]

Order.

[David Mowat]

We are clearly not going to agree on this point, but there is no service change in what is being done.

Motion lapsed (Standing Order No. 10(6)).

NHS and Social Care Commission

Geraint Davies Excerpts

Thursday 28th January 2016 Commons Chamber

[Norman Lamb]

I totally agree with the hon. Lady. I have always been a strong supporter of the forward view. Simon Stevens is a good leader of the NHS. He has a vision, and he recognises that the solutions to this challenge often lie beyond the NHS. Some of the models that are being trialled across the country are very interesting. I do not want what I am saying to be seen in any way as undermining the very good work that is under way in the so-called vanguards around the country.

[Geraint Davies (Swansea West) (Lab/Co-op)]

On bed blocking, when I was leader of Croydon Council it cost £300 a night to keep someone in Mayday hospital and £100 a night for us to provide a bed as a local authority. We had no money, so I asked the health authority to pay for our beds and save £200, and it did. However, that was an ad hoc strategy, and surely we want a holistic, integrated approach, as the right hon. Gentleman is so eloquently explaining.

[Norman Lamb]

I totally agree with the hon. Gentleman’s last point, but also his substantive point. The problem is that these are all ad hoc arrangements that are about good leaders doing something despite the system, not because of it. We have to mainstream this and align the incentives throughout the healthcare system so that everyone is focused on preventing ill health, preventing deterioration of health, and getting people better as quickly as possible.

Let me give an example of the pressure that the system is facing. It is fair to say, as a gentle challenge to the Government, that this year we are not seeing the data on accident and emergency pressures over the winter period, so the situation is slightly hidden from view. However, I heard that on Tuesday this week all the hospitals in Hertfordshire, north London, Bedfordshire, Northamptonshire and Leicestershire were on black alert, which occurs, in essence, when hospitals are completely full and under enormous pressure. One of the key system leaders in that area said that he had not seen anything like it for 20 years. This is happening at a time when there is no flu epidemic, and certainly no severe weather. This is one of the mildest winters on record, and yet we are seeing hospitals placed under impossible pressure.

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[Norman Lamb]

The right hon. Gentleman makes a very powerful point. Indeed, the staff are working under impossible pressure.

Incidentally, the assumptions about the funding gap by 2020 do not take into account the work that the right hon. Gentleman and I have done together to make the case for equality of access for people who suffer from mental ill health. This is about a historical injustice that has to be dealt with. Paul Farmer, who has led a taskforce for NHS England, has concluded that mental health will require an extra £1.2 billion a year by 2020 in order to ensure equal rights of access with everyone else. It is very hard to deny the justice of that cause and the right of people to get access to social care in the same way as everyone else.

[Geraint Davies]

rose—

[Norman Lamb]

I am conscious that you may start to get slightly irritated with me, Madam Deputy Speaker —

[Norman Lamb]

I am relieved. I sensed that I might be getting into trouble. I will give way to the hon. Gentleman.

[Geraint Davies]

Very briefly, in terms of aggregating the expenditure of health and social care, which, incidentally, is higher in Wales where there is an attempt to have a more integrated approach, the cutting of social care will increase the total amount, as undue pressure will be put on the NHS, which then cannot release beds, and it costs more per night to keep someone in a hospital.

[Norman Lamb]

The hon. Gentleman is absolutely right. Simon Stevens has made the point that if we cut social care, the £30 billion gap widens. There is no escaping from that. The brutal truth is that the whole system is under very substantial pressure. Analysis by the Office for Budget Responsibility, which is independent of Government, shows that between now and 2020, we are planning to spend a reducing percentage of our GDP on health. At a time when demand is increasing so dramatically, does that decision make any sense at all? Back in 2013, the OECD did an analysis of all OECD countries in the European Union. Only five were spending a lower proportion of their GDP on health than we do. The NHS is very good value for money, but it is under extraordinary pressure.

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[Dr Wollaston]

I agree with my right hon. Friend. However, in parallel with the process of looking at long-term funding arrangements and settlements, we must get on—here and now—with changes that are needed in the short term. I want to touch on a few such areas.

The first area is prevention. I absolutely agree with the right hon. Member for North Norfolk that it is bad practice to cut money from public health, simply because of the challenges we face. If we look at the NHS budget, we can see that 70% of it goes on helping those living with long-term conditions. We know that many future problems are brewing here and now.

Let us just take childhood obesity, which we discussed at length last week. A quarter of the most disadvantaged children now leave primary school not just overweight, but actually obese. Given the problems that that is saving up, in the personal cost to those children and the wider costs to the NHS—nearly 10% of the entire NHS budget already goes towards treating type 2 diabetes—how can we not be grasping that nettle as a matter of urgent prevention to save money for the whole system?

[Geraint Davies]

Does the hon. Lady agree that there is an inter-relationship between child poverty and obesity, and indeed between child poverty and other health problems that generate costs, and is not part of the solution to the dilemma of how to meet the costs of health and social care to look again at such demographic drivers?

[Dr Wollaston]

Indeed. The data from Public Heath England are absolutely stark: from looking at the index of multiple deprivation and the incidence of childhood obesity, we can see that not only is there a large gap, but that that gap is widening. As part of the strategy, the Government must aim not only to lower overall levels of childhood obesity, but to narrow that gap, particularly by looking at measures that will help to do so. I thank the hon. Gentleman for making that point.

The right hon. Member for North Norfolk referred to the need for self-care, and we know that we need a much greater focus on how we can support people to improve their own health. If we are going to raise money for the whole health and care system, there are mechanisms to do so that will also help to prevent ill health in the future. One example is a sugary drinks tax, which could lever money into a very straitened public health budget to put in place measures that we know will help. We need the NHS to get on with prevention, and in my view we need more of the funding that is available to go into saving money for the future.

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[Dr Wollaston]

If that were the case, it would be a problem. I think that the two things could happen in parallel. We could work towards a consensus about future funding at the same time as focusing relentlessly on what needs to be done in the here and now. However, I agree that if it were a distraction, it would be a problem.

As well as continuing to have a relentless focus on tackling variation, we need to follow the evidence in healthcare. When money is stretched, we must be sure not only that we spend it in a way that follows the evidence, but that we do not waste money in the system. I caution the Minister on the issue of seven-day services, which we have discussed at the Health Committee. If there is evidence that GP surgeries are empty on a Sunday afternoon because there is no demand, and in parallel with that we are being told that out-of-hours services are in danger of collapse because, in a financially stretched system, there are not the resources or manpower to offer both, we must be led by the evidence and be prepared to change what we are doing.

When money is tight, we owe it to our patients to focus on the things that really will improve their care. There must be no delay in making changes when we know that something that has been put in place with the best possible intentions may be having unintended consequences. We must be clear that we will follow the evidence on best practice and value for money, so that patients get the best outcomes in a financially stretched system.

[Geraint Davies]

The Government have decided to make Saturday a working day in a regime where a couple who are both doctors can be sent, without a choice, to different parts of the country to practise in hospitals and only have family time together at weekends. Now that Saturday will be a working day, their situation will be virtually impossible. Does the hon. Lady agree that that needs to be considered in case it causes a further leakage of doctors and, therefore, less efficiency in the system?

[Dr Wollaston]

I have to declare a personal interest here, because one reason why my daughter, who is a junior doctor, has spent a year in Australia is that there are sometimes difficulties with married couples—or, indeed, people in any relationship—being able to work in the same part of the country. There is far more that could be done to help junior doctors, in addition to the contract negotiation about money. However, as I have a personal interest, it is probably best if I do not comment further on that.

I want to draw attention to the role of the voluntary sector, which the right hon. Member for North Norfolk referred to. I pay tribute to the voluntary sector partners in my constituency—bodies such as Dartmouth Caring and Brixham Does Care. Across the constituency, a number of organisations are making a real difference to people’s lives, yet very many voluntary sector organisations are coming under extreme pressure. I could give examples of voluntary sector partners that have had to close, sometimes for the want of very small amounts of money, even though they have delivered enormous value. These are locally-facing organisations.

It was welcome that Simon Stevens gave a commitment to look at making the arrangements for commissioning voluntary sector partners easier. Even though those commissioning arrangements may have been made easier, often the resources are not there to fund such organisations. We need to look again at how we can deliver best value for patients by supporting voluntary sector partners across all our constituencies.

Those are the areas that I want the Minister to focus on in the here and now, but I agree that in the long term, we must look at funding. One challenge in this country—and I think it is a wonderful thing—is that almost all the funding for the health service comes directly from taxation or national insurance. We are almost unique in that. Only two other countries exceed us in that regard. Government funding for the NHS accounts for 7.3% of GDP and only an additional 1.5% is levered in from the private sector.

The choice before us is whether to expand the amount that we raise through charging and top-ups. Personally, I do not support that. The Barker commission did not support it either. Top-ups and charging do not raise as much as people imagine by the time the bureaucracy involved in collecting the money and the unintended consequences that are often found, such as widening health inequalities, are accounted for. I hope that we do not choose to go down that route. The most equitable funding mechanism is taxation.

There is an issue of intergenerational fairness here, as the right hon. Member for North Norfolk said, and we need to consider it. These are hard political choices, which can no longer be ducked. Given the demographic challenge and the challenge of complexity that we face, the alternatives are appalling. The alternatives are to abandon our older people. The pressures that our hospitals face from those who cannot be discharged into the community and those in the community who cannot get into hospital are mounting. We can ignore them no longer.

I call on the Government to consider very carefully working with our Opposition partners at scale and at pace to bring forward an agreement on how we will bring more money into the system as a whole, and in the meantime, to make sure that the money we do spend is spent in the best interests of patients.

Childhood Obesity Strategy

Geraint Davies Excerpts

Thursday 21st January 2016 Commons Chamber

[Dr Sarah Wollaston (Totnes) (Con)]

I beg to move,

That this House calls on the Government to bring forward a bold and effective strategy to tackle childhood obesity.

I want to thank the Backbench Business Committee for granting time for this debate. I also want to thank all my colleagues from across the House who are members of the Health Select Committee—and the staff of the Committee, particularly Laura Daniels—for their work on the report on childhood obesity that was published recently. Outside this House, there are also many organisations and individuals who have campaigned tirelessly to improve children’s health.

Perhaps we can start by looking at the example of Team GB and their success in the Olympics. On the morning of their track cycling victory, the architect of the team’s success, Sir David Brailsford, put their success down to the principle of marginal gains and their relentless pursuit of identifying every efficiency in the rider, the bike, the environment around them and their training regime. All those marginal gains were added together to win gold for Team GB in the Olympics. I think we need to adopt the same principle when it comes to tackling childhood obesity.

Too often, I hear people saying that it is all about education, or about getting children to move more in PE at school, but I would say that there is no single measure. We all know that this is an extremely complex problem that requires action at every level. I therefore call on the Minister to look at every single aspect of tackling childhood obesity. If we were running a cycling team hoping to win the Olympics, we would realise that we could not achieve success if we left any of the factors out, so let us apply that principle here.

