Medical Innovation Bill [HL]

Debate between Lord Giddens and Earl Howe

Friday 23rd January 2015 Lords Chamber

[Earl Howe]

My Lords, I have been in the House long enough to know that when the noble and learned Lord, Lord Woolf, opines on something, it is a matter that all noble Lords would do well to listen to, and I am grateful to him. I agree that the amendment does not change the standard of care, we are agreed on that, but our concern is that a court might look at the requirements under the Act—and this is one of the requirements—as part of the picture that it would form as to whether or not the doctor had acted responsibly. It is merely part of the picture.

If we are agreed on that, and I hope that we are, it does not seem sensible to me that we should impose requirements in the Bill additional to those under the existing law, as that could risk deterring doctors from innovating under the Bill. Let us not forget that a doctor does not have to follow the Bill if he or she does not want to; they can simply rely on the Bolam test later on if they are challenged. Do we want to deter doctors in the form of a test or requirement that obliges them to go further than they would otherwise go? If they were deterred by that, it would defeat the whole object of the Bill and result in less benefit to patients, so I worry about that.

The amendment from the noble Lord, Lord Hunt, specifies that the use of a scheme be enforced through professional requirements. We have sought advice from the GMC about whether professional requirements in the form of guidance might be a suitable route to enforce the sharing of learning from innovation. The GMC has been clear that it is very happy to consider anything it can do to be helpful. However, from those initial conversations, it seems that this may not in fact be an effective route. The GMC’s statutory power is to provide advice. Doctors must be prepared to justify their decisions and actions against the standards set out in its guidance.

Serious or persistent failure to follow the guidance would put a doctor’s registration at risk. So on the one hand, were we to go down this route, a doctor who failed only once to use a data registry might not face any consequences; that would be okay for the doctor. However, this would not address noble Lords’ concerns that the results of each and every innovative treatment, whether or not successful, should be recorded. On the other hand, if a doctor persistently failed to use the data registry, this could result in fitness to practise proceedings being brought against him or her for not having recorded information on an online database designed to foster the sharing of learning from innovation. Should a doctor’s fitness to practise be called in question simply on those grounds, that really does not seem a proportionate response.

For the reasons that I have outlined today—namely, the difficulty of relying on professional requirements and the link, which I hope noble Lords will accept, to the test of clinical negligence—the Government would not be able to support this amendment.

[Lord Giddens]

I am not a medical specialist but I have followed this all the way through. What kind of structure would the Minister envisage being put in place if there is not a formal requirement of this sort? If you do not have some kind of system of dealing with the data produced, the whole thing becomes an erratic exercise and therefore does not contribute to the overall fund of medical knowledge.

Food: Regulation and Guidance

Debate between Lord Giddens and Earl Howe

Thursday 7th October 2010 Lords Chamber

[The Parliamentary Under-Secretary of State, Department of Health (Earl Howe)]

My Lords, I thank the noble Lord, Lord Whitty, for calling this debate on food standards and the role of regulation and guidance in the food chain. As your Lordships may know, this is an area for which the noble Lord and I have, at one time or another, both been responsible in our previous roles as agriculture ministers, his experience being much more recent than my own. Along with other noble Lords I pay tribute to the noble Lord’s work as the chair of Consumer Focus.

The food that we eat is fundamental to who we are. It is, of course, a source of essential sustenance necessary for basic survival. But food can also be much more. A meal made with the finest ingredients, prepared with skill and care and shared with loved ones can be one of life’s great pleasures. Yet no matter what our culinary preference, we all expect our food to be safe. It is no longer enough that we do not expect to be taken ill with a mild dose of salmonella or to have our lives put at serious risk by botulism; we also need to pay attention to the less acute causes of harm which noble Lords have rightly highlighted—the high levels of salt, sugar and fat that can do so much harm over the course of our lives.

