(2 days, 12 hours ago)
Lords ChamberPerhaps I could assist by clarifying that the spending review, which allows for an increase of over £4 billion of funding available for social care, is by 2028-29; it is not a matter of waiting for that long. That is in comparison with 2025-26. I hope I was helpful to your Lordships’ House in identifying a number of actions we have already taken to professionalise, upskill and allow people to build careers in the social care workforce. That is absolutely crucial. That, aligned with stopping international recruitment in this area—with a period of time for transition of some years—will shift to improve and increase the adult social care workforce in this country.
My Lords, while there are legitimate concerns over the levels of immigration, it is important to recognise the contribution that immigrants have made to our great country, not least to recall that after the war, our public services were saved by immigrants, especially from Commonwealth countries. We should not forget that.
My question is about the NHS and Care Volunteer Responders programme, which was set up during the pandemic and extended to adult social care in 2023. Unfortunately, the Government recently closed the volunteering service without an obvious alternative. While I recognise that volunteering will not make up for workforce shortages, what action are the Government taking to ensure that those who wish to volunteer in the social care sector can make a worthwhile contribution?
While I absolutely agree about the value of volunteering, as we have discussed before, I should make clear that volunteering is not a substitute for employment on the right pay, the right terms and conditions and with the right status. I also absolutely agree with the noble Lord about the contribution that has been made by those from overseas to supporting our care services, and indeed by all care workers.
As we have discussed in this Chamber, the scheme was not simply closed. It was something that was appropriate for when we were in a pandemic but not for now. In fact, we have introduced a whole range of measures which I will be very pleased to remind the noble Lord of, to ensure that we can have more volunteers who are better used and more highly regarded. They are a complement to our workforce, and very valuable they are too.
(3 days, 12 hours ago)
Grand CommitteeMy Lords, I thank the Minister for outlining the purpose of these regulations so eloquently and succinctly. It is clear that the change to the fee structure for regulating medical devices and medical products is part of a realm of profound importance both to public health and to the future of healthcare in the UK. As Liberal Democrats, we unequivocally support a robust, efficient and well-resourced Medicines and Healthcare products Regulatory Agency, but it is important that our regulatory bodies possess the financial stability to ensure the safety, quality and efficacy of medical products and blood safety, which touch the lives of millions throughout the year.
I am not going to speak on these regulations at great length; I just want to tease out a couple of issues about which I would like a little more information from the Minister. First, increasing the fees will mean that costs will be covered automatically. What mechanisms are in place to ensure that efficiency and effectiveness are in place, rather than just ballooning costs that it would be assumed the industry would absorb? I am not clear from reading the impact assessment or the regulations exactly how the Government will ensure that the cost really is the cost and is not excessive cost.
Secondly, it is clear in the impact assessment that most of those who gave feedback to the consultation question were against these fees. How have the Government taken into consideration the reservations, not just of the “no” element but in particular that the fees were seen in some cases to be disproportionately high and to exceed inflation? How has that developed? Why are these costs disproportionately high and why do they exceed inflation?
Finally, it is important to increase the fees to ensure the agency’s work can continue but, critically, the impact assessment demonstrates a lack of concrete detail on how these increased fees will translate into tangible improvements in these MHRA services. Although the rationale for increased fees is often framed around enhancing regulatory efficiency and speed, the document provides insufficient assurances of the measurable commitments as to how the additional revenue will be specifically utilised. There is no clear framework for accountability that demonstrates how these funds will lead to faster approvals or increased safety. How will the department measure such improvements? In particular, what improvements are expected on the back of this fee increase?
These regulations are a serious matter. They impact on the health of our nation and, to some degree, the vibrancy of our life sciences industry, but we must ensure that our regulatory framework is not only robust but forward thinking and truly serves the best interests of every patient in the UK by ensuring that the increased cost will both increase efficiency and, we hope, improve the services that the MHRA provides.
My Lords, I also thank the Minister for introducing these regulations succinctly, as the noble Lord, Lord Scriven, said. Perhaps in common with the Liberal Democrats, we on these Benches—the numerous people on these Benches—do not seek to oppose this statutory instrument. Rather, we just wish to reflect on its purpose and practical implications, and ask a few questions for clarification that I hope the Minister will be able to answer.
