Diabetic Prevention Programme

Lord Brooke of Alverthorpe Excerpts

Thursday 23rd June 2022 Lords Chamber

Asked by

[Lord Brooke of Alverthorpe]

To ask Her Majesty’s Government what was the business case for not recording the percentage of patients who joined the Diabetic Prevention Programme between 2018 and 2019 but failed to complete the course; and whether this information is now recorded.

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

Data on completion rates is collected for specific reference periods. Rather than looking just at a yearly comparison, completion is analysed to understand the impact of changes to the programme, such as providing a digital option for consumers. Data collected at specific reference points, such as from January 2017 to March 2019, shows a completion rate of 53%.

[Lord Brooke of Alverthorpe (Lab)]

My Lords, I am grateful to the Minister for that. He may not know it, but I have been on the diabetes prevention courses, as I am on the cusp of diabetes. I was amazed by the rate of drop-out on the course that I was on. It ran for nine months. I wondered about the cost and so asked a Written Question on the details, which the Minister has now given me. With a nearly 50% drop-out rate, surely there is something wrong with the course. I want to see more courses but they should be run properly. Can we get the NAO to look at this to see if we can have some improvements and get better returns?

[Lord Kamall (Con)]

I thank the noble Lord for the question and pay tribute to him for his work in this area over many years. He is absolutely right. One of the challenges of this programme is that it is a nine-month course. Clearly, like many things, it was impacted by Covid, with a lack of in-person consultations and appointments. However, the silver lining to the cloud was the digital service. The course was able to move some patients on to digital services and to self-referring. One impact of that has been more people signing up to this programme.

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[Lord Kamall (Con)]

The noble Lord makes an important point. The Office for Health Improvement and Disparities is looking at a number of these areas and where the health service or the ICS locally has to target more resources. Clearly, one of the big concerns is disparities. The noble Lord has given the example of the north-east; as he rightly said, there will be parts of the country where those checks are not happening. It is vital that we tackle those disparities.

[Lord Brooke of Alverthorpe (Lab)]

I am sorry to be so persistent, but we are spending millions on these programmes. Since some work is being done to try to improve them, could the Minister give the House a report in six months’ time to tell us what progress is being made and give us some targets that are being delivered?

[Lord Kamall (Con)]

I am not entirely sure that I can give the noble Lord what he asks for, but I suggest that he asks me a Question about progress in six months’ time. Given that the noble Lord asked this Question, I will go back to the department and see what answers we can give.

Health and Social Care Leadership Review

Lord Brooke of Alverthorpe Excerpts

Thursday 9th June 2022 Lords Chamber

[Lord Kamall (Con)]

I thank my noble friend for the question. It is important that we recognise that not only do we have more doctors and nurses than ever before, but we need staff to be good leaders. That includes understanding diverse workforces and, as I said earlier, making sure that we have good leaders at the top. Why do we have a diverse workforce? In fact, that diversity is not represented right at the top, in the leadership. Sometimes, when you want to change an organisation—I am sorry, but I did an PhD in organisational change—there are a number of aspects and one of them is the culture and the leadership. Sometimes a new leadership comes in that can drive that change in the organisation. It is not just about structures but about making sure that we improve the standard of care we give to people. This issue came up in the report, because we have to have the right leadership and focus on patient care and on making sure that we have a proper integrated health and social care system for patients all the way through their lives.

[Lord Brooke of Alverthorpe (Lab)]

My Lords, I welcome the report, and particular work needs to be done in the area the Minister has just described. The NHS is very diverse, more than most public sector groupings. Therefore, if there is a problem there, it needs addressing and it should be given high priority.

First, the real issue that worries the public at the moment concerns the little statement sneaked out by the Secretary of State that he has now agreed to a 15-year work strategy being prepared. The public are worried about the great number of unfilled vacancies in the National Health Service. That number continues to rise, and we now have more than 100,000 vacancies. The public expect the Government to move in a number of ways to try to fill those vacancies, rather than simply waiting for a long-term strategy. Will the Minister tell the House what new ideas the Government have to fill the vacancies? I know that is not an easy question to answer.

