Mental Health and NHS Performance Update

Lord Brooke of Alverthorpe Excerpts

Monday 9th January 2017 Lords Chamber

[Lord O'Shaughnessy]

Mental health is an issue that spans education and health. I recognise the problems that the noble Baroness is describing. I do not know the specific details about the performance of referrals but I will write to her with that information. One of the purposes of the strategy, and the adoption of all the recommendations of this review, is to make sure that we make the system work better so that what the noble Baroness describes—which is not what we want to happen—happens less frequently.

[Lord Brooke of Alverthorpe (Lab)]

My Lords, I too welcome the noble Lord to his new appointment and wish him well. I place on record my gratitude to his predecessor, the noble Lord, Lord Prior, who was always open and honest in his dealings with us and straightforward in answering our questions. I hope we are going to have an open and honest discussion about the role of A&Es in the future and whether there is any likelihood that we are going to lose the four-hour limit. Over the holiday period, Sir Simon Stevens commented that A&E is not to be used as a “national hangover service”. Is there a possibility that we are to lose some of the terms we have had in the past because of the number of drunks who are being treated on Fridays, Saturdays and Sundays throughout the year—not just over bank holidays? This is creating immense problems within A&E, yet the Government refuse to do anything about the fundamental cause of that: to use Mr Cameron’s phrase, “cheap booze”. Back in 2012 he was advocating a change to try to stop this. Unless that is addressed, there will be a scandalised outcry about changes in the fundamental terms relating to A&E.

[Lord O'Shaughnessy]

I thank the noble Lord for his welcome. On A&E, the Statement is very clear that the Government are,

“committed to maintaining and delivering that vital four-hour commitment to patients”.

As the noble Lord described, there has been a change in the case load going into A&E. You only need to spend a bit of time in an A&E to know that alcohol is a factor. I do not know whether this is increasing, but I shall endeavour to find out. I absolutely agree that any proper strategy for relieving pressure on A&E must include cracking down on problem drinking.

Public Health England: Alcohol

Lord Brooke of Alverthorpe Excerpts

Tuesday 5th July 2016 Lords Chamber

Asked by

[Lord Brooke of Alverthorpe]

To ask Her Majesty’s Government when they expect Public Health England to publish its independent evidence-based report on alcohol.

[The Parliamentary Under-Secretary of State, Department of Health (Lord Prior of Brampton) (Con)]

My Lords, the evidence review is currently being peer reviewed and PHE will publish it later this year.

[Lord Brooke of Alverthorpe (Lab)]

I am grateful to the Minister for that response and I look forward to the report. Is he aware that the latest statistics from the Health and Social Care Information Centre show that hospital admissions due to alcohol-related illnesses are continuing to rise and are now more than 1 million, that the number of deaths arising from alcohol continues to go up, and that the cost to the NHS of alcohol-related problems is more than £2.5 billion? Given the difficulties that the NHS faces in funding itself at the moment, given that the economy may slow down as a result of Brexit so that less funding is available and given that we heard today about the prospect of another doctors’ strike, are the Government prepared to review the plan for the NHS to which the noble Lord so frequently refers? It may need to be changed completely, so what is plan B?

[Lord Prior of Brampton]

My Lords, that goes slightly beyond the Question on the Order Paper. The Government are committed between now and 2020 to putting £10 billion of new money in real terms into the NHS and we have a plan to deliver on that. Clearly, if the economy changes to a great extent, we will have to keep that in mind.

Health: Alcohol

Lord Brooke of Alverthorpe Excerpts

Thursday 12th May 2016 Lords Chamber

Asked by

[Lord Brooke of Alverthorpe]

To ask Her Majesty’s Government what steps they are taking to alert the public to the dangers of alcohol and its causal links with hypertension, depression, Alzheimer’s and other forms of dementia.

[The Parliamentary Under-Secretary of State, Department of Health (Lord Prior of Brampton) (Con)]

My Lords, the new UK Chief Medical Officer’s advice on low-risk drinking helps people understand how they can reduce their risks from alcohol consumption. Public Health England has recently launched One You, a marketing programme providing personalised feedback on alcohol and other potentially harmful behaviours. In primary care, alcohol-risk assessments are offered to all patients registering with a new GP and 3.5 million people have had one as part of their NHS health check.

