Health: Sugar Consumption

Lord Brooke of Alverthorpe Excerpts

Wednesday 6th February 2013 Lords Chamber

[Earl Howe]

My Lords, my noble friend may know that a UK-wide consultation on front-of-pack labelling was held last year. We published a formal response to it at the end of January. The responses identified a number of issues which we need to consider further and officials are working on those. However, my noble friend is absolutely right that not just the calorie content but the clarity of the messages around calories need to be clear not only to adults but to children.

[Lord Brooke of Alverthorpe]

Does the noble Earl know that drinking alcohol is a big factor in introducing sugar into the body? The drinks industry is totally exempt from any requirement to show the calorific effect of alcohol, or indeed its energy factors. Is the Minister happy that the partners in the responsibility deal within the drinks industry are taking no action on that issue, or is he prepared to say that the Government will push through the responsibility deal to try to bring about some change?

[Earl Howe]

My Lords, our alcohol strategy includes a commitment for the Responsibility Deal Alcohol Network to seek to make further progress on including energy information as part of the responsibility deal alcohol-labelling pledge. We have already secured provisions in recent EU labelling legislation that will enable companies to provide this information on a voluntary basis. The pledge on improving information for consumers in the off-trade area already includes a commitment to raise awareness of the energy content of alcoholic drinks, and we will continue along those lines.

NHS: Clinical Commissioning Groups

Lord Brooke of Alverthorpe Excerpts

Wednesday 16th January 2013 Lords Chamber

[Earl Howe]

Yes, my Lords. In this case, the board concluded that the formula proposed by ACRA accurately predicted the future spending requirements of CCGs, but it was concerned that the use of the formula on its own to redistribute funding would predominantly have resulted in higher levels of growth for areas that already have the best health outcomes compared with those with the worst outcomes. In other words, the formula on its own would have disadvantaged precisely the areas that the noble Lord is most concerned about. On the face of it, this would appear to be inconsistent with the board’s purpose, which is to improve health outcomes for all patients and citizens, and to reduce inequalities, which is a key aspect of the mandate.

[Lord Brooke of Alverthorpe]

My Lords, as patients are to be at the heart of the new NHS from April, will it be the Commissioning Board or the Government who are responsible for advising patients throughout the country of their rights and responsibilities?

[Earl Howe]

My Lords, the NHS constitution is currently under revision. It is a task for the Department of Health to take forward but, as the noble Lord will know, in the mandate and indeed in the Health and Social Care Act the Commissioning Board is charged with upholding and promoting the NHS constitution. The process of updating the constitution is, of course, subject to full public consultation.

NHS: Diabetic Services

Lord Brooke of Alverthorpe Excerpts

Thursday 29th November 2012 Lords Chamber

[Lord Brooke of Alverthorpe]

My Lords, I thank my noble friend Lord Harrison for putting this debate before us. I suspect that I come under the category that was just described as “articulate concern”. I am certainly concerned; whether I am articulate remains to be seen.

I was drawn to the report by the Public Accounts Committee. In particular, I want to address the recommendation where it talked about the projected increase in the diabetic population having a significant impact on NHS resources. It said:

“The Department and Public Health England should set out the steps they will take to minimise the growth in numbers through well-resourced public health campaigns and action on the risk factors for diabetes, such as the link with obesity, and the complications they can cause”.

It is to those that I wish to address my remarks. Before doing so, I offer the Minister, at the end of rather a hard day for him, with quite a battering, some words of encouragement and thanks. I thank the Government for announcing yesterday in a Written Statement that they will consult on the proposal to introduce a 45p minimum unit price for alcohol. That is a brave step forward, on which they are to be congratulated. The figure is different from that in Scotland, but that is the lesser of the issues. I hope that all will come together, including the BMA and the rest of the medical profession, and work with the Government to move forward on this front.

This process will not be easy. It has taken time to get to the consultation stage and plenty of people will try to prevent this new policy being put in place. I have recently spent some time with the drinks and retail industry looking at the Government’s strategic policy on alcohol, and have encountered little enthusiasm for this change. Indeed, we have already seen one legal challenge against the Scottish proposal. I understand that the Bulgarians have a great interest in this matter and will raise question marks and seek a legal challenge. I suspect that there will also be a legal challenge against the Government’s proposal.

