Amputees: Limb Fitting

Debate between Lord McColl of Dulwich and Baroness Manzoor

Thursday 2nd May 2019 Lords Chamber

[Lord McColl of Dulwich]

To ask Her Majesty’s Government what plans they have, if any, to introduce a national system of recording (1) the number of, (2) the treatment received by, and (3) the dates of treatments for, new amputees attending limb fitting centres in England.

[Baroness Manzoor (Con)]

My Lords, I pay tribute to my noble friend for his continuing interest in wanting to improve services in this important area. As an ex-surgeon he has significant expertise and insight. From 1 April this year, NHS England’s specialised commissioning has required all limb centres delivering amputee services to complete a data reporting template which will collect the information described. The data is not expected to be published as a national statistic but is collected to support the commissioning process.

[Lord McColl of Dulwich (Con)]

My Lords, I thank the Minister for her usual helpful reply. She has done so well in stimulating the Department of Health, because in November last year the department told us that it did not collect this information centrally—so I am very glad that she has had success. Will the information be collated?

[Baroness Manzoor]

My Lords, the data collection is not expected to be published routinely but is submitted by the provider to the relevant commissioning hub as a contractual requirement under schedule 6 of the NHS contract information reporting requirements. But I hope that my noble friend will be pleased to hear that we will be considering making available a summary of this data in due course once we have established that it has been collected and reported appropriately.

--- Later in debate ---

[Baroness Manzoor]

I agree that it is important that we reduce the variations and that NICE guidelines are followed. NHS England’s service specifications include a duty to reduce inequalities. They set out a number of issues to ensure that there is improved access, including flexible appointments, rehabilitation and reablement—but the noble Lord is quite right that we must address the variations.

[Lord McColl of Dulwich]

Does the Minister agree that the way to reduce the number of amputations is to reduce the causes of them, one of which is the obesity epidemic? If a person’s waist measurement is more than half their height, it means that they are eating too much of the gross national product.

[Baroness Manzoor]

My Lords, absolutely. As someone who has had a problem with her weight all her life, I do agree. Losing weight is not as easy to do it as it is to say, but obesity plays a key role in diabetes and we need to get it under control.

Organ Donation (Deemed Consent) Bill

Debate between Lord McColl of Dulwich and Baroness Manzoor

Committee: 1st sitting (Hansard): House of Lords
Friday 1st February 2019 Lords Chamber

[Lord McColl of Dulwich]

We have always encouraged the carrying of donor cards. We used to keep a whole stack of them in our pockets and hand them out to the patients at Guy’s. As for the evidence, I am not sure, but they cannot do any harm and I would certainly encourage people to carry them.

Finally, and keeping in mind the need for review at a more general level, I ask the Minister in passing whether consideration has been given to extending the proposal that Muslims and Jews should be able to carry donation cards that say that they wish to donate but only subject to their faith being respected. On the basis of the views I have encountered, I think that this would provide reassurance to members of other faith communities as well. I beg to move.

[Baroness Manzoor]

My Lords, I thank my noble friend for introducing this amendment, which relates to a very important issue. Like him, I believe in evidence-based medicine.

The Government have maintained, and have been clear, that a change in the law by itself is unlikely to lead to an increase in the number of organs and tissues available for donation. However, it is an important measure in addressing the tragic death rate due to a lack of organs and tissues available for donation, and we hope that this will be a significant step towards changing the culture regarding organ and tissue donation in England, as I said previously.

I point out to the Committee that NHS Blood and Transplant already has a legal duty to report to the Secretary of State on all its activity and is a world leader in collecting and analysing data on organ donation, retrieval and transplantation. The ongoing data collection encompasses data regarding the registrations on the organ donor register, the number of potential and actual donors, organ retrieval and organ transplantation activity. This data is published in a variety of formats, placed on its website and set out annually in a comprehensive report.

