The NHS

Lord Brooke of Alverthorpe Excerpts

Thursday 5th July 2018 Lords Chamber

[Lord Brooke of Alverthorpe (Lab)]

My Lords, I am grateful to my noble friend Lord Darzi for a towering speech, made with spirit and committed to the fundamentals of the health service. We are extremely grateful to him. I express my gratitude to all who work in the NHS for all the outstanding work that they continue to do, often in difficult circumstances. I wear no badge today, but I have a kind of badge on my head, as I am wearing an NHS bandage from treatment I had this week. I shall be going to my doctor’s surgery tomorrow morning.

It is all part of my life. I was born before the health service was created, but I have had two near misses with my life. When I was 55, I had bowel cancer and was saved by the Royal Marsden. I was quite close to death, and here I am, 20 years on and still enjoying a fruitful life, for which I am eternally grateful to the health service and the people who work in it.

I shall take a different approach from anyone else. I have a different concern about the extent to which the public and I are responsible for the care of the NHS and how we deal with it. People can take it for granted in many instances and, as a consequence, the health service suffers. We do not get efficiency and effectiveness from it because of that—people not turning up for appointments and so on. It is important to continue to look at what we as individuals can do to make the health service even healthier.

I have suggested, and raised previously with the Minister, that one way in which we might bring about a change in attitude is to know what the cost of our health services is; after all, there is not much that we get in life whose cost we do not know, but that is not so with the health service.

The Government do not like this idea because they say that it might discourage people from taking up services. That is questionable. I have suggested in turn that those who would like to know the cost should be told, so that, if they feel gratitude to the NHS, they could make a charitable contribution towards a fund. It would be a fund that not just went towards the hospital where they had been treated or given the service but would be redirected to those areas in the country where we see the most ill health and the greatest deprivation in terms of health services.

The Minister has not responded very positively to these suggestions on previous occasions, so my appeal today is not to the Government but to my fellow Peers and to MPs: we should come together and, instead of words, words, words with nothing happening, we set up an all-party parliamentary group to look at how we might establish a charity that commemorated the 70 years of service that we have had from the NHS but in turn found ways of taking in contributions from those who were able to make them and wanted to express their gratitude for the services or operations that they had had from the NHS. I would certainly be prepared to do that. We would have a group of qualified people—maybe Peers or surgeons—who redirected the funds or gave advice on where they should go in the NHS. We should do it ourselves. If the Government will not do it, this is a source of considerable money among the public at large to which the NHS fails to respond. There is great feeling for the service. I believe that people would make bequests or offerings after they had had operations. It is time that we took advantage of what is there for us. I hope the Minister will respond that when he replies.

Childhood Obesity Strategy

Lord Brooke of Alverthorpe Excerpts

Monday 25th June 2018 Lords Chamber

[Lord O'Shaughnessy]

I thank my noble friend for her questions. I salute the work she has done and the leadership she has shown on this issue. As to the content of the consultations, that will depend on when they are launched but it refers in the paper to consulting before the end of 2018 on a number of issues, so that will go through the normal process, I suppose, of a three-month consultation.

I shall look at the issue of the “eatwell plate”. It is worth pointing out that, under the “Schools” heading, there is a desire to update school food standards, reduce sugar consumption, strengthen nutrition standards and the government buying standards for food and catering services. So there is a desire to look at the official guidance that goes out and to make sure that it reflects the best science and enables any institution that is looking after children, families, schools, adults and others to give the best possible nutritional food that they can.

[Lord Brooke of Alverthorpe (Lab)]

My Lords, I welcome the proposals for further action, but I am sorry that the Government have not seen fit, if they are taking this really seriously, to make a Statement about it without the requirement for an Urgent Question to elicit a response. I have two points. I regret that there is still no mention of the point that the noble Lord, Lord McColl, has been pressing so vigorously—that we need to bring together these numerous initiatives and try to present a single campaign for parents and children. I also regret that there is still no mention of the Government dealing with the major broadcasters, in particular the BBC, to see how a longer-term plan might be produced which would make a direct link with children and thus try to ensure that effective changes take place.

My second point is that last week the Minister was kind enough to reply to my Question for Written Answer about the extent to which the Government are aware of how much children between the ages of 12 and 16 weigh. I am surprised to hear that while we weigh children at the ages of four and 11, nothing is done about weighing children beyond that age. We do not know what the scale of the problem is up to the age of 16. A survey has been undertaken in which only 2,000 people were involved. There is a requirement that we move towards weighing these children. Is the Minister prepared to consider doing that?

