National Health Service: 75th Anniversary

Lord Brooke of Alverthorpe Excerpts

Thursday 30th November 2023 Lords Chamber

[Lord Brooke of Alverthorpe (Lab)]

My Lords, I am grateful to my noble friend Lord Hunt of Kings Heath for his—as expected—truly amazing speech. He is a man with great experience of the health service, both before he came into this House and, in particular, while he was serving here as a Minister. He is a man of great value; he is one of the few politicians around who resigned on principle on an issue. He resigned over Iraq. I was one of those who was on the wrong side and I admire him greatly for the work he has done and what he continues to do.

As he mentioned—as did the Baroness, Lady Pitkeathley—I also spoke on this way back in 2003. I also spoke in 2018, when we were celebrating 70 years. What particularly interested me then was that the standing of the NHS in the eyes of the public was very high. I thought it was a great opportunity for us to try to take this jewel. The NHS is something which binds us together. As the previous speaker just said, it is important that we go back to that and find ways in which the public attitude, as it presently stands, is reversed.

I suggested in 2018 that we ought to think about creating a national charity for people to participate in and leave gifts in their wills to, and so on. The Government said no, because some trusts already have their charities and that would undermine them. Well, some trusts do have them and they are very successful, but, if you examine it, you will find that the ones getting great amounts of money are in wealthy areas. In the dispossessed areas, where we have the worst health and growing rates of ill health, you will find that charities either do not exist or, if they do, not much money is going in. I would be prepared to put something in my will—not for Chelsea and Westminster, which I am close to, but for the NHS. The money would then be redirected to the areas of poverty where we need to be making the greatest changes.

If we look at what is happening, as my noble friend Lord Hunt pointed out, we are starting to see for the first time in near history that life expectancy is halting and going in the other direction. If you live in Westminster, your life expectancy is going to be of the order of 86 years, but if you are in Manchester it is down to 77 or 78—and this is happening against a background of general decline in many areas of the health service.

I hope the Minister might still give some thought to the idea that we should try to find ways of having far greater involvement of the public. The charity approach was one idea. When Alan Milburn was Secretary of State, he tried to find ways to get more people involved. They even explored the idea of shares in the NHS, so that people were making a personal commitment to it. I still believe there is merit in going back to some of those issues.

Covid has of course made a difference, and we should not deny that—the Minister will, without a doubt, labour this point in defending the state we are in. When we came into power in 1997, the health service was in a mess and, as was said, it is in a mess again. We have to find our way forward. Care in particular has to be addressed, and we have a plan there, but I believe that the way forward will be to try to involve more people in building a base for revising our approach to it. I appeal to the Minister: the Government made promises in 2019 but have not delivered on anything, so would they be prepared to consider working closely with the new Government, if Labour comes to power, to try to take care out of the Punch and Judy that we have had so much in the past—to come together and to shift care away from political disputes between the parties? I hope the Lib Dems might be willing to give their support to that entirely different approach to care, because it is so desperately needed.

I wonder why this review of Covid is going on until 2026. How much money will be spent on it before it is completed? Would it not be better spent on trying to address some of our current problems in the health service? With Covid, some underlying causes needed addressing. The first was age—and care is the way we start to address that properly. The second was the underlying cause of weight: 50% of the deaths attributed were attached, for a variety of reasons, to people being overweight. The Government have a number of proposals for change, but have fallen well short. They made a grave mistake in winding up Public Health England—at least it was seen as a focal point for campaigning, and it was coming out with strategies that were noticed. We have completely lost focus on where we go in campaigning on obesity, and I hope that, when my party comes to power, it will address that more than it has been addressed in the past. The third area that was identified in the Covid review was the disproportionate number of people of colour who suffered badly. As was mentioned, a recent report says that people of colour are still gravely disadvantaged in health terms compared with the white population. We need to find new policies to address that difficulty and to turn it around so that people start to feel that they are a better part of the community than they are now.

My appeal overall is to try to take certain areas where we are failing to make progress out of the Punch and Judy of politics, to develop new relationships that would move us forward on issues that we have all had policies on for years but have not made progress on. I hope the Minister spends some time, in responding, on the need to get the public more involved than they have been and to get some unity of purpose between the parties in the areas where we have still not made any movement but should have.