[Lord Brooke of Alverthorpe (Lab)]

I am grateful to the Minister for his Answer and for the efforts which I know he makes on this topic. Is he aware that we now have 9 million people suffering from hypertension, that the number of people with depression has doubled since 2005 and that the evidence now quite clearly shows that 62 illnesses are related to alcohol? Given the amount of money which the drinks industry spends on advertising seeking to persuade people to drink more, is it not time that the Government start to undertake some important work with a publicity campaign gently to persuade people to drink less and live a better, longer and happier life?

[Lord Prior of Brampton]

My Lords, the new guidelines published by the CMO are very clear about how much alcohol should be drunk and the implications it has for health. I do not know whether the noble Lord has been on to the One You website or has downloaded the drink tracker app. The information is out there. A campaign is being conducted by Public Health England, and we are making some progress.

Alcohol Strategy (EUC Report)

Lord Brooke of Alverthorpe Excerpts

Wednesday 10th February 2016 Grand Committee

[Lord Brooke of Alverthorpe (Lab)]

My Lords, I am grateful to the noble Baroness, Lady Prashar, and her committee for the report they have produced. Again, it was of a high standard and matched what one expects of House of Lords scrutiny committees. Like her, I regret that it has taken so long to obtain a debate on it; that it has taken six months for the Government to reply; and that it is still taking the Commission an extraordinarily long time to make up its mind whether it wants to renew with a further strategy—or whatever we might care to call it.

It is a pity that this debate is not being held in the Chamber and that we are pushed away to one side, which reflects, to a degree, the phrases used in the report. There is a degree of apathy about this issue at Commission level—and we are discussing this in a secondary Chamber rather than the main one—even though so many people are dying and suffering as a consequence of alcohol misuse. Not enough attention is given to it.

As the noble Baroness mentioned and as the report says, after tobacco and high blood pressure, alcohol is the third leading risk factor for deaths and disease in Europe. As she also mentioned, Europe leads the world in the volume of alcohol consumed.

On the 2006-12 strategy, I share the committee’s view that a review similar to the original one would be of little value even if minor amendments were made to it. I also share the committee’s view that if there is to be a further strategy, or whatever one might call it, it must be far more radical than we have witnessed so far. I share, too, the committee’s view that it should not be focused only in the health DG—although that is very important—and that we need to look at the way it interacts with other DGs in Europe. As the noble Baroness said, it should deal with drink-driving, which is very important. Labelling is dealt with under an entirely different DG. Minimum unit pricing is also dealt with elsewhere, as is taxation.

I note that in the Government’s response, they share the view that there is a requirement to read across and not just focus on one department. However, I am happy to see ever greater emphasis being placed on the health aspects and consequences that arise from abuse of alcohol. I am pleased that we have a health Minister here today to listen to our views. Given the problems he faces with the NHS, particularly the current financial difficulties, and given that alcohol is a contributory factor to those difficulties, he brings a sympathetic ear—I hope—to the representations many of us are making. Therefore, I agree with and support most of the recommendations that the noble Baroness and the committee have made. Initially, I disagreed with her view on minimum unit pricing. Having read the document, I know that the committee recommends that we should find out what is happening in Scotland, monitor it and then decide whether we should move forward on that issue.

I am firmly of the opinion that there is now a body of evidence which indicates that we should move to a minimum unit price. The Prime Minister said in 2012 that we needed to have minimum unit pricing. I hold consistently to that view, and believe there is now even more evidence that we should move to a minimum unit price and not wait to see what happens in Scotland. Like the noble Baroness, I look forward with interest to the Minister’s remarks on that issue. However, I am of the view that we should move fairly quickly on MUP, especially given the major problems arising from obesity, diabetes and excess sugar consumption. Alcohol is a contributory factor given its sugar content, but many people are totally unaware of that. Fresh initiatives are required in these fields. I look forward to seeing what the Government bring forward in their policy on obesity. I hope that it will not be limited simply to children but will recognise that there is a serious problem across the whole population. I hope they will address that and not focus solely on children.

I particularly support and commend Recommendation 6 in paragraph 117, that,

“Future EU action … should not be confined”—

solely to health policy, as I said—

“but should take a ‘health in all policies’ approach”,

right across the board. In looking at the government response, I hope I am right in thinking that they share that view. I hope that the UK Government will not only support that practice being put in place in Brussels, but will start to practise that themselves in the UK, where they have total control.