Let me set the scene by telling the House why this subject matters so much. We know from the child measurement programme in our schools that around one in five of our children who enter reception class are either obese or overweight. However, by the time they leave in year 6, a third of our children are either obese or overweight. Perhaps even more worrying are the stark data on the health inequality of obesity. A quarter of the children from the most disadvantaged groups in our society are leaving school not just overweight but obese, which is now more than twice the rate among children from the most advantaged families. My first question for the Minister is this: will the childhood obesity strategy not only tackle the overall levels of obesity but seek to narrow that yawning and growing gap in our society between the least and most advantaged children? Any strategy that fails to narrow that gap will have failed our children.

[Geraint Davies (Swansea West) (Lab/Co-op)]

Does the hon. Lady agree that some of the overall problem can be explained by the fact that people do not know how much sugar is in their food? She will know that women are supposed to have no more than six spoonfuls a day, and men no more than nine. Only today, when I was in Portcullis House, I bought three items: a Snickers bar, which has five spoonfuls of sugar; a yoghurt with seven spoonfuls; and a Coke with nine. She will be glad to hear that I did not eat any of them; perhaps I was just removing them from other people. Does she agree that an awareness of how much sugar we are eating is very important if we are to manage our diets?

[Dr Wollaston]

Indeed. I completely agree with the hon. Gentleman, and I shall come on to that subject later. I am relieved to hear that he is not on a sugar high for the debate.

I want to set out not only the scale of the problem but its consequences. It has consequences for the whole lifetime of our children, in relation to their physical and emotional health. They also suffer the impact of bullying at school, as they are too often stigmatised in the classroom because of their weight. There is increasing evidence that obesity is a factor in causing many preventable cancers, and it also has an impact on conditions such as diabetes and heart disease. This has a cost not only to individuals but to wider society and to the NHS.

The Minister will know how essential it is that, as part of the “Five Year Forward View”, we tackle the issue of prevention. We cannot do that without tackling obesity, particularly among children, given the lifetime impact and consequences of the condition. She will know that 9p in every £1 we spend in the NHS is spent on diabetes. We estimate from the evidence that the Health Committee took during our hearings that the overall cost of obesity to the NHS is now £5.1 billion a year, and the wider costs to society have been estimated to be as high as £27 billion, although the estimates vary. We simply cannot afford to take no action.

Physical activity is of course extraordinarily important and I am confident that it will feature strongly in the Government’s strategy, but it is no good focusing solely on that. Physical activity is good for children, whatever their weight. Indeed, it is good for all of us, whatever our age. However, any strategy that assumes that we can tackle childhood obesity solely through physical activity will simply be ignoring the overwhelming evidence that most of the gain will be in reducing calories. That is not just about sugar, however. It is easy to be accused of demonising sugar. The fact is that children have more than three times the recommended amount of sugar in their diet, but that is perhaps the easiest aspect of the problem to tackle. The Minister will recognise the fact that we are talking about overall calories, which also include fats.

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[Dr Wollaston]

I thank my hon. Friend and fellow member of the Health Committee for her intervention. At a time of shrinking public health budgets, there is a huge additional benefit from having this kind of levy, in that many of the other measures that the Minister will want to see in the strategy—on exercise in schools, teaching in cookery lessons and health education—could be funded in part through a sugary drinks tax. I hope she will look carefully at this idea and consider introducing it.

[Geraint Davies]

rose—

[Mr Deputy Speaker (Mr Lindsay Hoyle)]

Order. It is meant to be a 15-minute opening speech. Mr Davies will want to speak and he will not want me to take any minutes off him, so I am sure this will be a very quick intervention.

[Geraint Davies]

The debate is often between reformulation and tax. I agree with the tax on fizzy drinks, but if we had a tax on overall sugar input—for the sake of argument, let us suppose that sugar makes up half a Hobnob and the tax is at 10%—that would give an incentive to the manufacturers to reformulate without the price going up and we could get the sugar content down.

[Dr Wollaston]

I thank the hon. Gentleman for that, which brings me on to reformulation. It should also form a core part of the strategy. Our view was that we should have a centrally led programme of reformulation across foods and drinks, and that what manufacturers want is a level playing field. The trouble with reformulation is that it takes time; there has been an effective programme on salt, but that has happened very gradually, over a 10-year period. There is no reason why these things should be mutually exclusive; I come back to that point about marginal gains and say let us do all of the above. I know that the Minister is looking closely at reformulation and understands how powerful it will be. The evidence we heard was that it could take 6% of the sugar out of children’s diets. Reformulation, alongside other programmes, will play a part, but it will not work on its own and, unfortunately, it will take longer.

We also need to examine the pervasive effect of marketing and promotion. Do I want to have a kilogram of chocolate for almost nothing when I buy my newspaper? Of course I do, but please do not offer it to me. Please do not make me walk past the chicanes of sugar at the checkout or when I am queuing to pay for petrol. We know that 37% of all the confectionary we buy is bought on impulse. It does not matter how much we are intending not to buy it, if it is presented to us on impulse, we buy it, as impulse is an extraordinarily powerful driver. I therefore hope that any strategy will tackle that part of consumption, along with portion sizing. The supersizing of our society is in part down to the supersizing of portions and offers. All of this needs to be included in our approach, as does dealing with advertising. This advertising is pervasive and it is hitting our children everywhere they go, on television, online and through the influence of “advergames”. We know that this is very powerful in driving choices for children, so I hope the Minister will look carefully at that. She will have seen our recommendation of a watershed of 9 pm.

Time is running short, so I shall close my remarks, as I know other Members will want to cover many other aspects, such as exercise, the effect of what local authorities do, how much more powerful they could be in their roles if we gave them greater planning powers, and so on. Early intervention, research, education, teaspoon labelling—please do it all. We need a bold, brave and effective strategy, and we need to learn from British cycling and the law of marginal gains.

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[Will Quince]

My hon. Friend makes a very good point, and I will come on to that in a bit more detail. The important element is that any approach we take must be evidence-based. I absolutely agree with her that we need to look at all the evidence.

I stated that the proportion of those aged two to 10 who were obese had gone from 17% in 2005 to 13% in 2013. The evidence suggests that childhood obesity rose quickly in the mid-2000s and has slightly fallen ever since. That is an important fact for two reasons. First, it suggests that our education programmes in our schools and the Government-backed campaigns on obesity within the last decade have had a positive impact in halting the increase in childhood obesity. Secondly, it undermines the scaremongering that suggests that childhood obesity is rocketing year on year. It simply is not; the reality is much more complex.

As my hon. Friend the Member for Totnes has already mentioned, there is a growing clamour for a sugar tax on soft drinks to combat childhood obesity. She has called in a recent article for a 20% tax on sugary drinks as part of that overall solution. Her calls have been echoed by the British Medical Association and other public health campaigners. I have huge respect for my hon. Friend, but I think that a sugar tax is completely the wrong answer. A sugar tax is illiberal and patronising —in my view, nanny statism at its worst.

Given how sugar tax campaigners argue, one might think that consumption of sugar in the UK is at a record high. It is not. Consumption of sugar per head in the UK is falling, from a high of more than 50 kg a year in the 1980s to less than 40 kg a year now. What is more, soft drink consumption in the UK is falling. The latest household food survey from the Department for Environment, Food and Rural Affairs shows that household soft drink consumption purchases have fallen by 5.2% since 2011 and by 19% for high-calorie soft drinks in the same period. Regular soft drink purchases are now at their lowest level since 1992.

[Geraint Davies]

Does not the hon. Gentleman agree, though, that a sugar tax would be eminently fiscally responsible? It would gather revenue, increase life chances, increase health and reduce health costs. From the point of view of the Exchequer, it would be very sensible. Can he not come up with other sensible ideas like that?

[Will Quince]

The hon. Gentleman makes an important point and, of course, that would make sense if the evidence suggested that a soft drink tax implemented anywhere else in the world had actually worked and had the effect that he suggests. He is right to suggest that there are a lot of other measures that we as a Government and that businesses and organisations can take to address this issue; I do not believe that the sugar tax is the right one.

Sugar tax advocates have pointed out the introduction of a sugar tax in Mexico and the corresponding 6% decline in soft drink sales since the tax was introduced. However, research in The BMJ does not show evidence of a link between the introduction of the tax and the small decline in soft drinks consumption. Further taxes on non-essential energy dense foods were also introduced at the same time as the sugar tax, and they accounted for a higher proportion of Mexicans’ daily calorific intake. As the authors of the research admitted,

“we cannot determine the independent role of each”

of the taxes. The research even acknowledges that there is a lack of information on nutritional data for packaged drinks in Mexico, which means that researchers cannot see what the fall in soft drink consumption meant for a decline in sugar intake.

As many Members may know, Mexico does not have safe drinking water. As a high-profile advocate of the sugar tax in Mexico, Alejandro Calvillo, stated:

“We know that there are people who drink a lot of sodas and they don’t have access to drinking water.”

How can we possibly compare the results in a developing country that has unclean, unsafe drinking water with how a tax might operate here in the United Kingdom? Instead, let us compare like with like. When sugar taxes have been tried in developed nations such as France, they have had a negligible effect on reducing consumption. Denmark scrapped its sugar tax on soft drinks in 2014 and labelled it an expensive failure. The Danish Ministry of Taxation labelled food and drink taxes as

“misguided at best and may be counter-productive at worst”.

They even described it as an expensive liability for business, and, as we all know, a sugar tax would be a very bitter pill for British businesses to swallow.

Study after study on soft drinks taxes in the USA also shows that they have a negligible impact on sugary drink intake and calorie consumption. What is more, the small decline in sugary drinks is almost entirely offset by consumption of other sugary products.

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[Geraint Davies (Swansea West) (Lab/Co-op)]

It is a pleasure to follow the hon. Member for Mid Worcestershire (Nigel Huddleston). I agreed with everything he said, including his disagreement with the hon. Member for Colchester (Will Quince). I also agree with the points made by the hon. Member for St Austell and Newquay (Steve Double). We are both members of the SAS—Surfers Against Sewage, that is, before people get the wrong idea.

I congratulate the Chair of the Health Committee, the hon. Member for Totnes (Dr Wollaston), on introducing this debate. As she will know, I have been active in this area, not least in the Sugar in Food and Drinks (Targets, Labelling and Advertising) Bill, which has its Second Reading tomorrow. The Bill basically asks for sugar labelling because people do not realise how much sugar they are eating. As I said earlier, this morning I bought three products from Portcullis House: a can of Coke, which has nine spoonfuls of sugar, the daily limit for a man; a container of yogurt, which has seven spoonfuls, more than a woman is allowed; and a Snickers bar, which has five spoonfuls.

The reason for a focus on fizzy drinks, other than the reasons set by the Chair of the Health Committee, is that they represent a very large proportion of the overall sugar intake of children, and so they represent an easy big hit, early on. There was a trading of statistics about the efficacy of sugar taxes, but we need only look at the elasticity of demand for fizzy drinks. Part of my background is in marketing products in multinational companies—not these products. I was the marketing manager for Colgate, for example. People have talked about the impact on teeth. When I was at Colgate, we thought that with the advent of fluoride we were going to see the end of tooth decay. However, there has been such a big increase in the consumption of fizzy drinks through focused marketing, that we have turned the corner and gone into reverse, and people’s teeth are dropping out. The point about marketing aimed at children highlights some of the demographic differences in the impact of sugar, because high consumers of television tend to be less well-off people who pick up brand awareness from watching it and then follow those brands.

