Premature Deaths: Heart and Circulatory Conditions

Debate between Lord Brooke of Alverthorpe and Lord Markham

Tuesday 6th February 2024 Lords Chamber

[Lord Markham (Con)]

Yes. Those are all key measures that we need to take and, I like to think, are making progress on. I thank the noble Baroness for her work and all the noble Lords who have been working on the Times Health Commission, which is a valuable contribution to this debate. I mentioned digital health checks. I have seen technology where holding your phone up in front of you can test your blood pressure and your heart rate. We need to verify that, but I think that is definitely the way of the future as well.

[Lord Brooke of Alverthorpe (Lab)]

Can the Minister say why the Government are refusing to review the regulations governing children’s meals? We know that the sugar content in them is too high and that our children are eating too much sugar. This needs to change, yet the Government refuse to look at the regulations and enforce them properly.

[Lord Markham (Con)]

I am not quite sure that I agree with the word “refuse”, but I agree with the noble Lord that healthy food in all environments is a good thing. I know that the delay happened because it was originally planned for 2020 or 2021, I think, and then the pandemic got in the way. I freely accept that the review now needs to take place. We are not refusing to do it, because it is an important part of the armoury.

Ultra-processed Food

Debate between Lord Brooke of Alverthorpe and Lord Markham

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

Debate between Lord Brooke of Alverthorpe and Lord Markham

Tuesday 12th September 2023 Lords Chamber

[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

Debate between Lord Brooke of Alverthorpe and Lord Markham

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

Debate between Lord Brooke of Alverthorpe and Lord Markham

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

Debate between Lord Brooke of Alverthorpe and Lord Markham

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

Debate between Lord Brooke of Alverthorpe and Lord Markham

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

Debate between Lord Brooke of Alverthorpe and Lord Markham

Thursday 25th May 2023 Lords Chamber

[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

Debate between Lord Brooke of Alverthorpe and Lord Markham

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.

Urgent and Emergency Care Recovery Plan

Debate between Lord Brooke of Alverthorpe and Lord Markham

Thursday 2nd February 2023 Lords Chamber

[Lord Markham (Con)]

That is absolutely right. The figure that struck me on one of my many hospital visits was that apparently people lose 10% of their muscle mass each week they are in hospital, making it harder for them to look after themselves. The noble Baroness, Lady Merron, mentioned that we need to make sure the resources and investment are in the right places. All too often, hospitals become the place of last resort, when we all know that it is much better to put resources into the primary care at the front end or the social care and domestic help for physios who can visit homes at the back end. Central to the plans of my colleague, Minister Whately, is recognition that we will solve this in the long term, as all noble Lords want, only if we invest those resources in the right places.

[Lord Brooke of Alverthorpe (Lab)]

My Lords, I welcome the plan and hope that the Government can keep to the targets they have set. I had experience of being in a major London hospital recently, spending five hours in A&E. It was the first time I had been in A&E for a long time. I was surprised at the number of young people there. When eventually I was seen by a nurse, I asked why so many young people were there. She said, “We’re surprised; there was a good football match on tonight, and we thought there wouldn’t be so many”.

It is odd when people are in A&E. Should they be with a GP? We wait with interest to see the report on GPs. I suspect that we have far more people now getting involved in health, for a whole variety of reasons, than need be in the system. This takes us back to prevention. I still do not believe we are addressing prevention as we should—trying to reduce the number of people in ill health. The programmes we have on obesity and in a whole range of areas where we are trying to get people to change their lifestyle are not having any impact. Until we seriously address those and put money and personnel into them to get ourselves reasonably healthy by comparison with the rest of Europe, we will just see the health service getting into even more difficulty, no matter who is in power.

I am sorry for going on at length. I hope the Minister will say something about a proper plan on prevention.

[Lord Markham (Con)]

I agree with the noble Lord. We have a manifesto pledge about five years of healthier living. I am keen to do exactly that, to say, “Okay, let’s unpack this—how can we make that realistic?”. We have all talked about being realistic. What are the causes of death or ill health that we need to get on top of? I mentioned cardiovascular disease earlier. We need to quickly address that because there is a cohort of people of my age who have missed out. Obesity is a clear thing. It is not just the treatments but everything we talk about in terms of supermarkets. I know that there is some discussion in the House on whether we have gone far enough on some of those things, but the action we have taken is hitting the big numbers. It is hitting about 95% of the planned reduction in calorific intake; we are seeing that have an impact already. There is also anti-smoking; I am keen to make that into a coherent plan. We all know that we can spend more and more money on hospitals and the health service, but we will have healthier lifestyles only if we can get up stream on the problem and talk about protection.

