Children and Families Bill
Lord Hunt of Kings Heath Excerpts(12 years, 2 months ago)
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Lord Hunt of Kings Heath (Lab)
My Lords, I shall speak also to my Amendments 61 and 57BB. I very much welcome Her Majesty’s Government’s change of heart as far as standardised packaging is concerned, and I certainly welcome the appointment of Sir Cyril Chantler to review the evidence. Sir Cyril is known to many of your Lordships and has made a significant contribution to the NHS. We can have complete confidence in his work.
My two amendments are designed to press the noble Earl on the comments he made in his final remarks and to encourage him to give the House an absolute assurance that should Sir Cyril Chantler conclude that the evidence is clear that standardised packaging is effective in reducing the risk of harm to children, the Government will speedily move to lay the regulations specified in his Amendment 57B. The noble Earl will know that at the moment line 3 of his amendment merely says,
“The Secretary of State may make regulations”.
I would have preferred to see the word “must”. To an extent, the noble Earl has already explained why it is to be “may”, but are there any circumstances where, on the assumption that Sir Cyril has concluded positively, the Government would not proceed to legislate?
Amendment 57BB concerns the proposal that it be an offence for any person who drives a vehicle to fail to prevent smoking in the vehicle where a child or children are present. I do this on the basis that the past 15 years have seen an impressive reduction in the amount of smoking in this country. Indeed, since the previous Government’s 1998 Smoking Kills action plan, smoking rates among children, who are, of course, the focus of this Bill, have fallen by more than half following a period of little progress lasting 20 years. I have little doubt that the ban on advertising was pivotal, but the fall was also due to a series of other concerned measures which included an increase in the age of sale, picture warnings on packs and an above-inflation increase in tobacco duty to reduce affordability.
I believe that we should continue the momentum and protect future generations from the dangers of smoking. That is why I welcome the Government’s agreement to legislate on standardised packages and the proposals that the Minister has outlined today in relation to proxy purchasing and the restriction of the sale of e-cigarettes to under 18 year-olds. However, the Government could do more by accepting my amendments and support the principle of a ban on the use of cigarettes when children are present in cars.
Children’s lungs are smaller and they have faster breathing rates, which makes them particularly vulnerable to second-hand smoke, especially within the close confines of a car. Members of the public are protected by smoke-free legislation when in public transport and work vehicles. However, large numbers of children remain exposed to high concentrations of second-hand smoke when confined in family cars. Indeed, around one child in five reports being regularly exposed to second-hand smoke in cars, with catastrophic health consequences. Figures released by the British Lung Foundation show that around 185,000 children between the ages of 11 and 15 in England are exposed to potentially toxic concentrations of second-hand smoke in their family car every day or on most days.
We know that children exposed to second-hand smoke have a raised risk of lower respiratory infections, wheeze, asthma, middle ear infections and meningitis. Every year, exposure to second-hand smoke leads to an estimated 165,000 additional cases of these conditions among children. Many of those cases are serious, leading to an estimated 8,500 hospital admissions.
I was very surprised by research identified by the British Lung Foundation, which shows that a single cigarette smoked in a moving car with the window half open exposes a child in the centre of the back seat to around two-thirds as much second-hand smoke as in an average smoke-filled pub of days gone by. Levels increase to 11 times those of a smoky pub when the cigarette is smoked in a stationary car with the windows closed.
Some noble Lords will argue—as I heard the FOREST spokesman arguing this morning—that a car is a private space and that we should not legislate for what happens in such a space. However, there are more important principles than that, one of which is the need for child protection. Unlike most adults, children lack the freedom to decide when and how to travel, and they lack the authority most adults have to ask people not to smoke in their company. In those circumstances it is right for Parliament to step in to protect children.
I know that the Government argue that the most effective way to reduce smoking in cars carrying children is not through legislation. In his letter to us the noble Earl talked of two successful campaigns aimed at encouraging people to change their behaviour, and said that the evaluations are encouraging. From what I see—and they do not appear to be very robust evaluations—I am not aware that the scientific evidence of behavioural change has been published. Can he give an assurance that the evaluations spanned several months and not just immediately after the campaign? Can he also confirm that they took into account what was reported by children and not just adults? There is sometimes a discrepancy between what adults say they do and their behaviour as reported by children. Can he also confirm that the research includes actual measurement of behavioural change? I do not believe that marketing measures such as website visits effectively demonstrate behaviour change. Can the noble Earl also say why, if the Government are so keen on evaluation, Ministers forced NICE to abandon a project to give public health guidance for commissioners and providers on the development and implementation of policies on smoke-free homes, private cars and other vehicles?
The noble Earl will argue that this is best done through education. I understand that argument and I certainly accept that education programmes can achieve much. However, my contention is that we are now close to—
Lord Stoddart of Swindon (Ind Lab)
I have listened to the noble Lord very carefully and I cannot understand—perhaps he can explain it to me—why on earth he has joined the question of plain packaging with smoking in cars. They are two completely different issues. Is it expected that those of us who are concerned with both amendments now have to speak in one debate rather than two, on two particularly difficult and important matters?
Lord Hunt of Kings Heath
My Lords, a number of amendments have been grouped together. Some deal with standardised packaging, others with the issue of smoking in cars. My answer to the noble Lord is that we will deal with both issues in one debate. The House always has to trade off having separate debates on individual amendments or pulling them together. I, for one, think it is better that we have a wider debate; but of course the noble Lord is entitled to speak on both issues. I hope that he will do so because he always has interesting insights—although I do not always agree with him on this particular one.
In finishing, I want to come back—and anticipating the noble Earl’s response—to the issues around awareness campaigns. As I said, of course they can achieve much, but sometimes legislation also needs to be brought into the picture.
Lord Forsyth of Drumlean (Con)
The noble Lord said earlier in his speech that the principle of not legislating into private space and private family activity was one that should be breached on certain occasions. Could he explain why he is stopping at cars and not at living rooms in small flats, for example?
