Tobacco and Vapes Bill

Lord Darzi of Denham Excerpts

Report stage
Tuesday 3rd March 2026 Lords Chamber

[Lord Udny-Lister (Con)]

My Lords, my Amendment 136A deals with the rapid emergence of devices with a very high puff count—so-called “big puff” devices—which are clearly designed to circumvent the spirit of existing regulation. The Tobacco and Related Products Regulations 2016, approved by this House and the other place, set a 2-millilitre limit on vape tank size. That limit was deliberate. It was intended to restrict the volume of nicotine liquid immediately accessible within a device. Yet now we see devices incorporating multiple pods or attaching 10-millilitre refill containers directly to the unit. These create systems with an effective capacity far beyond 2 millilitres. If the law says 2 millilitres it should mean 2 millilitres, not 2 millilitres multiplied by clever engineering.

These are no longer niche products. Millions are now sold weekly. They are cheaper per puff than standard devices and they are particularly attractive to younger users. Research indicates that almost half of 16 to 34 year-olds who vape are opting for these devices with a higher puff count. We now see products on the market claiming to deliver 100,000 puffs. To put that into perspective, that is broadly equivalent to the puff volume of something like 8,000 cigarettes all contained within a single device. The concentration of nicotine exposure in one unit on that scale should give us all very serious cause for concern.

I do not believe this is simply a matter of marketing exaggeration. Some of these devices contain several times more liquid than traditional products, materially increasing the potential volume of nicotine consumption and moving far beyond what Parliament envisaged when it established the 2-millilitre limit. We also see superficial attempts to comply with the ban on disposable vapes. Devices are fitted with USB charging points but retain non-replaceable coils, so that once the coil burns out, the entire device is discarded. This is disposability in all but name.

I anticipate that the Minister may suggest that the Bill already contains sufficient powers to regulate such devices through secondary legislation. If that is so, this amendment merely makes explicit what the Government believe is already implicit. Parliament has previously set a clear quantitative limit. It is entirely reasonable to reaffirm that limit in unambiguous terms, particularly where the market has moved to exploit perceived gaps.

The Minister may also say that the Government have launched a call for evidence and that legislation at this stage would be premature. However, the concern here is not about developing future policy but about the exploitation of the existing framework. The 2-millilitre limit is already law. The issue is whether that settled position can be circumvented in practice through structural design. This amendment does not stifle legitimate reusable products. It does not prohibit refill bottles sold separately. It does not alter the 10-millimetre refill rule. It does not interfere with lawful refillable systems. It simply ensures that a single device cannot be engineered to exceed the 2-millilitre limit through multiple tanks or attached containers.

Effective enforcement depends on legislative clarity. Trading standards officers should not be left to debate whether what is in effect a 12-millimetre system technically complies with the 2-millimetre rule. Clear drafting reduces ambiguity and strengthens compliance. At the very least I hope the Minister will be able to reassure the House that there will be no undue delay in addressing devices that are clearly designed to sidestep the intent of the current rules and that prompt action will be taken to close this loophole and uphold the 2-millimetre limit in practice.

[Lord Darzi of Denham (Non-Afl)]

My Lords, I strongly support the Bill and the ambition to create a smoke- free generation. Throughout my clinical and academic career, I have consistently argued for bold preventive action, because nothing would do more to reduce preventable death and health inequality than ending tobacco addiction. I am grateful to the noble Lord, Lord Moylan, and the noble Baroness, Lady Fox of Buckley, for Amendments 125 and 134. I understand the instincts behind them, but I cannot support them. These amendments would limit the Government’s power to regulate flavour descriptors—the words on the packet rather than the chemical ingredients that create the flavour. Put simply, we would be regulating the label, not the substance.

The Chief Medical Officer’s evidence note is clear. Flavoured vaping products contain a wide range of chemicals, many of which are safe to eat but dangerous to inhale. The long-term effects of inhaling these substances are simply not known yet. Restricting regulations to descriptors alone would deny the Government’s ability to act as new science emerges. As we have heard, flavour is one of the principal drivers of youth uptake. If we regulate only what the packet says and not what the product contains, manufacturers will simply reformulate to maintain the same appeal. We would be inviting a regulatory game of cat and mouse, and it is a game that children will lose.

[Lord Moylan (Con)]

I hate to interrupt the noble Lord, but Clause 91 gives the Secretary of State powers to regulate the substances that may be included in a relevant product. I am not proposing that we change that at all. I am simply suggesting we change “flavour” to “flavour descriptor”, because flavour is inherently subjective. The substances which may be toxic or harmful would remain in scope of the legislation in the language the Government have chosen to use, irrespective of my amendment. I interrupt the noble Lord only because I am not entirely sure that he has grasped the effect of my amendment, and I thought he might want to reflect on that.

[Lord Darzi of Denham (Non-Afl)]

If I have not, then I apologise. I still believe it is not clear on paper. I feel it is the flavour that is being bound, but if the noble Lord’s amendment is correcting that, that is fine. Narrowing the powers before the science is settled is another issue. There is very little scientific evidence on the impact of the taste or whatever the inhaler contains. This has not been utilised before, so we do not know the dangers of the substance that is being inhaled. The prudent course is to retain the widest possible powers and to act on evidence as it emerges. To do otherwise will leave our children exposed to risks we could have prevented. I urge the House to at least look at these amendments or reject them.

[Baroness Fox of Buckley (Non-Afl)]

My Lords, I shall be brief, because the noble Lord, Lord Moylan, has explained what his amendment is trying to do. I just want to query whether narrowing the powers before the science is settled is an admirable aspiration. That gives authoritarian power to the Government to do anything they want because there is no science and it is not settled. How is that evidence-based policy? It is the opposite and I think that is very dangerous.