As noble Lords have said, this instrument amends three pieces of legislation. We understand that these changes are intended to enable the MHRA to increase the fees to manufacturers, suppliers and other regulated entities involved in the approval of medical devices and blood components. Noble Lords understand that the current model relies primarily on contributions from industry and that the MHRA’s fees were last comprehensively reviewed in April 2023, as the Minister said. Of course, we have seen a rise in operational costs, particularly relating to staff and overheads, so we completely understand that the intention behind these regulations is to bring the MHRA’s income more closely in line with the cost of delivering its services. It is also to place the agency on a more sustainable financial footing, thereby reducing its reliance on central government funding, which I think is something on which we all agree.
As the noble Lord, Lord Scriven, said, the impact assessment accompanying this instrument identified the primary benefit of this additional income—to enable the MHRA to continue fulfilling its responsibilities —but, as was raised by some in the industry and in the other place, it is less clear how these changes will directly benefit patients, healthcare providers or, indeed, medical innovators, in particular those operating in the small and medium-sized business sector. We understand that the Government decided to pause their proposed reforms to the medical device registration fee following concerns raised by stakeholders. That decision is welcome, and I thank the Minister and the Government for that. The paused proposals would have had a disproportionate impact on companies registering a large number of products, particularly due to the proposed fee model linked to the global medical device nomenclature codes. However, the broad uplift in the other fees will still go ahead, and it is in this wider context that we seek some reassurance about these changes.
I shall look at some of the areas on which some clarity would be welcome. First, we recognise the MHRA’s need for stable funding, but we want to make sure it does not create barriers to innovation, in particular for start-ups and SMEs, which, as we know, often operate on much narrower margins and already navigate a complex regulatory environment. What assessment has been made of the cumulative impact of these fee increases on smaller firms? Do we know how these changes compare with the regulatory costs faced by manufacturers in other major markets, such as the EU, the US or Asia? Is the Minister able to give some international context here?
Secondly, the impact assessment confirms that the staffing costs remain the largest cost driver for the MHRA and assumes a 2.2% annual pay increase through to 2027—below the current rate of inflation. Has any thought been given to whether that is a realistic assumption and basis for planning? If the actual costs prove higher than forecast, how will that impact the MHRA’s progress towards the full cost of recovery? Would the agency be forced to scale back its services, or would the taxpayer be expected to cover any shortfall?
(3 days, 12 hours ago)
Grand CommitteeMy Lords, I thank the Minister for introducing this statutory instrument in her usual succinct way and all noble Lords who spoke in this debate. We on these very efficient Benches—so efficient that we have only one person here today, which is very good for productivity—recognise the Government’s intention to modernise pharmacy through the introduction of hub-and-spoke arrangements and to increase efficiency and free up pharmacies to focus more on patient care, finally getting away from the 1945 model that we have been stuck with where patients try to get an appointment with their GP in the morning and, if they are fortunate enough to see them, get triaged off to a pharmacist or to secondary care. This is much more efficient, and we welcome it.
I also welcome what many other noble Lords have said about more diagnosis and testing occurring at the level of the pharmacy. As we saw, one of the silver linings of Covid was the fact that people got more used to home testing. If we can see more home testing and more pharmacy testing out in the community, maybe we can reach those communities that we have found very hard to reach until now. We thought about this lots when I was in government; all Governments think about how to reach those hard-to-reach communities.
That said, while the aim is understandable and commendable, we have some concerns. First, the Government have chosen to proceed with only one model—the patient-spoke-hub-spoke-patient model—rather than the two models proposed by the previous Conservative Government, the other of which was patient-spoke-hub-patient. We see this as a significant narrowing of options, particularly when the consultation revealed a divided response from stakeholders. As the noble Lord, Lord Scriven, said, while large pharmacies were very much in favour of the model that the Government ended up choosing, many smaller and independent pharmacies remained opposed, as well as patients and providers who may have benefited from the second model, where patients are dispensed to directly.
In the world that we live in, with Amazon, eBay and the advent of direct-to-consumer online pharmacies, which will dispense only if there is a valid prescription—they are not just selling stuff off prescription—it is really important that we encourage that innovation. It would be wonderful for patients, particularly those with limited mobility who find it difficult to get to pharmacies, to be able to order on the NHS app, have it approved and know it will be delivered to them within so many hours or days. That would be a far more efficient model. I hope that we are not inhibiting online pharmacies with all those safeguards.
