Health: Liver Disease

Lord Brooke of Alverthorpe Excerpts

Tuesday 6th May 2014 Lords Chamber

Asked by

[Lord Brooke of Alverthorpe]

To ask Her Majesty’s Government whether they will produce a strategy to reduce liver disease.

[The Parliamentary Under-Secretary of State, Department of Health (Earl Howe) (Con)]

My Lords, improving outcomes for people with liver disease is a priority. Public Health England has a wide-ranging programme aimed at tackling its three major causes—viral hepatitis, alcohol abuse and obesity—through strengthening local action, promoting healthy choices and giving appropriate information to support healthier lives.

[Lord Brooke of Alverthorpe (Lab)]

My Lords, I gather from that that the Government are not prepared to consider introducing a strategy, which is a great pity given that liver disease is now the fifth biggest killer and we have some of the worst figures in the whole of Europe. How does the Minister see a more general approach, rather than a specific target in a strategy, producing a change in the terrible figures which we now see in the number of deaths, given that the deprived areas of the country where most of them occur, such as Manchester, had a reduction in the funding to commissioners and GPs for this purpose last month?

[Earl Howe]

My Lords, as the noble Lord is aware, NHS England is responsible for the overall national approach to improving clinical outcomes for people with liver disease. At the moment, it has no plans to produce a strategy specifically for liver disease, but it is adopting a broad strategy to reduce premature mortality, including mortality from liver disease. There is a major emphasis in the work being done by NHS England and Public Health England on prevention. They are supporting clinical commissioning groups and local authorities with a suite of tools to help them maximise the best possible outcomes for their local communities, such as local authority profiles. That can help local authorities and CCGs indentify the significance of liver disease in their area compared to the rest of the country, and the actions they could take to tackle it.

Alcohol: Calorie Labelling

Lord Brooke of Alverthorpe Excerpts

Thursday 13th March 2014 Lords Chamber

Asked by

[Lord Brooke of Alverthorpe]

To ask Her Majesty’s Government, further to the answer by Earl Howe on 11 February (HL Deb, col. 535), whether they will publish a list of the alcohol producers and retailers who have pledged themselves voluntarily in the Responsibility Deal to display the calories and sugar content of the drink on the labels of their alcohol products.

[The Parliamentary Under-Secretary of State, Department of Health (Earl Howe) (Con)]

My Lords, we welcome companies such as Sainsbury’s, which have taken action in this area. While there is no responsibility deal pledge to voluntarily display energy and sugar content on the labels of alcohol products, we will continue to consider what more can be done through the responsibility deal to improve public health, including through consumer information.

[Lord Brooke of Alverthorpe (Lab)]

I am truly grateful to the noble Earl for the efforts he has been making to try to persuade the drinks industry and the supermarkets that they have to accept some responsibility for the damage to health that alcohol causes. From the pledges he has been given by the producers and the supermarkets, can he say how many have as yet actually displayed calories and sugar on the labels of their lagers and beers? While I acknowledge that progress is happily now being made with wine, will he say what he intends to do, given that Tesco and Morrisons have now publicly stated that in no way will they go down this route?

[Earl Howe]

My Lords, I mentioned Sainsbury’s, which is setting a very good example in this area, but I can tell the noble Lord that Waitrose and the Co-op have also taken steps to display calories on their own-brand alcohol labelling. Naturally, we hope that others will follow their lead. As yet, none has, and it is a pity that Tesco has said that it will not, but we will continue to work on this issue. Work is also going on at a European level, and the noble Lord may like to know that the UK pressed for mandatory energy declarations during negotiations on the EU Food Information for Consumers Regulation. It met with significant resistance, and we did not succeed, but we are still pressing for that.

Food and Soft Drink Industry: Sugar

Lord Brooke of Alverthorpe Excerpts

Tuesday 11th February 2014 Lords Chamber

[Earl Howe]

My noble friend raises a series of important issues. I can tell her some encouraging news on this front. Sainsbury’s and Tesco, for example, have pledged to reduce the sugar content in their own-brand soft drinks. We are asking other supermarkets to follow suit. I think that the noble Baroness will be aware that Lidl made an encouraging gesture the other day in pledging not to display sweets at till exits. However, we are working across a range of areas, not just reformulation of food but pack size, introducing low-sugar or no-sugar alternatives, and looking at ways in which food is promoted.

[Lord Brooke of Alverthorpe (Lab)]

Will the Minister please explain why in his first Answer he referred only to the food and soft drinks industry? Why did he not refer to the alcoholic drinks industry? Is it not true that, in the 130 meetings which the Government have had with the drinks industry since 2010, no progress whatever has been made on persuading it voluntarily to show calorific effects and sugar content on the labels of its products?

[Earl Howe]

No, my Lords, that is not so. Ninety-two producers and retailers committed through the responsibility deal to having 80% of bottles and cans on sale in the UK displaying unit and health information and a pregnancy warning by the end of 2013. The three elements that industry has committed to display on labels are: the drink’s unit content, the Government’s guidelines for lower-risk drinking, and pregnancy warnings. I argue with the noble Lord that this is progress.