Lord Hunt of Kings Heath
My Lords, they are two different issues. I certainly do not propose that we legislate in relation to people’s homes. The differences lie, first, in the scale of the health issue. As I have already indicated, the amount of second-hand smoke that a young person is likely to inhale in a car generally will be very much higher than in a person’s home. Secondly, by and large there are usually rooms in a person’s home that are not used for smoking, so there is more of an element of choice. I accept that this is a continuum, but I assure the noble Lord that it is not my intention to propose a ban on smoking in people’s homes. There are specific circumstances that make the banning of smoking in cars while children are present a particular health issue.
Lord Cormack (Con)
I am grateful to the noble Lord. Surely, my noble friend Lord Forsyth highlighted a very important point. He talked about small flats; there are small flats where there may be several children and only one living room. What is the logic of the noble Lord’s argument in that case? Personally, I do not think we should invade private space; that is my position and I may seek to defend it later. There is no logical difference between a single child in a car and four children in the living room of a small flat.
Lord Hunt of Kings Heath
My Lords, I do not accept that. Clearly, in relation to a child travelling in a car we are going to debate where the balance lies: whether a car should be regarded as a private entity in which the state ought not to intervene, or whether noble Lords consider that a child’s health becomes the paramount concern.
A private car is rather different from a home; the health damage to a young person inhaling smoke in a car generally will be much greater than in a person’s home. I do not want to repeat the point that I have already made to the noble Lord, Lord Forsyth, although I may be tempting him to intervene again. However, within a home there are likely to be opportunities for young people to avoid the smoke-filled parts of that home.
Lord Forsyth of Drumlean
I do not want to prolong the noble Lord’s speech; I am not making a debating point, but am genuinely interested in his logic. A child in a car—which I accept is a very confined space—will probably be in a car for a short journey. If children are in a living room, they are there all evening. Perhaps I should declare an interest; my late mother used to smoke 60 cigarettes a day. That is one of the reasons why I would never touch a cigarette. Surely, if a child is in a small living room in which continuous smoking is going on, that seems to me, without any evidence, to be as great a health hazard as being in a car. I am not advocating invading private space, but where is the evidence that supports what the noble Lord is saying—namely, that it is a much worse hazard being in a car, probably on a short journey, than being in a living room where smoking goes on all day?
Lord Hunt of Kings Heath
My Lords, I do not have evidence on the length of the average car journey, though clearly short and long distances may be travelled during which smoking may take place. I suspect that we can argue that until the cows come home. However, I come back to the core argument that in a confined space, such as a car, a child is likely to be more damaged through inhaling second-hand smoke than they are in a person’s home. That is the reason for making a distinction between legislation affecting an individual vehicle and legislation affecting a person’s home.
Lord Scott of Foscote (CB)
I wonder whether the noble Lord can help me. Does “private vehicle” in the amendment include a motor boat? One drives a motor boat.
Lord Hunt of Kings Heath
No, my Lords, I do not think that that is covered in my amendment—although, of course, it is open to the noble and learned Lord to propose an amendment to increase the scope of the measure. I would give such an amendment all due consideration.
I refer noble Lords to an inquiry into smoking in private vehicles by the All-Party Parliamentary Group on Smoking and Health, carried out in 2011, which concluded that the evidence from smoke-free public places was that legislation would be necessary to reduce exposure to cigarette smoke in cars. That is the basic case I am making. At this stage, I am asking noble Lords to support the principle of a ban. If my amendment were accepted, I would be very happy to work on a cross-party basis to consult on the type of offence that should be put in place. I have not gone as far as the noble Lord, Lord Ribeiro, and his colleagues in terms of specifying the offence because I think that needs further consideration and discussion.
We would not be alone in legislating to protect children from the damage of smoking in cars. Seven other countries already do so, including four US states, 10 of the 13 Canadian provinces and all but one jurisdiction in Australia. As far as the public are concerned, a YouGov poll in 2011 found that 78% of adults in Great Britain agree that smoking should be banned in cars carrying children younger than 18 years of age. Just as significantly, perhaps, a British Lung Foundation survey in 2011 found that 86% of children want action to be taken to protect them from cigarette smoke in cars. I think that we should listen to the voice of children in this respect. I hope that noble Lords will support the amendment that I shall propose later.
In concluding, I should have pointed out to noble Lords my health interests in the register, including being chairman of a foundation trust, a consultant and trainer with Cumberlege Connections and president of GS1.
Lord Ribeiro (Con)
My Lords, the amendment of the noble Lord, Lord Hunt of Kings Heath, is compelling but fails to acknowledge the impact of second-hand smoke on children in confined spaces or in the home, as we heard in an earlier debate. For this to happen, the public, particularly parents, have to be educated about the harm that second-hand smoke can do to young children’s lungs. The noble Lord identified some of those problems. That is why I believe that education and behavioural change are important.
As a doctor, I recognise the damage that second-hand smoke can cause, and in particular the long-lasting effect it can have on the lungs of young children. Just this Sunday, I was present at the birth of my first grandson out of six grandchildren.
Lord Cormack
My Lords, that was really a speech rather than an intervention. There is all the difference in the world between the physical or sexual exploitation of a child and smoking. Smoking is not an illegal activity. Some of us may wish that it were, but it is not. It would be wholly impractical, as the noble Lord, Lord Patel, made plain in his remarks, for us to outlaw smoking. That is a road down which we cannot go. Therefore, to invade the private space of individuals who are committing a perfectly legal act seems to me a step too far. That is why we should look at other means. I have mentioned taxation and increased insurance premiums; there are many routes down which we could go to make it more and more difficult for adults to smoke in the presence of children.
Most importantly, it is up to experienced people such as the noble Baroness and my noble friend Lord Ribeiro to ensure that there is a well informed education campaign so that no one is in any doubt that smoking is a harmful activity and that inhaling passive smoke is dangerous and injurious to health. I am with the noble Baroness and my noble friend on that all the way, but the invasion of personal space—prosecuting people for what is a legal activity—seems a step too far. That is why, while I welcome and applaud the amendment introduced by my noble friend Lord Howe—if there were a Division, although I am sure that there will not be, I would enthusiastically go into the Lobby to support him—I cannot support something that I believe is a step too far in the invasion of personal space, which would also be monumentally difficult to enforce. We have to bear in mind the responsibilities of the police, whose job it would be to stop the cars and ask the questions.