I completely understand that there is always a balance between innovation and safety and precautions. Can the Government explain why they chose only one model? Was it because of concerns over safety, good lobbying or the interests of larger pharmacists being heard over the smaller pharmacists? We would be very interested in that. We are concerned about limiting it to a single model, particularly when we know that community pharmacies dispensing for GPs and distance sellers are finding innovative solutions.
Secondly, there is funding and support. The updated impact assessment openly admits that there is considerable uncertainty over the cost of establishing these hubs, their operating expenses and the level of uptake. Once again, there is an impact on smaller pharmacies. How do the Government intend to avoid the risk that smaller providers could be left behind or forced out of the market, reducing choice for patients and challenging the role of small community pharmacists? Are they concerned about this? In addressing that, have they looked at any incentives or ways to help smaller pharmacists who may not have the resources for that upfront investment?
Thirdly, the question of oversight and transparency remains. The Minister will be aware that I ask a lot of questions on patient data and accountability of data. The Government are yet to clarify who will be responsible for collecting and publishing data on the implementation and impact of these new arrangements, particularly in light of the abolition of NHS England. This oversight is crucial not only to ensure patient safety and quality of service but to understand the broader impact on costs and service delivery.
Let me be clear: we support the idea of the single patient record and the federated data platform. One of my jobs when I was a Minister was to make sure that we joined up and digitised the data as quickly as possible. We know what efficiencies that could lead to in our healthcare, but patient safety and data protection must be addressed with rigour. The framework for sharing patient information between hubs and spokes is a key feature of this reform, yet the SI and the supporting documents provide limited detail on how patient confidentiality will be maintained and how the risk inherent in multiparty data sharing will be mitigated.
We do not oppose the principle of modernising pharmacy dispensing through the hub-and-spoke model. We were disappointed that one model was chosen, as we thought we could have some innovation with the other model. Without clearer information and incentives to smaller providers, we worry about smaller community pharmacies being pushed out, particularly in the light of having only one model. How will the Government make sure that that risk is avoided? We urge them to engage more fully with all stakeholders, clarify their plans for funding and data governance, remain open to innovation and not close down other options prematurely. With that, I look forward to hearing from the Minister.
My Lords, I thank noble Lords on all sides of the Committee for their helpful contributions to today’s debate. I get a sense of support for where we are going and questions about how it will happen, which I completely accept. This instrument is part of a package of measures to relieve pressure in community pharmacy and improve patient care and the ability of the NHS to serve patients, particularly in a community setting—one of the main pillars of change for our NHS fit for the future. It builds on legislation that is already in place to enable pharmacies to increase efficiency by dispensing medicines in their original packs. Pharmacy technicians are now able to act under patient group directions to supply medicines, and the Government will shortly bring forward legislation to enable them to be authorised to do more in the pharmacy.
My noble friend Lord Stansgate raised a number of issues; he asked how it has been received and raised the financial sustainability and attraction of these measures. I reiterate that the changes being introduced are enabling. They are purely voluntary. It is entirely up to pharmacists, which are independent businesses—it is important to remember that—to decide whether they feel that engaging one, two or several hubs is going to be beneficial to their business model. It is up to them to decide.
I appreciate the response from the Minister. She said that she will keep this under review. As part of that review, are the Government or officials looking at ways in which they could mitigate concerns about model 2 in terms of those relationship and safety concerns? That would perhaps enable investigation of a future model 2.
It would be fair to say that the review will be on how well this is working rather than an attempt to move to model 2. In all the modelling, we believe this is the best way to go. Patient safety is paramount, as it always should be, as is the expansion of services to individuals, but we will keep the whole matter under review.
There were two other questions. The noble Lord, Lord Scriven, asked about the fee structure. The spoke will still receive the fee for dispensing and the paying hub for the services it provides. We are not planning to dictate how the fee structure will work between hubs and spokes, as I said in an earlier answer.
(3 days, 12 hours ago)
Lords ChamberWe are very focused on that, and NHS England is working with all areas of the country and local services to ensure that that is the case. There is a national plan for learning disability nursing that has been developed with key partners and focuses on four priorities: attracting, retaining, developing and celebrating the workforce. It is very important that we elevate the standing of learning disability nurses, to whom we are all grateful.