I want to more accurately emphasise that flavours are part of smoking cessation, but I am only going to do that briefly. The reason why I want to do that is to quote ASH, because—guess what?—ASH says that flavours are a very important way in which adults vape and therefore give up smoking. So, for once, I am quoting ASH in a positive way to say that flavours cannot be demonised and we have to be very careful what we wish for.

Medical Training (Prioritisation) Bill

Lord Darzi of Denham Excerpts

Committee stage
Thursday 12th February 2026 Lords Chamber

[Lord Winston (Lab)]

My Lords, I too am a little bit concerned about unintended consequences. It is a real pleasure to see my noble friend Lord Darzi in his place, because I hope he will have comments on this issue.

I trained as a clinical academic. Indeed, we know that clinical academics have had a unique value to the health service. They work part-time in the health service with a reduced salary and do research at the same time. I am very concerned that many of the clinical academics we have had at Imperial College, for example, have been from overseas. They were medically qualified elsewhere but had not yet been in Britain and were still junior doctors, in a sense. I am really concerned that there are many such people who come to Britain, do a postdoctoral degree such as a PhD and, in the meantime, keep their medical skills flowing, as I did myself. I was seven years in this situation with the Wellcome Trust. I remember it very well. I was overseas but at least knew that I could come back to Britain. But I was a British subject—that was easy.

There are so many of these people. To give just one example, Professor Jan Brosens at Warwick University is undoubtedly one of the key people who have contributed massively to female health, particularly on implantation of the ovum and in his magnificent work on endometriosis. He came as a junior doctor from Belgium, from Leuven University, to what was then Hammersmith Hospital, which is now, of course, Imperial College. Now, he is a very distinguished professor at Warwick University with a very large team. His recruitment made a very big difference to the whole field. His is not an isolated example; there are many such people I can think of. I hope the noble Baroness can suggest some way of dealing with this problem of unusually good graduates from elsewhere, who may not be British citizens, perhaps, in the current priorities, but who would really be deserving of serious consideration for certain specialty jobs. Not to do that would be a great loss to the health service.

[Lord Darzi of Denham (Non-Afl)]

My Lords, many of you will know that I did my medical training in Ireland. In fact, I exercised some of my skills in this Chamber back in 2007. Irish medical education is excellent, and many of its graduates have gone on to distinguished careers in the NHS. I speak today to ensure we strike the right balance in this Bill, specifically by securing fair treatment for doctors who hold degrees approved by the Irish Medical Council.

As drafted, the Bill would exclude graduates of the Royal College of Surgeons in Ireland at its medical campus in Bahrain, for example—a campus that was established more than 20 years ago. Let me be clear about what that institution delivers: it has the same curriculum, the same examinations and the same quality assurance as Dublin, leading to a single national University of Ireland degree. Its programme and clinical training sites are also accredited under Irish regulatory oversight by the Irish Medical Council. I urge that, on Report, wording be introduced to bring graduates of this institution within the priority group. Such a clarification would sit squarely alongside the amendments from the noble Baroness, Lady Gerada, and the noble Lords, Lord Clement-Jones and Lord Mendelsohn. These seek to ensure that medical graduates of a UK university holding a GMC-approved degree and following the same curriculum and assessment, but studying outside the British Isles, are included in the priority group. It would also be consistent with the similar amendment tabled by the noble Lords, Lord Forbes and Lord Shipley, and the noble Baronesses, Lady Finlay and Lady Hollins.

I draw a further anomaly to your Lordships’ attention. The unamended Bill would place graduates of the Royal College of Surgeons in Ireland’s campus in Penang, Malaysia—a joint programme with University College Dublin—within this priority group. These students study an Irish Medical Council-accredited, GMC-recognised degree, completing half their education in Ireland and half in Malaysia. Yet the well-intentioned clarifying amendment of the noble Baroness, Lady Finlay, requiring at least 60% of the time to be spent in Ireland, would inadvertently exclude them.

[Lord Clement-Jones (LD)]

My Lords, it has been many years since I last spoke in a health debate. There is a sense of déjà vu in seeing the noble Earl, Lord Howe, on the Opposition Front Bench. It is also an absolute pleasure to hear from the noble Lord, Lord Darzi, and to hear the arguments he has made, which are very consistent with those we will be making later in the group of amendments from the noble Baroness, Lady Gerada.

I rise to speak to the amendments in this group, but particularly to Amendment 2, in the name of the noble Baroness, Lady Coffey, and the amendments tabled by the noble Lord, Lord Patel. On Amendment 2, while I understand the intent of the noble Baroness to protect the domestic workforce, we on these Benches cannot support the introduction of citizenship as a primary filter for medical training priority. To do so would undermine the central logic of this Bill, which is to protect the taxpayers’ investment in training, not to police the passport of the trainee. If a non-UK citizen comes to this country, trains in our medical school for five years, often paying significant international fees—my noble friend made an extremely good point about the value of that to our universities—they cross-subsidise our universities and then commit to the NHS. They are a UK medical graduate in every sense that matters to workforce planning. Their training is identical; their clinical exposure is identical. We on these Benches believe that to deprioritise them, based purely on nationality, would send a disastrous signal to the global talent pool that our NHS has always relied upon. It would also contradict the argument we will make later regarding the amendments from the noble Baroness, Lady Gerada, on the Queen Mary University of London Malta Campus: that it is the content and quality of the qualification that matters, not the geography or the nationality.