I am in favour of labels noting the number of spoonfuls of sugar. I know that the Minister will say that there are issues with packaging in Europe, but my understanding is that, while there is a European competence, we have a national opportunity to do our own thing, and that is what we should do. Jamie Oliver and the Health Committee are following up on that. Retailers could put pressure on manufacturers to take voluntary action, but, sadly, even though retailers claim they are doing so, they are not taking proper responsibility, certainly not on cola drinks, which is a massive problem.

At one point in my distant past, I promoted the School Meals and Nutrition Bill. Its suggestions that Ofsted should be required to audit nutrition in schools and to get rid of unhealthy vending were agreed. I also still stand by its suggestion to gate children in schools so that they could not run to McDonald’s or elsewhere at lunchtime.

Obesity is costing the economy about £47 billion a year. This is not just about diabetes and the cost to the NHS, which is terribly important; the overall economy is suffering. Members have mentioned bullying in school, but obesity also has an effect on people’s quality of life. It is uncomfortable and those who are obese live shorter lives. If people know that one jar of pasta sauce has six teaspoonfuls of sugar and another has three, they will be able to make a rational choice; otherwise they will pick the one that is sweeter. The mechanisms available are simple. Members have also mentioned the need to encourage exercise, which is clearly very important.

On the main thrust of the debate, I agree with a fizzy drinks tax, but I want us to move towards an ingredient tax, which would mesh into the reformulation. Professor Graham MacGregor, who is now working with Action on Sugar, has been instrumental in getting the salt content down through reformulation. As I have said, if a 10% tax is put on a Hobnob, for example, the producer could reduce the amount of sugar and the price would not go up.

There are concerns about regressive taxation. The sad fact is that poorer people find it more difficult to afford fresh foods. People pooh-pooh that argument, but if various products are mashed up with sugar, salt and fat and then frozen, they will stay on the shelf for months on end. However, if produce has to be sold within a week because it is going to decay, it will be more expensive, which causes problems. There is a case to be made for taking the revenues from the tax and hypothecating it to provide easier access to fresh foods for people with less money. As well as putting up the prices of sugar-rich products, we need to provide information. We have a battery of opportunity to confront this difficult task.

It has been suggested that multinationals have been helping. Such companies are rational, focused and see the lie of the land. They know that people have cottoned on to the fact that sugar consumption is costing the country an arm and a leg, sometimes literally. Productivity is down and costs are up, and they know that the Government will ultimately take action, so they are following a rational trajectory. We need to encourage them to do so.

We have heard stories about elasticity of demand before. As every economist knows, when the price is put up, demand goes down. That is not a point of argument. Certain manufacturers used to say that there was nothing wrong with smoking. We know there is a problem with sugar. The emerging science suggests that if, for example, I and the hon. Member for Colchester both consumed 2,000 calories a day but I took in more sugar than him, over time I would develop a predisposition that meant that more of the calories I consumed would settle as fat. I would then feel hungry and listless and become obese. There are, therefore, other issues associated with sugar consumption.

The World Health Organisation has said that the sugar calorie intake should be 5%. Those of us here know that that means six spoonfuls for women and nine spoonfuls for men, but people out there do not realise how much sugar they are supposed to have, and even if they did they are not able to calculate it. Public Health England has produced an app that enables people to scan products with their phone to find out how many cubes of sugar they are consuming. It is difficult to calculate how much sugar is in one chunk of chocolate and in the bar as a whole. It would be better if it was all clearly labelled, without having to go through that process. The app is helpful and I welcome it, but it is not a serious solution.

[Dr Tania Mathias (Twickenham) (Con)]

I concur with the hon. Gentleman on labelling. Does he agree that, whether we label a chocolate bar or fruit, we need information on sucrose, glucose and fructose? We need to know how many of those chemicals are in everything we consume, including fruit.

[Geraint Davies]

I agree that people should be aware of that. My big beef, as it were, is that people do not know how much added sugar they are consuming. For instance, they do not know if there is twice as much sugar in one jar of pasta sauce than another. People need to know how much sugar they are taking in. To a certain extent, people prefer naturally occurring sugar in bananas and similar products, but I agree with the hon. Lady that people should know what they are eating.

The manufacturers argue that they have done everything they can. The back of a packet of Frosties has all the information, so long as people have a PhD and a lens through which to read the data. Products are packaged in such a way as to give the impression that they are healthy. The Bill that I am promoting tomorrow argues that products should not be allowed to be promoted as low fat when they are in fact high in sugar, because people infer from that that they are healthy. It also proposes an overall, aggregate sugar target—similar to a carbon target—so that the Government can see how much sugar we are consuming overall and gradually manage strategies to get it down.

[Dr Tania Mathias (Twickenham) (Con)]

May I join other Members in applauding my hon. Friend the Member for Totnes (Dr Wollaston) for securing this important debate? I did not come across paediatric type 2 diabetes when I was a medical student. Perhaps her experience was similar to mine. Like many people, I was shocked to find at the turn of the century that there were instances in this country of childhood type 2 diabetes. There are now more than 100 cases a year in this country of that incredibly serious condition. Just a few months ago, a three-year-old in America was diagnosed with type 2 diabetes. The treatment involved decreasing the weight of the child, who was obese.

I believe that the Minister’s strategy should be cultural. The papers show that more evidence is emerging and it is prescient. It involves not just genetics, but nurture. Studies of children who have been adopted by obese parents show that there is a risk that they will have childhood obesity.

On culture, I, like others, have seen many households with a TV room but no dining room. Families do not eat at a dining table in the same way as previous generations did. Members have talked in depth about the cultural change relating to exercise. I applaud the head of St Ninians in Stirling, who introduced a 1-mile-a-day idea for the primary schoolchildren. Interestingly, obesity levels on entry to the school are not as high as those in other schools; the figure a few years ago was one in 10. There is now an association—we are not talking about causation—between the 1 mile a day and pupils leaving St Ninians without being obese. That lady has rightly been given Pride of Britain awards. I want that culture change to continue and for the House to applaud it.

At the moment, I am not in favour of new taxation. In our culture, we can access such information. I absolutely agree with what everybody has said about better labelling, and we need more of it. However, as I said to the hon. Member for Swansea West (Geraint Davies), we need information about all the foods we eat—about fruit and vegetables, as well as about fast food. There is a debate about using sucrose as opposed to fructose, but we need to be aware of all such chemicals. In our culture today, we can give people that information. I would like to have such information myself.

As we get more evidence, the treatment and management of, as well as education about, childhood obesity will rise to the levels available for adult obesity. For many people, the concern is not about the obesity itself, but about its medical consequences. An obese adult who goes to their GP can look at the algorithm or the chart, and discuss the five or 10-year risk of their developing cardiovascular problems. If we give parents such information about their child, they will, in time, change their family habits. They do not want their child to have an increased five or 10-year risk of cardiovascular complications.

[Geraint Davies]

On that basis, does the hon. Lady advocate removing the tax on cigarettes?

--- Later in debate ---

[Mrs Drummond]

That is exactly what I was going to come on to, so I thank the hon. Lady very much indeed.

Last week, I met Home Start, a national family charity with a strong presence in Portsmouth. It has an army of volunteers who offer unconditional help and support to all families who need help in getting it right, and show them how to cook healthily. There is, however, a major role for our schools in tackling obesity. The school where I am a governor, Milton Park primary, is taking the lead locally in educating children about healthier choices. The cooks at the school have won awards and I can recommend their so-called “chocolate muffins,” which in fact are made of beetroot.

I would like to see cooking classes become mandatory in schools. I know it would be difficult to re-establish kitchens, but the rewards would be worth it. I see that as the only way to prevent future generations from continuing poor eating habits. The only way to do that is by teaching them how to cook healthily and how to budget. Like some of my colleagues, I was against a sugar tax to start with. If we can use the sugar tax to fund cooking classes in schools, however, then I am all for it.

In Portsmouth, there are a number of charitable organisations actively engaging with the community to help to tackle obesity through a more active lifestyle. Affiliated with Portsmouth football club, Pompey in the Community provides education and opportunities for children in the city.

[Geraint Davies]

The hon. Lady makes some interesting points about the relationship between nutrition and poverty. Does she agree that it is a good idea to provide free school breakfasts in school? They help poorer children in particular to achieve and to know what good food tastes like.

[Mrs Drummond]

I totally agree. I also back the attempt by the right hon. Member for Birkenhead (Frank Field) to get free school meals for everybody receiving the pupil premium. That is a very good point; I am thinking particularly of a healthy breakfast with porridge, not necessarily sugar-laden cereals.

Not only does Pompey in the Community provide a lot of the physical education curriculum in local schools, but it runs a number of out-of-school and holiday clubs. There are plenty of sports clubs in Portsmouth. I would like to see a lot more outreach from sports clubs to children from low-income families. The Portsmouth Sail Training Trust does this with sailing, focusing solely on children from low-income backgrounds. More sports clubs need to get out and do this, too. Perhaps we could use the sugar tax to help to fund some of those sports activities. I would also like to see more sport in the curriculum, with the possibility of at least one hour of activity every day. We heard about a school doing one mile a day. Every school should be doing that. I would like the Department for Education and the Department of Health to lead on more sport in school, perhaps with extended days to fit it in.

Often the simplest changes are the most effective. By encouraging our children to walk to school, and by continuing to develop nutritional education, I am sure we will see more positive results. Members on both sides of the House talk a lot about tackling deprivation in our communities. It is crystal clear that the House must now turn its energy towards fighting the terrible problem of obesity, through education and providing more opportunities for an active lifestyle.

[Dr Lisa Cameron (East Kilbride, Strathaven and Lesmahagow) (SNP)]

I thank the hon. Member for Totnes (Dr Wollaston) for securing this extremely important debate. It is not listed in my entry in the Register of Members’ Financial Interests, but I must declare a terrible sweet tooth, which gives me great experience from which to speak in this debate.

Over preceding decades, there have been profound changes in the UK in the relationship we have with food. Historically, the public health challenges we faced tended to relate to under-nutrition and unsafe food and water. However, in modern society, those issues have largely been replaced by the risks of poor diet. Food is now more readily available and there have been significant changes in how we eat, the type of foods we consume, and how they are produced and marketed. Busy lifestyles and easy access to convenience and processed foods have helped them to become a staple part of many families’ diets.

In general, we over-consume foods high in fat, sugar and salt, and we do not eat enough fruit, vegetables, fibre and oily fish. Our type of diet underlies many of the chronic diseases that cause considerable suffering, ill health and premature death. It is also a major factor in the issue of childhood obesity, heart disease and type 2 diabetes. The recently published findings from the Health Committee’s investigation into childhood obesity highlighted that one in five children is overweight or obese when they begin school. That figure was found to rise to one in three by the end of primary school. There was also evidence of inequality between different sectors of society, with those from deprived backgrounds found to fare significantly worse and to be twice as likely as their more affluent counterparts to be overweight or obese.