Public Health Responsibility Deal

Lord Brooke of Alverthorpe Excerpts

Tuesday 14th January 2014 Lords Chamber

[Earl Howe]

My noble friend is absolutely right to place his finger on a central point that, in the end, it is up to individuals to take responsibility for their own state of health.

[Lord Brooke of Alverthorpe (Lab)]

My Lords, if individuals are required to take responsibility but they do not know what they are consuming because the manufacturers or producers do not let them know, or indeed the Government are complicit in not pressing those manufacturers to let people know what they are consuming, should there not be a responsibility on the Government? For example, no one knows the calories in alcohol. There has been no change since this responsibility deal was introduced and there is no change in prospect.

[Earl Howe]

My Lords, under the responsibility deal, 92 producers and retailers have committed to having 80% of bottles and cans in the UK displaying unit and health information and a pregnancy warning by the end of last year. That is a worthwhile step forward. As regards the calorie labelling of alcoholic drinks, that, as the noble Lord will know, is an EU competence. It is subject to discussion at this time, but most large retailers include the calorie content of alcohol products on their websites, and that information is also available elsewhere.

NHS: Walk-in Centres

Lord Brooke of Alverthorpe Excerpts

Tuesday 10th December 2013 Lords Chamber

[Earl Howe]

Yes, my Lords, and that is exactly why Sir Bruce Keogh has been tasked to look system-wide not simply at walk-in centres but at the entire community and urgent and emergency care network to make sure that patients go where is most appropriate for them, that there is not undue pressure on any single part of the system, and that tariffs reflect the right balance of patient flows.

[Lord Brooke of Alverthorpe (Lab)]

My Lords, if there is an expectation that there should be consultation with patients and it does not take place, who is accountable for that failure?

[Earl Howe]

In some cases, a change of services will be so minor that formal consultation with patients is not required under the existing rules if, for example, a service moves a few yards down the road or something of that kind. However, it is the responsibility of the commissioner—either NHS England or a clinical commissioning group—to make sure that consultation where appropriate does take place.

Health and Social Care Act 2012: Risk Register

Lord Brooke of Alverthorpe Excerpts

Wednesday 4th December 2013 Lords Chamber

Asked by

[Lord Brooke of Alverthorpe]

To ask Her Majesty’s Government whether they will now publish the risk register prepared in advance of the passage through Parliament of the Health and Social Care Act 2012.

[The Parliamentary Under-Secretary of State, Department of Health (Earl Howe) (Con)]

My Lords, it remains the Government’s position that they will not be publishing the transition risk register. The decision to withhold the risk register was based on the principle that Governments, together with their civil servants, need to be able to consider all aspects of policy formation, including its risks, in private. It remains our view that a full and candid assessment of risk and the mitigating action required to manage it is carried out within a safe space.

[Lord Brooke of Alverthorpe (Lab)]

My Lords, the House will be grateful to the Minister for reminding us of the Government’s position and of what is in the public domain, but I remind him that the Question is about what the Cabinet and the Secretary of State decided should not be in the public domain. Is there no shame or embarrassment on the part of the Government, who have imposed, quite rightly, a duty of candour on the NHS but who decline to practise that policy themselves by being candid with the public, particularly with those of us who use the NHS? What are the Government hiding? If it is nothing, they should publish the register tomorrow and put it away.

[Earl Howe]

My Lords, the Government are fully committed to transparency and openness, but they need also to be able to manage large and complex projects and programmes efficiently and effectively. If requests for information are made that threaten to compromise their ability to do that, as is the case here, then the Government have to weigh up whether releasing what is being asked for is, on balance and bearing in mind the consequences, in the public interest. Up to now, we have taken the view that the public interest is not served by publication.

Tobacco Products Directive

Lord Brooke of Alverthorpe Excerpts

Tuesday 15th October 2013 Lords Chamber

[Earl Howe]

My noble friend is right. E-cigarettes certainly have the potential for being a force for good in helping smokers to quit. At the same time, we do not want them to become a gateway into smoking. The aim is to have licensed products that have demonstrated safety, quality and efficacy, and for such products to be available as widely as possible.

[Lord Brooke of Alverthorpe (Lab)]

Will the Minister take note of the fact that people have moved from heroin to methadone, which is less dangerous to them than heroin? In fact, we now have hundreds of thousands of people parked on methadone and there is no way in which we can get them off it. That is extraordinarily expensive for the country and bad for their health.

[Earl Howe]

I recognise the issue that the noble Lord raises, but perhaps that is a debate for another time.

NHS: Foundation Trusts

Lord Brooke of Alverthorpe Excerpts

Tuesday 16th July 2013 Lords Chamber

[Lord Brooke of Alverthorpe]

My Lords, given the Government’s commitment to the duty of candour in the NHS, can the Minister give us an indication of some of the reasons why there has been a long delay in the production of Sir Ian Carruthers’s report?

[Earl Howe]

My Lords, I am not aware of the underlying reasons why Sir Ian Carruthers’s report has not been released. As far as I am aware, that is a matter for NHS England. However, if I can enlighten the noble Lord, I will be happy to write to him. I can say that the programme for bringing trusts to foundation trust status has to be taken slightly more slowly than we thought was appropriate perhaps a couple of years ago. That is because of the Francis report. I make no apology for that, because it is right for trusts to take a longer and harder look at the issues that Robert Francis flagged up.