Regarding the amendments in the name of the noble Lord, Lord Patel, I sympathise with his desire to ensure that UK graduates are prioritised. That is, after all, the purpose of the Bill, and while we can argue about the definition of a UK graduate, we must be careful not to make the legislation so rigid that it removes any flexibility for the Secretary of State to address shortages in specific specialties, or where international talent is essential. Several noble Lords have mentioned that we have all received correspondence from doctors in hard-to-fill areas who warn that absolute exclusion could leave rotas empty. Prioritisation must not constitute a blockade.

Academic Health Science Centres

Lord Darzi of Denham Excerpts

Tuesday 2nd July 2019 Grand Committee

[Lord Darzi of Denham (Lab)]

My Lords, I also thank the noble Lord, Lord Butler of Brockwell, for calling this debate on the future policy of academic health science centres. I declare an interest: I chair the Accelerated Access Collaborative, I am a non-executive director of NHS Improvement, and I am professor of surgery at Imperial College London.

As some in this House may recall, in 2007 I led a review of London’s healthcare—A Framework for Action —which recommended the creation of a number of AHSCs in the capital. That created significant noise nationally. Subsequently, in 2008 we published the NHS next-stage review, called High Quality Care For All, and the Department of Health, under the auspices of the NIHR, commissioned five academic health science centres nationally.

AHSCs are organisations that hold a joint and equal responsibility for the delivery of healthcare, education and research. The combination of scientific method and clinical care has been seen as the fastest means of ensuring that scientific advances are translated into improvements in patient care. The establishment of the AHSCs in the UK was through a competitive process, as we heard earlier, judged by an international panel, and represented an attempt to regain this lost momentum. With no additional funding, the universities and their NHS partners in these five centres pledged to combine strategy, operations, and in some cases finance to deliver innovations in teaching, research and service delivery. Over the last decade, as we have heard, the AHSCs, with their BRCs, have made a significant contribution to translational research. Translation has typically either meant “bench to bedside”, meaning basic science to first in human use, or “knowledge translation”, meaning uptake of new innovations. This brings me to the Accelerated Access Collaborative and its role in the NHS innovation landscape.

The AAC is a convening board bringing together NHS commissioners and providers, NHS arm’s-length bodies, industry, patient organisations and Government to ensure that the innovation landscape builds a strong pipeline of proven innovations that meets the service needs and to increase the adoption and diffusion of such across the NHS. The remit of the AAC has recently been expanded by the announcement of the noble Baroness, Lady Blackwood, to include six priorities: implementing a system to identify the best new innovations; setting up a single point of call for innovators, so they can understand the system and where to go for support; signalling the needs of clinicians and patients, so innovators know which problems they need to solve; establishing a globally leading testing infrastructure, so innovators can generate the evidence they need to get their products into the NHS; and overseeing a health innovation funding strategy that ensures that public money is focused on the areas of greatest impact for the NHS and our patients.

In light of all this, I see the AHSCs as having a unique and distinct contribution to make to the innovation ecosystem and the priorities of the AAC by providing a pragmatic testing environment, enhancing the uptake of innovation through their expertise in research methods, access to data and our great NHS clinicians.

The Accelerated Access Collaborative will work with the department of health over the next month to define further the role the AHSCs and their future designation.

The NHS

Lord Darzi of Denham Excerpts

Thursday 5th July 2018 Lords Chamber

Moved by

[Lord Darzi of Denham]

That this House takes note of the creation of the National Health Service in 1948, and the case for integration of health, mental health, social and community care to equip the National Health Service for the next 70 years.

[Lord Darzi of Denham (Lab)]

My Lords, in opening this debate, I declare my interest. I am a practising surgeon in the NHS at St Mary’s Hospital, Paddington, and the Royal Marsden and am the chair of surgery at Imperial College. I proudly sit as a non-executive director of NHS Improvement. Over the past 10 months, I have led an independent review of the health and care system with the Institute for Public Policy Research.

As a surgeon and a former Health Minister, it is a great honour to speak in this place to mark the 70th anniversary of the National Health Service. The NHS is this country’s most treasured institution. It touches our lives at times of the most basic human need when care and compassion matter most. This is a time for reflection to celebrate the institution and give thanks to NHS staff for their service to our nation, and to look to the future.

The NHS is the expression of the moral principle that no one should be denied healthcare because of their means—the idea that the provision of healthcare should be based on need and not the ability to pay. Most people alive today cannot recall the time before the health service was created. With each passing year, the number of people who can recall the pre-NHS era recedes, but if we are to secure its future we must never forget what preceded it.

A friend recently told me the story of his family. His parent worked in the textile mills in Lancashire that have long since disappeared. In the simple kitchen there were two sugar bowls. One was for the sugar and the other for the doctor. It was where they would save a penny or two whenever they could so that, if any member of the family got sick, they could pay for a visit to a doctor. Fear of falling sick was a normal part of daily life in Britain. Illness was the surest path to poverty and destitution, not just for the individuals but for whole families. The founding of the NHS took that fear away for millions and it is a fear that those of us born since have never known and can only imagine.

The NHS was the greatest achievement of the post-war Labour Government. We owe an eternal debt of gratitude to Nye Bevan for his vision, passion and determination to establish the health service. He memorably described the NHS as taking the place of fear. It remains one of the most extraordinary achievements of any society anywhere in the world. It is on occasions such as the 70th anniversary that we must make and remake the case for comprehensive, universal healthcare, free at the point of need for all.

Never let anyone tell you that we cannot afford the NHS. The moral principle of universal access to healthcare is shared by all people everywhere. Those countries that have made it a reality have done so in different ways, but by far the most efficient, dignified and lowest cost is to create a universal service free at the point of need funded by taxation. Private insurance and social insurance systems are much more costly. Those who argue that we cannot afford the NHS are seriously wrong. It is a fundamental error of logic to say that something is unaffordable so we should make the move to something more expensive.