Lord Hunt of Kings Heath
Does not the noble Lord accept that, although there may be difficulties of enforcement, the very fact of passing a law combined with the kind of educational programme that he supports is likely to have a positive effect?
Lord Cormack
No, frankly, I do not. I respect the noble Lord—he knows that—and we agree on many issues, but we will have to disagree on this one. I think it would make the job of the police even more difficult than it is at the moment and endanger what popularity they have with many law-abiding citizens. It is a burden that we should not place on them.
I repeat: let us do everything we can to educate; let us do everything we can to deter; let us have the plain packaging; let us listen very carefully to what Sir Cyril says in his report; but let us not take the ultimate step that the noble Lord advocates.
Lord Storey (LD)
My Lords, I want to speak to Amendments 57B and 62. First, on Amendment 57B, the Government are to be congratulated. The package that they propose—if I dare to use the term “package”—of proxy purchase, e-cigarettes and looking at the whole question of standardised packaging of cigarettes and tobacco products is to be welcomed. I think it will result in thousands of people being saved from getting respiratory and lung diseases; it will save literally thousands of lives. I congratulate the Minister and the Government. I want also to thank those cross-party noble Lords who put down the original amendment, because they initiated this debate.
On Amendment 62, I said in Committee and say again: some noble Lords have mentioned their grandchildren. Can you imagine carrying your grandson or granddaughter in a carry-cot, putting that child into a metal box—a car—and allowing somebody to pump cigarette fumes into that metal box? You would not do that at all; you would not allow that to happen. Whatever our concerns are about personal space or civil liberties or whatever it is, this is about the rights of a child; the rights of a baby. A baby cannot say, “Well, actually, I don’t mind”; a child cannot say, “Actually, I don’t mind”. In fact, research—certainly from talking to children—shows that they do mind. As we have heard, we can see when we look at the figures that children are particularly vulnerable to second-hand smoke. Why? Because they have small lungs, because they have faster breathing, and because they have a less developed immune system. That makes them more susceptible to respiratory problems: asthma, bronchitis and lung malfunction. Knowing that, and that passive smoking results in more than 165,000 new episodes of all sorts of diseases associated with lungs and respiration—and I am talking about children here—are we serious about allowing children and babies to be strapped in a car where that happens? Surely not; all the other arguments pale into insignificance.
We seem to cite lots of surveys here. Interestingly, in 2010 a survey that directly asked 11 year-olds and 15 year-olds found that one in five reported being exposed to second-hand smoke in cars.
A number of people have said, “How are we going to make this happen? The police are very busy; can we really make it happen?”. I have two answers to that. Do noble Lords remember when seat-belt legislation was suggested? People got up and said, “Oh no, this is an attack on my civil liberties; oh no, we will solve the problem by advertising”. It was the “clunk click” advertisement, was it not? Oh—perhaps we had better move on from that. With the “clunk click” advertisements, in fact, something like 24% of people started to belt up in cars. Legislation was then brought in and we found that 97% of people then put on a seat belt. We do that automatically; we do not think about it, or sit in our cars saying, “This is an infringement of our liberties; we shouldn’t be doing this”; we do it. Why do we do it? Because it saves lives: it saves our lives and the lives of other people who are travelling in the car.
Interestingly, a study conducted in Scotland—we talk about Scotland a lot in this Chamber, thank goodness—suggested that air quality inside a smoker’s car was comparable to industrial smog in cities such as Beijing or Moscow, even when the driver has the window open. Are we seriously suggesting that children and young people should be subjected to air quality which is akin to that in Beijing or Moscow? Of course, we are not. Research by Aberdeen University found that 7% of 11 year-olds experience smoking in cars. That is why I am pleased that one of my colleagues in Scotland, the Liberal Democrat MSP, Jim Hume, is introducing a Private Member’s Bill looking at safeguarding children by banning smoking in cars. That is now going out to public consultation.
I end by making two further brief points. It is easy to find all sorts of reasons why you cannot do something. We could ask, “What about cars that are convertible? What about yachts? What about this? What about that?”. However, if you believe in something and think that it is right, you get on and do it. My only regret regarding the amendment is that it was initially an all-party amendment. When I listen to the news, I hear that it is a Labour initiative. I am sorry that it has been politicised and has become a party-political issue; I hoped that it would not be.
Lord Hunt of Kings Heath
The noble Lord has made an impassioned speech. My understanding was that the original cross-party amendment had been degrouped and would be taken only late at night. I therefore brought forward this amendment to enable the House to make a decision. I agree with him about the cross-party nature of the debate.
Lord Storey
I respect what the noble Lord says and thank him for it.
The Minister is a listening Minister. I hope that he will reflect on what has been said and accept the amendment because it is important to take the whole House with him on issues such as this. I hope that he will look again at continuing the advertising campaign but, perhaps more importantly, that he will consider a review of this issue so that we can go forward on it together.
Earl Howe
My Lords, this has been a fascinating and very helpful debate and I am very pleased with the support that I have heard for the government amendments on standardised packaging. I would like, if I may, to commend noble Lords for their continued work in supporting tobacco control. We all want to drive down rates of smoking in this country and, in particular, to stop young people from taking up smoking in the first place. Let me address the points on standardised packaging first.
The noble Baroness, Lady Finlay, the noble Lord, Lord Faulkner, and my noble friends Lady Tyler and Lord McColl tabled a revised amendment following discussion in Grand Committee, and I see that they reflected the comments that I made in redrafting it. I particularly welcome their support for the Government’s amendments and can reassure them that our amendments would achieve all of the things that they seek to do.
