Health: Public Health Responsibility Deal

Lord Clement-Jones Excerpts

Thursday 27th June 2013 Grand Committee

Asked by

[Lord Clement-Jones]

To ask Her Majesty’s Government what assessment they have made of the progress and impact of the Public Health Responsibility Deal.

[Lord Clement-Jones]

My Lords, it is now more than two years since the then Secretary of State for Health, my right honourable friend Andrew Lansley, local government and the leaders of a number of industries came together in March 2011 to agree the public health responsibility deal. There is no doubt that as a country we face significant public health challenges. Working-age ill health is estimated to cost the UK economy more than £100 billion a year. England has among the highest levels of adult obesity in Europe. We have more than 8,000 what might be described as premature deaths every year from too much salt in our food. Alcohol misuse costs the NHS £3.5 billion a year. Physical inactivity costs it £1 billion a year and the costs to the wider economy from sickness absence have been estimated at around £5.5 billion.

The essence of the PHRD, as the Secretary of State said in his introduction, was to agree voluntary action to ensure we,

“have more progress, more quickly”

with less cost than legislation. There are those who are sceptical about this kind of action. A recent paper in the Lancet by Professor Rob Moodie of the University of Melbourne concluded that the only way to achieve the UN’s goal of halving the mortality rate for diseases caused by tobacco, alcohol and poor diet was through greater regulation. Likewise, Which? is sceptical. Its executive director, Richard Lloyd, last year speaking about the responsibility deal, said:

“We have the worst obesity rates in Europe and diet-related diseases, like heart disease and stroke, are blighting the public’s health. Our audit of progress made under the Government’s Responsibility Deal has shown the current approach is overly reliant on vague voluntary promises by the food industry. This has so far failed to bring about change on anything like the scale needed”.

The BMA in its briefing for this debate said it believes that relying largely on voluntary agreements with the food and drinks industry is inadequate. It, of course, refused to sign up to the responsibility deal.

The question at the core of this is how far is nudging effective? The Health Select Committee in its report last year on the Government’s alcohol strategy said that,

“we do not oppose the exploration of innovative techniques such as ‘nudging’, where it can be shown, following proper evaluation, to be an effective way of delivering policy objectives. The Committee were, however, unconvinced that the new Responsibility Deal will be effective in resolving issues such as obesity and alcohol abuse and expect the Department of Health to set out clearly how progress will be monitored and tougher regulation applied if necessary”.

Clearly, issues of physical activity, alcohol misuse and obesity have to be tackled in a variety of ways but I know I am not alone in preferring to see voluntary action initially rather than increased regulation unless the former is shown to have failed. It is far too purist a line to say that industry should not be involved in public health initiatives. In the responsibility deal, different sectors made particular pledges for action, regarding food and diet, alcohol, physical activity and health at work. The essence of the deal was acceptance by signatories of the role they play in improving people’s health—encouraging them to adopt a healthier diet, fostering a culture of responsible drinking, encouraging and assisting them to become more physically active and actively supporting their workforce to lead healthier lives. The organisations involved made a series of collective pledges by sector, individual pledges by organisation, and what were called supporting pledges, regarding collaboration, monitoring and evaluation, information and development of further pledges.

Today, I regard all aspects of the deal as important but, given the time available, I want to focus on two limbs of the deal, relating to food and alcohol. The initial collective pledges by the food industry involved, for example, salt reduction, front-of-pack nutrition labelling, artificial trans fats removal and calorie reduction. One of the recent fruits of the responsibility deal has been the new voluntary UK traffic light scheme for front-of-pack nutrition labelling, which was launched on 19 June this year. This will introduce more consistent nutrition labelling across the UK by providing, on the front of food and drink products, clear information on energy and those nutrients of public health concern that the majority of us should be aiming to limit in our diets. Then of course there are the steps towards calorie reduction by the food and soft drink manufacturers, and the significant actual and planned reduction of salt in food, in supermarket products and catering.

For the alcohol industry, including manufacturers and the on and off-trades, the pledges involved: fostering a culture of responsible drinking; a reduction in alcohol units to remove 1 billion units from the market; a commitment to labels with clear unit content; awareness of alcohol units in the on and off-trades; tackling alcohol sales to those who are underage; action on advertising and marketing alcohol; community action to tackle alcohol harm, and support for Drinkaware. This partly depends on having clear, common understanding of the facts but these are not always straightforward. There are many conflicting statistics and it is not always easy to draw conclusions.