NHS: Accident and Emergency Units

Lord Brooke of Alverthorpe Excerpts

Wednesday 19th June 2013 Lords Chamber

[Earl Howe]

My Lords, yes, the whole patient journey should be looked at, including the role of social care in making sure that patients who are not seriously ill but need care can be looked after in their own homes or in a suitable residential setting.

[Lord Brooke of Alverthorpe]

My Lords, will the Minister be kind enough to enlighten us as to whether Ministers are under instructions these days to blame the NHS and its different levels for failings but to accept no responsibility for putting it right? I watch with increasing fascination the number of Ministers who are now attacking the way that A&E operates, although they are to blame. I heard a Minister the other day attacking GPs for failing to act in the way they should. At the end of the day, I wonder who is responsible for putting this right. The noble Earl said earlier that this is a not a “top-down” operation now. Who, then, is going to accept responsibility for the failings which are now starting to take place within the health service?

[Earl Howe]

My Lords, Ministers are responsible to Parliament for the provision of the health service so I do not duck that responsibility for a second. Nevertheless, Ministers do not manage the health service day-to-day and have never done so. We are involved day-to-day in the plans to ensure that we have a health service that is properly configured to meet the needs of patients. My right honourable friend the Secretary of State could not be more assiduous in the work that he is doing to make sure that that happens. Responsibilities are not being ducked; nobody is being blamed. The fact is that demand is going up considerably, and has been for a number of years. We need to address that and we need to do it cleverly. It is not always a question of piling more money in; it is looking at how the services are configured and delivering care in the right place.

Health: Anorexia

Lord Brooke of Alverthorpe Excerpts

Monday 25th February 2013 Lords Chamber

[Lord Brooke of Alverthorpe]

My Lords, I, too, am grateful to my noble friend Lord Giddens for promoting this very important debate. I commence by declaring an interest as a trustee of the charity Action on Addiction, which provides day and residential accommodation for people suffering primarily from drink and drug addiction, but additionally we have many people who are cross-addicted. We deal with people with eating disorders, gambling difficulties, sex addictions, nicotine problems and a whole list of difficulties. Invariably, it is unusual to find a person with just one addictive issue that we have to address.

Anorexia nervosa is an extraordinarily difficult disease to deal with. The level of success when people leave at the end of treatment is often fairly small by comparison with the progress that can be made when dealing with people with drug and alcohol addictions and indeed, to a degree, with those with obesity. It is on the obesity side—the other eating disorders—that I wish to address my remarks. I address them as a founding member of the All-Party Parliamentary Group on Obesity, which is due to be launched in Parliament on 16 April and is long overdue. I hope that there will be a good response to it from the Government.

Last week, I was moved when I read the report highlighted in the Guardian which referred to the UK as the fat man of Europe. The full-page coverage of the report from the Academy of Medical Royal Colleges referred to the almost unstoppable growth of obesity and said that the number of people falling ill with it is almost beyond what can be coped with by the NHS. The Academy of Medical Royal Colleges is united—as are many other people—in seeing obesity as a problem of epidemic proportions and one of the greatest public health crises currently facing the United Kingdom.

I wish to pose a number of questions to the noble Earl on that topic. Does he agree with what the Academy of Medical Royal Colleges stated last week? What do the Government think about the report? The academy wants a dramatic increase in efforts to counter obesity and has made 10 recommendations for action. Time does not permit me to go into those tonight, but I specifically ask the noble Earl to address one of them. It asks the NHS to spend at least £300 million over the next three years to tackle the serious problem of the shortage of weight management programmes so that more patients can be helped in a supportive and sensitive manner. Since reading this, it is difficult to find the extent to which support is currently being given. As I will tell the Minister in a moment, people indicate that that support is declining rather than increasing.

I also heard in the course of my inquiries last week that an estimate has now been made that more than 70% of the million people employed by the NHS are classed as obese. Could the Minister please make an observation on that? As the principal person responsible for employing them, could he say what he intends to do about it, as it is an area in which the Government have a degree of responsibility?

Secondly, last week, prompted by the prospect of this debate, I went to visit an outfit in south London called Discovery. It is an organisation in the private sector, verging on a charitable operation, which provides two levels of service: contracts with the NHS to provide direct weight management programmes for individuals who are obese and in real trouble; and training for people in the NHS and related bodies who are endeavouring to start weight management programmes for those who are classed as obese. Discovery tells me that it is extraordinarily fearful about what the future holds for it under the changed arrangements set out in the Health and Social Care Act, which comes into force on 1 April. It says that the PCTs, which previously provided funding and contracts, are now disappearing. The contracts are also disappearing and not being renewed anywhere. Many weight management providers are facing the possibility that, although we have this growth in obesity, unless something happens in April, they may well go out of business later in the year. This is apparently a fear held not just within the organisation I mentioned but elsewhere as well. Therefore, I would like to know what the Minister intends to do about the immediate problem faced by people in this arena, when all the calls are for greater investment, not less.