NHS: Agency Medical Staff

Lord McColl of Dulwich Excerpts

Wednesday 9th September 2026 Lords Chamber

[Baroness Merron (Lab)]

On the basis we have moved beyond spring of this year, I can say that, to ensure the workforce plan reflects the new Government we have, the Secretary of State and my colleague, Minister Karin Smyth MP, the responsible Minister, are working to ensure the workforce plan properly reflects the priorities —so I hope we will not be keeping your Lordships’ House or the noble Lord waiting for too long.

[Lord McColl of Dulwich (Con)]

My Lords—

[Baroness Pidgeon (LD)]

My Lords—

--- Later in debate ---

[Lord Watts (Lab)]

My Lords—

[Lord McColl of Dulwich (Con)]

My Lords—

[Baroness Anderson of Stoke-on-Trent (Lab)]

My Lords, there has not yet been a Labour question during this Question. It will be Labour then the Conservative Benches, please.

[Baroness Merron (Lab)]

The key theme my noble friend is raising here is very much about staff retention within the NHS. That is not only the ideal but the practical, best way forward. We are taking action, including, as my noble friend talks about, on flexible working. We are also taking action to make staff feel safer in the workplace, enhancing support for staff health and well-being by, for example, improving access to support for mental health and musculoskeletal conditions. They are the two biggest causes of sickness absence, which also drive demand for temporary cover.

[Lord McColl of Dulwich (Con)]

My Lords, when the permanent staff are asked to do overtime or to fill in, rather than have agency medical staff, they are paid at a lower rate. Why do we not pay them the same rate as the agency medical staff? This would boost morale, lead to more continuity of care and also reduce the hassle of finding agency medical staff.

[Baroness Merron (Lab)]

Agency staff can cost the NHS more, which the noble Lord referred to. That is why we now have the agency price cap, which did not exist when agency spending rose completely out of control—for example, it stood at around £3.7 billion in 2015-16, because there were limited national controls. The agency price cap is the maximum amount that an NHS trust would normally pay for an agency worker. I do not quite recognise the situation that the noble Lord referred to on NHS staff, but I will take it away and check the situation.

Healthy Life Expectancy: England

Lord McColl of Dulwich Excerpts

Monday 18th May 2026 Lords Chamber

[Baroness Merron (Lab)]

It is an important area of government activity and I certainly do not recognise the comments that were in the Telegraph. I can confirm to noble Lords that we have a whole package of measures to tackle obesity, including restricting junk food advertising on TV and online aimed at children and giving local councils stronger powers to block new fast food outlets. That is still the case.

[Lord McColl of Dulwich (Con)]

My Lords, is the Minister aware that there are scientists who are propagating nonsense that nothing can be done about the obesity epidemic because it is all genetic? These people are saying that the individual cannot be relied upon to take action and that it must be the Government who do it. It is complete nonsense, because the individual can take responsibility—and, indeed, millions are taking injections to do that very thing.

[Baroness Merron (Lab)]

I recognise the noble Lord’s point. We are certainly seeking to give individuals the ability to grasp the opportunity to live well for longer and to support them in their choices. For example, in addition to the points I made to the noble Lord, Lord Krebs, we are working on restricting volume price promotions such as “buy three for the price of two” offers on less healthy food and drink.

Under-16s Energy Drinks Ban

Lord McColl of Dulwich Excerpts

Tuesday 10th February 2026 Lords Chamber

[Baroness Merron (Lab)]

I actually do not know the answer to that, so I cannot confirm it is the case, but I will certainly look into it. I take the noble Baroness’s point about caffeine. That is the problem here, but it is also right that we consider sugar intake.

[Lord McColl of Dulwich (Con)]

My Lords, is the Minister aware that combating the obesity epidemic has been seriously impaired by a number of pseudo- scientists who have put forward the idea that obesity is inevitable and that we cannot do anything about it, so it must be government that does something about it? Does the Minister agree that there is only one cause of obesity and that is eating too much?

[Baroness Merron (Lab)]

The noble Lord always tempts me to agree with him. The causes of obesity are complex and include what people eat, how much they eat and who they are. It is the reason that the Government have taken on the responsibilities they can, such as restricting junk food advertising on TV and online, giving local councils stronger powers to block new fast food outlets, and announcing changes to the soft drinks industry levy. All these support people in making better choices.