Ultra-processed Food

Lord Brooke of Alverthorpe Excerpts

Thursday 26th October 2023 Lords Chamber

[Lord Markham (Con)]

I have said many times that the prize is reformulation. I do not think that any of us should have a problem per se with the food if the bad stuff is taken out. Diet Coke is a perfect example. It is not particularly good for you but not bad for you either, so why should Coca-Cola not be able to advertise Diet Coke? If you take out the bad stuff, we should encourage industry because advertising works. It wants to advertise, so if it is encouraged to take out the bad stuff, that is a big incentive.

[Lord Brooke of Alverthorpe (Lab)]

My Lords, as far as I recall, it was said that we should keep it simple and that the focus should be on sugar. When will the Government look at children’s school meals, review the regulations and reduce the sugar in children’s free school meals?

[Lord Markham (Con)]

The noble Lord makes a very good point. A healthy start to life is vital, which is why I am very pleased to say that we have the highest level of free school meals ever, with every infant school kid and a third of children overall having a free school meal. On the composition of those foods, I know that this was planned but was stopped due to Covid. The timing is now being reviewed again, because things move on in terms of the content and healthy foods.

Children’s Health: Sugar

Lord Brooke of Alverthorpe Excerpts

Tuesday 12th September 2023 Lords Chamber

Asked by

[Lord Brooke of Alverthorpe]

To ask His Majesty’s Government what assessment they have made of the impact of sugar on children’s health.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Markham) (Con)]

The Scientific Advisory Committee on Nutrition undertook a comprehensive assessment of sugar intake and health in its 2015 report Carbohydrates and Health. In 2023, it looked specifically at children aged one to five. SACN concluded that reducing the intake of sugar would lower the risk of tooth decay and weight gain in children and adolescents. The Government have an ambitious programme to reduce children’s sugar intake, which includes the soft drinks industry levy.

[Lord Brooke of Alverthorpe (Lab)]

I thank the Minister for his reply. One area where the Government have failed to take the action they should is to encourage the industry to reformulate food more than it is doing at the moment—to take out sugar and substitute the alternative, organic, healthy sweeteners that are available. Would the Government look into this and do some more work? Would they be prepared to invite companies that are willing to enter public/private partnerships to start doing that?

[Lord Markham (Con)]

First, I recognise all the work the noble Lord does in this space. Secondly, I completely agree that reformulation is the big prize as part of this. The House will remember me mention before that Mars, Galaxy, Bounty and Snickers have all reformulated their food, as has Mr Kipling and his “exceedingly good” cakes—they are compliant cakes as well. There is a lot being done here, but there is more to do. We meet the industry all the time and are very happy doing so.

MMR Vaccine

Lord Brooke of Alverthorpe Excerpts

Thursday 20th July 2023 Lords Chamber

[Lord Markham (Con)]

Yes. That is where we really see UKHSA coming into its own in terms of taking an intelligence-led approach. The concern came from its modelling: its epidemiologists brought this up as a concern, which led to the alert going out on 14 July. Likewise, it is looking into other categories and, where there are those concerns, it will come out and suggest such outreach programmes.

[Lord Brooke of Alverthorpe (Lab)]

My Lords, I refer to the question asked earlier by the noble Lord, Lord Young, about the high level of absence of children from school at the moment; I believe the present figure is in the order of 24%. What special steps are being taken there, where the appeal to the school will not make any difference yet we have to try to get to the homes of the individual parents?

[Lord Markham (Con)]

As mentioned, there are outreach programmes, particularly for home-schooled children or children who are not there. There are also programmes in community centres, with the idea of trying to pick them up in as many places as possible. Obviously, there is concern about certain communities that are harder to reach than others. That is particularly the case in London, as I mentioned earlier. That is where we are trying to specifically target those community centres with outreach work.

Food: Two-For-One Offers

Lord Brooke of Alverthorpe Excerpts

Wednesday 19th July 2023 Lords Chamber

[Lord Markham (Con)]

I am aware of the Amsterdam initiative. Off the back of that, the OECD said that there were four main strands to what countries should be doing: first, information and education, such as the good examples I spoke about; secondly, increasing healthy choices through the reformulation of foods, which again is something we are doing; thirdly, the modifying of costs—the sugar tax, which has reduced sugar consumption by as much as 40%, is a perfect example of that; and, fourthly, restrictions on where product placement should take place. I am absolutely familiar with the initiative in Amsterdam, and am pleased to see that we have taken action on a lot of those things.