[Lord O’Shaughnessy]

There is a single campaign which is exemplified in the document and we need to put that across. I know that the noble Lord is working with broadcasters. I am not sure about the merits of weighing teenagers, but I will look into that and write to him.

Childhood Obesity: Yoga

Lord Brooke of Alverthorpe Excerpts

Thursday 21st June 2018 Lords Chamber

Asked by

[Lord Brooke of Alverthorpe]

To ask Her Majesty’s Government whether they have made an assessment of the benefits of yoga for obese schoolchildren.

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

My Lords, while there is some evidence that regular yoga is beneficial for people with high blood pressure, heart disease, aches and pains, depression and stress, no central assessment has been made of its benefits for obese schoolchildren.

[Lord Brooke of Alverthorpe (Lab)]

My Lords, I am grateful for the noble Lord’s observation. Is he aware that the largest NGO in India, the Kripa Foundation, uses yoga as a means of attracting young drug addicts, drunks and people with HIV into recovery? Given the success there and the problems we have with our current obesity plan, which fails to get into the heads of young people—we have great difficulty in making connections so that they can become more self-aware about the need to take responsibility for their own health—might we explore methods such as yoga with them? It might be a means whereby they could take a closer look at themselves, their problems and the opportunities they have to make a better life in the future.

[Lord O’Shaughnessy]

I am not aware of the charity that the noble Lord mentioned, although after university I spent six months in India as a teacher. The school I taught in practised yoga with its children and it seemed to have a calming effect on them—which is just as well, because I am not sure my teaching skills had such an effect. I am sure many noble Lords know personally the benefits of yoga. It has not been proven to have any impact on obesity, although it has many other benefits, as the noble Lord pointed out. It is something that schools can and do use as part of their repertoire in the PE curriculum to provide exercise for children, although it does not count towards the moderate and higher levels of activity demanded by the PE curriculum.

Psychiatrists: Referral Fees

Lord Brooke of Alverthorpe Excerpts

Thursday 7th June 2018 Lords Chamber

[Lord O'Shaughnessy]

We do not have any detail on further cases at this point. Of course we would always welcome any evidence, as would the GMC, in order to investigate that. It is important to point out that doctors are revalidated medically every year and fully revalidated every five years. In that process, they are asked to demonstrate that they have stuck by the ethical guidelines in the GMC practice and, if any evidence alights contrary to that, it would put their registration at risk.

[Lord Brooke of Alverthorpe (Lab)]

My Lords, as someone who has been in this area for quite some time, this exposure in the Sunday Times comes as no surprise whatever—it has been going on for many years. More importantly, is the Minister aware that there is a growing crisis in the private sector provision of alcohol and drug treatment centres? The numbers are declining and many are closing. The CQC produced a very critical report on the standards, which showed that 60% to 70% of them are failing to meet the appropriate level of performance, and that there is a distinct possibility that even less money will be available to provide for this kind of service in 2020, when the funding shifts to business rates. Is the Minister concerned about these kind of developments, and if so, would he be willing to talk to people who are equally concerned about it to try to find some way forward with better prospects for the future?

[Lord O'Shaughnessy]

I am as disturbed as the noble Lord is, not only by the stories we have seen in the press but by his view that this came as no surprise. If substantiated, from a professional perspective this is clearly a great cause of concern. I would be interested to meet him to talk about the overall support for the private sector. Clearly the CQC has a role in providing for patient safety and quality, but we need to make sure that publicly funded services are available for people recovering from alcohol and drug addiction.

Children: Obesity

Lord Brooke of Alverthorpe Excerpts

Thursday 10th May 2018 Lords Chamber

Asked by

[Lord Brooke of Alverthorpe]

To ask Her Majesty’s Government what plans they have as part of their review of the Childhood Obesity Plan for Action to work with the BBC to ensure that efforts to reduce obesity involve schoolchildren nationwide.

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

My Lords, broadcasters have an important role in shaping the national conversation about reducing obesity and promoting healthier lifestyles, as has been demonstrated by recent programming. Officials from my department are in discussions with those in the Department for Digital, Culture, Media and Sport to explore how we can work together with broadcasters on this important issue.

[Lord Brooke of Alverthorpe (Lab)]

I am grateful to the Minister for that helpful and hopeful reply. Like the noble Lord, Lord McColl, I believe that we need a major overarching campaign that must be focused on children, and principally the BBC would be the organisation to lead it. I hope the discussions that are taking place will produce a positive programme so that we can see that the 8 million children, many of whom have a serious problem and face difficulties ahead, are given the assistance they need to get to better health in the future.