Primary and Community Care

Lord McColl of Dulwich Excerpts

Thursday 5th June 2025 Lords Chamber

[Baroness Merron (Lab)]

This is a good news story, and I certainly share my noble friend’s view of the benefits that he outlined. Community diagnostic centres are now delivering additional tests and checks in 169 sites across the country. They have delivered almost 4.5 million tests, checks and scans since last July, and we have committed to expanding the number of existing CDCs and their opening times. In England, Pharmacy First clinical pathways have been developed closely with various experts, including pharmacists. The funding for the core community pharmacy contractual framework has been increased to over £3 billion, representing the largest uplift in funding of any part of the NHS. We are grateful for the role that pharmacies play.

[Lord McColl of Dulwich (Con)]

My Lords, does the Minister agree that, when we discuss in vitro testing, we should also talk about in vivo testing? That involves taking a history and doing a thorough physical examination of the patient on the spot, but it seems to be going out of fashion. I will illustrate that with the story of a member of staff who had consulted me. He had been investigated at the “St. Elsewhere” hospital for six months, but they had missed the fact that he had ruptured his Achilles tendon. I did an in vivo spot diagnosis. I put my index finger down his Achilles tendon—with his permission, of course—and I could feel the gap in his Achilles tendon where it had ruptured. They had not examined him. Is it not time that we did this inexpensive business of taking a history and doing a thorough physical examination?

[Baroness Merron (Lab)]

I am very glad that the noble Lord asked for permission. I take his point. I know that he understands the value of in vitro point-of-care testing, but he makes the good point that what matters is what is clinically appropriate in the circumstance. We would all expect that to happen for the benefit of the patient.

Health: Ultra-processed Food

Lord McColl of Dulwich Excerpts

Tuesday 3rd June 2025 Lords Chamber

[Lord Krebs (CB)]

My Lords—

[Lord McColl of Dulwich (Con)]

My Lords—

[Captain of the Honourable Corps of Gentlemen-at-Arms and Chief Whip (Lord Kennedy of Southwark) (Lab Co-op)]

My Lords, we have plenty of time. We will hear from the Cross Benches next.

[Baroness Merron (Lab)]

I am grateful to the noble Lord for bringing his expertise and commitment to this area. It is indeed the case that the majority of foods classified or considered as ultra-processed foods also tend to be high in calories, saturated fat, salt and sugar, for which there is more definitive evidence, as the noble Lord has referred to. It is the case that many UPFs are already captured by the Government’s considerable programme of work to improve the food environment.

[Lord McColl of Dulwich (Con)]

My Lords, I congratulate the Government in general, and the Minister in particular, on taking such a sensible view about the great red herring that is ultra-processed food. There is no scientific evidence that it specifically causes obesity. Obesity is caused by eating too much of anything, and the answer is to reduce the amount of food that people eat.

[Baroness Merron (Lab)]

I am grateful to the noble Lord for his appreciation of the Government’s efforts in this regard. I believe we have to consider the role of ultra-processed foods, but that has to be based on evidence and scientific truth, rather than speculation. That is why the Scientific Advisory Committee on Nutrition has shown concern but cannot prove a direct link. It is not necessarily about the processing, but we know that high fat, salt and sugar is a problem for healthy living, and that is mostly a very good description of UPFs.

Healthy Life Expectancy

Lord McColl of Dulwich Excerpts

Tuesday 20th May 2025 Lords Chamber

[Baroness Merron (Lab)]

My noble friend raises an extremely important point about inequality. The Health Foundation report focusing on the 2010s shines a light on the need to drive action, which we are doing across government through our missions, with a very ambitious goal and the right approach of halving the gap in healthy life expectancy between the richest and poorest regions. Although I am certainly very interested in what the Health Foundation report says, further strategy is not needed at this time because of the approach we are taking. But I assure my noble friend that in addressing health inequalities, including in areas of past industrial decline, we will be driving economic growth and removing health-related barriers to health, wealth and prosperity.

[Lord McColl of Dulwich (Con)]

My Lords, people are not living as long as they were because of the obesity epidemic, which is killing people at an earlier age from a variety of very unpleasant diseases. Does the Minister agree that there are a lot of pseudoscientists around putting out propaganda that people cannot exercise personal responsibility and therefore government action must be taken? Could it be that those people do not want to see the end of the obesity epidemic because they are making so much money out of it?