These figures are extremely concerning. Obesity is a serious problem that has significant implications, both on the long-term wellbeing of the individual child and on society as a whole. Many of the most serious and potentially life-shortening physical health risks that accompany obesity are well publicised and have been raised already in the Chamber today. I will not, therefore, go into them again.

Instead, I will highlight the detrimental social effects that can impact on individuals’ overall wellbeing and life chances. Research indicates that childhood obesity is associated with mental health issues in both children and adults, such as depression, low self-esteem, social isolation, self-harm and behavioural problems. It is also associated with stigma and bullying. In addition to obesity, a poor diet that includes too much sugar and acidic food substances can lead to oral health issues, which can impact on an individual’s ability to eat and socialise, and this again can adversely affect their mental health and contribute to their social isolation.

Addressing these issues will require a concerted effort to alter health choices, to address cultural and lifestyle issues and to improve our relationship with exercise and sport. It will require a multifaceted response; no single measure will do the trick. We need a response from private enterprise to improve choices and healthy options that are appealing and, importantly, cheap, as was highlighted by my hon. Friend the Member for North Ayrshire and Arran (Patricia Gibson). We need to address the effect that marketing can have on children and parents and make sure it is done responsibly, as was mentioned by my hon. Friend the Member for Glasgow Central (Alison Thewliss). We need to enhance skills gained at school and home in cooking healthy meals, and this must be role-modelled at school, with fruit bars, water and other healthy choices that are low in fat, salt and sugar, as was discussed in detail by the hon. Member for Washington and Sunderland West (Mrs Hodgson).

Childhood obesity must also be addressed by local commissioning in areas where fast-food outlets are placed near to schools. In one of my local areas, refuse staff are in place at school lunch times to clear up fast-food packages left by school children in shopping squares. This must be addressed and must not be encouraged. Wider Government initiatives are also required to improve food labelling. We need labelling that is understandable to families and ordinary people and which does not look like gobbledegook.

As debated today, taxation should be considered as part of an evidence-based approach. We also require an increased focus on sports, exercise and healthy pursuits as being integral to our lifestyle; increased funding; and an emphasis on engaging children and young adults in these activities and making them affordable to people from all walks of life. We know from psychological research that education, in itself, does little to change behaviour. We therefore require a Government strategy to reinforce healthy choices. This would be cost-effective in the long term for our health service and quality of life.

[Geraint Davies]

The hon. Lady is making a powerful and excellent speech. She might know that in Mexico the average consumption of Coca-Cola is 0.5 litres a day per person and that children are being fed Coke in baby bottles. Does she agree that the Government need to take action not just on pricing but on marketing? We cannot have this situation where people can buy two litres for 5% more, so that we have these huge stocks of Coke that people feel they have to get rid of before it loses its fizz, and everybody’s teeth fall out.

[Dr Cameron]

The hon. Gentleman makes a good point. I have pinpointed the need to address the effect of marketing on children and parents’ healthy choices.

A clear strategy would benefit our children, society as a whole and future generations. That is surely Parliament’s job. We should not shy away from a bold and effective obesity strategy.

[Andrew Gwynne (Denton and Reddish) (Lab)]

I pay tribute to the Backbench Business Committee for allocating time for such an important debate and to the hon. Member for Totnes (Dr Wollaston) for her eloquent opening speech. I also extend my thanks to the entire Health Select Committee for producing such a comprehensive report on childhood obesity. She was dead right to entitle it, “Childhood obesity—brave and bold action”, because that is precisely what is needed. I would also like to thank for their contributions my hon. Friend the Member for Washington and Sunderland West (Mrs Hodgson), my right hon. Friend the Member for Leicester East (Keith Vaz), my hon. Friend the Member for Swansea West (Geraint Davies) and the hon. Members for Colchester (Will Quince), for St Austell and Newquay (Steve Double), for Strangford (Jim Shannon), for Mid Worcestershire (Nigel Huddleston), for Twickenham (Dr Mathias), for North Ayrshire and Arran (Patricia Gibson), for Erewash (Maggie Throup), for Glasgow Central (Alison Thewliss), for Portsmouth South (Mrs Drummond) and for East Kilbride, Strathaven and Lesmahagow (Dr Cameron)—I am sure I pronounced that kind of right.

Returning to the Select Committee report, the starting point has to be the scale and the consequences of the problem, and this requires looking at doing things differently. Failure to act will make the problem worse—not just for the individuals concerned, but for the public purse, which will, frankly, struggle to cope with the health inequalities that we are exacerbating.

The statistics are clear. Childhood obesity is strongly linked to deprivation, almost reversing the trend of the entire history of the human race whereby malnourishment, not obesity, was the key indicator of poverty. As we know from the statistics of Public Health England, the most deprived children are twice as likely to be obese at reception and at year 6 than the least deprived children—and that gap is widening, as the hon. Member for Totnes set out.

We often get into the habit of praising the fact that a debate is even taking place here, but in this instance, the timeliness of the debate really cannot be overstated. It is no understatement to say that the Government’s strategy has been a long time coming. Although we are debating obesity today, I hope that this is not a sign that the document is being slimmed down. Today’s debate has suffered from the slight disadvantage of addressing the contents of a document that does not yet exist. Perhaps the Minister will give some certainty—perhaps even a date—on when we can expect publication of the strategy. This also presents a rare opportunity, hopefully, to influence what will eventually be published in that strategy. It is important to remember that Government can do immense good when it comes to public health.

If we think about some of the great strides in public health that we have taken in recent years—from the banning of smoking in public places to reducing the rates of teenage pregnancy—we realise that these moves came about, in part, as a result of Members putting difficult issues on to the political agenda. With that in mind, I shall focus my remarks today around the key issue of obesity and diet.

I believe that we need action to tackle the problem at the supply side on the part of food and drink companies, and also action to tackle it on the demand side, with a need for far better education on how we could be looking after ourselves, as well as give people the means to eat healthier food. We believe a comprehensive and broad approach is necessary to help families, schools and children to make the right decisions. I commend the work of my hon. Friend the Member for Washington and Sunderland West, who has long been a champion of better standards of food in our schools.

In November, the Health and Social Care Information Centre released data showing that one in every five children leaving primary school are classified as obese, and one in every three children are either obese or overweight. Frankly, those figures should shame each and every one of us. Although there has been a shift in providing healthier, more nutritious meals at schools, so many of the problems start before school or at least outside of school hours.

Between April and September 2015, Trussell Trust food banks in Greater Manchester, which includes my constituency, gave 22,739 three-day emergency food supplies to people in crisis. Some 8,666 of those three-day emergency food supplies were given to children. When so many families are having to rely on food banks to feed their children, they may be limited in their ability to provide fresh and healthy meals. In these upsetting circumstances, feeding their child something is better than seeing them go hungry. Wider problems of poverty must be addressed to ensure that people have access to good diets. How does the Minister plan to help families who are having to rely on food banks to improve their diets?

Funding is a crucial side issue. Following the removal of protected status from all Department of Health budgets that are not controlled by NHS England, the pot of money that pays for public health will be subjected to huge cuts in the coming years. That will have a significant impact on Public Health England, and could put at risk our ability to tackle obesity to the necessary extent. It could also put at risk the future of public awareness campaigns, many of which have been a great success. The cuts in the public health grant to local authorities could drastically reduce the amount of support that is available locally to those who want to lose weight or have a healthier lifestyle. I should be interested to hear from the Minister how the public health cuts in the coming years are consistent with the emphasis on prevention in the “Five Year Forward View”, and, in particular, whether the crucial issue of funding will be addressed in the forthcoming strategy.

[Geraint Davies]

Obviously funds are tight, but does my hon. Friend agree that if we introduce a sugar tax, it will ease the burden and enable us to focus our fire on reducing obesity in other ways?

[Andrew Gwynne]

That may well be the case, but we must of course ensure that any income raised by such a tax is reinvested in public health.

It is also important to increase levels of physical activity among adults and children throughout the United Kingdom. Inactivity is a key factor in ill health, and it is important that we encourage children to maintain active lifestyles from an early age. I believe that increasing the opportunities for young people to get involved in physical activity is just as important as improving diets. Treating obesity and its consequences alone currently costs the NHS £5.1 billion every year. Given that nearly 25% of adults, 10% of four to five-year-olds and 19% of 10 to 11-year-olds in England are classified as obese, the human and financial cost of inaction is significant. We must do much more to ingrain physical activity in our daily lives, whether that means walking instead of driving or taking the stairs instead of the lift. Every little helps.

A number of Members have touched on a point that is crucial to the debate. Many people have argued that the Government should introduce some form of tax on sugary products, particularly soft drinks, and the debate on that issue goes far beyond the Chamber. Public figures such as Jamie Oliver have come out in support of a sugar tax, and he has made a compelling case. However, the issue is complex, and I do not think that the answer is necessarily straightforward. Labour Members have always feared that a sugar tax, in itself, could be regressive, and that it would focus attention on consumers, many of whom are addicted to sugar, rather than manufacturers, who should be reducing the amount of sugar in their products. That said, however, I suggest to the Minister that it is right for us to look at the emerging evidence from other countries, which has shown that where similar taxes have been introduced they have had a positive effect, not least in changing behaviour.

--- Later in debate ---

[The Parliamentary Under-Secretary of State for Health (Jane Ellison)]

I am delighted to respond to the debate on behalf of the Government, and, following on from what the shadow Minister just said, I welcome the opportunity to take forward all the points made in the many excellent and well-informed—although occasionally a little confessional—contributions. It is a timely debate that will make a valuable contribution as we finalise our strategy.

The House is at a slight advantage as it has the chance to influence, but I am at a disadvantage as we have yet to publish the strategy and therefore I have to talk in slightly more general terms.

I welcome the Health Committee’s recent report, which we have debated once already, and its previous report, “Impact of physical activity and diet on health”. We will be formally responding to the Health Committee’s most recent report soon.

There is no denying that in England, and indeed globally, we have an obesity problem. Many shocking statistics have been given in this debate and I will not repeat them, but many Members on both sides of the House dwelled on the health inequalities issue—the gap that is emerging—and I will come back to that. My hon. Friend the Member for Colchester (Will Quince) drew our attention to what is, in effect, a stabilising of childhood obesity statistics, although it is at far too high a level. As he acknowledged, there is a pronounced gap between different income groups.

Once weight is gained, it can be difficult to lose and obese children are much more likely to become obese adults. In adulthood, obesity is a leading cause of serious diseases such as type 2 diabetes—as the right hon. Member for Leicester East (Keith Vaz) and others mentioned—heart disease and cancer. It is also a major risk factor for non-alcoholic fatty liver disease.

We also know that eating too much sugar is linked to tooth decay; it was good to hear my hon. Friend the Member for Mole Valley (Sir Paul Beresford) make that point. In 2013-14 over 62,000 children were admitted to hospital for the extraction of teeth. This is a serious procedure that frequently requires a general anaesthetic. Children should not have to go through this.