My noble friend Lord Naseby raised a number of legal issues. I would like to reassure him that we have given very careful consideration to the legal situation. We believe that the government amendment gives us sufficient room to proceed with the regulations, should we choose to do so, and introduce standardised packaging, if that is what is decided. He queried the fact that the amendment is drafted in such a way that the devolved Administrations and Assemblies have to give consent, but it is the Secretary of State and not Parliament who gives consent in England. We do of course want Parliament to have a say, which is why we have introduced Amendment 63B to make the regulations subject to the affirmative procedure.
The noble Lord, Lord Stoddart—whose robust state of health I very much welcome—indicated that there has been no proper consultation on standardised packaging. In fact, in 2012 the Government ran a full public consultation and received almost 2,500 substantive responses and well over half a million postcard and petition responses. The consultation asked 15 specific questions and invited comments on the consultation stage impact assessment, which was also published. So it was a very thorough exercise.
The noble Lord, Lord Stoddart, suggested that this was the thin end of the wedge, if I can put it that way, and might herald similar measures in relation to junk food. I think we need to remember that tobacco is a uniquely harmful consumer good. Tobacco kills one in two long-term smokers. There is no safe level of smoking. That is why we have a range of specific legislation and an international treaty around tobacco control.
My noble friend Lord Naseby referred to illicit tobacco. We received a wide range of responses to the question in the consultation on illicit tobacco. They are summarised in the consultation report. In 2000, around 21% of the UK cigarette market was illicit. The latest estimate from HMRC, for 2012-13, is that this has dropped to around 9%. It is too high, I concede, but we are heading in a positive direction.
The noble Baroness, Lady Howarth, asked about the timetable for the regulations. I emphasise here that I do not want to pre-empt any decision that the Government may make on whether to proceed with standardised tobacco packaging, and I know that the noble Baroness understands that; but equally for that reason, it would be premature to set out a detailed timetable. What I can confirm is that the regulations would be subject to the affirmative procedure to ensure an appropriate opportunity for parliamentary scrutiny in both Houses. She may like to be aware that before being laid in Parliament, any draft regulation that seeks to regulate tobacco packaging would need to be notified to the European Commission and member states. There is a process that goes with that, which would mean that we would not be able to lay regulations instantly after taking a positive decision. I am happy, however, to reiterate the Government’s commitment to make a decision quickly when we receive Sir Cyril Chantler’s independent report. Tabling these amendments is, I hope, evidence of our commitment to act without delay if we decide to go ahead. But the Government, as I am sure she appreciates, must rightly consider the wider issues raised by this policy, and I can assure her that we will do so.
I can understand the intention of the noble Lord, Lord Hunt, in tabling both of his amendments, Amendments 57BA and 61, which seek to compel Ministers to introduce standardised packaging. However, I am sure that he will not be surprised to hear me say that we cannot accept provisions that tie our hands in this way. One of the amendments imposes an arbitrary timetable for government action, and both pre-empt Ministers’ proper and careful decision-making, involving consideration of all the relevant issues. Litigation by the tobacco industry is always a risk when introducing tobacco control legislation. Indeed, the World Health Organisation says that one of the six main forms of tobacco industry interference in public health is the intimidation of Governments with litigation or the threat of litigation. Government must have time and space to give proper consideration to the wider issues raised by standardised packaging of tobacco, and demonstrate that it has done so. Doing so will also reduce the risk of successful litigation. I do appreciate the desire to go faster but we must follow the proper decision-making process to enable us to arrive at the right policy decision. It is right that we should wait for Sir Cyril’s report. Once we do, I say again, we will make a decision quickly.
The noble Lord, Lord Hunt, asked me to put on the record that we will definitely introduce the regulations should the case be made and should we be persuaded of the case that Sir Cyril presents. I hope that I have been clear about that. I will repeat the comments made by my honourable friend the Minister for Public Health when she announced the review:
“The Government will introduce standardised tobacco packaging if, following the review and consideration of the wider issues raised by this policy, we are satisfied that there are sufficient grounds to proceed, including public health benefit”.—[Official Report, 28/11/13; col. WS 96.]
I thank the noble Lord, Lord Faulkner, the noble Baroness, Lady Finlay, and my noble friends Lady Tyler and Lord McColl for having made clear their intention not to press their amendment on standardised packaging. I hope that the noble Baroness, Lady Hughes, and the noble Lord, Lord Hunt, will do the same with theirs.
I turn to smoking in cars. Since we considered the issue at the previous stage of the Bill, I have met a number of noble Lords who support the idea of legislating to stop smoking in cars with children present. I have also listened very carefully to the debate as it has proceeded this afternoon. One thing is clear from those meetings and the debate—we all want to eradicate smoking in cars carrying children. None of us wants to see children continuing to be exposed to harmful second-hand smoke, whether in the home or the family car. However, although we agree on the destination, I have to acknowledge that there are differing views on the most effective route. As your Lordships will know, the Government believe that encouraging positive and lasting behaviour change by making smokers aware of the significant health risks of second-hand smoke will be more effective than resorting to the use of legislation—which is of course a blunt instrument—to tackle the problem. I believe very clearly that we should consider resorting to the use of legislation only if our work to promote positive changes in behaviour is shown not to have had the desired effect.
When we debated this issue in Grand Committee, a good deal of time was spent considering the practicalities of enforcing an offence of smoking in cars carrying children. I do not propose to rehearse those arguments in detail again today. Nevertheless, I want to encourage your Lordships to reflect on just how difficult it would be to enforce such a provision. My noble friend Lord Cormack referred to this. In my view, there would be substantial challenges in enforcing any such legislation, particularly with respect to vehicles travelling at speed. Currently, local authorities enforce smoke-free legislation, but they do not have the powers or the means to require moving vehicles to pull over. We would need therefore to set up a complex and probably resource-intensive enforcement regime, which would need to involve the police. These remaining questions of how to achieve effective enforcement undermine the credibility of the measures that have been proposed. If it were known that there was little chance of enforcement action, I have to ask whether individuals would comply with the law.