The Long-term Sustainability of the NHS and Adult Social Care

Lord Brooke of Alverthorpe Excerpts

Thursday 26th April 2018 Lords Chamber

[Lord Brooke of Alverthorpe (Lab)]

My Lords, like other noble Lords, I am grateful to the noble Lord, Lord Patel, and his Select Committee for producing their wide-ranging and influential report. Nye Bevan said that the NHS will last as long as there are folk with the faith to fight for it. Without doubt the noble Lord, Lord Patel, and the Select Committee have demonstrated that they have faith ,and they are ably supported by the right reverend Prelate the Bishop of Carlisle.

I shall confine myself to the Government’s response to the part of the Select Committee’s report headed “Public Health, Prevention and Patient Responsibility” and Recommendations 29 to 31. While longevity for both sexes has gone up, worrying evidence is now starting to emerge that in some locations it is not only stalling but possibly starting to reverse. Mental health illnesses are also greatly on the increase. There are social factors behind the causes, but a major problem, which we fail to address head on, is the unhealthy lifestyle habits that have developed in recent years in both adults and children.

As other noble Lords have said, 63% of adults and nearly one-third of children in England are classed as overweight or obese, rates of smoking are still at 17% and 10.5 million people are drinking at levels that pose some risk to their health, which has a knock-on effect with illnesses such as diabetes, cancer and heart disease. This in turn puts significant strain on NHS resources. As the noble Lord, Lord Ribeiro, indicated, it is estimated that alcohol alone costs the NHS £3.5 billion a year, and obesity is going up and is now estimated to cost about £5.1 billion a year.

These costs and the related illnesses and diseases can be reduced. While the rate of smoking is still far too high, great changes have been achieved in a relatively short time through very effective public campaigning and by having Governments who have been prepared to take tough decisions on issues such as pricing, marketing and availability.

I turn to the Government’s comments on obesity, where some very tough decisions need to be taken. I am pleased that they are being positive. In their response they set out a range of actions, all of which are to be applauded, but are they enough and sufficiently hard-hitting to achieve their objective?

The Government said that they will monitor change in the prevalence of childhood obesity through various schemes, including the national child measurement programme and the Health Survey for England. More detailed assessments will be carried out next year and in 2020, but when we check on this we find that we have been doing this since 2006. To my surprise, we have been weighing and measuring the height of 1 million children aged 4 and 11 every year since 2006 when the problem was first identified, and we are now talking about doing further assessments in 2019 and 2020. This review was set up with two key purposes. The first was,

“to provide robust public health surveillance data on child weight status: to understand and monitor obesity prevalence and trends at national and local levels, inform obesity planning”.

This was back in 2006. The second was,

“to provide parents with feedback on their child’s weight status: to help them understand their child’s health status, support and encourage behaviour change where it will help a child achieve a healthy weight, and provide a mechanism for direct engagement with families”.

What have we done with all this data that has been collected? This is not a mandated programme. Local authorities are only encouraged, they are not required. As we know, local authorities have suffered cuts to their income of close to 70% over recent years, so is it any surprise that after running this programme since 2006 we find obesity is now worse than it was when we commenced this exercise virtually at the turn of the century?

We now find ourselves in the position where overweight is becoming the norm with parents and even health professionals, and they are struggling to identify overweight children by sight. True, the Government have an obesity plan. The sugar tax is greatly welcome, as is the reformulation of food, which they are working on. I believe further changes are likely to come, restricting children’s exposure to junk food and advertising, as reported in the Times earlier this week. We see Members from all parties coming together at last and recognising that the only way we can make a movement is by working together and not engaging in the usual feuding.

There are a number of initiatives, all with the best of intentions. Frankly, though, many of us believe there is a case for this all to be brought together with an overarching national campaign involving all schoolchildren. Here I look across at the noble Lord, Lord Saatchi; maybe this is an area where he could bring his particular expertise to bear. We should be endeavouring to engage 8 million children in this programme in the 24,000 schools around the country, not just a small element, as we have done since 2006. They need to be weighed and then, in turn, to be given the facts, full support and encouragement, with the involvement of their parents, to try to persuade them to lead healthier and more fulfilling lifestyles than they engage in at the moment.