Eating Disorders: Medical Training

Debate between Lord McColl of Dulwich and Baroness Manzoor

Wednesday 12th September 2018 Lords Chamber

[Baroness Manzoor]

My apologies to the noble Lord if I was not clear. In addition to medical school training at undergraduate level, there is a further two-year training at foundation level where students undertake a four-month rotation in psychiatry and a four-month rotation in general practice. Then there is further training at speciality level in psychiatry, and there are modules to do with diet, further education and eating disorders. As I have already mentioned, HEE is working very closely with the devolved Administrations to ensure that the review is completed by 2021 on what further can be done.

[Lord McColl of Dulwich (Con)]

My Lords, can we have some compulsory education—

Obesity

Debate between Lord McColl of Dulwich and Baroness Manzoor

Wednesday 18th July 2018 Lords Chamber

[Lord McColl of Dulwich (Con)]

My Lords, I say at the outset how much I am looking forward to the maiden speech of the noble Baroness, Lady Boycott, with all her expertise. We hope to hear a lot of her expertise in the years to come.

I start by recounting the story of Labour’s deputy leader Tom Watson, which he recently broadcast in the media. He explained that he was 51, very overweight and had tried many diets. When he started looking into the problem, he realised that all the advice given by the authorities was completely wrong. His research showed that he needed to cut down radically on sugar and starchy carbohydrates, and find ways of getting fat into his diet. Fat stops one feeling so hungry during the day. He also overcame his craving for sugar. This regime resulted in him losing seven stone, or 39 kilograms.

What Mr Watson rediscovered was what had been well known during the war. In 1939, one-third of the British people were either underfed or fed on the wrong food. Food rationing cured that rapidly. For the first time, people had the right quantity and right kind of food. There was no obesity then because they ate food that satisfied them: food they had to chew, including wholemeal bread with plenty of dripping on it—there is nothing wrong with fat, except saturated fats. Also, of course, there was very little sugar and less starchy food. I should explain that when we eat fat it leaves the stomach and goes into the duodenum, releasing a hormone which specifically delays the emptying of the stomach and makes one feel full. Hence, it limits the amount we eat. After the end of rationing in the 1950s, the food industry wished to increase its sales and profits. Realising that it was not selling a great deal of food and that fat was actually a brake on how much people ate, it decided to demonise fat and encourage carbo- hydrates. A low-fat, high-carbohydrate diet is pretty tasteless because it is fat that gives it the taste. The industry had to add large quantities of sugar so that people would eat it, and so began the obesity epidemic.

Another story I would like to tell is of a Member of your Lordships’ House who was paralysed and in a wheelchair. Being overweight, he decided to take three stone of weight off. He could not exercise and so decided on a really revolutionary way of losing weight. He lost three stone simply by eating less. Politicians and that organisation, NICE, have repeatedly stated that all the calories we eat are expended on exercise. This simply is not true. Only a fraction of the calories we eat are used up on exercise. Anyone who disputes this can go to the gym and exercise on one of the machines for half an hour. If they slave away and look at the dial to see how many calories have been used up, it will be about 300 calories in half an hour. That is what one gets from a small bar of chocolate.

The press and the media have been very helpful in the last year or two in drawing attention to the real cause of obesity, which is putting too many calories into one’s mouth. Many people find it difficult to eat less, so it is probably worthwhile looking at preventable problems that make obesity more likely. A lady of 42 with an eating disorder gathered together about 45 other ladies with a similar condition to see whether they could help one another with their problem. When they went round telling their stories, they had all been sexually abused as children. That is of course an anecdote—anecdote being Greek for “unpublished”, which is arguably what most anecdotes should remain—so let us look at science.

An excellent paper published by Danese and Tan in 2014 demonstrated without doubt that the maltreatment of children is associated with a substantial elevated risk of developing obesity. There is so much domestic violence and sexual abuse of children that a greater drive on reducing these risks might also help to solve the obesity epidemic. There has also been a suggestion that as mothers increasingly work outside the home, that may lead to families increasingly relying upon ready-made junk food, which never satisfies hunger and therefore leads to people eating far too much of it and hence obesity. This may be an important contributing factor.