Lord Hunt of Kings Heath
I am most grateful to the noble Earl. Would he accept that my amendment has been drafted in a way that allows your Lordships to vote on the principle but then allows for work to be done, hopefully cross-party, and for the Government to bring in regulations, during which some of these matters could be talked out thoroughly?
Earl Howe
I have noted the way the noble Lord’s amendment has been drafted. However, we need to be very careful before accepting it, for the reasons that I am explaining now. One of the points made about enforcement was that we could make a useful comparison with seat-belt legislation. I understand why that comparison has been made but it needs to be borne in mind that we are not comparing like with like. Seat-belt legislation is a road safety measure which is properly enforced by the police; smoking in cars is a public health matter and the police have no public health role or functions. That is part of the reason that the issue is so complex. Before launching into the kind of amendment that the noble Lord, Lord Hunt, invites us to accept, we need to take stock of these questions. There is no point in putting something on the statute book if it is impractical to implement.
“Protection of Children’s health: offence of smoking in a private vehicle
The Secretary of State may bring forward regulations making it an offence for any person who drives a private vehicle to fail to prevent smoking in the vehicle when a child or children are present.”
Health: Confidential Patient Information
Lord Hunt of Kings Heath Excerpts(12 years, 2 months ago)
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Lord Hunt of Kings Heath
To ask Her Majesty’s Government what assessment they have made of the likely impact of proposed European Union legislation on their plans to sell confidential patient information to drug and insurance companies.
Lord Hunt of Kings Heath (Lab)
My Lords, I beg leave to ask the Question standing in my name on the Order Paper. In doing so, I refer noble Lords to my interests in the register.
The Parliamentary Under-Secretary of State, Department of Health (Earl Howe) (Con)
My Lords, while we have concerns about the EU proposals, there has been no cause to conduct an assessment of the sort suggested at this stage. The Government do not sell confidential patient information to companies. Drug and insurance companies can receive patient confidential information only where they have a legal gateway, either consent of the patient or some form of statutory authority. In these circumstances the cost of providing information may be recovered, but it is not sold.
Lord Hunt of Kings Heath
My Lords, clearly there is great advantage in using patient research in large-scale research projects. However, can the noble Earl assure the House that patient confidentiality can be assured? Also, is it right that projects such as the UK Biobank could be put in jeopardy were the proposed European legislation to be enacted in its current draft form?
Earl Howe
My Lords, under the 2012 Act, the Health and Social Care Information Centre cannot release data that could be used to identify an individual without a legal basis to do so. As a result, there are strict controls about how such information is released. As regards the UK Biobank, the noble Lord is right to be concerned because the proposed text from the so-called LIBE committee would rule out the work of the UK Biobank, in that it would need explicit and time-limited consent for any research project that it undertook, instead of being able to support a range of research purposes, as it now can, using its existing consenting mechanism. So there is cause for concern if this text is adopted, but that is not yet clear.
Health: Dementia
Lord Hunt of Kings Heath Excerpts(12 years, 2 months ago)
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Lord Hunt of Kings Heath (Lab)
First, I refer noble Lords to my health interests as chair of a foundation trust, president of GSI and consultant and trainer with Cumberlege Connections. I, too, would like very much to thank the noble Baroness, Lady Gardner of Parkes, for allowing us to debate this important issue tonight. I also echo the tribute paid by my noble friend Lord Jones to the Alzheimer’s Society, both for the work that it does and for the very helpful briefing that I have received tonight.
If we come back to the question put by the noble Baroness, Lady Gardner, she is surely right about the important focus on improving information to the public, and trying to get over some of the stigma problems to which she referred. She referred to cancer—and I remember when, in the 1950s, people would not actually use the word “cancer”. It was almost hidden away. Clearly, there are issues with dementia, which we must tackle with enthusiasm. My noble friend Lady Turner spoke eloquently of the terrible impact that dementia can have on loved ones.
On a more optimistic note, both the noble Baroness, Lady Greengross, and the noble Lord, Lord Jones, said that much can be done. However, the problem is that often people do not know that that is the case. A major problem is the lack of information in many cases when a diagnosis is made. That, of course, assumes that a diagnosis is made. My understanding is that diagnosis rates are currently only 48% in the UK, and vary widely across the country. This suggests that more than half of people with dementia do not receive a formal diagnosis and therefore do not get access to vital treatment and support. How does the noble Earl think that we might improve diagnosis rates? Will he also consider the Alzheimer’s Society’s priorities for improving post-diagnostic support, to which my noble friend Lord Jones referred? That society’s priorities are that health and care professionals should provide post-diagnosis information packs, that information must be accessible and useful to people with dementia and not just available digitally—a very important point—and that commissioners must also consider the needs of carers of people with dementia in their local plans.
When a diagnosis is made of any condition, not just dementia, why is the information provided by societies such as the Alzheimer’s Society not automatically given to patients? It has long been a puzzle to me why the health service in particular finds it so difficult to give out this information. Any help the noble Earl can give in that regard would be appreciated.
Will the noble Earl say a little more about research? A number of noble Lords have referred to this. Research into dementia has improved but there is a long way to go compared with research into other diseases. I hope that the noble Earl will be prepared to comment on his own department’s policies on this issue and on the influence of the Medical Research Council in this area.
My noble friend Lady Turner said that people with dementia are best looked after at home. That must surely be right. However, the noble Earl will know that at the moment many patients with dementia are in National Health Service acute hospitals. Some people use the wretched term “bed blocking”, which I think is very unfortunate. However, there is no doubt that one of the problems for accident and emergency departments is the difficulty of discharging patients with dementia once they get to hospital, and, of course, those patients often suffer from co-morbidities. Has the noble Earl looked at the report of the Royal College of Physicians which suggests that, rather than having specialised hospital consultants, we need general physicians who can treat patients with co-morbidities? This is very relevant to people with dementia. Will he write to me on that issue if he cannot comment on it today?