I regret that the present obesity plan does not have a central focal point; it is a whole range of different small initiatives. We need some major pulling together of the threads with a strong lead being given. As I mentioned to the Minister last week, for some reason broadcasters are not involved in the plan or even mentioned in it, but they should be. Why are they not? The BBC, with its national and regional TV, radio and online facilities should be spearheading a flagship programme and related co-ordinated activities for the health not only of our youngsters; if we can run an anti-smoking campaign that affects parents, as that one did, we can do the same to see movement on obesity. Is it possible? Yes, it is. We need willingness, power and determination.

Even if the Government are not prepared to move on this, I hope that, in looking at the report, we can stand up and start to push people in a direction where we involve a massive number of them in tackling a major epidemic that cannot be left untackled any longer.

Children: Obesity

Lord Brooke of Alverthorpe Excerpts

Thursday 19th April 2018 Lords Chamber

[Lord O'Shaughnessy]

The noble Baroness is absolutely right: parents are of course the first educators of their children and it is about them being able to set an example. I would focus on a couple of things: first, the national curriculum in schools, which is encouraging parents to get involved in understanding what good nutrition is, how to cook well and so on. The second is Public Health England’s new One You campaign, posters of which are up now, which talks about the 400, 600, 600 of calories per meal per day to encourage parents to get into good habits, because of course, if they have good habits and are well informed, their children will too.

[Lord Brooke of Alverthorpe (Lab)]

My Lords, does the Minister believe that within the plan there may be a greater role for the major broadcasters in this country to give a stronger lead against these problems? The BBC, in particular, has major flagship programmes which are primarily about eating, putting on weight and calories, but the same applies to the other channels. Will he join me in a conversation with the BBC to try to persuade them to produce a major flagship programme that addresses the issue, particularly with regard to children?

[Lord O'Shaughnessy]

That is rather an interesting idea and suggestion from the noble Lord. We would need to speak to colleagues in the DCMS—which I would be delighted to do. I think that broadcasters such as the BBC have traditionally played a very important and positive role in public health issues and continue to do so, and I am happy to encourage them to do so in this area, too.

NHS: Winter 2017-18

Lord Brooke of Alverthorpe Excerpts

Wednesday 18th April 2018 Lords Chamber

[Lord O'Shaughnessy]

I think the structure of our GP service and primary care is envied around the world. It has many strengths, such as the partnership model being based in the community, but it is changing. For example, more GPs are employed in hospitals. There is a major programme of investment going into primary care, including new models of care around how GPs are structured, but the presence of primary care doctors in the community is one of the great strengths of the NHS.

[Lord Brooke of Alverthorpe (Lab)]

My Lords, I welcome the review which the Minister has announced. Does he agree that it would be beneficial if we had a debate in this House on the review when it is out, and will he commit to trying to ensure that his Chief Whip gives us the time to have such a debate?

[Lord O'Shaughnessy]

I am not sure how much pressure I can bring on the Chief Whip for anything, but I look forward to debating the review in whatever form we can when it comes out.

Brexit: Health and Welfare

Lord Brooke of Alverthorpe Excerpts

Thursday 29th March 2018 Lords Chamber

[Lord Brooke of Alverthorpe (Lab)]

My Lords, I am grateful to the noble Baroness, Lady Brinton, for securing this debate and for her persuasive arguments. I am grateful to all others who have contributed to what has been a very comprehensive debate. I will say something on the impact of Brexit on health inequalities.

I am sure that many of your Lordships are aware of the work by Michael Marmot, who has highlighted that there is a social gradient in health—that is, the lower a person’s social position, the worse his or her health. People living in poorer neighbourhoods in England have lower expectancies and spend more of their shorter lives with a disability, compared with people in wealthier neighbourhoods. For example, the longest life expectancy in the country is in the richest borough, quite close to us, Kensington and Chelsea, where it is 83 for men and women there live to the age of 86. By contrast, the lowest life expectancy is in the north of England, where many people voted for Brexit. For example, in Blackpool we have life expectancy for men down at 74; in Manchester, it is only 79 for women.

Health inequalities stem from avoidable inequalities in society—inequalities in income, education, employment and neighbourhood circumstances. Inequalities present before birth set the scene for poorer health and other outcomes throughout the course of an individual’s life. Action on health inequalities requires action across all the social determinants of health. Marmot made a number of recommendations in his 2010 review to reduce health inequalities, which included giving every child the best start in life; enabling people to maximise their capabilities and have control over their lives; creating fair employment and good work for all; ensuring a healthy of standard of living for all; creating and developing healthy and sustainable places and communities; and strengthening, in particular, ill-health prevention.