The NHS is funded by us all. It serves each of us and it reflects the best of us. The health service employs 1.5 million people across the four nations of the United Kingdom—that is 5% of all working people in our country. The NHS is its people, not only the doctors and nurses but clinicians of all kinds and the porters, cooks, cleaners and, yes, the vital managers and administrators too. Spending a day working as a porter in the NHS was one of the most illuminating moments of my career. Every member of Team NHS matters. Every one has a contribution to make and each is valuable. I pay tribute to the NHS employees of today who are my colleagues, and to the NHS staff of previous generations. On this day of thanksgiving, we owe them a lasting debt of gratitude.

I have worked in the NHS for longer than I have been a citizen of this country. In a time of great anxiety, I pay a special tribute to the citizens of other countries who have helped to build our NHS throughout its existence and remain the backbone of it today. From the Windrush generation to the European citizens and nationals of every race and creed, from every corner of the world today, they have made an immeasurable contribution. Let that never be forgotten.

NHS staff work at the frontiers of innovation because healthcare exists at the limits of science. This country is a scientific superpower with an extraordinary record of discovery and invention, yet in recent years we have fallen behind on investments in R&D. R&D is the engine of innovation yet R&D spending as a share of GDP has been falling while our competitors have invested more. We need a new commitment to be at the top quartile of advanced countries for R&D investment. The future prosperity of our country depends on it.

Many of the most important medical discoveries took place in this country, often through partnership between the NHS and the universities. No matter the challenges, we are constantly finding new ways to treat disease and soothe pain and suffering. That means that high-quality care is constantly a moving target: to stand still is to fall back. What energises NHS staff is relentlessly improving the quality of care they deliver to their patients. In my review of the NHS with the IPPR we found that, on a wide range of measures, the NHS has maintained and improved the quality of care it provides. Fewer people are harmed and more people are cured than ever before. There is a huge amount to celebrate and to be proud of, yet we should frankly acknowledge the difficulties the health service has faced. The past decade has been the most austere since the health service was founded. Waiting times have risen considerably and the system has been subject to needless destructive reforms. The NHS is not failing, but it is fragile.

A properly funded NHS is the foundation on which a fair, cohesive and inclusive society is built, so the new funding settlement announced by the Prime Minister, the Chancellor and the Secretary of State for Health is very welcome. My friend the noble Lord, Lord Prior, and I, together with the IPPR, recommended a 3.5% annual funding increase: the Government came close, with 3.4%. However, the settlement did not include public health, capital investment or education and training. Each of these is vital and the Government must now deliver on them too.

Securing the NHS is an eternal task. It is no more perfect than life itself. That is why new investment must be joined with reform. Together with the noble Lord, Lord Prior, and the IPPR, I set out a 10-point plan for a 21st-century NHS. At its heart is a new vision, what we call “neighbourhood NHS”, where services are organised around groups of patients with broadly similar needs, rather than groups of professionals with broadly similar skills. We argue that there should be a new option for single integrated care trusts, able to take responsibility for all the health and care needs of a population.

Warm words on mental health must be followed by bold actions. Parity of esteem should mean parity of service. Bringing care closer to people is a crucial principle for a modern NHS, yet for too long the NHS has said it would invest more in care closer to people yet continues to do the inverse of its stated strategy. Each year we say that resources will shift and each year they flow upwards towards hospitals rather than outwards towards communities. That is why we must lock in more spending on primary, community and mental health services each year in the decade ahead.

As we celebrate the past on this anniversary day, we must also look to the future. It is our duty to seize all the technological opportunities that this new era offers. There must be a tilt towards tech to create a digital-first health and care system. That will demand investment in digital infrastructure, improved data sharing and embracing full automation. Many people fear that automation will destroy jobs, but it is much more likely to reshape them by taking away mundane tasks that fill most of our time working in the NHS. This will release more time to care and give more space for clinical reasoning, for research and for innovation.

I have spent decades developing robotic surgery. The robots have yet to replace me, but they have helped me deliver higher-quality care to my patients. For all these improvements to happen, we need a radical simplification of the system. It has become impossibly complicated and is in desperate need of change. I therefore welcome the Prime Minister’s commitment to bring forward legislative change. Tinkering at the edges will not be enough: we need fundamental reform. Above all else, we need to confront the great social challenge of today, which is social care, as we heard earlier.

When the NHS was founded, life expectancy for men was 66 and for women it was just 71. Today, it is 79 and 83 respectively. Today, one-quarter of NHS beds are occupied by patients who are medically fit to go home, if there were good enough support for them. More than £3 billion a year of NHS money is wasted by delayed transfers or transitions of care. If Bevan were designing the health service today, it is unimaginable that he would have excluded social care. We must now extend that simple, noble, brilliant principle of care based on need rather than the ability to pay from the NHS and apply it to social care.

Social care reform has become the third rail of British politics: any politician touching it swiftly expires. Between now and 2030 the number of people over the age of 65 will increase by about one-third and the number of those over 85 will nearly double. At the same time, the working-age population will increase by just about 3%. If we do not act now, a heavy burden will fall on families to take care of their relatives. Since 2010, social care has been slashed. Despite rising demand, state social care has plummeted by 27%. That does not mean that less care has been provided. There has been a dramatic rise in informal care. Critics will argue that the older generation should contribute more of their wealth to pay for social care, particularly the wealth locked up in housing, but tying social care reform to the thorny issue of wealth inequality and taxation is wrong. If we make that hurdle for social care reform, there will be no progress at all. Surely, the level of personal wealth is a better basis for wealth taxation than the need for social care.