Many Members highlighted—I think there is consensus on this—that there is no silver bullet to tackle obesity. That means that in order to reduce rates we need a range of measures and all of us, and all the parts of our society mentioned in the debate, have a part to play, as our forthcoming strategy will make clear.

Sometimes in the national debate around obesity people question the role of the state and how it should intervene to drive change. In the face of such high obesity rates, with such significant implications for the life chances of a generation, it is right that tackling obesity, particularly in children, is one of this Government’s major priorities, and we showed the priority we place on the issue by making it a manifesto commitment.

As my hon. Friend the Member for Portsmouth South (Mrs Drummond) said, the human cost is enormous. Young children in particular have limited influence over their choices and Government have a history of intervening to protect them: we do not question the requirement that younger children use car seats on the grounds of safety, for example. Children deserve protecting from the effects of obesity, for their current and future health and wellbeing and to ensure they have the same life chances as other children, especially those in better-off parts of our society.

As I have said, I was struck by how many Members alluded to the health inequalities issue. There is strong evidence of a link between obesity and lower income groups. The obesity prevalence among reception year children living in the most deprived areas was 12% compared with 5.7%, and that gap rose to 25% as against 11.5% respectively by the time they leave primary school. That is not acceptable, and we must take action to tackle it.

Any Government with a state-funded health service also have a responsibility to take an interest in the nation’s health to ensure the sustainability of the NHS. The huge cost of treating lifestyle-related type 2 diabetes has been mentioned by a number of Members. Our election manifesto supported the programme for prevention set out in the NHS England’s “Five Year Forward View”, which states that

“the future health of millions of children, the sustainability of the NHS, and the economic prosperity of Britain all now depend on a radical upgrade in prevention and public health.”

Tackling obesity is a key component of this work. I accept the challenge from the shadow Minister on budgets, but I can give him the assurance that over the spending review period we are still going to be spending £16 billion on public health. We can complement local action with national initiatives, and we will talk more about that when we publish our strategy.

We are continuing to invest in the Change4Life campaign, which has been going on for many years. We have learned a lot from it, and we now have valuable evidence about what works and what provides motivation and support for families to make small but significant improvements. On 4 January, we launched the new Sugar Smart app to encourage parents to take control of how much sugar their children eat and drink. Members have described how people can scan the barcode on any of the thousands of everyday products that are catered for by the algorithm. This allows people to visualise the number of 4 gram sugar cubes the product contains. In the first 10 days of the campaign, about 800,000 people downloaded the sugar app. That is a great success, and an example of how we can empower families with information so that they can make decisions about their diet. A number of Members made that point, including my hon. Friend the Member for St Austell and Newquay (Steve Double), who talked about the role of families.

[Geraint Davies]

Will the Minister give way?

[Jane Ellison]

I do not think I have time. I think I know what the hon. Gentleman is about to say, and we have had the teaspoon discussion before. I recommend the sugar app to him; he acknowledged its introduction in his speech, for which I am grateful.

The Sugar Smart app builds on the Change4Life Sugar Swaps campaign, from which we learned a lot. More than 410,000 families registered with the campaign. However, we know that public health messaging and support are not enough. That is why our childhood obesity strategy will be wide ranging and involve Government action across a range of areas.

The food and drink industry also has a role to play, as many Members have said, and I am pleased that it has made progress in recent years. My hon. Friend the Member for Erewash (Maggie Throup) alluded to that fact earlier. Under the voluntary partnership arrangements and the responsibility deal, there has been a focus on calorie reduction, of which sugar has been a big part. We have made progress. Some retailers have also played their part by removing sweets from checkouts, which we welcome. We urge others to follow suit. Importantly, parents and customers have strongly welcomed that change and supported the measures being taken by the industry. But the challenge to the industry to make further substantial progress remains.

Providing clear information to consumers is vital if we are going to help them to make healthier choices. That has been a theme of the debate. The voluntary front-of-pack nutrition labelling scheme, introduced in 2013, plays a vital part in our work to encourage healthier eating and to reduce levels of obesity and other conditions. The scheme enables consumers to make healthier and more balanced choices by helping them to better understand the nutrient content of food and drinks. It is popular with consumers and provides information on the calories and nutrients in various foodstuffs. Businesses that have decided to adopt the scheme account for two thirds of the market for pre-packed foods and drinks.

As a Conservative and a former retailer I believe in customer choice, but if consumers are to make an informed choice they need information. Informed consumers can of course shape markets and drive change, as my hon. Friend the Member for Twickenham (Dr Mathias) pointed out in her thoughtful speech. That point came out strongly in the debate, and I shall reflect on it a great deal.

I want to say a little about physical activity, which is also a key theme. We are very clear that for those who are overweight and obese, eating and drinking less is key to weight loss, but we know that physical activity has a role to play in maintaining a healthy weight. It is also hugely beneficial in many other ways. For children it is a vital part of growing into a healthy, happy adult, so it has been great to hear about the work being done in schools up and down the country. We heard examples of that from my hon. Friends the Members for Mid Worcestershire (Nigel Huddleston) and for Erewash. That is why raising levels of participation in sport and exercise among children and young people is an area the Government are keen to make further progress on.

The Department worked closely with the Department for Culture, Media and Sport on the new sports strategy, published just before Christmas. We will be working with DCMS, Sport England and Public Health England in the coming months to implement the strategy. The Minister for sport and I have worked closely together on both the obesity agenda and her agenda on physical activity. We are also working to raise awareness of the UK chief medical officer’s physical activity guidelines. We have already developed an infographic for health professionals to use when they discuss physical activity with adults, but we want to go further and work on further infographics to raise awareness of the daily activity levels required for children and young people, including the under-fives. We hope that that will be a useful resource, not only for families, but for the leisure sector and for many more who have a key role in encouraging people to be more active.

A slightly different point was made by the hon. Member for Glasgow Central (Alison Thewliss), but it was an important one and she spoke knowledgeably about nutrition in the very early years and during pregnancy. I commend to her the recent chief medical officer’s report on women’s health, as it contained a number of chapters that I think she would find of huge interest if she has not already had the chance to look at them.

There has been a consensus on a number of facts, although a key one stood out: obesity is a complex issue, which the Government cannot tackle alone. Businesses, health professionals, schools, local authorities, families and individuals all have a role to play, as does Parliament. We were all struck by the contribution made by the hon. Member for Washington and Sunderland West (Mrs Hodgson), who spoke so passionately about the need to tackle health inequalities. She spoke about the influence of a good start in life and how that works all the way through one’s life. Parliament does have a role to play, so I welcome the engagement of so many Members from all parts of the House. I would be happy to provide more information if it is ever of help to Members about key public health indicators in their own local areas and how they can help to take this agenda forward. Local leadership will be important as we seek to make the critical leap forward on preventive health action described in the NHS “Five Year Forward View”.

This has been a great debate and I thank Members for their contributions. I look forward to discussing this issue further when we publish our comprehensive childhood obesity strategy.

Sugary Drinks Tax

Geraint Davies Excerpts

Monday 30th November 2015 Westminster Hall

[Helen Jones]

If we were dealing with a level playing field, the hon. Lady might be right, but we are not. We are dealing with goods that are heavily marketed, especially to children. I am sure she cannot really be arguing that it is great for hospitals to profit from unhealthy food and then for the other end of the hospital to deal with the consequences of that.

[Geraint Davies (Swansea West) (Lab/Co-op)]

Will my hon. Friend give way?

[Helen Jones]

I will take one more intervention, then I am going to make some progress, because other Members need to speak.

[Geraint Davies]

On the issue of personal responsibility and consumer choice, as my hon. Friend will know, the World Health Organisation says that men should have up to nine teaspoons of sugar a day and that women should have up to six. Would it not be helpful if, in addition to the poison of sugar being taxed, all products were labelled in teaspoonfuls so that everybody knew what they were eating and could make empowered choices?

[Helen Jones]

That is right. I have already said that clearer labelling has a role to play, but the Government need to understand and recognise the link between obesity and food poverty, which is not—before anyone misquotes me—to say that all poor people are obese or that all obese people are poor. The children who are most at risk are concentrated in the most deprived areas of the country. The same is true of adults. Figures provided to me by the Library show that there is a stark division. For instance, 32.7% of adults in Hartlepool are obese; in the Chilterns, it is 17.7%. In Barnsley, 35% of people are obese; in Cambridge, it is 14.7%.

The noble Lord Prior recently said in the other place that he found it puzzling that obesity is growing while people are using food banks. Let me try to explain it simply to him. If people live in an area where shops do not sell reasonably priced food, fruit and veg, and they cannot afford the bus fare into town, they are more likely to buy cheap, fatty products. If people are fuel-poor, it is difficult to cook healthy meals, as it is if they are time-poor. I have just said at a public engagement event that there are women in my constituency who are working two or three part-time jobs, trying to make ends meet. Most poor families are good at managing their budgets, but if they do not have time to cook and are worried about waste, they are more likely to buy easy things that can be cooked quickly—we need to recognise that. I would do the same in that situation, and it is why we need to invest more in preventive measures and to subsidise healthy foods, rather than unhealthy foods.

If we look at the detail of the Chancellor’s autumn statement, however, the public health grant will continue to fall. Some 25% of the grant goes on sexual health services, and 30% goes on drug and alcohol services, which are demand-led statutory services that cannot be cut. If we add the child measurement programme, child medical examinations and health protection, there is not much left over. That is why the Local Government Association has said

“councils don’t have enough…to do the preventive work needed to tackle one of the biggest challenges we face.”

The Government also need to look carefully at what has happened to their obesity strategy. The strategy was launched with great fanfare in 2011, but since then, as the National Obesity Forum has said,

“little has been heard of the strategy”.

The National Obesity Forum has asked for a “much more determined approach”. Even the Change4Life programme, which does not address obesity but helps to prevent people from becoming obese in the first place, has found its budget cut. We have heard much about the public health responsibility deal, which is currently under review. I hope the Government will seriously look at the deal, because all the indications are that, as presently constituted, it is not working.

Simon Capewell, professor of public health and policy at Liverpool University, called the public health responsibility deal a “predictable failure” and

“a successful strategy for food companies who wanted to maximise profits.”

It is right to work with the industry as one strand of our approach, but it is not right to give industry the final say on what happens because, as the Health Committee said in the last Parliament,

“those with a financial interest must not be allowed to set the agenda for health improvement.”

We need a much tougher responsibility deal.

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[Dr Wollaston]

Yes. As I pointed out, we could end up inadvertently widening health inequalities. The hon. Lady is absolutely right that a tax would send a clear message—right in front of people, on the shelf—that certain products are cheaper because they are not as harmful. That is the clear beauty of it.

I ask Members to consider what could be achieved with such a levy. If it might raise between £300 million and even £1 billion a year, the possibilities are extraordinary in terms of what we could do to improve the health and wellbeing of the nation’s children. We should not miss that opportunity. I hope that the Government will accept all the points and concerns raised by hon. Members and reconsider their policy, giving serious consideration to how much could be achieved for the benefit of our nation’s children and their health.