The noble Baroness, Lady Gardner of Parkes, referred to nursing. I very much agree with her that in retrospect the phasing out of state enrolled nurses was an absolute disaster. I am afraid that it was done at the behest of the nursing profession. It is not satisfactory that we now have only one tier of registered nurse. I will not go back to the issue of healthcare assistant regulation, although rumours reach one of a Bill that will allow us to debate that again at some point in the near future. However, the substantive point the noble Baroness made was that we need to look at nurse training and, I think, healthcare assistant training, in this area.
We can tackle this issue only in a wider context. My noble friend Lord Jones said that the Question posed by the noble Baroness is a strategic one. I very much agree with that. The noble Baroness, Lady Greengross, talked of the need, in the case of an individual with dementia, for a navigator and co-ordinator. My argument would be that we need the equivalent at the national level also. We have the national dementia strategy for England but my understanding is that it is due to end in April 2014. I ask the noble Earl whether he thinks that the Government would be prepared to run with another national strategy.
This is a terrible illness. It impacts on 850,000 people at the moment; I believe that that figure is estimated to increase to 1 million or so by 2021. The need for national leadership and a national strategy is overwhelming. The noble Earl might not be able to commit to that tonight but I hope that he will take the message from noble Lords here, which is that this is a terrible illness, much can be done to help people with dementia if we have co-ordinated action, much more research ought to be done, and we need greater co-ordination at local level.
I hope that the noble Earl will pick up the suggestion of the noble Baroness, Lady Greengross, that local co-ordinators and navigators of care would be extremely helpful. Perhaps he will also pick up the point raised by my noble friend Lord Jones about the role of business and industry in supporting local societies. He gave a brilliant example of how that can pull people together and provide real support for organisations such as the Alzheimer’s Society at local level.
Health: Flour Fortification
Lord Hunt of Kings Heath Excerpts(12 years, 2 months ago)
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Earl Howe
I am sure the noble Lord would agree that we have to take a decision based on the most up-to-date data. The data that we had prior to this were 10 years old and it is important to take a decision in the context of the nutritional state of health of the population. On his first question, all I can say is that the risk to which I referred was considered as part of SACN’s overall assessment and we will draw on that in reaching our decisions on the fortification of flour and give it the appropriate weight that it deserves.
Lord Hunt of Kings Heath (Lab)
My Lords, on the issue of up-to-date information, as the noble Lord, Lord Rooker, has said, we now have the Wolfson study, which actually leads that organisation to recommend that all countries should introduce folic acid fortification. The Government already have the recommendation of the Scientific Advisory Committee on Nutrition for mandatory fortification. Yes, it says it should be accompanied by actions to restrict voluntary fortification of food with folic acid for the reasons to which noble Lords have already referred. Why on earth are the Government delaying action on this?
Earl Howe
My Lords, I can only repeat what I said before, which was that taking this step would be a major step by any standards. We must base it on a proper assessment of the risks and benefits. We have some excellent advice from SACN and we need to evaluate that advice fully before taking a decision.
Public Health Responsibility Deal
Lord Hunt of Kings Heath Excerpts(12 years, 2 months ago)
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Lord Hunt of Kings Heath (Lab)
My Lords, I hope that the noble Earl will encourage his own noble colleagues to look at themselves in the mirror in the light of that unwarranted attack on my own Benches. Perhaps I can just refer the noble Earl to the report of the National Obesity Forum yesterday, which suggested that, on one of the worst-case scenarios, more than half of the population of this country will be obese by 2050. Does he not think that the volunteer approach may no longer be appropriate? Do the Government not have to take a greater lead on this?
Earl Howe
My Lords, there are certainly no grounds for complacency on obesity levels throughout the nation. However, the current data do not support the claim by the National Obesity Forum. In 2007, the Foresight team projected that, based on data from 1993-2004, more than half the population could be obese by 2050 if no action is taken. An analysis based on recent data suggests a flatter trend than the one projected by the Foresight team. I do not agree that we should belittle the responsibility deal. It has many worthwhile achievements to its credit and they are being added to month by month.
Health: Birth Defects
Lord Hunt of Kings Heath Excerpts(12 years, 3 months ago)
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Earl Howe
My Lords, I recognise the opinion that is shared among many members of the medical community on this. However, the advice we received from SACN, our expert adviser, clearly showed that there are risks and benefits associated with this proposal. It is not an open-and-shut case. Among the things that we have had to consider are the practical implications of implementing SACN’s advice, which is no small matter.
Lord Hunt of Kings Heath (Lab)
My Lords, does the noble Earl not recognise that in fact the scientific committee he referred to has looked at the issue that he raised and has upheld its previous recommendation that the Government should go ahead? Some 50 countries have already done that; the scientific advice is clear; why on earth are the Government not getting on with it?
Earl Howe
My Lords, as I said, SACN’s recommendations highlighted both the risks and the benefits of this proposal—and I certainly acknowledge that there would be benefits. However, there are also implications. For example, SACN recommended that mandatory fortification should proceed only if accompanied by:
“Action to restrict voluntary fortification of foods with folic acid; measures for careful monitoring of emerging evidence on any adverse effects of long-term exposure to intakes of folic acid … and guidance on supplement use for particular population groups”.
We have to take those recommendations into account before taking any long-term decision.
Smoking: E-cigarettes
Lord Hunt of Kings Heath Excerpts(12 years, 3 months ago)
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Lord Hunt of Kings Heath (Lab)
My Lords, first, I apologise to the Committee for being a little late for the start of the debate. I welcome this debate and I congratulate the noble Viscount, Lord Astor, on allowing us to discuss a very interesting subject. I am sure that we are all looking forward to the noble Earl’s response to the many questions that have been put to him.
With more than 100,000 people dying from smoking-related diseases across Britain every year, it is clear that we need to do all we can to support people to give up smoking and discourage young people from taking it up in the first place. One thing I am convinced about is that e-cigarettes have the potential to provide a significant boost to public health. I understand that the National Institute for Health and Care Excellence supports the use of nicotine-containing products such as e-cigarettes to aid smokers in cutting down on tobacco. As we have heard, an estimated 400,000 people across the UK have already switched from smoking to e-cigarettes.