Better social care means that families spend less time on functional tasks and more time on relationships. If we want a less lonely and more dignified future for our ageing society, now is the time to act. There could be no better birthday present for the health service. It has been a privilege for me to open this debate, but it has been the greatest honour of my life serving the National Health Service for nearly 30 years. In 30 years from today I hope to see the NHS’s centenary. It is a great comfort to know, for me just as for all of us, that the NHS will be there to provide care and compassion when it matters most.

[Baroness Manzoor (Con)]

My Lords, to assist the House, I say that Back-Bench speeches are limited to four minutes so, when the clock strikes four, time is up.

--- Later in debate ---

[Lord Darzi of Denham]

My Lords, I have a few minutes to finish off. I thank everyone here for their amazing contributions on this very special day—the 70th anniversary of the NHS. The thoughts and ideas, although diverse, were all united in one thing: not just celebrating the past but designing the future. I particularly thank the noble Baroness, Lady Jolly, my noble friend Lord Hunt and the Minister. The noble Lord, Lord O’Shaughnessy, is a man of tremendous integrity and resolve. He addressed every speech. I know of his ability but also the talent he is surrounded with. We all wish him the best with his six-point plan.

I will end with one piece of advice: as we move into the future, we need to work with the patients and the public who are funding this, while remembering that the NHS staff whom we congratulated are people we would want to work with rather than do things to. We have learned that by experience and we look forward to the autumn and the plans that the Minister will bring back to this Chamber. I very much hope that all parties in this Chamber will support it. We have one chance to do this. I congratulate the Minister on making sure that we got the money—3.4%—which none of us was expecting. We need to spend that money wisely because there is a confidence issue out there with the taxpayer and the public. Again, I thank noble Lords for a wonderful debate.

Motion agreed.

London Health Commission: Smoking

Lord Darzi of Denham Excerpts

Thursday 15th January 2015 Grand Committee

Asked by

[Lord Darzi of Denham]

To ask Her Majesty’s Government what plans they have to support the recommendations of the London Health Commission with regard to combatting the impact of smoking on health.

[Lord Darzi of Denham (Lab)]

My Lords, in opening the debate, I declare my interests as in the register. Over the past year, I had the privilege to chair the London Health Commission at the request of the mayor, Boris Johnson. I express my thanks to the mayor for giving me the opportunity to do so. As a politician, the mayor took a brave step by establishing an independent commission, tasking it with examining the evidence and giving my fellow commissioners and I the freedom to make the right recommendations for London.

I also express my thanks to the thousands of health and care professionals and Londoners who contributed to the commission. They were generous with their time and their ideas. The work of the commission and the report, Better Health for London, are the expression of the passion and the ambition that Londoners have for better health. London can be the healthiest major global city. As our nation’s capital, London should be a leader and set an example for other cities in Britain. London should not be an exception, and the proposals set out by the commission could, and indeed should, apply to other cities in our country.

We all want to lead healthy lives. Our health is determined by all different parts of our lives—what we eat and drink, whether we choose to smoke or drink and how much, how we travel to school or work, and how we choose to spend our leisure time. Yet we can lead healthy lives only by working together to improve health—schools, employers, charities and voluntary groups, local and regional government, transport, the NHS and, above all, individuals and families. We each can choose to invest in our own health and we can help each other to choose better health.

At the heart of the commission’s vision of a healthy city lies a very simple idea: making healthy choices should be easier. Making those choices easier requires action from us all. The healthiest choice is not always easy or obvious. Every day, we make hundreds of choices that affect our health: how we get to and from school or work, what we choose to eat and how we spend our free time. The goal is to make each of those millions of individual choices that little bit easier, because in that difference is everything: making small changes individually will make a huge difference collectively.

Smoking is one of the worst choices for health. Every year, in London alone, about 8,000 people die prematurely due to smoking and more than 80,000 people die prematurely across the country as a whole. The consequences of smoking cost society as a whole at least £2.7 billion a year. Smoking does not simply cause an earlier death; it causes poorer quality of life. Tobacco does enormous harm to health and limits life’s possibilities. Tragically, about 45% of cigarettes that are smoked are consumed by people with mental illness, contributing to life expectancy that is 10 to 15 years shorter than in the population as a whole.

Hundreds of children take up smoking every week—two classrooms’ full a day. With advertising outlawed, they do so inspired by the adults they see. Once they start, they continue, as cigarettes are more powerfully addictive than narcotics. It is little surprise that in places where more adults smoke, more children begin to smoke as well.

Just as smokers’ lungs are polluted, the lungs of our city—our parks and green spaces—are polluted by smoking. London should lead the way for Britain, and the mayor should lead the way for London by acting to make our public spaces smoke-free. Our parks and green spaces account for nearly 40% of the capital, the equivalent of 20,000 football pitches—imagine that space completely smoke-free. I also believe that Trafalgar Square and Parliament Square should be rid of smoking. It would be a powerful message for the iconic centre of our city and the political heart of our country to become smoke-free. Indeed, such a measure would make our capital and our country an exemplar for the world.

Many noble Lords will have seen the launch of the commission’s report last October, when the mayor and I played a game of football with a classroom of schoolchildren. Of course, noble Lords may have seen it for all the wrong reasons, as it featured the rather entertaining sight of the mayor fouling a nine year-old boy. What was so striking was what the children had to say, not about the foul, but about making parks smoke-free. They were universally stridently in favour of the idea. They were far better advocates than I. One said, “It’s horrible when people come and smoke where we are playing football. I hate it”. Another said, “They leave all their cigarette ends on the floor”, and another young child said, “It’s really disgusting. I wish they wouldn’t do it”.