[Geraint Davies]

I support a sugar tax. In Mexico, the average person has half a litre of Coke every day. Did the hon. Lady consider the possibility of a tax on sugar as an input into other products? After all, if I was making Hobnobs and the tax was at 10%, and 50% of a Hobnob was sugar, I would only have to make a slight change to the price, the formulation, or the number of biscuits. Would it not be better instead to have a tax on all sugar inputs, to give the right incentives to both consumers and producers?

[Dr Wollaston]

I thank the hon. Gentleman for his intervention, but the point is that we wanted to respond to the issue about whether a sugar tax is regressive. It is much more challenging to use a direct replacement for the sugar, which would mean zero sugar for those kinds of products. That was partly why we took that view.

However, the approach that we recommend for the kind of products that the hon. Gentleman has mentioned is one of reformulation. During the last decade, there has been a successful programme of reformulating salt within our processed foods, but such a change takes time, because we have to adjust the nation’s palate gradually. Yes, we can make bigger step changes if we replace part of the sugar in one go, but there is sometimes something about the chemistry of sugar within cookery that means a sugar substitute does not do the same job. We wanted a tax where a sugar substitute did the same job as sugar, in effect.

I am confident that reformulation will be part of the Government’s response, because there is clear evidence that it works. Having said that, we know that it works better when there is some teeth to it, so I urge the Minister to go further than the responsibility deal and have something with real teeth. Things worked better when we had the Food Standards Agency and a bit of a stick in the background to make such changes happen, and industry wants a level playing field.

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[Dr Wollaston]

I am sure that will be part of it, but as I have said, I am not here to beat industry over the head. I want to bring industry with us. I celebrate what it has done, but it needs to go further. What we heard on our Committee was that industry needs a level playing field, and that a bit of regulation helps, because then everybody goes together. For example, take the chicanes of sugar that we have at checkout aisles, and the fact that we are being flogged a kilogram of chocolate when we go to buy a newspaper. With those types of things, we need a level playing field, so that we do not have any industry going down that route.

My view is not that we should not have discount promotions; we need those discounts and promotions to happen for healthier foods. The argument is often made that we will hit people in their wallets if we take these promotions away, but what we want is for people to be able to afford healthier, quality food. I would love that type of food to be the focus of deep discounting and promotions.

We then come on to the issue of clearer labelling. Jamie Oliver, in his presentation to us, made a compelling case about labelling. Let us put the number of teaspoons of sugar on drinks. This morning, I was trying to look at drinks labels, and I found them confusing. We need clear information that says whether the product contains 12, 13, or six teaspoons of sugar. To answer the point that my right hon. Friend the Member for Cities of London and Westminster (Mark Field) made about industry, it helps industry if people can clearly see that companies have made an effort to make a lower-sugar product. Let us allow that within clear labelling.

Let me come on to improved education. I would love to see more education about food in school, including proper cookery lessons, and for schools to have the resources to be able to do so much more in that regard. That is where I see one of the benefits of this levy going; it could go to support those kinds of lessons, not only in schools but in the wider community, and school sport. All those things are important. If we are to have school food standards, they should apply to all schools. Do we not care about every child in school?

[Geraint Davies]

The hon. Lady will know that I put forward a sugar Bill supporting sugar being denominated in spoonfuls. Does she accept that if there were two pasta sauces that were clearly labelled—one with six teaspoonfuls and one with three—there would clearly be an incentive for consumers to pick the lower-sugar one and that manufacturers would compete to get sugar content down, rather than up, in order to get people to buy their products?

[Dr Wollaston]

I completely agree with the hon. Gentleman. We have seen that where companies want products to be marketed as “healthier”, there is an incentive for them to reformulate, although we need honesty about that; sometimes, products can be marketed as “healthy” because they are low-fat, when they are packed full of sugar. We need to be clear about that.

Also, look at advertising: some products are allowed to be marketed to children, including breakfast cereals whose contents are 22.5% sugar; that was the rather shocking evidence that we heard. We need clearer guidance as to what constitutes a “healthy” product.

On that point about advertising, we felt that there was a clear case to have the watershed of 9 pm apply, so that we do not see junk food being marketed to children when they are watching very popular programmes. We were also very concerned about the pervasive nature of advergames on the internet: children think they are playing a game but, in fact, the games are the product of marketing companies, and the children are being sold particular items.

We are absolutely clear that all these things are very important and, as I said at the beginning, there is no one single piece of the jigsaw that will complete the picture. Indeed, the more pieces of the jigsaw that are put in place, the more effective a strategy there will be around childhood obesity.

I return to the point I made at the start: this issue matters and we cannot continue as we are. Also, although we did not go into this in great depth in our report, I urge the Minister to consider what interventions can be put in place for those children who are already affected by obesity. We were very supportive of the child measurement programme, but we were told by local authorities that funds are tight. As for extending the programme to bring in children from earlier years and pick them up before they get to primary school and run into difficulties, authorities do not have the resources to both put in place another year of monitoring and do what we need to in order to help those children who are already affected by obesity. Resources matter. I again urge the Minister, when she discusses this issue with colleagues, to consider what we can achieve, because we should not take the view that that nothing can be done about childhood obesity. We can do extraordinary good for the health of our children, and I really hope that when the Government bring forward their obesity strategy, they will be bold and brave, and recognise the urgency of this health emergency.

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[Paul Flynn]

Yes, Sir. Thank you, Mr Chairman. I was unfortunately—inadvertently—diverted from the point involved, but I shall return to it.

[Geraint Davies]

Is my hon. Friend aware that last night on Welsh television the Welsh Minister for Health and Social Services, Mark Drakeford, said that there should be much greater control over the advertising of sugary drinks to children until after 9 pm? The Minister would, I am sure, welcome the devolved power that is implicitly being called for to be able to tax sugar in Wales and do the other things we are talking about.

[Paul Flynn]

I did see the programme; it was the Welsh segment of the “Politics Show”. That is why I find the account-giving of the view in Wales to be not plausible—Mark Drakeford is a splendid Health Minister.

Last year, a Daily Mail investigation revealed that the food industry lobby had been given unprecedented access to the Government. The Prime Minister hosted Coca-Cola, Mars, Nestlé, McDonald’s, Pepsi, Nando’s and Tesco. They were all welcomed to No. 10 Downing Street, and given big hugs no doubt—they are great pals. Those are the ones the Government are listening to, not the needs and the health of young children.

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[Barbara Keeley (Worsley and Eccles South) (Lab)]

It is a pleasure to speak in the debate with you in the Chair, Mr McCabe. I thank my hon. Friend the Member for Warrington North (Helen Jones) for the excellent way in which she opened the debate. In fact, we have had some excellent speeches. There was a bit of discord in some of the interventions and speeches, but broadly we have settled on a similar set of views. I want to emphasise that the causes of obesity are complex and that a number of factors can be involved.

We need to tackle the problem at both ends. We have talked extensively about the supply side and the drink companies, but we also need to talk about the demand side. We need far better education about how we can look after ourselves. We also need to give people the means of eating better food. In addition, we need to encourage them to take more exercise—we have touched on that, but I will talk about it a bit more later.

To tackle obesity—I am sure that this is the consensus that is developing—we need a comprehensive and broad approach that helps families, schools and children to make the right decisions. That might include people seeking medical help—I have had constituents in this situation—to get them started on the path away from obesity. That might include a programme or a summer camp—some way of starting to have a different diet and lots of exercise.

Many Members have referred to the statistics on obesity. The Health and Social Care Information Centre statistics are quite frightening: one in five children leaving primary school is classified as obese, and one in every three children is obese or overweight. There has been a significant move towards healthier, more nutritious meals in schools, and that is vital. However, I have concerns about how children and their families manage in the school holidays, when those healthier school meals are not available.

[Geraint Davies]

On a point of order, Mr McCabe. Like you, I sit on the Panel of Chairs. I was here for the first one and a half hours of the debate, and I had to leave the room for 20 minutes. I have introduced a Bill on sugar, and I was wondering whether I could crave your indulgence and make a small contribution, given that the debate is meant to go on until 7.30 pm.

[Steve McCabe (in the Chair)]

You are welcome to intervene in the debate, Mr Davies, but we have moved on to the winding-up speeches.

[Geraint Davies]

I appreciate that, but I was wondering whether you might exercise some discretion.

[Steve McCabe (in the Chair)]

No, we are going to continue with the winding-up speeches.

[Barbara Keeley]

I was saying that I have concerns about how children and their families manage in the school holidays. For anyone who has not heard about it, I want to commend the Feeding Birkenhead project, and the work done on it by my right hon. Friend the Member for Birkenhead (Frank Field). The project makes sure that children have healthy food in the school holidays. It is sad that we need to think about that issue, but we do.

Between April and September 2015, Trussell Trust food banks in Greater Manchester gave more than 22,000 lots of three-day emergency food supplies to people in crisis. Of those, nearly 9,000 were directed to children. We have talked about choice, but if we think this through, we realise that, if families rely on food banks to feed their children, that will limit the number of healthy meals they can make with fresh food. Clearly, for people in the upsetting circumstances of not managing financially, feeding their child with something is better than seeing them go hungry.

At the start of the debate, we heard about people who do not have local shops that sell healthy food, and we have to take that into account, too. Some people are also fuel-poor, while others work a number of jobs, which leaves them with little time to cook. We must not, therefore, jump to conclusions about why people are in this situation.

We should look at the wider issues around poverty, which must be addressed to ensure that people can access a good-quality diet. There is an awful lot more to achieving a good-quality diet than just wanting to do that. How, therefore, does the Minister plan to help families that have to rely on food banks? Next weekend, I will be helping the Trussell Trust food bank to collect food in my local supermarkets. On a previous occasion, one donor gave me lots of vegetables—onions and things like that. I thought they were part of her shopping, so I ran after her to give them back. However, she said, “That is just to liven the donations up. All the packet food seems a bit dull.” However, that is not the way Trussell Trust food banks operate—they have to have packet and tinned food. We have to think through what is happening in families where there is a reliance on donated food, which will not always contribute to a good enough diet.

Education must play a significant role. We want to provide children and adults with information about how they can achieve a healthy diet. One of the most interesting things Jamie Oliver has done—it was not his recent interventions here in the House—was his programme showing people how to cook. There were families that existed entirely on one or two sorts of takeaway.

[Geraint Davies]

Does my hon. Friend accept that, if one wanted to make money out of a potato, the easiest way to do that would be not to sell it, but to smash it up, mix it with salt, sugar and fat, reshape it into something called “Dennis’s Dinosaurs”, freeze them, give them a jingle and sell them cheaper than a potato to get addicts of sugar and other additives for manufacturers? Should we not, therefore, focus on providing lower-priced fresh food, and on increasing the price of sugar-impregnated food?