As I say, the Government’s action is a step in the right direction. In the past, the important link between alcohol consumption and diabetes has in many respects not been addressed to the extent that I would have hoped. I shall speak primarily about type 2 diabetes, and alcohol consumption causes difficulties in that respect as well as the consumption of high-fat and sugary foods. Drinks, particularly alcoholic drinks, contain a significant amount of sugar, of which nobody who consumes them is aware. Although food and fizzy drink labels show fat and calorific content, alcoholic drinks are totally exempt from any requirement to show energy or calorific factors. This means that people who drink excessively are not only harming themselves in other areas but are particularly at risk of raising their sugar levels, which may lead to type 2 diabetes.

The Minister seemed surprised to hear about what has been going on at the other end of the Corridor, but Dr Phillip Lee MP has said this week that, as a doctor, he believes that type 2 diabetes is self-inflicted in many respects and that, due to cost factors, the department should stop providing free prescriptions for people with this type of diabetes. Like my noble friend Lord Harrison, I hope that the Minister will state very clearly this afternoon where the Government stand on this issue and will refute Dr Lee’s proposition. That is not to say that there may not be some fundamental issues behind Dr Lee’s comments regarding costs in the NHS that we need to address, and I will come to that.

I see a link between drinking, obesity, diabetes and alcohol abuse. I hope that the Government will be prepared to stick to their objectives on that front and resist any challenges that may arise in Europe. I have taken soundings, as that is what we can do in this amazing Chamber, from some of my learned counsel friends who tell me that, if we are challenged in Europe, there is an opportunity for us to fight that very vigorously indeed on the basis of our having a margin of appreciation—that is, because of the scale of the problem with diabetes in the UK, we should have the freedom to act differently on this issue from other countries in Europe, even though the Commission may initially oppose such action.

Similarly, with regard to alcohol labelling, which the Minister knows I have raised previously, I have been encouraged to wait until the Commission comes back to this issue in 2014 because we cannot move unilaterally. Again, noble counsel here tells me that we could use the exemption that I referred to as a means to press the industry to move quickly and require it to move forward and introduce labelling on alcohol products that would show the number of calories in them. We should also think about the energy side of that.

Opportunities are there for us to keep pressing ahead on this front. This links to where we stand on public education, on which I will spend a few moments. Last night I had the good fortune to go to a celebration that was held in the River Room by the Terrence Higgins Trust to celebrate its 30 years of existence and the work that it has done. We were addressed by the noble Lord, Lord Fowler. He is a former Health Secretary who is remembered particularly—this was discussed at some length last night—for the very effective and world-leading public campaign on HIV that he raised in the 1980s and 1990s, and which had such a great impact on public health in this country.

After seeing reference to the emergence of a strategy on obesity, I look to see what the Government will do on that front, too. There have been plenty of other campaigns in addition to the one on HIV. There were campaigns on alcohol and drinking and driving and a range of campaigns on smoking, and they have been very effective. However, we await a national programme to highlight the problems that arise from eating and drinking too much. When can we anticipate something moving on this front? Given the evidence that we face with obesity and type 2 diabetes, such a campaign should be on the kind of scale that we had in the past. In particular, I look to see a Government that will address some of these issues in relation to children. A phenomenal number of young children are now classed as obese, and a growing number in turn will be likely to fall into the group of the 7 million possible candidates for type 2 diabetes.

We must be honest and straightforward in such a campaign. We must recognise that not only must the food and drinks industry be socially responsible but we must seek to persuade people in all the ways we can to accept responsibility for their own health. That means letting people—particularly young people—see that if they do not care for their health in the way that is best for them, there is a distinct possibility that their lives will be shortened, their health diminished and their opportunities greatly reduced. We need to highlight some of the topics that we have been talking about today, such as the risks of amputation, blindness and so on. We should not run away from presenting them to the public at large in a wide-scale programme of action. I hope that the Minister will tell us when we can expect a campaign of major proportions to come forward.

NHS: Walk-in Centres

Lord Brooke of Alverthorpe Excerpts

Thursday 11th October 2012 Lords Chamber

[Earl Howe]

I can only express my gratitude to my noble friend for pointing that out. I will ask my officials to review the information provided on the DoH website and to ensure that it is as up to date as possible.

[Lord Brooke of Alverthorpe]

My Lords, reverting to the earlier question about access to GPs, I hope that the NHS and the Minister will have information on the length of waiting times for patients to see their doctors. Indeed, we had questions on this issue earlier in the year. What steps have been taken to reduce the ever-increasing length of waiting lists to see doctors, particularly in the London area?