That is what London schoolchildren think. Making parks smoke-free will not only help smokers to make better choices by reducing the opportunities to smoke, it will help children to make the right choice to never start smoking. Yet this is more serious than childish debate. The question of making parks smoke-free exists precisely at the boundaries of the proper role of the state. I understand and I acknowledge that different people will hold different beliefs. Our parks are public. They are shared spaces that we should enjoy together. We already accept some limitations on our actions within them. There are restrictions on letting dogs foul, dropping litter or consuming alcohol. I believe that our parks should be spaces that promote healthy behaviour, such as exercise.

As a cancer surgeon, I see the pain and suffering of people afflicted by smoking-related diseases, as well as that of their friends and families. True compassion for their experience lacks authenticity if it is not joined with resolute action. I have not come across a single patient who did not wish that they had never smoked. I contest the notion that it is a question of liberty. Cigarettes are more powerfully addictive than narcotics, as I said. There is no freedom in addiction. Indeed, addiction is the antithesis of freedom. I have always been struck by that great revolutionary rallying call, “Give me liberty or give me death”. The advocates of smokers’ rights are generous enough to give them both.

I have no doubt that parks will become smoke-free by the end of this decade. Thirty years ago, it would have been unthinkable that pubs and restaurants would be smoke-free. Today, it is unthinkable that we would ever return to smoking indoors. The 2007 smoking ban was a major achievement of the previous Government and the present Government have continued the good work with new measures to control advertising at the point of sale and to stop smoking in cars with children. These measures are very welcome and I applaud the Government for having taken them. None the less, it is vital that the work continues.

As part of the work of the commission, we examined cities around the world that have made progress in the fight against smoking. New York City has famously led the way. Noble Lords who have visited New York recently will know that Central Park and all the city’s parks are smoke-free. Today, significantly fewer New Yorkers smoke than Londoners. The lesson of two decades of pioneering tobacco control in New York is that the fight must be sustained with new measures and initiatives. When it is not, smoking rates creep back up again. For that reason, I urge the Government to progress their plans for plain packaging of cigarettes in a timely manner so that the regulations are made within this Parliament. If they do, they will surely be saving lives. With the election so uncertain a few months from now, Ministers, Members of the other place and noble Lords can proudly know that they will have saved lives. Other than the protection of corporate interests, I can see no earthly reason to protect the brand value of tobacco.

As I close, I encourage noble Lords to take a moment to read the findings of the commission. I am an advocate for smoke-free parks, yet the report presents a broader range of measures to make our capital the healthiest major global city. Progress for better health can be made only through bold aspirations. I thank noble Lords for their contributions today and for demonstrating their commitment to better health for all the people of this land.

Health and Social Care Bill

Lord Darzi of Denham Excerpts

Wednesday 9th November 2011 Lords Chamber

[Lord Darzi of Denham]

My Lords, I enter the debate speaking as a professional working in the health service, but also as someone who has had the opportunity and privilege of serving in government. I might know something, therefore, about the accountability of driving quality and improvements. I also had to learn fairly quickly about the accountability in this democracy and the accountability, as the noble Lord, Lord Mawhinney, put it very clearly, about the expenditure of the health service.

I will use the example of a piece of work that I had the privilege of leading. Many noble Lords in the Chamber helped me through it. It was a review of the London healthcare services, called Healthcare for London: A Framework for Action. I led this piece of work with 150 clinicians, in addition to 100 Londoners—members of the public and also patients. The work took place in 2006, after a formidable amount of expenditure and growth in the expenditure of the NHS. As someone who worked and lived in London, looking at the quality of some of these services, the case for change was quite striking. Thirty-one organisations in London were providing stroke services but none of them was meeting the international guidelines and standards for stroke services. One-third of our primary care providers were single-handed and patient satisfaction was well below the national average.

I will put inequality in health on one side, but there are inequalities in healthcare not far from this building. If you take the Underground from Westminster to Canning Town, you will find that life expectancy there is about eight years worse. Those were striking issues that had to be dealt with. The question is who deals with that important issue—the accountability for quality in improving and changing services. That was a fairly long, democratic process. It had very important principles. It had to be clinically led, locally owned and evidence-based. We made a strong pledge: if change is to happen, an alternative needs to be described to the local population and patients before such change happens.

A year later, a significant amount of public consultation ended in an agreement to drive those fairly radical changes in a city that is competitive globally, whether considering its financial services, its scientific output or its universities. That was 10 years after another review by my noble friend Lord Turnberg in the same city, trying to address the same challenges facing us back in 1996-97.

I could not agree more about accountability. I say that having had the privilege of serving in government. Ultimately, accountability has to rest with the Secretary of State. It is important to recognise that. However, I support the noble Baroness, Lady Cumberlege, to a degree. I will mention the K factor. I am not sure how many noble Lords have heard of the K factor. It was well before “The X Factor” was invented. The K factor refers to Kidderminster, where something interesting happened. There was a significant change in a little hospital, for which the whole driver was quality and improvement in facing the challenges of that local health economy. A local MP lost his seat and was replaced for a decade in the other House by a retired physician, who is no longer there. The K factor created a huge amount of sensitivity within the political world—in all political parties in this country. The noble Lord, Lord Mawhinney, was a brave man to throw out the person who came to challenge him about that reconfiguration. I was not the Secretary of State; I was the most junior Minister; I was starting on the learning curve and I wanted to be the most junior Minister in the department. I cannot remember a single week in which I was not lobbied about a change. It was never written; it was all mentioned over cups of tea.