While I do not believe that the role of the Secretary of State is to tell people what they can and cannot eat, there is a role in making sure that the food we eat is safe; that we make people fully aware of any long-term risks from our diets; and that those risks are minimised as far as possible. The sensible use of appropriate regulation and guidance is essential to this. The warnings sounded by the noble Lord, Lord Patel, are well founded. Far too many people in this country eat far too much salt, saturated fat and sugar, and nowhere near enough fruit, vegetables and oily fish. The personal costs to our health and the high financial costs to business and, through the National Health Service, to the taxpayer are huge. If everyone ate a diet that matched national nutritional guidelines we could prevent around 70,000 deaths every year. The current cost to the NHS of those deaths is thought to be around £8 billion a year. This does not include the further costs to the wider economy in lost productivity.

As the noble Lord, Lord Giddens, for one, pointed out, obesity in particular is a serious and growing problem. Nearly three-quarters of a million people in the UK are classified as morbidly obese—overweight enough to cause real long-term damage to their health. As such, they increase their risk of being diagnosed with diabetes, some cancers and cardiovascular disease, as well as a wide range of conditions that have a significant negative impact on a person’s quality of life.

The Government are committed to improving the health of the nation. We consider public health to be a high priority and to be everyone’s business. Much has already been achieved—and here I pay tribute to a great deal of the work done by the previous Government: there is clearer and easier to understand information on the front of food packaging than ever before, helping people to make healthy choices at a glance; there are national guidelines to protect the most vulnerable and ensure high-quality food in places such as schools, hospitals, care homes and prisons; voluntary initiatives with the food industry have seen significant reductions in the amount of salt in our foods; we have put in place a new Change4Life strategy; we are working with industry on appropriate safeguards for marketing food and drink to children—I shall say more about that in a minute; and we will continue the national child measurement programme.

Something that many of these achievements have in common is that they stretch beyond the limitations of purely government actions. We recognise that public health is not a social good that can somehow be mandated from the centre. The way to make real progress is through a coalition of partners—government departments, private companies, charities and individuals all taking responsibility for their own actions. We want business to do more to help meet public health challenges. We want all partners to be joint owners of a long-term public health strategy and for each to play its part in improving people’s health. This is the thinking behind the Responsibility Deal, our response to the challenges that cannot be resolved through legislation or regulation alone. The Responsibility Deal is a partnership between government and business that balances proportionate regulation with corporate responsibility to tackle the health problems associated with poor diet, alcohol abuse and a lack of exercise.

The noble Lord, Lord Whitty, raised the specific issue of nutrition. Providing clear, easy-to-understand nutritional information for consumers is essential if people are to make informed choices. This is also true when eating out. We have challenged the food industry to give its customers this information. From a traditional bag of fish and chips to a special treat for the whole family, eating out has become an important part of our culture and must be included in any serious attempt to influence it.

In this and in all areas of regulation, guidance and food standards, there is a balance to be found between the impact on health outcomes and the impact on business. We need always to take a proportionate approach and to try to get the balance right. Food is the UK’s largest manufacturing sector. It is a real success story, bringing billions of pounds into the Exchequer and employing tens of thousands of people. We must be careful not to strangle this particular golden goose with excessive regulation. We want a light touch wherever possible. Where we can achieve our objectives through voluntary agreements, we should do so. We also need to be realistic about what is within our gift to do. Much food regulation is EU-wide, so we need to negotiate and agree certain changes at an EU level. I need hardly say that we should also avoid gold-plating any legislation when implementing it.

One other key plank of public health policy is informed consumer choice. The noble Lord, Lord Whitty, is a particularly strong advocate for consumers and their rights in his role as chair of Consumer Focus. Often, people’s health and well-being are rooted in their daily lifestyle choices. To improve public health, we need to support people in changing their behaviour, making the healthy choice the easy choice. Public health must not be about nannying consumers or demonising particular foods. We need to find new approaches, founded in behavioural science, which nudge people in the right direction.

While we have made some progress, we have only really started to scratch the surface. Our average salt intake is down almost 10 per cent over the past decade, which will save the lives of 6,000 people each year as well as saving the economy around £1.5 billion. But we still have a long way to go before we reach the recommended level.