The Government’s performance on these since 2010 has been very varied indeed. It is true that unemployment has gone down, but there are still very large question marks about the quality of the work that many people now undertake. We have of course seen of late that income has become virtually static. That is a cause for great concern. Efforts continue to try to make basic changes in education. Communities, through local grants and local authorities, have been starved of funding, with some councils now in dire financial straits, which is having a knock-on effect on social care in particular. Care and health services have generally faced increasing demands, with more patients, more people going into A&E, and people living longer.

In relative terms, while more cash has come in—it is true that the Government have put more money in—this has not matched what has been required, either in terms of the difference between GDP and inflation rate annually or the cost of the growing demand generally. Notwithstanding the defence that the noble Lord and his predecessor have put up that the Government are doing the maximum they could in regard to health, we have learned in the past week, with statements by the Prime Minister and the Secretary of State, that when many of us said for many years that not enough cash was going in and that more was needed, we did have a case. We now have the promise that more money is going to come. To a degree, I suspect that that makes the noble Lord’s response today somewhat easier than it might have been if that statement had not been made, because Brexit, the NHS and money was a central issue in the debate that led to people voting in particular directions. It is welcome news, but like others I hope that we are not going to have to wait too long to see the outline of the plans that the Government will draw up or have to wait too long before we start to see the extra money.

I believe, examining the poll results, that people in the areas of the country that voted for Brexit were influenced to a very substantial degree by the issue of immigration. They were also influenced greatly by the claim on the battle bus about money that would be available to be spent on the NHS. I think they also voted to a fair degree on the somewhat nebulous issue of taking control back from Brussels and being in charge their own country. The Government have to some degree started to answer the question on costs and the NHS but there is another worry and concern about where the NHS may end up, which will hit people in the Brexit areas if it works its way through, and that is that after we come out of Europe we will start to negotiate trade deals. In this speech I focus primarily on the topic which the noble Baroness opened on and wrote about in the House Magazine last week, which is the danger that we will not have the control over the NHS at the end of the day that we have at the moment when we are within the European Union.

All the rumours indicate that talks have been taking place on deals, particularly with the Americans, that the Government need to secure if Brexit is to be seen to be working in the fundamentals of our trade with the rest of the world. America is a very big part of that. There are concerns that the NHS will be on the agenda as part of the negotiations that may take place. If the NHS is on the agenda, it will be there for a purpose. From our angle it will not be improving matters; instead there will be a risk that the Americans want to make greater inroads into the NHS than they have been able to do so far, because of the protection we have had from the EU.

We had a short debate on this last week during which we raised questions about the American trade deal. The noble Viscount, Lord Younger of Leckie, responded for the Government. It was quite a wide-ranging debate within the eight minutes open to each of us and at the end of it we went away feeling we had had a good debate but that the noble Viscount had not been able to answer the points that had been raised by many participants from all sides of the House. We wanted to know why the NHS will be on the agenda and some of us had particular concerns that it may become part of the negotiating deal. If the Government are saying, “It is safe in our hands”, they can give us complete security by giving an undertaking that it will not be on the agenda and that therefore there will not be a risk of any changes, loss of control or damage to the interests of the people of this country. My question, which I put to the Minister last week, is a very simple one: in order to protect the NHS, could we not remove it totally from any agenda for negotiations with the Americans?

Prescription Drugs: Dependence

Lord Brooke of Alverthorpe Excerpts

Monday 19th March 2018 Lords Chamber

[Lord O'Shaughnessy]

I think the link between mental illness and GP prescribing will be investigated in the review. We know that we need to do better in mental health services in this country, but it is worth pointing out that we are increasing investment and introducing new waiting-time standards, so services are getting better.

[Lord Brooke of Alverthorpe (Lab)]

My Lords, is there not a case for a wider review of addictions in general? Public Health England did a review of alcohol and the Government ignored the report. A public health review in this area may be ignored entirely and there is nothing to make the Government do anything about it. We have just heard about what is happening with gambling; the Government have succumbed to the blandishments of the gambling industry and are not doing what many people in this House wanted on it. It is another addiction. Should we not have a review right across the board on addictions?

[Lord O'Shaughnessy]

The Government are taking steps to deal with addiction in a number of areas. We are obviously focusing on prescription drugs and the dependence on them. I hope the noble Lord will welcome the review and have the opportunity to contribute to it, as I know he feels strongly about these issues.