[Lord Brooke of Alverthorpe (Lab)]

Is the Minister not ashamed about what has happened to children’s health while the Conservatives have been in power since 2010? We have more obese children than ever before, and a plethora of policies which would work if implemented, yet so many are delayed. Will the Minister give a commitment to go back and look at the regulations governing children’s school meals? They were changed in 2014, with permission granted to give children more sugar. The Government were reviewing this in 2019 and 2020, but that stopped because of Covid. Will the Minister give a commitment again to start a review? Even if they cannot implement it, the next Government could.

[Lord Markham (Con)]

The noble Lord is correct: good school meals are fundamental to all of this. My understanding is that the review is something that the Government are looking to do, but I will happily provide more details on what the plan is.

Ultra-processed Food

Lord Brooke of Alverthorpe Excerpts

Tuesday 18th July 2023 Lords Chamber

[Lord Markham (Con)]

I thank my noble friend. We are focused on the sugar, salt and saturated fat content. It is not the fact that food is called ultra-processed, per se. We would not discourage people from eating whole- meal bread, but wholemeal bread is considered to be a processed food. The action we are taking is for a reduction in sugar, salt and saturated fat.

[Lord Brooke of Alverthorpe (Lab)]

The Minister is focusing on reducing fats, salt and sugar in meals. When are the Government going to reduce those elements in school meals for children?

[Lord Markham (Con)]

Absolutely. That is why we are at the highest level of free school meals for children ever. More than a third of children are now receiving free school meals, including all infant schoolchildren. The noble Lord is correct that a healthy start to life is vital, and if we can make sure that children are getting a good, nutritionally balanced school meal, that is a good start to life.

Community Health Services: Waiting Lists

Lord Brooke of Alverthorpe Excerpts

Wednesday 12th July 2023 Lords Chamber

[Lord Markham (Con)]

I thank my noble friend. This was actually a conversation of a big task force summit that we had just last week. We commented that a lot of people have pregnancy plans, for instance, which might say that they want to have birth planned at home; a lot of people will have “Do not resuscitate” plans; what we do not have enough of are frailty plans, which say, “I don’t want to go into hospital. I’d rather be cared for at home. I know it might mean that I don’t live for quite as long, but that’s my preference”. I think there is a whole debate that we need to have to start to move towards that, and to make sure we have that support in the community to do it as well.

[Lord Brooke of Alverthorpe (Lab)]

My Lords, is the Minister aware of the spare capacity of therapists in the private sector, some of them specialising in the mental health of children? As we have such long waiting lists for children and mental health, why is that not being used?

[Lord Markham (Con)]

The noble Lord is correct, and my understanding is that we are looking to use the independent sector more and more. I will check and verify this, as it was from the briefing probably about three or four months ago, but my belief is that about 51% of the physiotherapy that we use is from the private sector. I absolutely agree with the noble Lord that we need to use the independent sector more and more in these situations—something pioneered by the noble Lord, Lord Reid, over there.

NHS National Health Inequalities Improvement Programme

Lord Brooke of Alverthorpe Excerpts

Thursday 25th May 2023 Lords Chamber

Asked by

[Lord Brooke of Alverthorpe]

To ask His Majesty’s Government whether the NHS National Health Inequalities Improvement Programme plans to review and improve the nutrition of free school meals.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Markham) (Con)]

The focus of the NHS healthcare inequalities improvement programme is the delivery of healthcare services. Free school meals are outside its remit. The Department for Education continues to keep school food standards under review. The current standards provide a robust yet flexible framework to ensure that pupils in England continue to receive high-quality and nutritious food. Developing healthy habits early in life can influence health in childhood and reduce the risk of diet-related diseases in later life.

[Lord Brooke of Alverthorpe (Lab)]

My Lords, I am grateful to the Minister for his reply. Who actually is responsible if one tries to change the formulation of school meals for children? In previous debates on obesity, he has stressed the importance of reducing calories. The Government have estimated the number of calories that need to go down to get child obesity down. As we are giving children so much sugar in school meals and such highly processed food, why do they not run a trial with less sugar and healthier food than we are doing at the moment to try to deliver on the calorie objective, which he has talked about previously?