My Lords, I thank my noble friend Lady Monckton for raising the important issue of a workforce that understands how to deal with those with learning disabilities. Given the importance of this, will the Government consider committing to a targeted health promotion strategy, perhaps in partnership with local community organisations and sections of the private sector, to enable all children with a learning disability to access early promotion, intervention and prevention services to help them develop healthy habits and to improve long-life health outcomes for this vulnerable group?
This is indeed a vulnerable group, as the noble Lord says, and it is probably best that I refer to the upcoming 10-year plan, which will deal with inequalities throughout a number of sectors, including the most vulnerable and including this group.
(4 days, 12 hours ago)
Lords ChamberYour Lordships’ House will be aware of the financial situation that we inherited and seek to put right. The Government have made available up to £3.7 billion in additional funding for social care authorities in 2025-26, and the noble Baroness is right that just last week the spending review allowed for a further increase of over £4 billion to be made available for adult social care in 2028-29. We are taking a whole range of actions. The Employment Rights Bill, which we will come back to later today, seeks, for the first time ever, to bring in fair pay and professionalisation for those in the adult social care workforce. So it is not that nothing is happening in the meantime. We are making progress and ensuring that the funding will be available so that we have not just a decent adult social care workforce but a way of tackling what no Government have managed to tackle before.
My Lords, given the persistent workforce gaps in adult social care over many years, and given the concerns that there are over immigration—even though immigrants often do the work that local people do not want to do—can the Minister outline what plans the Government have, with a clear structure, to make this a more attractive career, particularly to young people in the UK? What are the Government doing in partnership with social care providers, which are stretched at the moment, to look at alternative ways of funding training and skills development and to make sure that this is an attractive career for those in the UK, rather than always having to rely on immigration?
(1 week, 1 day ago)
Grand CommitteeMy Lords, I begin by thanking my noble friend for securing this important debate and, as other noble Lords have said, for sharing his own experience in a very moving way. It really brought home to us that this is about not just figures or statistics but the human side of this story. I thank all noble Lords who have contributed to this debate. It is not a particularly political debate; across the political spectrum, we can agree that we should work as constructively as we can together to try to address these issues.
As the noble Lord, Lord Weir, reminded us, cardiovascular disease is the cause of one in four premature deaths in England. More than 6.4 million people suffer from it and it has resulted in 1.6 million disability-adjusted life years. According to the British Heart Foundation—many noble Lords will have read the excellent briefings that we have received from many organisations, to which we are grateful for informing us—this disease may be inherited or it may develop later in life. As the noble Baroness, Lady Winterton, said, those in the most deprived 10% of the population are twice as likely to die prematurely from these diseases than those in the least deprived 10% of the population. The highest premature mortality rate is in the north-west region, and men are twice as likely as women to die prematurely from this disease.
As the noble Lord, Lord Rennard, said, the NHS has identified high blood pressure, smoking, high cholesterol, diabetes, kidney disease, inactivity—to which my noble friend Lord Moynihan referred—and obesity as risk factors. We also know that those at increased risk of developing this disease include people of south Asian and black African and Caribbean backgrounds.
The King’s Fund think tank has estimated that there are 220,000 admissions for coronary heart diseases and 100,000 admissions for stroke a year, costing the NHS an estimated £10 billion and the economy £24 billion, so the human and financial cost are alarming. We must think about how we can work on this together, across the spectrum, to improve our use of resources and to reduce the number of deaths.
As noble Lords discussed, in January 2025 the Select Committee on Health and Social Care considered the NAO’s report, alluded to by the noble Baroness, Lady Winterton, on progress in preventing cardiovascular diseases. Following this, a letter of recommendation was sent to the Parliamentary Under-Secretary of State for Public Health and Prevention on improving data collection on cardiovascular disease.
When we were in government, we set out ambitious plans in the NHS long-term plan to detect and treat people with the risk factors of developing these diseases. This is not party political; any Government would have done that, because it is important. It included the NHS health check and face-to-face check-ups for adults aged between 40 and 74 in England. It was commissioned through local authorities and delivered through GP surgeries, to help spot early signs of heart disease. Indeed, many noble Lords spoke about how we identify and diagnose, as well as how we prevent. We also introduced a digital NHS health check to operate alongside the in-person NHS health check, to reduce the pressures faced by GP surgeries, particularly as more people now are aware of digital technology and are happy using it.