Secondly, I suggest that the Government have conversations with the agencies, which supply staff to so many different places in the NHS at such high costs, to see whether some accommodation could not be reached with them. Thirdly, I have personally had experience recently of being treated in the private sector. I spent some time talking to the staff, many of whom were ex-NHS and said they would never return to it. I would like to know what work has been done by the Government in exploring the views held by those people who have left NHS service to establish why they have gone, and what they would need to see change in the NHS to encourage them to return to it.

[Lord Kamall (Con)]

I thank the noble Lord for that question. We should look at the context of the different environment and the challenges that our health service and health and social care system is facing compared to in earlier years. A number of different factors have come together. One is that we have an ageing population and people are living longer but not necessarily living longer well, and therefore, where before the focus was mainly on physical treatments, we are now far more aware of issues like dementia and the challenges presented by ageing populations. On top of that, we are simply aware of more conditions. I have just come out of a debate on neurological conditions, of which I was told that there are probably 600. When I was a child, that probably would have been dismissed—no one would have thought that there were such a number—so there is more awareness of the issues to be treated.

Mental health is now treated more seriously. It was never taken seriously before; it was always about “pull yourself together” or the stiff upper lip, but now we understand that people have mental health conditions. We need to make sure that we have a health and care system, including private and independent, that can meet those needs.

One of the challenges is that we need more doctors and nurses. The funny thing is that we actually have more NHS doctors and nurses than ever before, but we recognise that on top of that we still need more. Investing in the workforce is therefore a key priority.

There is the 15-year plan, as I have said. The NHS also has the people recovery task force to make sure that all NHS staff are not only kept safe but retained. There are a number of initiatives, which I am happy to write to the noble Lord about, about helping staff who feel burned out, as well as retention programmes.

On top of that, we have increased the number of medical school places. We have found that students are sometimes more likely to stay close to areas where they have studied, so new medical schools have opened in some of those places which have found it hard to recruit. We also have more new nurses coming through the system but, despite that, there is still demand for more. We are looking at various ways to improve retention but also attract new staff.

Sugar Reduction Programme: Bread

Lord Brooke of Alverthorpe Excerpts

Wednesday 25th May 2022 Lords Chamber

Asked by

[Lord Brooke of Alverthorpe]

To ask Her Majesty’s Government why the recent sugar reduction programme, which challenged businesses to reduce the amount of sugar in food, did not include bread.

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

The sugar reduction programme focuses on those products which contribute the most to children’s intakes of sugar. Sweeter bread products such as buns, fruit loaves and bagels are within scope of the programme. Plain and savoury breads—for example, garlic bread—are included in the salt reduction programme, as these products make greater contributions to salt intakes than sugar intakes. Garlic breads are also included in the calorie reduction programme.

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[Lord Brooke of Alverthorpe (Lab)]

I thank the Minister for that reply. Sugar is in so many products these days and is so damaging. As the Minister knows, we have a crisis with diabetes and with obesity. Does he not agree that we should endeavour to remove sugar wherever we can? There was no sugar in bread 60 years ago. Why is there sugar now? Why do the Government not look at this again and stop it?

[Lord Kamall (Con)]

I pay tribute to the noble Lord. Since my first day at the Dispatch Box, he has challenged me on both sugar reduction and alcohol abuse. There comes a stage where it is diminishing returns. I know that the noble Lord and I are very keen on puns and dad jokes. When bread is being made, sugar is needed—kneaded; excuse the pun—because it extends shelf life by reducing the oxidation which causes food to deteriorate, it reduces the rate at which bread becomes stale, it activates yeast for fermentation, it adds the colour during the baking process, and it adds to the texture. The sugar contributes only about 2% of free sugars intakes in children. Therefore, it is much more worth while and targeted to focus on products that are higher in sugar.

NHS Dental Services

Lord Brooke of Alverthorpe Excerpts

Tuesday 24th May 2022 Lords Chamber

[Lord Kamall (Con)]

“Delay” means not the same date that was originally proposed. We clearly understand the children’s issues. During the pandemic, NHS dental practices were asked to meet as many priority needs as possible. One of the reasons that £50 million of additional funding was put in was to target them at those most in need of urgent dental treatment, including children.