I noted the comments of the noble Viscount, Lord Ridley, on the risks of regulation, and I agree with him that it is important that regulation does not stifle innovation. On the other hand, as with any new and fast-emerging product, some additional safeguards may be needed to cover any gaps in our existing consumer regulations. I want to ask the noble Earl, Lord Howe, about this. Does he consider that the medicinal regulation of e-cigarettes would put a lot of the current e-cigarette companies out of business? The noble Earl is of course very well acquainted with the work of the MHRA, issues to do with the regulation of medicines and, indeed, herbal medicines, which may be relevant in this context. I wonder if any work has been done to estimate the cost of regulation for these products.
For instance, I imagine that a dossier has to be produced with scientific evidence to show the efficacy and safety of these products. I wonder whether the noble Lord has an estimate of the cost of this, and whether that would inhibit many of the small companies in this market from being able to carry on in business when this is introduced. I support regulation that is light-touch and permissive rather than restrictive.
As the noble Viscount has said, the regulation of e-cigarettes has been debated as part of the EU trilogue negotiations on the tobacco products directive. Can the noble Earl inform the Committee of the progress of those negotiations? I understand that they are scheduled to end in the coming weeks, and an update would be appreciated, as would some sense of the timeline between agreement within Europe and the implementation of this proposed directive.
As the noble Lord, Lord Borwick, has commented, e-cigarettes have clearly been very successful in encouraging smokers to quit and to use e-cigarettes instead. He posed the question of whether there are circumstances in which e-cigarettes could be a passport to tobacco smoking. I think he talked about teenagers in particular, implying that some of the marketing approaches of the e-cigarette manufacturers might provide a cool image to young people, who would take up e-cigarettes and then be tempted to go on to tobacco products. I do not know whether the noble Lord, Lord Borwick, saw the complaints made about an advert for e-cigarettes screened by ITV on 3 December during “I’m a Celebrity”, which appeared to show a woman talking about oral sex, while at the end of the advert it was revealed to be a reference to e-cigarettes. The question I put to the noble Earl is: how do we ensure that e-cigarette manufacturers are not able to advertise in such a way as to make e-cigarettes attractive to young people who would not ordinarily have come to smoking, so that they act as a passport to tobacco smoking?
If the noble Earl can reassure us that regulation can be light-touch, that the process of being regulated as a medicinal product will not be overbearing, and that there can be appropriate controls on advertising, then we should welcome the impact of e-cigarettes, because the evidence is clear that they have helped a lot of people come off tobacco smoking. Surely, in the end, that is to be welcomed.
Olympic Legacy (S&T Report)
Lord Hunt of Kings Heath Excerpts(12 years, 3 months ago)
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Lord Hunt of Kings Heath (Lab)
My Lords, I, too, welcome this debate and the report of the committee chaired by the noble Lord, Lord Krebs. I think it is a truth universally acknowledged that the Olympic Games in London were outstanding and never to be forgotten and that the legacy is as important. The argument for investing in sports science in elite performance and in non-elite sports and exercise has been very persuasively put by all noble Lords who have spoken in the debate this afternoon.
The question first posed by the noble Lord, Lord Krebs, was: the performance of Team GB in the Olympics was outstanding, but could it have been even better if even more use had been made of science? The noble Lord, Lord Moynihan, answered in the affirmative and pointed the way forward in terms of there being a very strong case for future investment in science in relation to elite sport.
The noble Lord, Lord Krebs, referred to heated shorts. As a commuting cyclist, I am very attracted to the idea, particularly as Christmas is coming up and the winter will, no doubt, get colder. More seriously, it would be good to hear from the noble Earl, Lord Howe, about future investment in sports science in elite and non-elite sports. The noble Lord, Lord Moynihan, made a very important point when he said that there is a problem with the sharing of knowledge with the vested interests of investors in sports science as opposed to the non-vested interests. That does not necessarily have to be government, but government can, no doubt, play an important role.
The other question that arises from this is about the extent to which we are investing in science to increase our knowledge of the impact of exercise on good health. This is the second argument that has been put in your Lordships’ debate this afternoon. The noble Lord, Lord Krebs, and other noble Lords referred to the health benefits of exercise, and it is striking that although this is increasingly known about, it does not seem to have much impact on the general public’s desire to exercise. The post-legacy figures for the public taking up sport or more generally taking part in exercise have been very disappointing. The figure of 150 minutes of moderate exercise per week seems as far off for many of the population as it ever was. Noble Lords probably know that I live in Birmingham, and my understanding of the latest statistics there is that 22% of young people in Birmingham are classified as obese. That is a shocking figure. We know the impact that that will have in future years in terms of health inequalities and demands being made on the health service. As we know, we have an epidemic of diabetes in many parts of society and of the country. As regards the figure of 22% obesity among young people in Birmingham, you do not need much knowledge of science to know that that will lead to huge pressures being put on the health system in that city in the coming years.
I wish to ask the noble Earl, Lord Howe, about the role of general practitioners. A number of points have been made in that regard. It was argued persuasively that if GPs were to prescribe exercise that might have a positive impact in terms of people’s response. We know that as regards health issues, particularly smoking, nothing is more effective than a GP telling a patient that he or she needs to think about giving up smoking. It would be helpful to ensure that GPs are all facing in the right direction on this issue.
Does the noble Earl think that health and well-being boards ought to prioritise investment in sport and exercise vis-à-vis local authorities and the health service? After all, health and well-being boards recognise that local authorities have a big role to play in this area. Local authorities are also responsible for running extensive leisure services—or at least they were—and have a wider role in this area in liaising with schools. Surely sport and exercise ought to be a major priority in joint strategic needs assessments, which attempt to bring together wider health policies. Will the noble Earl assure the Committee that the Government will push health and well-being boards in that direction? I would argue that they could be the local equivalent of the committee set up by the BMA in the 1930s, and its successor organisations, to which the noble Lord, Lord Moynihan, referred.