Early indications suggest that people are starting to reduce their intake of saturated fat, but we are still a very long way from the ideal level. Although levels have fallen substantially in young children, we are still eating far too much added sugar. Sadly, the consumption of fruit and vegetables remains poor, with only a third of people eating the recommended five a day. For all these reasons, we will publish later this year a public health White Paper. It will set out in detail our plans to transform public health: a good, balanced diet, more exercise, drinking responsibly and stopping smoking.

The noble Lord, Lord Whitty, and other noble Lords dwelt to a considerable extent on the decision by the Government to move nutrition policy to the Department of Health from the Food Standards Agency, a transfer which took effect from 1 October. The main reason for doing that is not only to ensure that nutrition policy is delivered coherently and consistently in relation to nutrition—although nutrition is certainly part of it—but also to recognise the direct interrelationship between nutrition policy and public health policy in areas such as obesity, diabetes and coronary heart disease. It is an early step towards realising the Government’s vision of drawing together the diverse arrangements for delivering public health into an inclusive public health service. The transfer will mean that the Government can give the general public more consistent information. It will also mean, as I have indicated, a more co-ordinated and coherent policy-making process and a more effective partnership between Government and external stakeholders.

I agree with the noble Lord, Lord Whitty, that the creation of the Food Standards Agency was sensible and necessary in the context of public confidence at the time in the Government’s advice on food safety. I am not so sure that I agree with him that there was any lack of consumer confidence in the Government’s advice on nutrition. The main problem, I think, lay in issues around food safety.

I assure the noble Lord, Lord Rea, that the Food Standards Agency will continue to ensure the public’s safety by maintaining its essential and robust regulatory role on food safety, covering all aspects of development, implementation and delivery. In the context of consumer confidence, what matters is surely transparency. The Government are committed to provide evidence-based advice to consumers in order for them to make healthier lifestyle choices. We understand the need for transparency in our policy-making and the need for independent advice and scientific accuracy. The Government will continue to be advised by independent experts to ensure high-quality, trustworthy advice to consumers.

The noble Lord, Lord Rea, mentioned the press report that appeared on 24 September that suggested that various public bodies would be axed, including the Government’s independent Scientific Advisory Committee on Nutrition. In fact, discussions are still on-going and we will be in a position to make an announcement on the matter in due course. In the mean time, SACN will continue to provide expert advice on nutrition to the Government. Again let me reassure the noble Lord that our expert scientific committees, of which we have several, will continue to operate in line with government principles of scientific advice and codes of practice for scientific advisory committees. Those will ensure transparency in their work, and the minutes of those committees will be published.

The noble Baroness, Lady Thornton, questioned the evidence that food labelling belongs in Defra. She will recognise, I believe, that there was a division of responsibility for food labelling. We will now have a more consistent delivery of food labelling policy that will bring together general labelling and issues such as country-of-origin labelling.

The noble Lord, Lord Giddens, asked me to give the Government’s view of the FSA in general. I hope that I have indicated that we think very highly of the FSA. We recognise the good work that it has achieved as well as the principles that it has established of openness, transparency and evidence-based policy. At the same time, it is important in delivering the Government’s objectives on public health to draw together nutrition policy so that it can be delivered more coherently.

Much has been said this afternoon—not least by the noble Lord, Lord Patel—about saturated fat and salt and their connection with ill health. Two key dietary influences in the development of cardiovascular disease are the levels of saturated fat and salt in the diet. High intakes of saturated fat can cause increased cholesterol levels, which are a major risk factor for CVD. Similarly, high salt intake contributes to high blood pressure, which is also a risk factor. I say to the noble Earl, Lord Erroll, that there is strong international agreement with UK expert opinion on what constitutes a healthy balanced diet that is low in salt and saturated fat. The substantial body of scientific evidence supporting that view includes long-term epidemiological studies, which conclude that a healthy balanced diet has a positive effect on the prevention of diet-related chronic disease.