[Lord Brooke of Alverthorpe (Lab)]

My Lords, is it not true that many of these deserts are in fact areas that need levelling up? I come from one of those areas originally and, when I was a child, a dentist visited the school to check all the children annually. Why do we not have a programme to ensure that schools in these deserts are visited by a dentist per annum?

[Lord Kamall (Con)]

It is important for any review to look at out-of-the-box thinking and to learn from the past. The suggestion made by the noble Lord may indeed be sensible and affordable, so I will take it back to the department. There are clearly concerns about the dental deserts, some of which may be resolved by negotiations with the British Dental Association, work practices, incentives and training. Can you train dentists and dental technicians close to those dental deserts, so that they stay there afterwards?

NHS Dentistry

Lord Brooke of Alverthorpe Excerpts

Monday 31st January 2022 Lords Chamber

[Lord Kamall (Con)]

I am sure the right reverend Prelate will acknowledge that one of the things we have learned from Covid, the lockdown and its subsequent impact has been about the health inequalities that exist across the country. Both my right honourable friend the Secretary of State for Health and I believe strongly in tackling inequalities; that is one of the reasons why we are keen that this comes to the forefront of the forthcoming Health and Care Bill. But we acknowledge the inequalities and are working with the NHS and the BDA to address them.

[Lord Brooke of Alverthorpe (Lab)]

My Lords, is the Minister aware that, as a child of a working-class family in the 1940s, I was given a periodic free check on my teeth, as were all children alongside me at my school? Is it not a shame now, when we talk about inequalities and levelling up, that such a facility is not available for working-class children in this country? When will the Government, with their policy of levelling up, set out a programme that ensures an annual check on the teeth of all schoolchildren, regardless of their background?

[Lord Kamall (Con)]

I thank the noble Lord for that suggestion, which I will take back. The BDA, the NHS and the Department of Health and Social Care are well aware that we need to tackle a raft of health inequalities in this country, including in dental care. The Covid pandemic has highlighted some of those inequalities, and so we can focus on them.

Sugar

Lord Brooke of Alverthorpe Excerpts

Monday 24th January 2022 Lords Chamber

Asked by

[Lord Brooke of Alverthorpe]

To ask Her Majesty’s Government what assessment they have made of the effect of sugar on health in England; and what steps they will take to reduce its consumption.

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

My Lords, consuming too much sugar can lead to weight gain, which in turn increases the risk of serious diseases such as cancer, heart disease, type 2 diabetes and Covid-19. It also increases the risk of tooth decay. Through the healthy weight strategy, we are delivering a sugar reduction and reformulation programme, including the soft drinks industry levy, and legislating to restrict the promotion and advertising of products high in fat, salt, and sugar.

[Lord Brooke of Alverthorpe (Lab)]

My Lords, I am grateful to the Minister for his reply. He would agree that we need a suite of different approaches—

[Noble Lords]

Oh!

[Lord Brooke of Alverthorpe (Lab)]

—to try to make some headway. One of the great successes has been the sugar tax, yet the Government, for reasons which he previously explained, have decided not to extend it over a wider front because of unforeseen contingencies which created problems. Would he examine the prospect of taxing those unforeseen consequences so that the major driver for changing behaviour—pricing—will start to deliver the real results for us?

[Lord Kamall (Con)]

I thank the noble Lord for what I am sure was his unintended pun. I will try not to sugar-coat my response too much. We will see who can descend to the worst pun by the end.

We take seriously the issue of unintended consequences. As the noble Lord has rightly said, there has been evidence of people deciding to go to a different brand. In the case of Irn-Bru, it introduced a newer version, which I think it called “Irn-Bru 1901”, which has in fact a higher sugar content. We are very aware of that, which is why all the measures that we take must be evidence based.

Health and Care Bill

Lord Brooke of Alverthorpe Excerpts

Committee stage & Lords Hansard - Part 1
Tuesday 11th January 2022 Lords Chamber

As I have said, that diversity is not just people’s professional background. I could not agree more with the noble Lords who have just spoken that that diversity is important, but other elements of diversity are also important. We should rely on the chair, on parliamentary scrutiny for the appointment of the chair, and on stakeholder scrutiny through the department and the Secretary of State to ensure that the appointments are run properly. I think we should look to put on the face of the Bill the duties that the organisation needs to have, rather than the specific caricatures of individuals who should sit on the board.