There is a challenge. On the one hand, the Secretary of State needs to be accountable—I could not agree more about that—but at the same time the Secretary of State must have regard to evidence, if independently proved by groups of professionals, to make change happen. There must be a clear red dividing line between what I call the politics of saving votes and the politics of saving lives. There is a fine line between the two. One deals with accountability to the public purse and expenditure; one deals with accountability for quality. I have seen Secretaries of State who have had the leadership and strength to balance those two. I do not believe that such balancing could be written into legislation. It requires political leadership and political strength to make some of those tough decisions.

Change is happening all around us. Scientific discoveries have meant that life expectancy has increased by about 10 years since the creation of the NHS. We should not contaminate that with our own local agendas. It is unfortunate that even up to now our consumers—our patients—have not been empowered with the knowledge that I and other noble Lords in this House have of what is good and what is not good. Transparency is extremely important. I see evidence of that being reinforced by the Bill that I had the privilege of taking through in the past. Transparency is one way of getting the balance right between the politics of saving lives and the politics of saving votes.

[Baroness Masham of Ilton]

My Lords, I want to say only a few words. I cannot agree with the noble Baroness, Lady Cumberlege, that members of the public do not trust their Members of Parliament. Unfortunately, there have been a few problems, but surely we have moved on from there. I have just been to a meeting with about 20 Members of Parliament of all parties, who are supporting their constituents over the children’s heart surgery unit in Leeds. They trust their Members of Parliament more than they trust the people doing the review.

--- Later in debate ---

[Baroness Emerton]

My Lords, I have appreciated all the contributions on the amendments on research. There is just one thing that I take issue with: the contribution of the noble Lord, Lord Ribeiro, who said that his profession was the Cinderella of research. Other professions would describe themselves as being Cinderellas in terms of research funding. Obviously, I speak for nursing and midwifery, but also for the other healthcare professions, which are all graduate professions and which are concerned to give evidence-based practice wherever they are in the NHS. Perhaps the noble Earl could re-emphasise that it will be multiprofessional research. All the contributions this evening have been on medicine and scientific research, but the other professions can contribute an enormous amount. Nursing is very reliant on charitable, voluntary funds for its research and has done some tremendous research exercises in clinical procedures, as have the other professions—midwives and physiotherapists. Will the noble Earl consider this being a multiprofessional research board?

[Lord Darzi of Denham]

My Lords, I add my support to Amendment 42. I declare an obvious conflict: I am a recipient of funding from the National Institute of Health Research; I am also a senior fellow in the NIHR.

We should all be very proud that huge investment has gone into research in the NHS. The reforms of the past decade have been significant. We have been used as the exemplar across the globe not just on funding but on the structure and the processes, driving research within the NHS.

I should like to cover not just the health gains but the economic gains of research. Whichever way we look at it, the life science industry is worth about 4.3 per cent of our GDP. That is a significant contribution. The life science industry employs between 170,000 and 180,000 people. We are still very attractive to the pharmaceutical companies, which come here because some of the best brains are coming out of our universities. We need to work on making the NHS as attractive as the university sector. That is why safeguarding of funding within the National Institute of Health Research is vital for that important mission if we are to contribute to future economic growth.

Health and Social Care Bill

Lord Darzi of Denham Excerpts

Tuesday 11th October 2011 Lords Chamber

[Lord Darzi of Denham]

My Lords, we live in a time of rising fear. We fear losing our jobs, we fear riots in the streets and we fear that our economic future and our country's place in the world are no longer secure. A little over 60 years ago, the National Health Service was founded to take away the fear that getting sick meant going broke, and growing old meant becoming poor, with rising healthcare bills.

Today, people need our NHS more than ever. It remains this country's most cherished institution. One might conclude that, since our NHS is so precious, it should be protected from change. That is untrue. The NHS must embrace change. To believe in the NHS is to believe in its reform. Healthcare exists at the edge of science. We are constantly finding new drugs and treatments, and innovations in what we do and how we deliver care. The history of medicine has been the history of progress. People rightly expect the latest treatments in the most modern settings. In modern healthcare, to stand still is to fall back.

I will address the three most important features of the Bill before the House. The first is the meaning of competition. The second is the relationship between quality and clinical commissioning. The third is the leadership and management of the NHS. First, there has been much unreasoned debate on competition and choice. They are two sides of the same coin, arrived at from very different starting points. One starts with the ideology of faith in free markets and the responsiveness of corporations to competition in the thirst for profit. The other starts with faith in people and in their capacity to make good choices for themselves, supported and empowered by professionals.

When I was a Minister we introduced free choice, public or private, for all patients. Competition was a means, not an end in itself. With prices fixed and patients empowered, professionals could compete to provide the highest quality care for patients. The right competition for the right reasons can drive us to achieve more, work harder, strive higher, and stretch our hands and reach for excellence. It can spark creativity and light the fire of innovation.

I will also tell noble Lords what I know to be true. There has always been choice in the NHS—but for the few, not the many. Those in the know have always known where to go and how to get there. The reforms of recent years have been about extending choice to the many, not introducing choice for the first time. I fear that the debate today has lost its mind. I have been shocked by the ability to take a pragmatic concept and apply it to the point of absurdity.

I will make one final point on competition. I am tired of the victim mindset in the NHS. It is absolutely wrong and we need radical cultural change to change it. Let us be clear: we have an enormous depth of clinical talent; we have world-leading research; and we provide excellent quality care. In the past decade, waiting times have dropped from 18 months to just a few weeks. In 2009, 92 per cent of our patients rated their care as good, very good or excellent.

Secondly, we must not lose sight of our purpose: raising the quality of care for patients is what inspired me throughout my career. It is an ambition that I share with colleagues across the NHS. It is our collective purpose and common endeavour. I summed it up in the title of my review of the NHS, High Quality Care for All. Today, the NHS faces the huge challenge of raising the quality and efficiency of its services. Fortunately, in healthcare, quality and efficiency are two sides of the same coin. This twin challenge seems to have been lost in the technocratic debate on commissioning.