Some elements of the food industry have made an effort to stem the obesity epidemic. The late Professor Terence Wilkin produced some very good scientific work, which clearly showed that obesity leads to inactivity but that inactivity does not lead to obesity—so do not call children couch potatoes. When one examines the genetics of all this, it is not a question of simple inheritance. It has been shown that the children of obese parents are six to 10 times more likely to be obese but, even then, it is not inevitable that they will become so. They will become obese only if they put too many calories in their mouth. There are some medical conditions which affect appetite but none that directly lead to obesity. The tendency towards obesity looks as though it is established early on in life, long before children go to school. As Professor Wilkin stated, this questions the rhetoric around school meals, computer screens, playing fields and of course physical activity, which is fairly unstructured in early childhood.

It is important to restate that physical activity is important for mental health, the heart and the body’s general well-being and functioning. But I hope the Minister will finally put to rest the repeated statements from the Department of Health and Social Care and elsewhere, saying that obesity can be solved by increasing activity and diet. They link those two but only a fraction of the calories we eat are used up in exercise. In their advice, exercise and diet should not be coupled together. They should be separated, not put in the same sentence.

The obesity epidemic is probably costing £30 billion a year. Saving on that would be a great help to the NHS. This whole subject has been bedevilled by, first, the food industry demonising fat and promoting sugar and carbohydrates—by the way, among five to eight year-olds tooth decay is far and away the leading cause of hospital admissions, which are mainly caused by excessive sugar consumption. Secondly, there is the false statement that all the calories we eat are expended in exercise, when only a small fraction are, as I said before. Thirdly, there is blaming and insulting other people, such as calling children couch potatoes when in fact inactivity does not lead to obesity.

Fourthly, there is the nonsense of skimming milk. Skimmed milk is so tasteless that sugar has to be added to get children to drink it. There is no need to skim milk. Eight thousand children in Canada were given whole milk from birth until the age of eight; their calcium metabolism was good and they were not fat but very healthy. Whole milk can actually reduce the incidence of stroke, as in the work published quite recently by Professor Otto in Texas. Human breast milk contains 3.5% fat, as does cows’ milk. I do not think they have started skimming human breast milk yet but you never know.

A fifth part of the department’s advice was to have only two eggs a week. There is no scientific basis for this at all. You can have an egg every day if you want. The sixth thing was that GPs were told not to call patients obese because it was judgmental. There is a difference between being judgmental and making accurate diagnoses. Seventhly, psychological reasons may have a role in obesity but we do not quite understand how.

What is the answer to all this? It is an all-out campaign involving every man, woman and child, every institution, school, university and government department to try and reduce the obesity epidemic.

I believe that the Department of Health and Social Care is moving in the right direction. The idea is not to tell people what to do but to tell them the truth—not in a patronising way, as in the old days, when at 7.50 every morning, at breakfast time, you turned on the radio and the radio doctor would say, “I’m the radio doctor and I’m going to talk about your bowels”. The answer to that was to switch the thing off, saying, “We’re not having bowels for breakfast”.

There have been some very good programmes such as “The Archers”, “Horizon” and many others, which have been very professional in promoting preventive medicine. In a recent campaign against AIDS—

[Baroness Manzoor (Con)]

May I remind the noble Lord that he needs to wind up, because this is a timed debate? I am so sorry.

[Lord McColl of Dulwich]

I was just going to say that there was a successful campaign against the AIDS epidemic, run by the present Lord Speaker when he was Secretary of State for Health. Why was it so successful? Because he was honest and straightforward, and did not beat about the bush. He said, “Don’t die of AIDS. AIDS is lethal”. That is how we need to fight the obesity epidemic, which is killing millions and costing billions. The cure is free. Eat less. Put fewer calories into your mouth. We must do this: we owe it to our children.

[Baroness Manzoor]

My Lords, to assist the House, before the next speaker starts may I remind all speakers that when the clock strikes five minutes, time is up?