[Lord Brooke of Alverthorpe (Lab)]

My Lords, I generally support the direction of the Bill. I welcome it; I think a move towards less competition and more collaboration is the way forward. I support—[Interruption.]

[Baroness Jones of Moulsecoomb (GP)]

I am so sorry.

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[Lord Brooke of Alverthorpe (Lab)]

We have a Green intervention.

I support particularly the amendment tabled by the noble Baronesses, Lady Merron and Lady Walmsley, and the noble Lord, Lord Patel, and I pick up the points made so strongly by the noble Lord, Lord Patel, about Public Health England. The major issue where we are still lacking as we move forward is the recognition that we have to go beyond the clinical and be as inclusive and wide-ranging as we can in involving people in the health service. If we go way back, in the early days of the Labour Government, we even talked about people having shares in the National Health Service to try to get more people involved. We are not yet there.

At the other end of the scale, I take a contrary view to that of the noble Baroness, Lady Harding. I have spent a lifetime while I have been in this Chamber working on issues of addiction and with voluntary organisations that offer help free of charge. Often they make no progress, but quite often they produce remarkable results. I believe that Public Health England has not given big enough recognition to those organisations. It endeavours to work with them, but we need greater collaboration between the two. We need not just the public health element present on the board but the suggestion from the noble Lord, Lord Howarth, of wider involvement with what I would describe generally as the third sector. The development of the National Academy for Social Prescribing is a great movement, and it should be expanded at a faster pace. It would produce great benefits in relieving pressures in other parts of the health service.

As somebody who works on the other side—as distinct from being a director and running the organisation—I see the difficulties of trying to get influence at that end. From the noble Baroness’s viewpoint, not too many people are involved and the chair makes the decisions, but I beg to differ. I think we need wider representation there. The amendment in the name of the noble Baroness, Lady Merron, provides that, and I most certainly give strong support to Amendment 3 in the name of my noble friend Lord Howarth of Newport.

[Lord Patel (CB)]

My Lords, I would like to ask a question of the noble Baroness, Lady Harding, who has what is accepted as huge experience at board level, on boards of different sizes. If it is right, no matter the size of the board, to have representation selected on the basis of experience, can it be wrong, no matter the size of the board, to have as board members people with experience in, let us say, public health or local authorities—because they have experience specifically in that area—as opposed to people who might have wider experience, including in finance or whatever?

Health and Care Bill

Lord Brooke of Alverthorpe Excerpts

2nd reading
Tuesday 7th December 2021 Lords Chamber

[Lord Brooke of Alverthorpe (Lab)]

My Lords, I am grateful to the Minister for his introduction. I think he would be wise to reflect on what happened in 2012; he was not around, but there was a period of pausing to reflect before the Government decided to return to the work and move on. Given the problems we may encounter this winter, it is vital that health, not reorganisation, comes first, and the Government should be willing to delay if need be.

Changes to the Bill are needed. I am no expert on the overall structure of the NHS and its related bodies; my interest is primarily in welcoming in the Bill the mention of the narrow areas I work on, including public health related to obesity, diabetes, addictions, alcohol and so on. I welcome the movement on obesity, but more work needs to be done there. I give notice that I will raise some issues that were raised in the Commons concerning labelling, calories and alcohol.

The other big issue that I know a little about is the workforce. There is another angle from which we can try to approach this shortage of resources; we can look perhaps at the further development of social prescribing. As we all know, there is a considerable fund of support and enthusiasm for the NHS. Some 750,000 people volunteered to give service in the early part of the Covid pandemic, but nothing has really been done; from what I hear in speaking to some of them, they were not even contacted afterwards or given anything to do.

This is a major failing on our part, so I hope we might look beyond the NHS structure and see whether we can get greater resources there to help us. Matt Hancock’s idea of the National Academy for Social Prescribing is good. There is no reason why we should not endeavour to increase the number of people working in that area and have a faster rollout than presently planned. If we could do that, it would to a degree ease burdens on the staff in the NHS itself. We should look further to see how we can have greater public and patient involvement in the National Health Service. We have seen the great fund of good will there over the course of the past two years. I regret to say that we have not really built any kind of structure to pull more people in, one way or another.