The responsibility deal, legitimately, has the simple aim of reducing the volume of alcohol that is consumed. However, in March 2015, the Chancellor’s Budget not only froze alcohol duties but went further and reduced them on certain spirits. Indeed, yesterday I had a letter from an organisation representing breweries which said, “We’re having a party. Would you like to come and join us?”. For three years running we have had no change in duties on alcohol. So there we have it—the Chancellor is cutting the price of alcohol. I would like the Minister to confirm that the price of alcohol in the UK at the moment, especially given the strength of sterling, is probably the lowest it has been for about four or five years. I also draw to his attention that, following further inquiries on the Budget, I discovered that the Treasury itself—it is not represented here today—stated that the Chancellor’s actions would increase the volume of alcohol consumed in this country. So on the one hand we have the Chancellor increasing the amount of alcohol being consumed, and on the other we have the responsibility deal seeking to reduce it.

I then asked the Treasury whether it had consulted the Department of Health on this before it decided to change the rates of duty. Given that health is the second biggest area of expenditure the Chancellor deals with in the Budget, it seems a bit strange that I then discovered that he had never consulted the department about the cost effects on the health service. I tried to table a Question to ask how many people would have died as a result of the Chancellor’s action, but our clerks decided that that was a little beyond the pale and I did not manage to do so. Therefore, I suggest to the Minister that when we are looking at Europe we should start to practise a little bit more clearly and openly what we suggest they should be doing.

I would like the Minister to say what he feels about the Chancellor’s actions on limiting the growth in duty, and whether he believes that that will lead to a diminution in the number of people who die or suffer ill health as a consequence. Alternatively, I would like him to state where we stand on the future of the responsibility deal. The drinks industry and distributors are all very much in favour of the responsibility deal continuing, but of course, in the UK we have the division between the producers and the health industry which I believe the noble Baroness encountered when the committee did its report. There is a clear division between the health lobby and what has been happening with the drinks industry.

The effectiveness of some of the bodies established under the 2006 to 2012 strategy is questionable. The drinks industry wants the forum to continue, yet in the mean time a lot of the health organisations have withdrawn from it. Where do the Government stand on the forum: do they believe it has a worthwhile future, and if so, how do we make it much more effective? We need to practise at home what we preach; let us try to make sure that Europe introduces a long-term, meaningful strategy.

Will the Government return to MUP following the recommendations that keep coming from Public Health England, which says that MUP is desperately needed to address the issue fundamentally? Are the Government seriously looking at all the available evidence, and are they prepared to revisit the topic, which was regrettably set aside in 2014? MUP is fundamental to a change in attitudes. Happily, younger people are drinking less—quite a change has taken place there—and against that background, no doubt, many people say that we do not need many further changes. However, a close examination of what is happening shows that A&E and hospital admissions have increased by about 3% a year since 2012. Even though younger people are drinking less, older people still present at hospital needing attention, which costs the health service phenomenal amounts of money. Therefore, we have a major continuing problem in spite of the good news about young people.

I hope that the Minister will be able to say that the Government are considering drawing up a strategy for the UK, as well as pressing for one in Europe. The last one was drawn up by the coalition and, so far as I am aware, no such strategy currently exists. We have issues with obesity, I would like to know where we stand on the strategy for and approach to alcohol.

--- Later in debate ---

[Lord Brooke of Alverthorpe]

It is 50 milligrams to 100 millilitres of blood.

[Lord Prior of Brampton]

We will see what impact that has: if it is major, we should clearly take it into consideration.

Since April last year, the standard GMS contract has included delivery of an alcohol risk assessment to all patients registering with a new GP. This has the potential to raise awareness of alcohol as a risk factor with a large percentage of the population. The Government are also continuing to work with Public Health England, which is giving a high priority to alcohol issues by working with local authorities. However, we believe it is right that the primary responsibility for drug and alcohol issues should be with local authorities. PHE will support all local authorities and their partners to put in place high-quality interventions to prevent, mitigate and treat effectively alcohol-related health harm. As noble Lords will know, services include local licensing controls and specialist services to support recovery for dependent drinkers.

In 2014-15, the Department of Health commissioned PHE to review the evidence and provide advice on the public health impacts of alcohol. The review of evidence has been completed and is in the process of being written up as they complete a peer review process. It will be available in due course.

The new alcohol guidelines provided by the CMO are currently out for consultation. That will have an important impact on the debate as we go forward, so I hope that noble Lords in this House will contribute to that consultation. The department recognises that in the light of the new guidelines further work will need to be done on labelling and an appropriate transition period will be put in place to ensure industry can change its labelling in a cost-effective way.