Social Care: Workforce Strategy

Lord Brooke of Alverthorpe Excerpts

Wednesday 22nd March 2023 Lords Chamber

[Lord Markham (Con)]

Absolutely. I speak as an ex-carer myself. Caring is part of everyone’s role, as has been quite rightly written about. Part of this is about the people we are employing. I am glad to say that we are managing to increase recruitment, which is not easy in the age of full employment. It is about the parts that you and I—all of us—can play in care in the community, and organising domiciliary care so that we can have a full wraparound service.

[Lord Brooke of Alverthorpe (Lab)]

My Lords, on seeking to increase the size of the workforce, could the Minister give an indication of whether there will be more overseas workers? They have made such an important contribution in the past but have run down in numbers latterly, yet people want to see more coming from overseas.

[Lord Markham (Con)]

Yes, and I am delighted to say that it is working. We will have granted 57,000 visas towards that in the last year, which is a big increase on previous years. It is fundamental, and a fine tradition of our health and social care services, that we can use overseas workers.

Communications Act 2003 (Restrictions on the Advertising of Less Healthy Food) (Effective Date) (Amendment) Regulations 2022

Lord Brooke of Alverthorpe Excerpts

Monday 27th February 2023 Lords Chamber

[Lord Brooke of Alverthorpe (Lab)]

My Lords, I am grateful to the noble Lord, Lord Allan, for his Motion to Regret and for the excellent way in which he presented it, and to all other speakers who have contributed. I feel sorry for the Minister. He is one of several Ministers we have seen since 2015, since the Conservatives have been totally in charge of government, and, during that period, of course, we have seen obesity grow—it is the one area in which we have seen growth, growth, growth. It is an area that has now worryingly spread down, particularly to children. We can say what we will say today, but I know the Government are not changing their mind; they are kicking this ball into the long grass, into the next election and beyond. Really, I think we in this Chamber should start addressing ourselves to who will be in power next time around, and what we might try to do in persuading them to have policies that will effect changes, because the one thing that the Government should have learned is that relying on voluntary conversations and a voluntary response from the private sector and the businesses in the food and drinks industry rarely produces a response.

Yesterday, I had experience of where the Government have taken some action. I went out for lunch and I had a choice on the menu: I saw the number of calories available to me with the various foods that were in front of me. I chose to have food with 1,000 calories, as opposed to 1,500, which I might have chosen had they not got that legislation through—with our support. Where they failed, of course—we pointed this out at the time the legislation was going through—was when my colleagues sat down, my friends and family, and had the bottles of wine, the gin and tonics before and the rest of it. They had no idea what they were consuming. I have been talking about labelling on alcohol for years, and the Government have done nothing at all. They have relied on the private sector to try to effect changes; there have been some marginal ones, but we still do not have any knowledge of what people are consuming when they come to take alcoholic drinks. Often, they can be consuming far more calories in the form of drink than in food.

So, looking at a menu with calories on does work. Leaving it to the private sector to do it voluntarily does not. I am hoping that the next Government in power will recognise fairly early on that we have to take the action, do the research, get it on the statute book and then implement it and not fiddle around. Because we see that we now have type 2 diabetes emerging among children as young as nine, 10 and 11, and that was not the case back in 2010 when the Labour Government went out of power. It was not the case even in 2014. If we look at what is happening in America with type 2 diabetes, the projections of the numbers of citizens who will have it in the future are quite frightening. They are saying that there could be up to 90% with type 2 diabetes unless people start to address basic food and drink properly. Yet we are letting it slip through our fingers here today. I am hoping the Minister will sensibly recognise—he does endeavour to bring a business attitude to bear—that we need to get law and not rely on a voluntary approach.

Another approach linked to this—I hope my noble friend on the Front Bench might pick this up—is that we see increasingly that advertising is not so much influencing young people on television, but it is online, and these regulations do not touch on online advertising one iota. There may be a saving grace, in that there is a delay: whoever deals with it next will sweep up online advertising as well. Linked to that, there is a requirement to look at the whole advertising industry and see how it is operating and whether we should not contemplate introducing health taxes into advertising, so that those who are advertising the most harmful food and drinks should be paying taxes on their advertising, and those who are advertising good food should have encouragement and support. That is the kind of change that we may be looking for with a new Government—a different approach from the one we have had so far. So, I look forward with interest, as others do, to the defence the Minister is going to mount—a defence which will be about nothing changing while they are still in power.