I was interested in NHS charities. In 2018, I talked to the noble Lord, Lord Stevens, about creating a national charity for the NHS to which people like me could leave something in their wills. At present, I have nothing designated for the NHS, but I would like to give something. As I get older and have to have more and more treatment, I am sure I will feel even more grateful. There is a local charity in Chelsea and Westminster where I live, but it is not well known. Communications need to be reviewed to establish closer relationships between the charities and the public. There is a great fund there, with money and physical resources available for the NHS, if the authorities are prepared to look down more, rather than looking upwards all the time. That would be to the benefit of the country overall.

HIV and AIDS

Lord Brooke of Alverthorpe Excerpts

Wednesday 1st December 2021 Lords Chamber

[Lord Kamall (Con)]

The noble Lord makes an incredible point. Not many people are aware that there is no cure as such yet. It is about ensuring that you reduce the risk of transmission and that those who contract HIV can live longer, as opposed to the beginning of the 1980s, when this epidemic hit us, and sadly many people lost friends, loved ones and others prematurely. On looking for a cure, I assure the noble Lord that the department is very aware of that. In my briefing for this I asked how come we still do not have a cure after so long—a question that continues to be asked. Let us pay credit to the pharmaceutical industry and the medical profession. They have tried.

[Lord Brooke of Alverthorpe (Lab)]

What steps are being taken with those members of the Commonwealth who have difficulties accepting or supporting the gay community?

[Lord Kamall (Con)]

The noble Lord makes a very important point that we should be aware of and address. We are aware of certain countries—I have been warned not to name and shame them, sadly—which stigmatise, discriminate, or have some other explanation. One of the best ways to deal with this sometimes is not via government-to-government help but by ensuring that we get to NGOs that are working with people on the ground. Also, at the macro level, in international forums, we can raise this issue. The UK, to its credit, is seen as a world leader when raising these issues at different diplomatic forums.

Food (Promotion and Placement) (England) Regulations 2021

Lord Brooke of Alverthorpe Excerpts

Tuesday 23rd November 2021 Grand Committee

[The Deputy Chairman of Committees (Baroness McIntosh of Hudnall) (Lab)]

My Lords, the noble Baroness, Lady Brinton, will contribute virtually as the Liberal Democrat Front-Bencher at the appropriate point in the debate.

[Lord Brooke of Alverthorpe (Lab)]

My Lords, I am grateful to the Minister and the Government for the initiative, which I would describe as making tentative moves to try to reduce the growth of obesity. I declare an interest as vice-chair of the All-Party Parliamentary Group on Obesity, and I am grateful to the Obesity Health Alliance, which has recently produced a very wide-ranging and thorough examination of the problem. I am grateful to it for the briefing.

It is worth remembering that the last serious attempt to tackle this was after the coalition Government came into power in 2010-11, when an alcohol strategy was drawn up and there was an engagement between government and the private sector, and the many representatives of the health business, if I can describe it like that, who were anxious to see changes effected. We had the creation of the responsibility deal, which ran from 2011 through to 2015, when it collapsed. The health officials were unhappy about the way in which the agenda was being run, and in 2013 many of them withdrew because they felt that the private sector—the manufacturers and retailers—were controlling the agenda and that public health was rather lower down the line than profits. So it went in 2015, and since then we have had very little change, apart from a growth in obesity.

On the alcohol front, on which we have spoken from time to time, apart from with youngsters there continues to be a problem there, with more and more people going into hospital and more and more people dying from liver problems. The real concern here has been with the growth in obesity among youngsters. We have been at this since 2006, when the Labour Government first kicked it off with the national measurement scheme. Initially, the idea was that we would engage over a very wide area, but because of the continuing cuts that have taken place in public expenditure at local level, it has not really made a great deal of headway. We have had a fallow period, with many of us complaining over the years, but it would be churlish not to say that I welcome this move, although that is not to say that I am going overboard over what the Government are proposing.