The noble Lords, Lord Patel and Lord Rea, suggested that there should be a stronger regulatory approach to such matters rather than simply a continuation of the voluntary approach. The UK is moving further and faster on salt, saturated fat and sugar reduction than most other countries, even those that have taken a regulatory approach. The responsibility deal aims to build on that and to challenge industry to play its part in improving people’s health. Legislation would undoubtedly produce an additional burden, which could stifle industry innovation. Industry ought to have the flexibility to decide how it delivers public health benefits. Consumers also need to take responsibility. We need to find ways in which to support people in changing their behaviour and improving their diets. The Food Standards Agency is fully on board with this voluntary approach. It has worked with the food industry to deliver voluntary reductions and to secure public commitments to the reformulation of food.

The noble Lord, Lord Patel, spoke eloquently about trans fats. Action by the food industry in the UK has reduced average trans fatty acid intakes to less than half the maximum level set for public health. We understand the public concern over artificial trans fats and will continue to encourage the food industry to eliminate their use. The Government’s public health White Paper and the responsibility deal will set out more of the strategy, but my right honourable friend Andrew Lansley has stated that the Government will continue to encourage the food industry to eliminate the use of artificial trans fats.

[Lord Giddens]

In the light of what the noble Earl has said, will the Government consider completely banning trans fats?

[Earl Howe]

My Lords, the whole matter of trans fats is under review. I expect that we will be in a position to say something in the public health White Paper. In the context of the noble Lord’s question, it is instructive to look at the experience of other countries. The United States took legislative action on trans fats only after voluntary measures had failed and because intakes by New York citizens in particular were much higher than those recommended and much, much higher than those in the UK. Denmark acted to ensure that individual food products did not contain high levels. We believe that much of this can be achieved by voluntary measures, which will be considered as part of the responsibility deal.

The noble Lord, Lord Giddens, suggested in his speech that the ban of trans fats in Denmark has directly reduced the incidence of chronic diseases. I would be interested to see the evidence that he has for that. We are not aware of published scientific evidence of a direct linkage between reducing trans fat intakes and changes in disease rates in the population in Denmark, so I should be glad to communicate with him on that topic.

The noble Lord, Lord Patel, questioned whether the voluntary approach would be enough. Voluntary action by industry so far has shown that it can be successful. As I indicated, we want to make industry joint owners of the long-term public health strategy. That includes our drive to reduce salt levels in food, about which the noble Baroness, Lady Thornton, asked.

The noble Baroness, Lady Hayter, asked for reassurance that protection of the consumer will be a watchword for the Government. I can tell her that the responsibility deal most certainly includes representation from consumer-focused organisations, to make sure that consumers’ interests are protected. She also spoke about the impact of poverty on diet. We recognise the action that retailers have taken to ensure that the nutritional qualities of value food lines and premium food lines are comparable. The Government’s responsibility deal can take into account these types of issue to help to promote good nutritional standards.

I say to the noble Lord, Lord Patel, that the Government are committed to working with the industry, as I indicated. We have seen a great deal of progress with children’s diets, as he will know in relation to foods that are high in fat, salt and sugar.

The noble Baroness, Lady Finlay, asked what action the Government will take to help educate consumers, particularly about food labelling. The Government fully support consumer education to help achieve a balanced diet. That will continue with the “Change for Life” brand, which can evolve in response to evidence and the economic climate. We recognise the role of simple nutritional labelling on pre-packed foods and are supportive of measures that support its usefulness. We would like to see front-of-pack labels that include percentage guideline daily amounts for the five nutrients which are of particular dietary importance.

I shall write to noble Lords with answers to other points. Perhaps I may conclude by briefly emphasising that more than any other area of health, public health has the potential to change people’s lives for the better. It cannot be seen as an add-on, or as somehow secondary to the important business of saving lives. It is saving lives and, at a time of tightening budgets, by preventing people from becoming ill in the first place it saves money as well.