The noble Lord, Lord Brooke, raised the issue of duties and the mixed messages that might come from reducing duties. All Governments face this issue. They have to get the balance right between what is good for people and what people want to do in a free and democratic country. It is a difficult balance to strike. I do not think that the Chancellor has been any more or less responsible in this matter than previous Chancellors. One of the joys of living in a democracy is that these issues are balanced for us. In a world that was less free, a ban might be put in place—prohibition or something—but I do not think that many of us would like to live in that kind of society. So this balance between what is good for you and what people like doing is something that we vote for in general elections.

We recognise the contribution that not just individuals but also businesses and our communities can make to help people better understand the risks associated with alcohol. I am sure that this is an issue to which we will return in due course. Change will not happen overnight. I take very much on board what the noble Lord, Lord Hunt, said about how we approach this issue, and that a nudge can sometimes create a barrier to change.

The noble Baroness, Lady Prashar, has made a very important contribution to this debate and we take that very seriously. Any responsible Government would take this very seriously. How we get the right balance in this debate is very important. Part of getting that balance involves the kind of debate we have had this afternoon.

Health and Social Care: State Pension

Lord Brooke of Alverthorpe Excerpts

Thursday 21st January 2016 Lords Chamber

[Lord Prior of Brampton]

My Lords, as my noble friend knows, the Government accepted the findings of the Dilnot review but felt that now was not the right time to introduce them, given the financial pressures on local government. We are committed to introducing the Dilnot reforms by the end of this Parliament.

[Lord Brooke of Alverthorpe (Lab)]

Is not the plan inadequate? Many noble Lords come with requests for quite justifiable changes to health services and the Minister very generously and kindly kicks them back because of inadequate resources to meet those demands. Surely it is the case that in looking at the plan we need to look at the longer term and not just the short term in five years.

[Lord Prior of Brampton]

The NHS plan is for the whole five-year period—the lifetime of this Parliament. It was signed up to by all the arm’s-length bodies within the NHS. The Government support that plan and are front-loading the financing to support the plan as well, so we believe that the plan is achievable.

National Health Service

Lord Brooke of Alverthorpe Excerpts

Thursday 14th January 2016 Lords Chamber

[Lord Brooke of Alverthorpe (Lab)]

My Lords, I, too, am grateful to the noble Lord, Lord Turnberg, for promoting this debate. I am also grateful to the NHS for keeping me alive when I had cancer, and for the maiden speech of the noble Baroness, Lady Watkins. I look forward to hearing more from her in future.

I shall quickly say something on personal responsibility, public health policy and corporate social responsibility, which I do not think has been touched on so far. On personal responsibility, as leaders, we have to be much more courageous, honest and open about the need for individuals to understand and accept that they are ultimately personally responsible for the state of their health. We need stronger campaigning. As was proved by the noble Lord, Lord Fowler, when he dealt with AIDS, if people are willing to be honest, open and courageous, we can carry all levels of the country, be they poor or rich. People need to be given many more facts about their lifestyles and the damage that arises from some of what they are eating and drinking. Those of us who use the health service should learn the cost of the services that are being provided. Each time I go to the health service, I should be told the cost of the medicines. If there is a combination of all that, we will start to raise awareness and knowledge and to create a different approach to personal responsibility. I will say no more on that because the right reverend Prelate the Bishop of St Albans more than fully covered it.

Linked to that is progress on policy on Public Health England. It is an outrage that £200 million has been chopped from its budget when we face so many problems with the increasing number of people going to the health service for treatment. Fortunately, it was one of the successes of the 2012 reorganisation, with its evidence-based recommendations on sugar taxes and alcohol abuse, for example. We need to co-ordinate policies at different levels to avoid the clash of one organisation trying to reduce alcohol, and the Chancellor then cutting taxes on alcohol last year, meaning that we now have more people drinking than before. We need to get the co-ordination of policy right. This is being addressed by Public Health England.

Deep down, most politicians believe that what they are saying is correct and that they need to take action, but regrettably, we too frequently run away from putting such things into practice. We have too many knee-jerk reactions, such as we had from the Prime Minister on the question of a sugar tax.