Another very important point raised by the committee of the noble Lord, Lord Krebs, was the attitude of the Department for Culture, Media and Sport towards the health benefits of sport. The Government reject the committee’s assertion. My own experience in government suggests that there is a gap between the Department of Health’s policy of encouraging exercise and the DCMS’s focus on sport. Indeed, I have taken part in theological debates between the two departments on where one element ends and the other begins. This is a fruitless exercise as it is patently obvious to anyone with any common sense that sport and exercise go together. If those departments find it difficult to resolve that issue, something else needs to happen. That could involve assistance in the form of a Cabinet committee, to which the Government refer in their response to the report of the noble Lord, Lord Krebs, or, as the noble Lord, Lord Moynihan, suggested, we should simply make it clear that a good health outcome is the number one priority. I believe that something more needs to happen in this area.
Noble Lords have not really mentioned the role of the Department for Education despite the fact that it has a crucial role to play in this area. We have seen very regrettable reductions in government support for school sport and I hope that the noble Earl’s department has actively pointed out to Mr Gove the error of his ways. Following the reaction to the original cuts in government support for school sport, the Department for Education partly retracted its proposals and established the School Games project—as we are told in the Government’s response—which attempts to provide more opportunity for pupils of all abilities to take part in competitive sport in schools. But I would like to see more—and I would like to see the Department of Health become the champion in Whitehall of the need to promote school sports, competitive sports and other exercises.
I would also like to hear more about how we can encourage sports clubs to work in schools. The noble Baroness, Lady Heyhoe Flint, has done so much to encourage girls to take part in competitive sports; she will know of the Chance to Shine project, which is about encouraging state schools to come back to playing cricket. Part of that approach is to encourage local cricket clubs to send their coaches into schools. I would like to hear more about how the Government might encourage that in future.
We then come to the issue of investment. The noble Lord, Lord Krebs, referred to the role of the National Centre for Sport and Exercise Medicine. Clearly, there is a concern here about its future viability. Can the Minister give the Committee some comfort that the Government recognise that continued funding support needs to be provided? Does he think that the Department of Health’s own research and development fund could come up with some support? It seems a persuasive argument that, given that the department is concerned with improving the health of people in this country, and given that sports and exercise clearly have a vital role to play in doing so, I would have thought that the argument for some support and funding from his own department’s R&D fund, which is not extensive but is very significant, ought to be considered.
The noble Lord, Lord Addington, suggested that the noble Earl, Lord Howe, and I were interlopers in this debate. However, I have no doubt that the encouragement of sports and exercise can play a critical role in improving the nation’s health and well-being. I am also in no doubt, having listened to the debate and read the report, that investment in science and science research could help us and use that knowledge to encourage more of the population to play a part. When one looks at some of the great health problems that we face—of frailty, dementia and obesity—one can see emerging research that suggests that exercise and sports can very much help us to meet some of those challenges. Given the department’s role, does the Minister not accept that it could play a much bigger role in this whole area in future? I hope that the department will accept that opportunity.
Health and Social Care Act 2012: Risk Register
Lord Hunt of Kings Heath Excerpts(12 years, 4 months ago)
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Earl Howe
My Lords, the risk register, as the noble Lord knows, is simply a tool that records the risk assessment process and the actions that need to be taken to mitigate those risks. However, to be effective, the process has to be robust and consider all likely implications—and indeed some that are not so likely—of a proposed course of action. The candid recording of risks enables them to be effectively managed. However, as the noble Lord knows, we have gone as far as we can in publishing the areas of risk that are contained within the risk register. I remind the noble Lord that in 2012 we published an extensive document that set out quite a lot of detail. That document is still available on the department’s website.
Lord Hunt of Kings Heath (Lab)
My Lords, I refer noble Lords to my health interests. To return to the Question asked by my noble friend, is it not a fact that officials warned Ministers that they would be introducing a shambolic reform of the health service? Those officials, much-maligned by the noble Lord’s ministerial colleagues, have been proved to be absolutely right. As we are all looking forward to the new musical by the noble Lord, Lord Lloyd-Webber, can the noble Earl tell me which will be published first: the full Profumo papers or the noble Earl’s risk register?
Earl Howe
My Lords, I do not accept the noble Lord’s description of the transition, which has gone extremely smoothly. By most measures the NHS is performing very well indeed. Waiting times are low and stable, the number of people waiting more than 12 months has plummeted since 2010, hospital-acquired infections are at an all-time recorded low, we have more doctors and healthcare professionals in the system, and mixed-sex accommodation has been reduced to minimal levels. That does not indicate to me that the reforms have had a damaging effect—quite the reverse.
Tobacco: Packaging
Lord Hunt of Kings Heath Excerpts(12 years, 4 months ago)
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Lord Hunt of Kings Heath (Lab)
My Lords, I refer noble Lords to my health interests in the register. I am very grateful to the noble Earl for coming to the House and I am pleased that the Government have changed their position. We have seen plenty of U-turns in the past three years and this is a major one, undoubtedly caused by the Government’s fear of defeat in your Lordships’ House.
However, why another review? Why must we wait until 2015 before implementation? I have enormous respect for Sir Cyril, but the Government have already had a review. The evidence in that review was clear for all to see. Does the noble Earl agree that it found that standardised packaging would make cigarettes less attractive to young people? Did it not find that such packaging made health warnings more effective? And did it not refute the utter falsehood that some brands are safer than others?
Does the noble Earl accept that all royal colleges and health experts are united behind the case for standardised packaging? Is it not the case that if the Transparency of Lobbying, Non-Party Campaigning and Trade Union Administration Bill goes through in its current form, it would prevent charities such as Cancer Research UK ever raising issues like this in an election year?
Finally, the noble Earl will be aware of an amendment laid by my noble friends Lady Smith, Lord Rosser and Lord Beecham to ban proxy purchasing of tobacco products on behalf of children which will be debated in your Lordships’ House on Monday. Will the Government accept that amendment?