If clinical commissioning is about empowering clinicians to reshape and reform services in order to improve the quality of care for patients, it has my wholehearted support. However, I need Ministers to give their reassurance that all clinical professionals—GPs, community services and specialists working together—will undertake commissioning. As a surgeon, I would not know where to begin if I was asked to commission community podiatry services. I expect my GP colleagues would find it equally challenging to commission the highly specialised cancer services that my organisation delivers. In the 21st century, we need more integrated care, not more division. We need a health service that harnesses the talent of all our professionals, with a focus on integration and quality above all else.

Finally, I address the question of leadership and management in the NHS. The question is: how do you get the health service to change? How can reform lead to improvements in patient care? My first point is that we in both Houses must stop our frequent assaults on NHS management. If the newly appointed chief executive of a FTSE 100 company came into office and announced that he was firing half the company's management, shareholders would rightly revolt. Attacking NHS management may be good politics, but it is bad policy—and in the long run it will be self-defeating. Change in the NHS happens when coalitions of patients, clinicians and managers come together to break the status quo and to make the difficult decisions that are required to improve patient care. I say “difficult” because changing services is rarely popular. Given the demonisation of those making the changes, that is not a surprise.

Secondly, nothing in the Bill explains how strategic changes will be made to the NHS. With perhaps 300 consortia, how will the necessary changes be made on a regional level? The programme that I led, Healthcare for London, built an alliance of hundreds of clinicians and managers across the capital to improve care. It led to London becoming the world leader in stroke and cardiac care, and dramatically improved the quality of primary care provision. How will similar improvements happen in future?

We had “too big to fail” in the banking sector. Now, healthcare faces a set of reforms that are striking in their managerial complexity, with many changes begun prior to the Bill. We now have health and well-being boards, clinical commissioning groups, clinical senates, local Healthwatches, the NHS Commissioning Board, a quality regulator and an economic regulator—the list goes on. Is this now “too complex to quit”? At the end of the day, who is responsible for making sure that the NHS saves more lives this year than last? Who is accountable for how its budget is spent? Who will improve quality at system level, rather than in an individual organisation or consulting room? Who will inspire NHS staff to lead the difficult changes? What is coming next?

I am a surgeon, so perhaps I may be allowed a surgical analogy. It is the area I know best. The patient—the NHS—is on the table. It has been put to sleep and we have spent the past 18 months worrying more about new commissioning structures than about raising quality and productivity. The incision has been made, the old structures have been swept away and the new structures are beginning to form. The team could not agree on what operation to do. We have already had time out, and the Future Forum have made some good suggestions after the Government failed to listen to the concerns of patients and staff from the start. The question is: what next?

Is more waiting around what the NHS needs? The answer is no. We need to know where we are going and how and when we will get there. This has been a bumpy journey and it would be cruel to refuse to put the end in sight. That is why I find it difficult at this stage to support the amendment of my noble friend Lord Rea. I stand before noble Lords not as a politician but as a surgeon working in the NHS, with the needs of my patients and colleagues at the front of my mind. Our NHS needs leadership. We must never lose sight of our purpose. We aspire to high-quality care for all. The obligation of the Members of this and the other House is to support the NHS to do the things that are tough because they are right.

NHS: Future Forum

Lord Darzi of Denham Excerpts

Tuesday 14th June 2011 Lords Chamber

[Earl Howe]

I am most grateful to the noble Lord, Lord Walton, as I always am, particularly for his welcome for the idea of clinical senates. They will provide the kind of multiprofessional advice on local commissioning plans that everybody has been calling for. The senates will be hosted by the NHS Commissioning Board. The detail is still to be worked out, but it is likely that they will be located regionally. They will be in prime position to do the very thing that the noble Lord seeks: to provide expert advice on good commissioning, not just for the treatment of everyday conditions, but for specialised services, which I know is of particular concern to noble Lords.

The noble Lord suggested that there should be a role for the universities, and that is a constructive idea that I will take away. As regards clinical networks, we are certainly of the view that they have proved their worth over the past few years and we are keen to see more of them created. I hope that that will be facilitated by the structures we are putting in place.

[Lord Darzi of Denham]

My Lords, I welcome the Statement from the noble Earl and also congratulate him on his leadership in getting us back on track. One of the commonest sayings about a good clinician, whether a doctor or nurse, is that they listen to a patient but also seek the opinion of others if dealing with a complicated case. In this instance, the noble Earl has done both.

I am very reassured that the language has changed. As the noble Earl said, quality will remain the organising principle of the NHS. I know and he knows that quality is what unites those who deliver healthcare. Quality is what the public and patients expect. I am also reassured by the concept of using competition when necessary. I strongly support competition, have always done so and work in an organisation that competes not only in the NHS in England but also globally. I acknowledge, too, that integration should also be used as a tool where possible. The listening exercise is not at the end. It should start from now. Where will the engagement exercise lead?

Finally, and more importantly, there is the management and leadership now required to drive these important sets of reforms at a time of austerity. We have heard a lot about management. It is an easy political target but the NHS needs better management rather than less. I am pleased to see that the Government are committing to retaining the best managers and to develop managerial skills. However, this commitment is distinctly lacking in specifics. More detail and action are required before I could confidently say that the importance of management has been grasped. I say this within the context of the age of austerity. We need leadership and management to drive this set of reforms. I strongly agree that we need reforms and they need to be continual reforms rather than destructive ones. On that note, I look forward to Second Reading.