[Baroness Merron (Lab)]

The noble Lord always has interesting observations that I listen closely to. I certainly agree that obesity is a major contributor to ill health. Some 64% of the adult population is overweight or living with obesity, and it does indeed, as he says, pose a major health inequality issue. The approach has to be on many levels, and there is government action. For example, we have laid secondary legislation on TV and online advertising restrictions on less healthy foods. We got on with that because we thought it extremely important. Equally, we support people not just through policy or medical intervention, but by encouraging them to adopt a healthier lifestyle. The reasons why people are obese are complex, and we approach it in that way.

Prosthetics for Amputees

Lord McColl of Dulwich Excerpts

Thursday 1st May 2025 Grand Committee

[Lord McColl of Dulwich (Con)]

My Lords, I, too, thank the noble Lord, Lord Mackinlay, for securing this debate. I, too, pay tribute to him. What a marvellous man he is, and what an inspiration to us all. He reminds me very much of my friend, the late Duke Hussey—Lord Hussey—who was injured and taken prisoner at the Anzio beachhead in 1943. He lost his leg and the other leg was partly paralysed. He developed osteomyelitis of his spine, and the Germans assessed that he was dying and so repatriated him. He arrived in Oxford and the doctors confirmed that he was, in fact, dying.

Being Duke Hussey, he was not going to take this lying down, so he wrote to one of the most eminent professors of orthopaedics at the time and said, “Dear professor, I think you’re the only man in the world who can save me”. This professor was rather impressed with this, and he summoned him and said, “Now look here, Hussey, in this letter you said that you ‘think’ that I am the only man in the world who can save you—but I am the only man in the world who can save you”. He operated on his spine 33 times over a period of years to deal with the osteomyelitis, because the antibiotics were not available, and eventually he was cured. I never heard him complain.

Lord Hussey knew more about disability that most other people, so I got him to sit on my committee to look into the supply of artificial legs and wheelchairs, which Mrs Thatcher set up because she thought that the service was in a bad state—how right she was. I was also helped by the noble Lord, Lord Griffiths of Fforestfach. We found out just how bad the service was in terms of limbs that did not fit. It was not rocket science. With the amputee wearing his artificial limb, you could put your hand in the socket while he still had his stump there—such was the poor fit. The other thing was that they were not aligned properly. Some people got so fed up with this that they decided to have a peg leg, and then you had the alignment much better. Some of the farmers with a peg leg found it quite useful when they were planting potatoes, because they would walk down the field stamping on the ground, making a hole suitable into which to drop the potato—so it had its benefits.

We tried to get them to use modern techniques to make a socket that fitted the amputation stump, and it was not that difficult to do. One of the problems was that the companies had such a secure income that they did not bother to develop too much. I asked them what their export attempts were. They said, “It’s very poor indeed—very difficult to export”. I said, “Guess who exports to Israel?” They said, “We’ve no idea”. I said, “It’s a German firm called Ottobock”. I ask the Minister: what is going on at the moment to ensure that the limbs do fit and are aligned properly?

Food, Diet and Obesity Committee Report

Lord McColl of Dulwich Excerpts

Friday 28th March 2025 Lords Chamber

[Lord McColl of Dulwich (Con)]

My Lords, I, too, thank the noble Baroness, Lady Walmsley, for introducing this debate, chairing the committee so expertly and allowing me to attend all its meetings. I say at the beginning that, as far as controversy is concerned, I agree entirely with the noble Lord, Lord Krebs, in his views about ultra-processed foods: there is no scientific evidence that they are the cause of the obesity epidemic, and it is strange that his advice is not accepted.

The next controversy was with Dr Chris van Tulleken, who addressed the committee and told it that the personal responsibility argument is

“morally, economically, socially, politically and scientifically dead and buried”,

so all such policies must be removed from the table. To be fair to him, he was not around, as I was, during the successful campaign against AIDS in the 1980s and the campaign in Uganda. I was responsible for setting up hospices for people dying of AIDS in London and in Uganda. The reason why these campaigns were so successful is that they were honest. They did not wrap everything up in euphemisms. Norman Fowler was the Secretary of State for Health, and he was absolutely honest and frank. He said, “AIDS: Don’t Die of Ignorance”. You see, if you were honest with people and explained to them what was required, each individual had to take responsibility for himself or herself in taking precautions to avoid getting AIDS—and it worked. In fact, the programme in Uganda, the ABC programme, led by the Ugandan Government, brought down the incidence of AIDS from 34% to 4%. That is hard data and cannot be argued against. Perhaps we should be saying, “Don’t die of complacency, don’t die of obesity”. I have been saying this for the last 20 years.