[Earl Howe]

My Lords, the noble Lord raises an important point. I am aware that in certain parts of the country there is considerable concern about the length of time that patients sometimes need to wait for a GP appointment. However, that is not the case all over the country. We expect GP practices to configure themselves so as to ensure that the waiting time is kept to a minimum. It is an area on which we are working closely with the profession to resolve.

Drugs: Prescribed Drug Addiction

Lord Brooke of Alverthorpe Excerpts

Thursday 12th July 2012 Lords Chamber

[Earl Howe]

The noble Baroness is absolutely right, and I am very pleased that both the Royal College of General Practitioners and the Royal College of Psychiatrists have been keen participants in the round table group on addiction to medicines convened by my colleague Anne Milton. The actions agreed by the group have included greater recognition of the risk and the treatment of dependence on prescription drugs within the core competencies of psychiatrists and the further development of training and guidance on this issue for GPs and other healthcare practitioners.

[Lord Brooke of Alverthorpe]

My Lords, does the Minister agree that one of the biggest obstacles to recovery for people with addictions to alcohol and drugs is stigma? Will he confirm that there is no thought in mind of moving down the avenue suggested in the Question because that would lead to greater stigma?

[Earl Howe]

I am well aware of the point that the noble Lord appropriately raises. Stigma is an issue and we need to take account of the risk of it. That means that quite often when treatment services are provided to those who are addicted to medicines, they take place in a different setting from those administered to addicts of illegal substances.

Health: Local Healthwatch Organisations

Lord Brooke of Alverthorpe Excerpts

Monday 11th June 2012 Lords Chamber

[Earl Howe]

My Lords, I firmly believe that, and that is why the NHS outcomes framework specifically includes a domain relating to patient experience. As we go forward, I think patients will come to realise that their voice really counts. It is about a culture change—I do not wish to wriggle out of that. This is not going to happen overnight, but it is very important that commissioners and providers in the health service are fully engaged with patients, and vice versa, to ensure that the patient’s voice—and indeed the patient’s needs—are right at the centre of commissioning and provision.

[Lord Brooke of Alverthorpe]

My Lords, on the same theme, if patients are to be at the centre of the new arrangements, and the Government are handing this over, at least for the time being, to local authorities to ensure that they are participating in the new structure, is the Minister content that this arrangement will truly ensure full patient involvement right across the whole country? When will there be a review of the arrangements if they are not working?

[Earl Howe]

My Lords, of course we want to see the system working properly. It will be part of the role of Healthwatch England to provide information and best practice advice to local Healthwatch to make sure that local authorities are commissioning both effectively and efficiently. In that sense, there will be national oversight of what happens. Inherently, with the reports that local Healthwatch organisations will have to produce annually on the way that they fulfil their role, there will be transparency on how effective they are being, not just in delivering services but in involving all sections of the community in what they do.

NHS: Risk Register

Lord Brooke of Alverthorpe Excerpts

Tuesday 15th May 2012 Lords Chamber

[Earl Howe]

My Lords, the decision to exercise the veto, which is a decision provided for under the Freedom of information Act, was made by my right honourable friend the Secretary of State for Health. However, he would not have been able to exercise the veto without the collective approval of the Cabinet, and that approval was secured.

[Lord Brooke of Alverthorpe]

My Lords, last Thursday I asked the Minister a question that he answered in part. The part that he did not answer was whether the transitional risk register drew to the Government’s attention the risk that patients would have to wait longer to see their GP. Speaking as someone who uses the NHS and as part of the British public, I fear that the delays are getting longer and will continue to do so. Could he please now answer the question about whether or not this was in the risk register?

[Earl Howe]

I acknowledge that I did not answer that question and apologise to the noble Lord for not having done so last week. The whole issue of stakeholder support is one that the risk register addresses, as he will see from the document that we published. I do not recall the specific issue of waiting times to see one’s GP arising in the risk register for the simple reason that, although I acknowledge that it is currently a problem in some parts of the country, particularly London, that is not a direct result of anything that the Government are doing in our reform programme.

