Health and Social Care Bill

Lord Brooke of Alverthorpe Excerpts

Tuesday 11th October 2011 Lords Chamber

[Lord Brooke of Alverthorpe]

My Lords, I want to address my remarks to Clauses 8 and 9 on protecting and improving public health. As we all know, if we could move public health policies higher up the agenda and seriously start to address some of the fundamental health problems facing us, the savings that would accrue would not only lead to a better lifestyle for many of our population but go a long way towards easing the financial problems facing the NHS.

The major health problems confronting us have not just descended on us. It is worth recalling that it is now nearly a decade since Sir Derek Wanless was asked to look into the NHS. In 2002, he produced his first report in which he forecasted that, unless people can be persuaded to lead healthier lives, NHS costs would spiral out of control. He suggested a number of options for the way forward, ranging from, on one side, full engagement with the public health agenda to, at the other extreme, a minimal programme and uptake at fairly minimal expenditure compared with the rest of the NHS budgets. If the latter option were chosen, he warned that the NHS would have to meet additional costs of £30 billion a year by 2020.

Wanless was then asked to do a further piece of research and, in 2004, he delivered a report focusing on transforming the NHS from what he described as basically a national sickness service into one that was about preventing sickness, which is now proving so prohibitively costly to us. He offered a range of ideas, including a ban on smoking in public places, taxing fatty foods and boosting physical activity, with the main onus on motivating individuals to take better care of their health. He identified the main threats which could reach epidemic proportions as being obesity and its related illnesses, alcohol abuse, smoking and sexual health issues. That was back in the early part of this new century and those issues are still before us. His report anticipated that, unless positive actions were taken to improve public health, by 2050 we could expect 60 per cent of our men and 50 per cent of our women to be obese, with 25 per cent of our children falling into that category, with a consequentially steep rise in heart disease, strokes, cancer and diabetes.

Regrettably, as we all know, Wanless’s warnings have not been heeded and acted on. Since then, there has been only one significant major lifestyle change for the better: the ban on smoking in public places. Notwithstanding the brickbats which he has received recently, I congratulate our former Prime Minister Tony Blair on having the boldness and the guts to stick with that and to force it through against some very severe opposition at the time. Regrettably, we did not maintain the same fervour for driving through the other changes needed.

The issues that clearly stick out are fatty foods, sugar and alcohol. The drink and food industries were successful in persuading us that self-regulation was the way forward rather than resorting to legislation. There have been some self-regulated changes since, such as the traffic-light labelling on excessive fat, sugar, salt and calories. Not surprisingly, the industry even disagrees among itself about how that should be put forward and we have ended up with two sets of traffic lights, which leads to confusion among the public. Self-regulation has moved in the right direction, but not particularly well and at a very slow pace.

In the mean time, we now have even more worrying forecasts about the spread of obesity and related illnesses, and the facts on alcohol are equally depressing. Average consumption of pure alcohol has nearly doubled from fewer than six litres per person in 2000 up to 11.5 litres in 2008. Alcohol, which is now 62 per cent cheaper than it was in 1980, makes a major contribution to obesity, weight gain and problems such as diabetes which are often associated with obesity.

I know that the noble Earl has been very busy recently but he may recall that I recently asked him a Written Question on this topic. I asked him when the Government,

“last had discussions with the food and drink manufacturing industries about adding information on calorie contents to the labels of alcoholic drinks; and what was the outcome of those discussions”.

His response stated:

“The Government have not met the food manufacturing industry about adding information on calorie contents to the labels of alcoholic drinks.

The department last discussed the inclusion of calorie information on alcohol labels with the Portman Group early in March 2011. The Portman Group's guidelines on alcohol labelling refer (in paragraph 3.11) to the possibility that individual companies may wish to trial presentations of such information on labels”.—[Official Report, 3/10/11; col. WA 95.].

We shall wait and see what happens on that with the Portman Group. That kind of response raises little optimism for me about self-regulation and about the value and effectiveness of the long-awaited strategies that are coming on obesity. The same applies to the long-delayed publication of the coalition’s strategy on alcohol.

On a pleasanter and more supportive note, I am very pleased that the Government have decided to devolve some of the public health issues down to localities. However, those of us who tried recently to amend the alcohol licensing provisions in the recent Police Reform and Social Responsibility Bill, to extend the criteria for granting licences to sell alcohol to take into account public health consequences, ran straight into a brick wall with the Government. I would have thought that giving localities the power to deal with wide-scale issue of licences in many areas, which many local medical people oppose, was the kind of issue that, under the devolved arrangements set out before us, would be embraced with alacrity by the Government, but they rejected it.

Like others who have spoken today, I have considerable confidence in what the Minister does within this Chamber. I should like him to try to convince me that the new health and well-being bodies that are going to be established will have some real teeth and will not end up merely as talking shops for canvassing views and establishing strategies and needs, which in reality will deliver little more than did many of the strategies that my own Government produced in recent years.

I should also like to ask the Minister, based on a briefing which he gave recently, whether it is intended that local bodies will be required to operate within the strategies which have been drawn up at national level. That was my understanding of what he said. If so, I shall be concerned that we may end up with weak central strategies leading to weakness down the line. What facilities will there be for people to amend the national strategies at a faster pace than has normally been the case in the past?

Finally, I come back to where Wanless took us in the early part of this century. We have two options. The first is minimal spend on public health policies and continuing difficulties with alcoholism, obesity, sexual health and so on; the other is spending even more money on public health in the future than we have in the past. Are the Government prepared truly to pin their colours to effecting a major change there, so that we can see a shift in the allocation of the money being spent on public health within the NHS budget?