There are many different perspectives on current trends. It appears that national alcohol consumption trends are going in the right direction. Nationally, per capita consumption has fallen from 11.5 to 10 litres of alcohol per person per year, and is now below the European national average. More people drink within the guidelines. There is less drinking at harmful levels and binge drinking is down. There is less alcohol-related violent crime, and there has been a very significant drop in drink-driving fatalities over the past 20 years. All these statements are derived from official figures. However, hospital admissions are up, whether this is taken as those where alcohol is the primary diagnosis or those which are simply alcohol-related.

There are anomalies in respect of particular age groups and localities, even where the national picture shows improvement. Areas such as the north-west and the north-east have a disproportionate amount of binge drinking and hospital admissions, due to alcohol-related causes. Supporting Drinkaware, an independent organisation, is one of the key pledges given by the drinks industry. Drinkaware works with young adults to moderate drinking through the “Why let good times go bad?” campaign. It also helps parents tackle alcohol issues with their children. It has recently published an audit of effectiveness which demonstrates the progress it is making, and that its work is being increasingly recognised. Drinkaware says that binge drinking remains a social norm in many areas. We are, it seems, fighting a huge cultural battle so pledges are fine but translation into local action is key. There is clearly a need to target appropriate schemes at particular areas. The drinks industry tells me that it is working with local partners including local authorities, police and the third sector to do this.

There is in fact an impressive array of voluntary schemes. During the passage of the Police Reform and Social Responsibility Bill in July 2011, and in the debate initiated last year by the noble Baroness, Lady Coussins, I talked of the virtues of local voluntary actions designed to combat alcohol abuse. These are through schemes such as Purple Flag, Best Bar None, Pubwatch, business improvement districts and community alcohol partnerships, with central government working with the industry—both the on and off-trades and the manufacturers—and the advantage of those schemes over those imposed in a compulsory way, such as the early-morning restriction orders and the late-night levy. There is of course Challenge 21 and Challenge 25, a strategy that encourages anyone buying alcohol who looks under 25 to carry acceptable ID. There is also PASS, the nationally recognised Proof of Age Standards Scheme. It would be very interesting to know what evaluation has been done for these individual schemes, since each clearly has different objectives and outcomes. I am pleased that licensing authorities will have discretion to offer a discount from the late-night levy up to a maximum of 30% for premises that are part of—or members of—best practice schemes, subject to specific criteria.

A recent positive development is the revised version of the Portman Group’s Code of Practice on the Naming, Packaging and Promotion of Alcoholic Drinks. The new version of the code now specifically states that there should be no linkage to sexual activity, no images of under 25s, and easier promotion of lower strength products. Furthermore, progress on alcohol unit reduction is well under way towards the goal of 1 billion fewer units consumed. The strength of well known brands has been reduced, and new lower-alcohol alternatives have been introduced.

Of course, at the back of all our minds is the question as to the future of minimum unit pricing, as originally proposed by the Government. I am an agnostic, currently, but the proponents of minimum unit pricing refer to the Canadian experience. What can my noble friend say on that subject?

So what is the future for PHRD? The scoping review undertaken on behalf of the Department of Health by the Policy Innovation Research Unit at the London School of Hygiene and Tropical Medicine concludes that, if properly implemented and monitored,

“voluntary agreements can be an effective policy approach, though there is little evidence on whether they are more effective than compulsory approaches”.

The key questions that the PIRU is being asked to consider are: does the responsibility deal as a mechanism work? Can voluntary pledges achieve the necessary change? Are the pledges themselves amenable to evaluation? In fact, can any cause and effect ever be evaluated? Yet the unit itself believes that the most useful questions at this stage of the development of the responsibility deal are about what it is; its objectives; how it is expected to work; how it can be assessed; and how will we know whether it works—in particular, what further steps are needed. I wonder what we can really expect from the PIRU study at the end of the day.

No doubt there is a considerable task ahead for my noble friend the Minister in replying today, but even more questions remain. Under new leadership, is the department still committed to this approach, and is the deal essentially worth it for all concerned? I look forward to my noble friend’s reply.