Times Health Commission

Debate between Lord Brooke of Alverthorpe and Lord Markham

Thursday 19th January 2023 Lords Chamber

[Lord Brooke of Alverthorpe]

To ask His Majesty’s Government what assessment they have made of the establishment by the Times of the Times Health Commission on 15 January.

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

My Lords—

[Lord Markham (Con)]

I thank noble Lords. It is not quite the same as scoring a hat trick in football, but I will take the Order Paper home with pleasure.

We welcome the Times Health Commission’s contribution on how we can improve health and social care. We are always looking to build on good ideas, knowledge and experience, which this commission offers in bucketloads. I look forward to working with the commission and building on the best ideas.

[Lord Brooke of Alverthorpe (Lab)]

My Lords, I am grateful to the Minister for that quite positive reply but, first, given our long history of political failure to tackle the increasingly serious care and health problems facing the country, will the Government set out in more detail what support they will give to this initiative? Secondly—this is perhaps more difficult for the Minister—will he seek support from his colleagues to enter into discussions with the opposition parties about the way in which we may create a new and entirely separate joint political mechanism whereby the recommendations that come forward from this commission may be amended or revised but in fact, on a joint basis, would then be implemented regardless of the political power held by any of the parties?

[Lord Markham (Con)]

I thank the noble Lord and firmly agree that we should look to implement anything that is a good idea. I know that there are many things we can learn and that I am still to set up the meeting I talked to him about. I apologise that it has taken a while but we have had a few things on. In a word, yes, I will always look to work on a cross-party basis. One thing that I want to bring to Parliament soon is the new hospital programme I am working on, which I believe needs to go on for ever in terms of the way we are going to build new hospitals. It is something I would like to take forward as a cross-party action. Most of the things in this space are not political; they are all about getting good and effective treatment to our population, so I am very happy to work in a collaborative fashion.

Tobacco Control Plan

Debate between Lord Brooke of Alverthorpe and Lord Markham

Wednesday 23rd November 2022 Lords Chamber

[Lord Markham (Con)]

I will take everything I can. Clearly, we need to stop cigarettes coming in by all illegal means.

[Lord Brooke of Alverthorpe (Lab)]

The Government also lose a lot of income through illegal importation. If the Government are working very hard indeed to prevent it, can the noble Lord please spell out what they are doing? As I understand it, the number of staff involved at the ports is being cut.

[Lord Markham (Con)]

I do not have the figures on that, so I will need to give the noble Lord a detailed reply.

Childhood Obesity

Debate between Lord Brooke of Alverthorpe and Lord Markham

Thursday 17th November 2022 Lords Chamber

[Lord Markham (Con)]

I agree with the noble Baroness, particularly given her previous position, that sport and physical activity are vital. As I am sure she is aware, we have a 60-minute target for children and £320 million of PE funding to back that up—but active lifestyles and sport are critical to that.

At this moment, as both an Englishman and a Welshman, I take the opportunity to wish both teams all the best in the World Cup.

[Lord Brooke of Alverthorpe (Lab)]

My Lords, is it not a factor that exercise, no matter how much you do, will reduce only 20% of your overweight? Some 80% is from food and drink. Will the Government spend more time looking at fat and sugar? Why will they not promote research into alternatives to sugar, notably stevia? Instead, they leave it to the private sector and the manufacturers to do the work, and they are doing no work whatever on it. In those circumstances, will the Government take action themselves?

[Lord Markham (Con)]

I agree with the noble Lord that a healthy lifestyle in terms of exercise gets only you so far and that the amount we eat is critical to that. We have played a very active role on sugar reduction—of course, I say this in the context of this being Sugar Awareness Week. Obviously, the sugary drinks levy has reduced sugar in soft drinks by 44% by using artificial sweeteners, so this is something we will look to continue to research and to add to, if the evidence backs it up.

GPs: Anti-depressants and Alcohol

Debate between Lord Brooke of Alverthorpe and Lord Markham

Wednesday 16th November 2022 Lords Chamber

[Lord Brooke of Alverthorpe]

To ask His Majesty’s Government whether they will review the purpose, effectiveness, and the cost, of GPs prescribing anti-depressants to patients who continue to consume alcohol.

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

Decisions about what medicines to prescribe, and in what circumstances, are rightly made by the clinician caring for the patient. At the same time, NICE guidelines are clear that anti-depressants should not be used to treat alcohol dependency. Prescribers must be free to make their own decisions, based on their clinical judgment and discussion with their patients, with the appropriate care for the individual always being the primary consideration.

[Lord Brooke of Alverthorpe (Lab)]

I am grateful to the noble Lord for his reply. As we face public expenditure cuts and as the College of Medicine has estimated that 110 million items prescribed every year are wasted at a phenomenal cost, what steps are the Government going to take? Will they have discussions with GPs about the ways in which we can cut back on wasting money on useless prescriptions?