[Barbara Keeley]

As I was saying, we should look at the whole range of options. I want to talk about health campaigns. The Public Health England campaign Change4Life is an excellent example of providing families with information about small changes they can make to improve their health, as well as with advice on healthy recipes, diet and exercise. However, I fear that the announcement of a 25% cut to the non-NHS part of the Department of Health’s budget will have a significant impact on Public Health England. I want public health bodies to be able to continue campaigns to tackle obesity, but I am worried that their ability to do so will be damaged by these significant cuts. I am concerned that we will not in future be able to fund campaigns such as Change4Life, and that they may just not happen.

We must also be careful that the huge cuts to the public health grant given to local authorities do not reduce the advice and support available to those wanting to lose weight. At many community events in Salford, I have seen health improvement staff working with community groups and running all kinds of sessions. I fear that we will not have that in future.

Although the debate is about a sugar tax, I want to mention the importance of increasing physical activity among adults and children. I was a member of the all-party commission on physical activity, which published its report “Tackling Physical Inactivity—A Coordinated Approach” in 2014. We have discussed various aspects of our children’s health, but inactivity is a key factor, which is why a number of Members have referred to it. It is important that we encourage children to maintain active lifestyles from an early age.

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[Barbara Keeley]

I thank the hon. Lady for that intervention, but I think it is a bit too easy to lose sight of physical activity, and that is why I have raised the issue. I hope we can be brave and bold about these issues too—it is good to be brave and bold about children’s health, but let us cover all the issues.

It has been said that treating obesity and its consequences alone costs the NHS more than £5 billion a year. It is great that we are having this debate, because we are past the point where we can just let things trundle along. Let me come to the crucial point in the debate. Public figures such as Jamie Oliver have come out in support of a tax on sugar, and he has added stardust to the debate. However, this is a complex issue, and the solutions must deal with that complexity. We know that something must be done, but what is that something?

The problem goes deeper than the demand side. The food and drink industry has not been dealing with the real problems. A number of hon. Members have talked about the Government’s responsibility deal, which has not worked. Firms have made promises and then failed to carry out their pledges. We have talked about labelling, which I will come on to. Many of the suggested interventions involve better labelling of products, but research by a team at the London School of Hygiene and Tropical Medicine suggests that interventions that improve information about and awareness of the risks do not necessarily translate into positive behavioural change.

As has been touched on, the responsibility deal focused mostly on salt, which was perhaps welcome. There have been real moves in that area, although every time I have a bowl of tomato soup these days, I regret that it does not taste like it used to. It is clear that salt is being taken out of our diets, but not sugar, which is the focus of our debate. The research team also found that although responsibility deal partners claim there has been “considerable sugar reduction” under their calorie reduction pledge,

“the current progress reports do not substantiate these claims.”

In fact, responsibility deal partners say they have reduced sugar levels under the calorie reduction pledge, but they have not.

[Geraint Davies]

On the relationship between sugar and calories, is my hon. Friend aware of emerging science showing that if two people both eat, for argument’s sake, 2,000 calories a day, and one has a history of eating a lot of sugar, that person will be predisposed to convert more of the sugar to fat than the other person, irrespective of the amount of exercise they do? That is a particular reason we should target sugar.

[Barbara Keeley]

I did not know that; my hon. Friend clearly has background knowledge and experience that I do not.

I want to come back to the responsibility deal, which is important in terms of the Government’s approach. That deal is seen as flawed because firms were allowed to decide what pledges they signed up to, and there were no penalties for those that did not honour their promises or, indeed, take part at all. At the time of the responsibility deal’s introduction, organisations such as the BMA, the Royal College of Physicians and Alcohol Concern complained that the pledges were not specific or measurable and that, in fact, the food and drink industry had simply dictated the Government’s policy. We have to get away from that.

The Minister will tell us more about a sugar tax, but it seems that the Prime Minister has ruled out action on sugar, despite the independent report commissioned by the Department of Health. That leaves me wondering whether the Government are listening to vested interests, instead of the experts whom they commissioned to write the report. The corporations that make the bulk of sales of sugary drinks in the United Kingdom want to maximise profits for their shareholders. They will not voluntarily lower the amount of sugar in their drinks unless there is something in it for them, or unless they are required to do so by law. Likewise, they will not reduce the amount or nature of advertising of sugary drinks—not voluntarily, anyway.

We must look back to what happened with the tobacco industry, which consistently pushed for a voluntary approach to avoid legislation. The industry trundled along, smoking continued unabated and profits were left alone. In my local authority, Salford, smoking was increasing at levels that really concerned me, particularly among young people. However, once specific regulations were introduced, such as warnings on cigarette packets and the blanket ban on smoking in enclosed spaces, smoking levels started to decline. I am therefore inclined to think that one of the most effective remedies would be a modest but compulsory reduction in the amount of sugar in soft drinks. A fiscal solution such as a sugar tax could well form part of the solution, but the Opposition retain a concern about the impact that extra taxes will have on the pockets of parents, as has been mentioned, particularly in low-income families. If we have learned any lessons from what happened with the tobacco industry, it is that intervention will need to involve legislation.

The report produced by Public Health England makes a number of recommendations, which Opposition Members will study in full. We believe a fiscal solution such as a sugar tax may be necessary, but we are not yet fully convinced. As a number of Members have said, we should not focus on one thing as a silver bullet. The Opposition will consider all the evidence on what can be done to tackle childhood obesity as we review our policy over the coming weeks and months.

This has been a high-quality debate. I hope that the petition and the debate will ensure that the Government do not repeat past mistakes with voluntary approaches such as the responsibility deal, which has generally been seen to have failed. I urge the Minister to look at a wide range of activities to tackle childhood obesity, including doing much more on physical inactivity.

[The Parliamentary Under-Secretary of State for Health (Jane Ellison)]

What an excellent debate we have had. It has been a real pleasure to listen to so many extremely well-informed contributions. Let me start by acknowledging the strength of public feeling about the issue. We are responding today to an e-petition with a great many signatories, and I thank everyone who signed it. I also praise the passion and commitment shown by Jamie Oliver, as other Members have, in raising the profile of healthy eating and, in particular, the impact of sugar on our diets and health. I will attempt to respond to most of the specific points made, but I am a little constrained by the timing of the debate.

Let me reflect on where we start from. A number of Members have cited the current obesity statistics. The most recent figures, published only last Thursday, show that there has been a relatively small overall change in overweight and obesity prevalence in the past five years. In that sense, levels remain unacceptably high, but there is a degree of stability. We saw some slight encouragement in the figures for children in reception, but we then see obesity prevalence more than double between reception and year 6. As the Chair of the Health Select Committee, my hon. Friend the Member for Totnes (Dr Wollaston), and others have rightly underlined, there is a very wide gap in obesity prevalence between the most deprived and the least deprived areas. I share the deep concerns expressed in all parts of the Chamber about that.

We have seen some good progress made on school food in recent times, so there are reasons to think this is a good moment to move forward, as there are areas in which we have encouraging building blocks. This debate, alongside the Health Select Committee report published today, is a valuable and timely opportunity for Members to make their views known at a critical juncture in the development of our comprehensive cross-Government childhood obesity strategy. That is a perfectly sensible reason for the timing of this debate and the publication of the Committee’s report; it is extremely helpful to have them.

Earlier in the debate, one Member wondered whether I was feeling isolated. Far from it: it has been wonderful to spend the past few hours with Members from across the House who feel as passionately as I do about tackling this issue and, in particular, to hear the challenge of tackling childhood obesity framed in the context of improving the life chances of so many children, particularly those from the most deprived communities. That is certainly a strong strand of my thinking as I look at this issue. I have listened carefully to the comments made and will look in greater detail at the Select Committee’s report, to further inform our ongoing policy development.

It is no secret that the Government have no plans to introduce a tax on sugar, although all taxes are kept under review. Such decisions are a matter for the Chancellor, as part of the Budget process. That being said, driving sustained behaviour change will require broad-ranging and concerted action of the kind we have discussed. It is extremely welcome that, whatever Members’ views on a sugar tax, there is consensus across the House on the fact that there are no silver bullets in this debate. That is a really important point.

[Geraint Davies]

I happen to have introduced econometric modelling to Unilever. Would the Minister accept that if a sugar tax is introduced, less sugar will be consumed, and the Government will make money and save money on the health service? Is it not a no-brainer? What is the justification for her resistance to this obviously sensible measure?

[Jane Ellison]

I will touch on some of those points, but I want to take this opportunity to update the House on what we are already doing, to give some sense of our direction of travel and, in particular, to reassure people who have been urging us to look widely at a whole range of things beyond the silver bullet arguments. I hope to give some reassurance in the course of my remarks that we are, indeed, doing that.

[Geraint Davies]

What is the Minister’s justification for not introducing this measure?

[Jane Ellison]

Unless the hon. Gentleman continues to chunter at me from a sedentary position, I will come to the vital issue of teaspoons, about which he and I have spoken before, and upon which a number of Members have remarked.

Today, I will principally talk about some of the steps the Government are already taking to improve children’s health, particularly in relation to food and diet. I fear my response is rather limited in its scope by the proximity to the publication of our strategy, but I want to reassure Members that this is a major priority and a manifesto commitment of the Government. There is no argument from us about the scale of the challenge, which has been outlined well in a number of speeches today. As I said, I passionately agree with the Chairman of the Health Committee, my hon. Friend the Member for Totnes, about the impact on health inequalities of childhood obesity, so there is no argument there either.

We can all agree, and have all agreed, that as a society we are eating too much sugar. It is bad for our health and can lead to excess weight gain. That, in turn, increases the risk of heart disease, as other have said, as well as type 2 diabetes—my hon. Friend the Member for Erewash (Maggie Throup) gave a very good speech about that—stroke and some cancers. The link to tooth decay has also been brought out in a number of very good speeches.

I was interested to hear the, as ever, extremely well informed contribution from the hon. Member for Central Ayrshire (Dr Whitford). As a very distinguished clinician, she will be aware of the links between obesity and many of the big health challenges of our age, but I think that is less well understood more generally in the population. We need to talk more about that—I have challenged a lot of our major charities to talk about it more—so that people become as understanding of that as they have of the link between tobacco and some of the very significant disease groups.

However, public awareness is increasing. In recent evidence, 92% of people said that they were trying to manage or reduce the amount of sugar in the foods that they buy, while 26% of households were very concerned about sugar in food and 30% reported being more concerned than they were a year ago. Concern was higher for sugar than for fat or salt.

Before I talk about the report by the Scientific Advisory Committee on Nutrition, I would just say that I regret the comments made by the hon. Member for Newport West (Paul Flynn), who is not in his place. He spoke about some extremely respected clinicians—members of that committee—who have done great service not just to the committee, but to the nation’s nutrition more generally. The point was made very well by the hon. Member for Heywood and Middleton (Liz McInnes) about transparency and the need for people to declare their interest. That is all done by the members of that committee, and I want to thank them, on behalf of the Government again, for the work they have done for the committee’s report on carbohydrates and health, which it published in July. I accepted, on the Government’s behalf, the report’s recommendations, which were that no more than 5% of energy in our daily diet should be from sugar. That is the equivalent of about seven sugar cubes or five or six teaspoons and there are wider implications for the general dietary advice from the Government from that policy shift. We are working through those with Public Health England.