In the light of our experience with the responsibility deal, there needs to be a radical review of people’s relationship with the private sector. Retailers, especially supermarkets, food and drink manufacturers, producers and distributors need to accept that they have greater social responsibility than they have been prepared to accept so far for some of the health-related problems in this country. They have to face up to the fact that they need to embrace that change in culture and accept more responsibility for those problems. The Government have failed to achieve real progress with them on a voluntary basis. They should be faced with legislation if they will not move.

Sugar Tax

Lord Brooke of Alverthorpe Excerpts

Wednesday 13th January 2016 Lords Chamber

[Lord Prior of Brampton]

My Lords, as I said earlier, the Prime Minister and the Secretary of State for Health are thinking long and hard about what should be part of the obesity strategy. I am not sure that the noble Lord is right when he says that a modest tax would have much of an impact; it would have to be a significant tax to have a major impact on the consumption of sugary drinks.

[Lord Brooke of Alverthorpe (Lab)]

My Lords, does the Minister agree that the campaign against tobacco and cigarettes has been particularly effective? It has been applied across all sectors of the economy with no differentiation between any particular sectors. He mentions that, this time round, we have to be concerned about how sugar might impact on particular parts of the community but, surely, we should make our approach similar to what we did with cigarettes and tobacco and we should apply it right across the board so that we all gain from the change.

[Lord Prior of Brampton]

My Lords, I think that the noble Lord is right; indeed, the Prime Minister has called this the new smoking. Obesity is as important to public health as smoking has been in the past. We have to build a much stronger case among the public at large before we can start to introduce the full range of tax and other measures that we have had for cigarettes and alcohol.

Alcohol

Lord Brooke of Alverthorpe Excerpts

Wednesday 9th December 2015 Lords Chamber

Asked by

[Lord Brooke of Alverthorpe]

To ask Her Majesty’s Government whether they will review the responsibility deal for alcohol in the light of the Institute of Alcohol Studies’ report Dead on Arrival? Evaluating the Public Health Responsibility Deal for Alcohol.

[The Parliamentary Under-Secretary of State, Department of Health (Lord Prior of Brampton) (Con)]

My Lords, we are currently reviewing all aspects of the responsibility deal, including for alcohol. Partnership working continues to play an important role and the Government remain committed to its principles. We will continue to engage with the alcohol industry to encourage it to take action to reduce some of the harms caused by alcohol.

[Lord Brooke of Alverthorpe (Lab)]

My Lords, I am grateful to hear that the Government have decided to review the responsibility deal after its operation for the past five years. During that time, we have seen obesity grow; we have seen no increase in the activity undertaken by individuals; and we have seen more people presenting in hospital with alcohol problems. Will the Minister tell us whether he is sticking to the principles that guided the previous partnership, which was not, in fact, supported by the health industry? What will be the changes in the future to ensure that there is some real pace and real change taking place and that the mechanism of a voluntary approach is not used to delay?

[Lord Prior of Brampton]

My Lords, we have asked the London School of Hygiene and Tropical Medicine to review the impact of the responsibility deal, which it will do later in 2016. There have been, however, some benefits from it on alcohol, to which the noble Lord referred particularly. The number of units not sold as a result of it is 1.3 billion and the package labelling on alcohol products has improved substantially.

Health: Liver Disease

Lord Brooke of Alverthorpe Excerpts

Wednesday 9th December 2015 Lords Chamber

[Baroness Masham of Ilton (CB)]

My Lords—

[Lord Brooke of Alverthorpe (Lab)]

My Lords, may I quickly return to the issue of minimum unit pricing, because—

[Noble Lords]

Order!

Health: Post-polio Syndrome

Lord Brooke of Alverthorpe Excerpts

Tuesday 20th October 2015 Lords Chamber

[Lord Prior of Brampton]

NHS England’s approach to most people who are suffering from long-term conditions is best summed up through its House of Care programme, which is very much based around the individual and their carers and so is personalised. Of course, personal health budgets can have a big role to play for people with long-term, complex, chronic conditions.

[Lord Brooke of Alverthorpe (Lab)]

Is the Minister entirely content with the change that has taken place whereby we do not develop single-disease strategies? I speak as a patron of the British Liver Trust. We have long argued that there should be a strategy on liver disease, but this has been resisted. We find an increasing number of people dying from liver cancers, yet no strategy exists because of the decision that the Minister explained to us.

[Lord Prior of Brampton]

I agreed that I would meet with the noble Lord opposite to talk about post-polio syndrome, but perhaps this raises wider issues, including about liver disease and other disease categories, which we can cover at the same time.