There is only one cause of obesity: eating too much. The 40 million overweight people in this country are not like French geese subjected to gavage. They are not force-fed to produce pâté de foie gras. French geese should have a right to complain against their masters for force-feeding them, but obese people have no such luxury to engage in the blame game. It is time to recognise that we have to ignore many of the excuses that are put forward to persuade obese people that it is not their fault—that it is inevitable that they are obese because they live in an “obesogenic” society, as a professor at Oxford says. We really ought to understand that the total cost to the NHS, which I think has been mentioned, is not £5 billion but £98 billion. That is what is wrecking the National Health Service. If we want to save it, it is no good reforming it yet again; it has been reformed about eight times in the last few years, and none of those have worked. But if we start reducing demand, in getting people to slim down, that will work. The obesity epidemic is such a disaster. We have to do something about it and get people to realise their personal responsibility.

There is one cause of obesity and one cause only. There are no diseases that cause obesity. The one cause is eating too much. It is high time that that was recognised. We have to dispel the fake propaganda that people are victims of an obesogenic society, and to encourage successful methods such as fasting and calorie counting in reducing dietary intake. Of course, exercise is important for our general health but not for losing weight—it does not work very well indeed. The clarion call to the 40 million overweight people is this: save yourselves, save the NHS, save £98 billion a year, and find the way that you want to reduce your weight.

Diets: Fat

Lord McColl of Dulwich Excerpts

Thursday 31st October 2024 Grand Committee

Asked by

[Lord McColl of Dulwich]

To ask His Majesty’s Government what assessment they have made of the benefits of diets with adequate fat content for reducing appetite, as an alternative to the use of drugs such as Ozempic.

[Lord McColl of Dulwich (Con)]

My Lords, the Question in this debate lists two different treatments for the same problem: the obesity epidemic. The first treatment is as old as the hills—simply to eat the right amount of the right kind of fat. The other treatment is to use new drugs such as semaglutide, marketed as Ozempic, which have been found to act in the same way as fat. I suggest that the former—the healthy diet—should be where we concentrate our efforts to combat the epidemic.

When we consume healthy fats, gut hormones such as CCK and GLP-1 are secreted in the duodenum, delaying the emptying of the stomach and creating a natural sense of fullness that curbs overeating. When the fat has been absorbed and moves on, normal service is resumed by the stomach. This simple process helps to tackle the root cause of obesity. By contrast, the new weight-loss drugs have serious side effects, including pancreatitis and other problems, along with long-term effects that are as yet unknown.

The new weight-loss drugs require regular injections. They act in a similar way to fat but with a stark difference. Natural fats are safe, inexpensive and readily available in whole milk, nuts, butter and so on. Studies such as those showing lower obesity rates in Canadian children who were raised on whole milk underscore these benefits. Will the Minister ensure that her department considers this evidence instead of the biased propaganda of the food lobby? It was, after all, the food lobby that caused the obesity epidemic in the first place. It put profit over health by encouraging the overconsumption of the wrong types of food.

Since the 1960s the food industry has promoted a low-fat diet, allegedly to address concerns about atheroma, which tends to block arteries. As noble Lords will know from their Greek studies, atheroma is the ancient Greek word for porridge—well, it may be Greek porridge but it is no Scottish porridge, that is for sure. The food industry has excessively promoted low-fat products packed with a lot of sugar; a low-fat diet is pretty tasteless because fat is what gives food its taste. So they had to pour in vast quantities of sugar, which fuels the cravings and excessive calorie intake contributing to today’s obesity epidemic.

Despite evidence supporting the benefits of certain fats, the Department of Health still publishes on the web outdated low-fat guidelines, in part because misleading information such as the Eatwell Guide and the traffic light labelling on food packaging demonises fats without considering their positive role. After years of vilifying fats, we now turn to drugs that mimic fats’ natural benefits—a perfect case of the food industry being hoist by its own petard.