I have a number of questions. It has taken us six years—seven years, really, since it will be 2022 by the time we finish the consultation with the parties involved and this is put into effect—but the document talks about waiting another five years to do a review. Unless I have misunderstood, it will be five years before it is fully reviewed again. Could you correct me if I am wrong or, if I am right, explain why we have to wait another five years, which means that we will have run from 2010 to 2027 before we really look at some of the serious proposals made by the Government?

Secondly, I would like to know who is covered by the square footage provision. Obviously, hypermarkets and supermarkets are covered, but I would like to know whether convenience stores are also covered. I live in Battersea, near the bridge, and next to us we have a local co-op that does extraordinarily good business. Would it qualify to be covered by the changes that are proposed? I cannot remember the figure, but it may be 1,200 square feet. I would be grateful if the Minister could say whether convenience stores fall into it, because they are major retailers in this context as they sell nearly half as much as the supermarkets do. If they are not covered, it will be a major omission and something that we would want to return to.

Thirdly, I listen carefully to everything the Minister says as he finds his way with his new brief. At his first Questions, he talked about unintended consequences and said that it is very important when we are making changes that we try to foresee them. I am particularly interested in seeing how retailers effectively drive a coach and horses through so many areas of legislation with their ability to place their goods in a position which sells them best for them but on the other hand brings them to the attention of children, in particular.

Again, I mention my local Co-op. No longer can people see cigarettes. They are hidden. It took years to get that changed, but it is a worthy development that was put through by the Government. When I go in, I am now surrounded by alcohol. We have all this about advertising, thresholds and the rest of it, yet when children stand in the queue to buy their Mars bars in the Co-op, they are surrounded by alcohol and, on the other side, by doughnuts and a host of sweeties which are attractive to them and which, as we know, are at the heart of the growth of obesity. I wonder whether the Government have thought through what will go in place of the movement of some of these articles which are presently being sold, which have been identified as being very risky from a health point of view. If they do not cover it, I suspect we will find, for example, that alcohol goes there, which is what has happened previously. I know that is not about child obesity, but none the less it relates to obesity, as 10% of all obesity comes from the sugar in alcohol. So we are continuing with the same problem, especially given that we still do not have any indication on alcohol. You queue there, and there is no indication of the sugar content or the calorific effects in the drinks. Perhaps the Minister might say what the Government are intending to do about that. I know it is not in this document, but it is all interrelated with obesity, and we cannot separate it too much.

In another initiative, trying to be as positive as I can be with the Committee, Sir Keith Mills, who was responsible for Air Miles and Nectar points, has been doing a special piece of work for the Prime Minister and has come up with a number of trials. Is there a correlation between the work that will be put in place in this document and what he is endeavouring to do in incentivisation? I may sound negative, but I believe in incentives to encourage people to eat and drink better and I believe in trying to find incentives in which the private sector, particularly retailers, will not to try to take advantage but will work together so that we will see positive incentives offered to them to effect changes in the formulation of food and the way in which they present drink and food in retailing terms. Is there a link between the activities he is undertaking?

Finally, can we see more experimentation? I am very pleased that Sir Keith Mills is doing that. Wherever we can try to engage with those who are interested in the private sector, we should try to get joint working taking place where, if the Government see it works yet the private sector does not want it, they will do what they are doing today. I hope they will stick to their guns, legislate and make the changes stick rather than change their mind and run away under pressure from the industry.

[Baroness Neville-Rolfe (Con)]

My Lords, I congratulate the Minister on his clear and succinct explanation of these regulations and of the risks of obesity, which we have witnessed a great deal during the Covid crisis. The noble Lord, Lord Brooke of Alverthorpe, then spoke about the APPG’s work on obesity.

I probably should register an interest. Although I no longer have direct food sector interests, I have shares in Tesco. In fact, I recall that it moved early in banning sweets from checkouts, but obviously it will incur costs from these regulations. I also have shares in Amazon, which, I suspect, could benefit from a shift online as a result of the regulations, which probably bear less heavily on online.

Forgive me for a brief diversion, but I was absolutely delighted to see that the regulations were made under the Food Safety Act. The passage of that Act was one of my proudest achievements as a civil servant. In fact, I supported the late Baroness Trumpington, whom I miss so much; she even gave me a toy pig for my baby, which has now been passed on to the next generation.