Health Transition Risk Register

Lord Brooke of Alverthorpe Excerpts

Thursday 10th May 2012 Lords Chamber

[Earl Howe]

I am grateful to my noble friend. The answer to his final question is no, I do not believe that there is a difference of approach. I do not have data relating to all government departments but, as I said earlier, the previous Administration refused to release the Department of Health’s strategic risk registers in response to three freedom of information requests. Indeed, one of those was responded to by the right honourable gentleman Mr Burnham in language not dissimilar to that which I have used today. A search of my department’s freedom of information database indicates that, since the Act came into force in January 2005, the department has received six specific requests for risk registers. In no case was the request granted. My noble friend also referred to the Welsh example, which is a very interesting one. In April of this year the Labour Assembly Government in Wales refused to disclose a risk register, and it was a health register. The reasons given for withholding that register mirrored exactly those that we are using currently.

[Lord Brooke of Alverthorpe]

As the legislation focuses so much on GPs, can the noble Earl say whether the risk register made an assessment that there would be increasing delays for patients in getting to see their GPs during the transitional period and that those patients would be put at risk? Given that the Government abandoned the previously set targets for the time limit in which GPs have to see their patients, is he aware that patients in London have faced longer waits to see a GP, let alone the GP of their choice? Is that point covered in the recently published documents in the Library? If not, will he make sure that it is?

[Earl Howe]

There are two points in answer to that. I am aware that in London, in particular, there is an issue for some patients wishing to see their GP; indeed only two days ago I had a useful conversation with the Royal College of GPs about that very matter. However, that particular issue has nothing to do with the reforms that the Government have just enacted, but relates to the supply of GPs. We have many more GPs than we had 10 years ago. Unfortunately, however, we need more. There is a target every year for recruiting GPs but we have not quite reached that target in the past three years. We need to do something about that. Action is in hand to address the issue that the noble Lord has raised. However, I would impress on the House that it is not a reflection of the reforms. The reforms have only just been enacted, and we are only now just rolling them out.

Health: Diabetes

Lord Brooke of Alverthorpe Excerpts

Wednesday 1st February 2012 Lords Chamber

[Earl Howe]

I agree with my noble friend. We are firmly of the view that education is a major action area for primary care clinicians, and for those in secondary care too, if we are to avoid unplanned admissions to hospital, which are unpleasant for patients and very costly for the NHS.

[Lord Brooke of Alverthorpe]

Does the Minister agree—I am sure that he does—that the recommendation that there should be more comprehensive and effective preventive care is an important part of the report, and that it is important to highlight the link between obesity and this illness? Does he agree that it is now high time for the Government to introduce calorific labelling of alcohol products so that people know the number of calories they take in when they drink, and to stop citing the European Union as the reason why they are not doing it?

[Earl Howe]

The noble Lord is to be congratulated on bringing me back to the very important subject of the labelling of alcoholic drinks. I hope that the House will feel that he was a little unfair in blaming the Government for the line that they have taken on this. As the noble Lord knows, labelling is an area that is very largely a matter of EU competence. However, he is right that type 2 diabetes is closely linked to obesity and insufficient physical activity. We would like to see businesses use a more consistent front-of-pack nutrition labelling approach than has been achieved in the past, particularly with food.

Health: Obesity

Lord Brooke of Alverthorpe Excerpts

Wednesday 19th October 2011 Lords Chamber

[Earl Howe]

I agree with my noble friend about the campaign launched by our noble friend Lord Fowler, which was extremely effective. We recognise that excess weight is a really serious problem. That is why we have set out what we believe is an ambitious approach to dealing with it. We are radically overhauling the public health system. We are working with business to go further and faster on making it easier for people to make healthy choices for themselves and their families. We are also continuing to invest in programmes such as Change4Life. The Government cannot solve the problem on their own but we can encourage and support a wide range of partners to play their part. The call to action sets out how we are going to do that.

[Lord Brooke of Alverthorpe]

My Lords, will the noble Earl please explain how people can be expected to take personal responsibility for sorting out their health problems when so much information about the food and drink they consume is kept from them? Can he please also explain why the Government are failing to press the drinks industry to show the number of calories in alcoholic drinks on the labels, and declining to meet the industry and press it accordingly?

[Earl Howe]

I am not aware that we have declined to meet the drinks industry; the noble Lord may know something that I do not. We talk regularly to the drinks industry. As he will be aware from a Question tabled in this House the other day, the result of the European nutrition labelling regulation is that we now have the flexibility in this country to construct rules that suit us. That includes encouraging the drinks industry—and I believe that it is willing to do it—to place energy information on its labels.