[Baroness Merron (Lab)]

My Lords, the Children’s Minister recently admitted that the nation had a problem with childhood obesity that should not be ignored. I am sure that noble Lords who have spoken today, and I am grateful to them, will share that view, not least because children with obesity are five times more likely to become adults with obesity, increasing the risk of developing conditions including type 2 diabetes, cancer and heart and liver disease. This is an extremely serious and pressing matter, as the Minister has been reminded yet again.

Two in five children in England are above healthy weight when they leave primary school and we now see the fastest increase in childhood obesity on record, as my noble friend Lord Brooke highlighted in his remarks. But it gets worse. Children starting school in the most deprived areas are three times as likely to be severely obese as those in the wealthiest, while NHS data shows that almost half of boys in England’s poorest areas are overweight or obese when they leave primary school. Last year, there were 3,400 severely obese children aged four or five in the most deprived parts of the country, as compared with 630 in the richest. So will the Minister give some indication as to what account is being taken of this great disparity between those who have more and those who have less in the Levelling-up and Regeneration Bill currently being considered in your Lordships’ House?

As we have heard today, it is absolutely right that we make informed choices about what we eat and drink, but choice can only really be choice if there is no distortion, and if those who are making the decisions have all the information they need and are able to interpret it. As the noble Baroness, Lady Bull, said, we actually need an integrated health approach to tackle the complexities of achieving a healthy weight. So the question for the Minister that has run throughout this debate is: how will the statutory instrument support this integrated health approach to tackle the complexities we know we have?

In the Government’s original analysis, they suggested a watershed on advertising, saying that introducing restrictions to prevent adverts for products high in salt, fat and sugar being shown before 9 pm could lead to 20,000 fewer obese children. I took it that this was, as others have said in the debate today, about shifting the environment, shifting the power of influences, in order to manage the challenges that we all face in supporting our wish to secure good health. So, will the Minister tell your Lordships’ House what will be the change in opportunity to tackle children’s obesity because of this regulation and the change it brings about? I refer in particular to page 33 of the Secondary Legislation Scrutiny Committee report. The noble Baroness, Lady Walmsley, referred to the figures. The report states:

“Analysis conducted to inform the Government’s Impact Assessment of the advertising restrictions found that under current restrictions children were exposed to 2.9 billion less healthy food and drink TV impacts and 11 billion less healthy food and drink impressions online in 2019”.


The committee observes that the effect of the delays means that, presumably, this level of advertising will continue and asks for an explanation as to why this is acceptable given the harms stated. Perhaps the Minister could refer to an answer on this point. The committee also asks for an explanation as to how the Government anticipate that they will still achieve the target of halving childhood obesity by 2030 if various elements of the strategy are delayed. Again, perhaps the Minister can tell your Lordships’ House his view on this.

Of course, there is a difficult balance to strike when seeking to improve public health and also when working with broadcast and online and the advertising industries. The Government have produced a regulation that has been drawn to the attention of the Secondary Legislation Scrutiny Committee once again, and this clearly does not assist the striking of that balance. It is not acceptable that the Explanatory Memorandum is described as “poor”, and that it fails to evaluate the effects on public health and the NHS from this delay. Nor is it acceptable that it fails to explain the use of a different definition from previous legislation. This refers to the unexplained shift from “high-fat, sugar and salt” to “less healthy foods”. The committee rightly asks whether the Government’s intended scope of products that they want to regulations to cover have been changed. Perhaps the Minister could respond on this point.

The SLSC also says that it

“provides insufficient information to gain a clear understanding about the instrument’s policy objective and intended implementation.”

It also says that, worryingly:

“The views of the NHS are not addressed or explained.”


This, I believe, is quite remarkable and suggests a breath-taking lack of engagement with those who should be engaged with. Once again, poor policy-making and poor administration have come together to leave your Lordships’ House unable to properly scrutinise what the Government are doing and why, even though it is the job of your Lordships’ House to do this. Perhaps the Minister could address these points of concern.

The Minister will recall that I have raised many times before the point about his department’s approach to legislation and the criticism that it has attracted. He kindly gave an undertaking that he would look into this with a view of doing better in future. Can the Minister could update the House of progress in this regard? Finally, I hope that the Government will not be diverted from measures that will have an impact on the health and weight of the nation.