As the House knows, and as many speeches have touched on, we are currently consuming more than double the recommended limit for sugar, and teenagers’ consumption is nearly three times the recommended level. Again, we are under no illusion that we need to take action in this area. Earlier in the year, I requested that Public Health England prepare evidence for the Government on effective approaches for reducing sugar consumption. That is the report that the Health Committee has had chance to respond to.

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[Geraint Davies]

As the Minister would accept, there is an elasticity of demand for any product—namely a relationship between the price and the demand. Will she focus a few comments on why precisely she is resisting simply putting up the price of sugar through a tax? I appreciate what she said about my hon. Friend the Member for Newport West (Paul Flynn), but if no reasons are being given, he probably cannot understand why. If there is no rational reason for doing so, he is assuming it is because of the lobbyists.

[Jane Ellison]

That is not right. Again, I come back to the point stressed in the report by Public Health England—indeed, the Health Committee’s excellent report underlines it—that there is no silver bullet. It is really important that we address the fact that a number of wide-ranging issues need to be tackled and that several options are available to us in policy terms. PHE concluded that no single action on its own will be effective in reducing the nation’s sugar intakes. Its report shows evidence to suggest that higher prices in targeted high-sugar products, such as sugar-sweetened drinks, tend to reduce the purchases of such products in the short term.

Mention was made of the possibility of Cochrane reviews in coming years. An interesting article in the current issue of The Economist notes that the longer-term effect on public health is as yet unknown. Obviously that is because in most cases these measures have not been in place long enough, but it is an important concern—and the hon. Member for Swansea West (Geraint Davies) will have noted a degree of reticence on the part of those on his own Front Bench about the evidence, but anyway. We are, of course, well aware of what Public Health England said in its report about the evidence on higher prices. However, its report also argued strongly for implementing a broad, structured programme of parallel measures across all sectors, if we are likely to achieve meaningful reductions in sugar intakes across the population. As we have heard, it identified areas for action that include restrictions on marketing, advertising and price promotion, and work to reduce levels of sugar in food and drinks—I welcome the focus of a number of speeches on reformulation of product, as we think it has a significant role to play. Areas for action also included improving public food procurement and improving knowledge about diet and nutrition. We are considering all the evidence and working closely with Public Health England to develop our policies.

A number of Members have talked about education. This debate provides the opportunity for me to talk in more detail than I generally can in such debates about the Change4Life programme, in which we continue to invest significant sums. The Change4Life campaign has provided motivation and support for families to make small but significant improvements to their diets and activity levels. Last January, Change4Life’s Sugar Swaps campaign encouraged families to cut back on sugar through two TV advertisements focusing on sugary drinks and after-school snacks. That campaign also included radio, digital and outdoor advertising.

--- Later in debate ---

[Jane Ellison]

As the hon. Lady will see, the campaign is going to be very significant again this coming January, so as I say, we continue to invest significant sums. It is a very important campaign and a very important brand that is being developed, and we see it as something we want to build on.

[Geraint Davies]

Will the Minister give way?

[Jane Ellison]

I am going to make some progress and develop my point about Change4Life, because Members have asked questions about that.

The campaign included radio, digital and outdoor advertising; public relations and media partnerships; work with 25 national food retailers and manufacturing partners; community events and schools programmes; and, importantly, work with all 152 local authorities. More than 410,000 families registered with the last campaign. Families who signed up purchased 6% less sugary snacks by volume and 6% less sugary puddings by volume, while increasing consumption of lower-sugar snacks and puddings. For each person who signed up, another two in the general population said they had also made a food swap.

The Change4Life team is developing the next Sugar Smart campaign, to launch in early January 2016. The campaign will alert families to the problems of consuming too much sugar, reveal the amount of sugar in the most popular food and drink and tell them about the new guideline daily amounts. It will encourage people to download the Sugar Smart app, which I have seen being used and is very impressive—hidden sugars no more, I can assure the House. People will be able to see for themselves how much sugar is in the products they are buying. The campaign will include advertising on TV and online and posters, in addition to social media activity and PR. Five million information packs will be given to families through schools, commercial partners and local authorities, and there will be digital support to help families who want to cut back on sugar.

However, obesity is a complex issue, which the Government cannot tackle alone.

[Geraint Davies]

Will the Minister give way?

[Jane Ellison]

I am going to come on to teaspoons, and I do not want to run out of time before I do so. I will make a bit more progress and then see how we are getting on for interventions.

The Government cannot tackle obesity alone. I welcome the fact that we have consensus across the House on that, and the Committee draws that point out in its report. Businesses, health professionals, schools, local authorities, families and individuals have a role to play, as my hon. Friend the Member for St Austell and Newquay (Steve Double) brought out.

I want to talk about some of the industry action that has been taken. There has been progress in recent years on reducing sugar consumption. The focus under the voluntary partnership arrangements, which have been discussed, has been on overall calorie reduction, of which sugar can form a part. Billions of calories and tonnes of sugar have been removed from products and portion sizes have been reduced in some areas. Some major confectionery manufacturers have committed to a cap on single-serving confectionery at 250 calories, which is an important step.

We have to be realistic about consumer relations, which are important. Before I was an MP, I worked for the John Lewis Partnership—John Lewis and Waitrose—and I know only too well the important role that retail relationships play in an average family’s life. We need to involve those partners. Some retailers have played a part, for example by removing sweets from checkouts. Interestingly, they did so after asking their customers in surveys what support they wanted, as family shoppers, from industry to help them to make healthier choices. Much of the action that retailers have taken was in response to that.

I was very interested in the point that my hon. Friend the Member for Salisbury (John Glen) made in an intervention about consumer power. There is much greater consumer power to be unleashed, but the challenge to the industry to make further substantial progress remains. Like the Chair of the Health Committee, I have had some encouraging conversations in that regard, but we need to make more progress.

Providing clear information to consumers to help them make healthier choices is important, as a number of hon. Members have set out. The voluntary front-of-pack nutrition labelling scheme, introduced in 2013, plays a vital part in our work to encourage healthier eating and to reduce levels of obesity and other conditions. The scheme enables consumers to make healthier and more balanced choices by helping them better to understand the nutrient content of foods and drinks.

I turn to the issue of teaspoons of sugar, which has come up a lot in the debate. It is more complicated than something so simple should be; “teaspoons” sounds straightforward, but labelling is an EU competence, so member states cannot mandate additional forms of expression, such as spoonfuls of sugar, for pre-packed food. Under EU legislation, it would be possible for companies to represent sugar content in the form of spoons of sugar or sugar cubes on a voluntary basis, as long that met a number of EU criteria—I will outline what some of them are. It would sit alongside front-of-pack nutrition information, which I remind the House is voluntary, not mandated, in order to meet the same criteria.

--- Later in debate ---

[Jane Ellison]

As we approach the transposition of the new EU tobacco directive, the hon. Lady will see that the measures being taken are EU-wide, but those are two slightly different things. I am happy to come back to her in more detail after the debate, but generally speaking, packaging and labelling are EU competences.

I was delighted to hear so many hon. Members say that front-of-pack labelling was important. The scheme is popular with consumers. It provides information on calories and levels of specific nutrients in an easy-to-read, intuitive format. Businesses that have adopted the scheme account for two thirds of the market for pre-packed foods and drinks. Within the Change4Life programme, front-of-pack colour-coded nutrition labelling will continue to be included as a key message whenever there is a campaign focused on healthy eating. We use that in all the Change4Life materials, across a wide range of formats.

I want to reassure the hon. Member for Worsley and Eccles South (Barbara Keeley), who spoke from the Opposition Front Bench, that there will indeed be a physical activity strand in our childhood obesity strategy. I agree with the balance that the Health Committee struck on tackling childhood obesity, which is an important strand of the work. The great news about physical activity, as the Committee’s report underlined, is that it is good for everyone, whatever their weight. There is no downside to being more physically active, so of course we will want to reflect that.

This has not been touched on much this afternoon, but there is also a significant role for the family of health professionals in giving advice and supporting families to make changes to their lives. That relates particularly to families in more deprived communities. Only this morning I was talking about the role of health visitors, for example, in family education and family support. Again, a strand of our strategy will develop that.

[Geraint Davies]

Will the Minister give way?

[Jane Ellison]

Yes, but this will be the last intervention I take, because I want to leave time for the hon. Member for Warrington North (Helen Jones) to respond at the end of the debate.

[Geraint Davies]

I simply want to ask whether there will be any space for views to be heard on restricting advertising, whether that relates to high-sugar products being described as low-fat products, to watersheds or whatever. In the same way as we imposed restrictions on the advertising and pricing of cigarettes, will the Minister come forward with any suggestion on restricting advertising in this case?

[Jane Ellison]

We have already said that the childhood obesity strategy will be a comprehensive, cross-Government strategy. I commissioned advice from Public Health England, and of course I have been working closely with that organisation on policy development for many months now. I am paying close regard to the advice that it has provided us with, and I welcome the fact that the Health Committee found it so useful in producing its report.

I welcome the debate as an opportunity to respond to the important campaign on the e-petition and the important new Select Committee report. It is a timely opportunity. I want to reassure the House that the Government are considering a wide range of options for tackling obesity, and particularly for reducing sugar consumption among children and the wider population. I hope the House agrees that all of us—central Government, local government, the industry, schools, families, communities and individuals—have a part to play. I will reflect carefully on the speeches that I have heard today, on the Committee’s recommendations and on its overarching challenge to us to be “brave and bold”—a message that I have heard loud and clear this afternoon. I look forward to making progress, and I very much look forward to publishing our childhood obesity strategy in the new year and making progress throughout this Parliament, and indeed well beyond it, on one of the greatest health challenges of our age.

--- Later in debate ---

[Geraint Davies]

Will my hon. Friend give way?

[Helen Jones]

No, I am winding up; I am sorry. The health of our children demands action now. If we do not take such action, we will see much more illness in our society, much more drain on the NHS and a poorer life for all of us in the future.

Question put and agreed to,

Resolved,

That this House has considered e-petition 106651 relating to a tax on sugary drinks.

NHS Success Regime

Geraint Davies Excerpts

Thursday 4th June 2015 Commons Chamber

[Ben Gummer]

This is not about moving resources around the country. I must say that I differ with my hon. Friend on his views about the CQC. It was a complete basket case when the Government came to power in 2010, but it has since been turned around and is now providing exceptional inspection regimes, which is changing the whole nature of safety and quality in the NHS. I hope that it will continue to improve.

[Geraint Davies (Swansea West) (Lab/Co-op)]

The Minister says that there are systemic issues in Devon, Cumbria and Essex. Did the National Audit Office confirm that, and did he know that before the election? Why did he not reveal his hand then to say that he would intervene in one or more of those areas, or is he simply playing politics with patients’ lives?

[Ben Gummer]

The hon. Gentleman should know that there have been issues in those areas not just for months and years, but sometimes for decades. We have sought in the first instance to deal with problems with providers, which is why in two of the areas we have hospitals in special measures, or formerly in special measures. We are now seeking to fix the problems in the wider local health economy, led by local people. We are getting on with that, rather than just talking about it, which is what happened before.