These Benches also welcome the current Government’s manifesto commitment to deliver a renewed drive to tackle the biggest killers—cancer, cardiovascular disease and suicide—while ensuring that people live well for longer. I understand completely that the Government are in their early days, but, unfortunately, we are yet to see action in some of those areas. I admit that we were slightly disappointed that the new Government scrapped the major conditions strategy. I also understand, however, that we are waiting for the 10-year plan, and if these issues are integrated into the 10-year plan, as I hope they will be, that might be a better approach. As the noble Lord, Lord Weir, said, we should look at these things not in isolation but as part of an overall integrated plan. We would welcome any announcement from the Government on whether and how they would form part of the, I hope, more integrated 10-year plan. Like many other noble Lords, we eagerly await its publication.
I conclude by asking the Minister some specific questions. How do the Government plan to improve support for vulnerable communities who are at a higher risk of developing cardiovascular diseases, including men, those in more deprived areas and people of south Asian and black African or Caribbean backgrounds?
On 18 June, I will host an event with BRITE Box, a wonderful prevention charity that helps families from deprived areas to budget and to cook healthily on a budget, as a family together, to improve their health. I thank the Minister for agreeing to speak at that event. What specific programmes are the department aware of to improve this sort of prevention, including healthy diets and physical activity? How are the Government working with non-state, local community civil society organisations, such as BRITE Box, to make sure that we tackle these issues?
My noble friend Lord Moynihan spoke about the role that physical activity plays in support and prevention. What other specific steps are the Government taking to close the health inequalities of communities in the most deprived areas, especially those faced by some ethnic groups? What progress have the Government made to ensure that those commissioning and delivering health checks are obliged to collect and report on the demographic data so that we can improve the data on age, gender, ethnicity and socioeconomic status, so that we can target better?
My noble friend Lord Polak spoke about Cardiac Risk in the Young. I was slightly disappointed that when I wrote to one of the Minister’s colleagues in the department, they declined to meet with Hilary Nicholls, whom I had met to hear her daughter’s story and those of other people. I hope that the Minister and her officials will be able to accept the invitation from my noble friend Lord Polak, so that at least one person from the department can speak to Hilary Nicholls and Cardiac Risk in the Young. I hope that the Minister can confirm that this will be part of the overall 10-year plan.
I understand that I have asked lots of questions and gone over time, as usual in my typically Socratic way, like other noble Lords, but I look forward to the Minister’s answers. If she does not have them now, I know that, thanks to the wonders of technology and her wonderful officials, she will write to us.
(2 weeks, 1 day ago)
Lords ChamberMy Lords, we on these Benches welcome the Government’s stated commitment to innovation in primary care and the commitment to continue the rollout of community diagnostic centres, which were started by the previous Government. However, unfortunately, last year the Patients Association highlighted barriers to the rollout of point-of-care diagnostics, particularly in rural areas. Is the Minister aware of those concerns, and what plans does the department have to tackle those barriers?
Our commitment to moving towards a neighbourhood health service obviously allows for attention to be given to different circumstances, including in rural areas. It will mean that more care can be delivered locally and that problems can be spotted earlier, including any problems with rollout. We will shortly provide details of a national neighbourhood health implementation programme. We liaise with various groups, including the Patients Association, and I am grateful for their input and for flagging up any difficulties, which we absolutely seek to resolve.
(2 weeks, 1 day ago)
Lords ChamberI can say to my noble friend that serious shortage protocols are a tool that we have and use to manage and mitigate medicine and medical devices shortages. They enable community pharmacists to supply a specified medicine or device in accordance with a protocol rather than a prescription, with the patient’s consent, without needing to seek authorisation from the prescriber. They are used in cases of serious shortage, and we develop those protocols with input from expert clinicians. In addition, we are currently examining options around pharmacists’ flexibilities, including how any risks could be managed, and further details will be set out on this. I hope this gives some reassurance to my noble friend.
My Lords, we know that these unexpected shortages occur from time to time, and that this obviously causes patients to worry. As the Minister said, I understand the advice is that alternative therapies are available but may not be sufficient for all patients. Given this, can the Government reassure patients that they are confident that those who cannot turn to alternative therapies will be able to get the appropriate doses of Creon that they require? Also, do the Government have any idea, or have they been given any indication, of when they expect this particular shortage to end?