Ultra-processed foods have frequently been blamed for the obesity epidemic, but there is no scientific confirmation of this. It is clear that excessive consumption of UPF can cause obesity, of course. Unfortunately, many so-called scientific publications blur these lines, incorrectly blaming the obesity crisis on ultra-processed foods. Meanwhile, we overlook the impending disaster of nearly 40 million citizens facing premature death from obesity-related diseases.

The argument that obesity is unavoidable because we live in an obesogenic society, with factors such as genetics and thyroid dysfunction, is misleading. These claims suggest that obesity cannot be controlled, which diminishes the role of personal responsibility. The reality is that obesity results from consuming too much food or too much alcohol, regardless of genetics. It does not matter what your genetics are: there is only one way of getting obese, and that is putting too many calories into your mouth. There is no disease that causes obesity per se. A failing thyroid gland is often blamed, but it is the resulting slowing of the metabolism for such a patient that requires fewer calories. If people continue eating the same number of calories, obesity will result.

Beyond the physiological aspects, we need a transparent, evidence-based public health campaign. A well-executed campaign has been successful in the past, although this has been denied in some quarters. Let us look back in history, as most of the answers are in history. The AIDS awareness campaign launched in the UK by the then Secretary of State for Health, Norman Fowler—the noble Lord, Lord Fowler—was highly successful, as was a similar campaign in Uganda. A similar approach to obesity could save the UK economy £98 billion every year.

The Department of Health should encourage practical dietary changes, such as reducing daily intake and incorporating healthy fats, and support these choices through better regulations and labelling to clarify the benefits of healthy fats and reduce confusion about what constitutes a balanced diet. Rather than complex BMI measurements, we need only a simple assessment. For instance, if your waist measurement is more than half your height, you are eating too much of the gross national product.

It is important that this message gets through. The APPG on Obesity criticises the “nanny state” approach, yet if we seek a hands-off solution, more individual responsibility and awareness will be essential. Imagine the impact if each of the 40 million obese people in this country were to reduce their intake slightly, perhaps by skipping a meal a day or choosing foods with fats that encourage fullness. This approach could improve individual health, reduce NHS expenditure and, ultimately, save many from premature death.

Hospices: Funding

Lord McColl of Dulwich Excerpts

Thursday 24th October 2024 Lords Chamber

[Lord McColl of Dulwich (Con)]

My Lords, I, too, thank my noble friend Lord Farmer for initiating this important debate. For most of my professional life, I have been associated with hospices such as St Christopher’s, the Mildmay in the East End of London, the Mildmay in Uganda and the Phyllis Tuckwell Hospice in Surrey. I have learned a lot working in these places.

I remember, for instance, a lady of 28 with an inoperable cancer of the throat. She was in pain and a lot of respiratory distress and needed relief from these symptoms. I explained to her that I could put a needle into her vein and titrate her with analgesics until all her symptoms had gone. She agreed to this. I gave her a surprisingly large dose of heroin, which not only did not kill her but relieved all her symptoms and gave her three weeks of symptom-free life. During that time, she was able with a clear mind to say goodbye to her friends and to tidy up all those loose ends. Some people accused me of hypocrisy, saying, “You’re really killing them and just saying that you’re relieving their pain”. Well, anyone who thinks they know what is in my mind has delusions of grandeur.

Cicely Saunders and I were contemporaries as medical students. Her work on relieving symptoms in hospices was very important indeed. She established without any doubt that the right way was to keep a constant level of analgesia in the blood rather than give patients doses only when they had the pain. If you do this, you require less of the analgesics overall and so the patients are more awake and able to enjoy life. That was a very important contribution. The present laws against euthanasia and assisted dying are like a huge dam preventing great enthusiasm for euthanasia and assisted dying. That dam can sometimes develop a crack for those who want to legalise euthanasia. Once you have a little crack in the dam, the whole thing can give way. Cicely Saunders’s work was an extremely important aspect of this.

As far as the funding of hospices is concerned—

[Baroness Wheeler (Lab)]

Can the noble Lord wind up, please? His three minutes are over.

[Lord McColl of Dulwich (Con)]

There is an urgent need for more funding, as has been said many times, and a partnership between government, charities and local authorities is required.