The supply situation has improved since last year and there is now sufficient stock of lower-strength Creon to meet normal demand. There are still some supply constraints, as I have said, with the higher-strength product stock, but stock is regularly being delivered to pharmacies. As we have discussed, alternative products and unlicensed imports are also available. I totally accept that patients may have concerns, and that is why we have worked closely to keep in communication with patients to assure them that they will not be going without the medication they need. For example, it may be that lower strength in multiple provision can be made, or there are the alternatives that I have described. If any noble Lords are aware of real-life examples of shortages, I would be grateful to hear about them, because we believe that we have made the arrangements, and I can reassure noble Lords that these very important medicines are being provided to those who need them.
The noble Baroness puts forward an interesting perspective. There will always be a number of matters that are outside any Government’s control. What is in the Government’s control is what action we can take. In terms of alternatives to Creon, for example, supplies of Nutrizym have more than doubled since last year, and Essential Pharma has also secured additional manufacturing capacity for Pancrex. In May last year, pancreatin preparations—the active ingredient in the medicine we are talking about—were added to the list of medicines that cannot be exported from the UK or hoarded in order to reserve supplies. These actions, along with some of the ones that I have just mentioned and more, all show a very active government position.
My Lords, since we have a bit of time, perhaps I may be allowed a supplementary. Given that part of the answer is to import unlicensed medicines, what quality-control procedures are there in place to ensure that people can be reassured that these unlicensed medicines are suitable and fit for patients?
It would not be possible to prescribe them if they were not fit and safe for use. I am grateful to the noble Lord for allowing me to make that reassurance. There is very clear information on ordering and prescribing unlicensed imports on the NHS Specialist Pharmacy Service website, should the noble Lord or any other person wish to be reassured of what that means.
(2 weeks, 2 days ago)
Lords ChamberMy Lords, when there are concerns about nutritional content, there are three, perhaps more, possible approaches. First, you could ban the product, although prohibition does not always work. Secondly, you could try nudging consumers towards healthier choices—maybe by taxation or restrictions. Thirdly, you could work with local community organisations. In addition to family hubs and Start for Life, many local community non-state civil society organisations work with local families to help them cook and eat healthily together as a family. Given what has been mentioned already, will the Minister tell us what work the Government are doing with such local community organisations, apart from Start for Life and family hubs, to make sure that civil society is playing its role in educating our children?
On the three ways forward that the noble Lord identified, the approach often has to be a mix of all three. It is the balance that is the point under debate, and it has to be informed by evidence. I certainly share the noble Lord’s view about the importance of civil society and working with community groups. Indeed, my department, but also the Department for Education and other departments, have worked closely with community groups in order to advance the policies and practices we need to improve the health of the youngest in our communities.
(2 weeks, 3 days ago)
Lords ChamberFirst, I do not accept that the advertising restrictions represent any watering down. In May, a Written Ministerial Statement set out, to the noble Baroness’s point, that the Government will provide a brand exemption in legislation. The restrictions will come into force officially on 5 January. I realise that the noble Baroness regards this as not the position that she would choose, but I believe that it will provide certainty for businesses to invest in advertising campaigns with confidence and encourage them to develop more healthy products—that is the situation that we want—as well as protecting UK children from the harms of junk food advertising.
I thank the Minister for the answers that she has given so far on the evidence, because it is really important that any policy in this area is evidence led. When I looked at the British Heart Foundation website, I saw that it said that additives in ultra-processed foods
“could be responsible for negative health effects”
and that the
“actual processing of the food could … make a difference”.
It also says:
“Another … theory is that … ultra-processed foods could … affect our gut health”.
But what it says overall is that there is insufficient evidence here. We really need more research to be done. We are not sure whether it is something in the ultra-processed foods or the processing itself that makes them unhealthy. The Minister has touched on this already. We have talked about the timeframe for research, but when people are looking for a source to consider the dangers, or otherwise, of ultra-processed foods, are there any particular websites or sources that the Government could point people to, so that people are more aware of and more educated on the research on ultra-processed foods?
The important point that the noble Lord raises is that our role is to encourage people to ensure that they are choosing a healthy diet and can achieve a healthy diet. As the noble Lord said, the word “could” is a bit of a problem. That is why we continue to invest in research and, as I say, work closely with the Scientific Advisory Committee on Nutrition.