Health: Obesity

Debate between Lord McColl of Dulwich and Earl Howe

Thursday 26th February 2015 Lords Chamber

[Earl Howe]

Yes, my Lords, that is being factored in, but I do not think that we should confuse that point with a certain sort of fatalistic approach to obesity. There are things that people can do with their lifestyle to influence their own states of health in all sorts of areas and we have to help people understand what those things are.

[Lord McColl of Dulwich (Con)]

Does the Minister agree that this report is a model of its kind? It is brief and free of waffle and it emphasises the important point that obese people do not need to increase their activity one iota in order to lose weight; all they have to do is to eat less.

[Earl Howe]

I agree with my noble friend. We should recognise that increasing physical activity is important for our health, but for people who are overweight and obese, eating and drinking less has got to be the key to weight loss.

Health and Social Care (Safety and Quality) Bill

Debate between Lord McColl of Dulwich and Earl Howe

Friday 6th February 2015 Lords Chamber

[Earl Howe]

I would be happy to do so.

[Lord McColl of Dulwich]

Before the Minister sits down, could I ask him about the WHO checklist? When I go into an operating theatre, the operation cannot start until that list is completed by the surgeon, the anaesthetist and the nurses. Could that be put into regulations?

[Earl Howe]

My Lords, I am sure that anything is possible, but I would hesitate before giving a commitment along those lines because it seems to me too granular to be included in statutory regulations rather than in guidance or best-practice manuals.

Alcohol: Addiction

Debate between Lord McColl of Dulwich and Earl Howe

Monday 12th January 2015 Lords Chamber

[Earl Howe]

My Lords, the Royal College of GPs has a special focus at the moment on giving advice to GPs. We are also dramatically increasing the number of health visitors, who are, of course, highly instrumental in influencing the behaviours of mothers-to-be and young mothers.

[Lord McColl of Dulwich (Con)]

My Lords, does the Minister accept that although alcohol was until recently the commonest cause of liver disease, the commonest cause is now the obesity epidemic, which is killing millions of people? Some 13 million people in this country are suffering from obesity—far more than are suffering from alcohol problems.

[Earl Howe]

My noble friend is absolutely right. More than 90% of liver disease is due to three main, preventable and treatable risk factors—alcohol, hepatitis B and C, and obesity. Alcohol accounts for 37% of liver disease deaths, but obesity is indeed a major factor in this.

Children: Obesity

Debate between Lord McColl of Dulwich and Earl Howe

Monday 20th October 2014 Lords Chamber

[Earl Howe]

My Lords, first, I commend the all-party group for its report. Tackling obesity is one of our major priorities, as it is for Public Health England. We have a well developed and wide-ranging programme of actions to tackle obesity. We have set a national ambition for a downward trend in excess weight in children. We are delivering the programme through initiatives such as Change4Life, the National Child Measurement Programme, school sports funding and the School Food Plan, and through voluntary partnerships with industry. As regards co-ordination, Public Health England is a leader of the public health service and numerous government departments are contributing to the anti-obesity agenda. We have a Minister for Children, and we have already established the Obesity Review Group, which brings together a range of experts and delivery partners from across the system to try to co-ordinate efforts to meet our national ambitions.

[Lord McColl of Dulwich (Con)]

My Lords, will the Minister acknowledge that the Department of Health and NICE misled Parliament and the nation in saying that the obesity epidemic was due to lack of exercise? Will the Minister acknowledge that in fact obese people do not need to increase their activity one iota in order to lose weight? All they have to do is to eat or drink fewer calories.

[Earl Howe]

My Lords, although physical activity can have a role in maintaining a healthy weight, the Government agree with my noble friend that its health benefits are nevertheless subsidiary in those who are obese to the need to eat and drink less. My noble friend may be interested to know that NICE is currently consulting on its draft public health guideline on maintaining a healthy weight and preventing obesity among children and adults. It currently expects to publish this guideline in February next year.

NHS: Hospital Waiting Times

Debate between Lord McColl of Dulwich and Earl Howe

Thursday 10th July 2014 Lords Chamber

[Earl Howe]

My Lords, the noble Lord knows of the economic constraints that this country has to contend with at the moment. Despite that, the Government are increasing the NHS budget over the course of this Parliament by £12.7 billion. That should indicate to the noble Lord the priority that we are giving to the NHS.

[Lord McColl of Dulwich (Con)]

My Lords, the Minister mentioned that the strain on the NHS is due to old people getting older, but is it not true that the strain is due to young people getting fatter and fatter? Is it not true that the Department of Health misled the nation by saying that the obesity epidemic—the worst for 90 years—is due to a lack of exercise when really it is due to people eating too much?

[Earl Howe]

My noble friend is a very eloquent advocate of this particular issue and he is of course right.

NHS: General Practitioners

Debate between Lord McColl of Dulwich and Earl Howe

Wednesday 26th February 2014 Lords Chamber

[Earl Howe]

The noble Baroness is quite right. The NHS is seeing an extra 1 million patients in A&E compared to three years ago. Despite the additional workload, it is generally coping very well although we know that departments are under strain. This is not just about A&E, as the noble Baroness will be aware, but about how the NHS works as a whole: how it works with other areas, such as social care, and how it deals with an ageing population and more people with long-term conditions. Dealing with all that means looking at the underlying causes, and that work is going on at the moment in NHS England.

[Lord McColl of Dulwich (Con)]

Does the Minister agree that it was very unfortunate indeed that certain politicians, who shall remain nameless, said to the general practitioners: “We know what you’re doing. You should have been working but you were on the golf course and, from now on, we’re going to pay you only for what you do”? The general practitioners thought this was a rather good idea, because it resulted in a substantial pay rise.

[Earl Howe]

My Lords, there is no doubt that the general practitioners bit the Government of the day’s hand off, 10 years ago, and they had every reason to do so with the money that was being offered to them. However, while a feature of that contract was the quality and outcomes framework, which was a good idea in itself, it has resulted in a lot of box-ticking for GPs and it is that element which we have drastically reduced in the contract for next year. That will be helpful in freeing up GPs’ time.

Public Health Responsibility Deal

Debate between Lord McColl of Dulwich and Earl Howe

Tuesday 14th January 2014 Lords Chamber

[Earl Howe]

My Lords, I shall take that request away and write to the noble Lord.

[Lord McColl of Dulwich (Con)]

Does the Minister approve of the letter, which will shortly be sent to all Members of this House and of another place, asking them to measure their waist and to ensure that it is less than half their height? That would apply to quite a few Members opposite, who are clearly eating too much of the gross national product.

[Earl Howe]

My Lords, we should welcome any measure that encourages us all to improve our diet, to reduce physical inactivity and to be aware of what we need to do to keep our weight under control. I do welcome that letter.

Children and Families Bill

Debate between Lord McColl of Dulwich and Earl Howe

Wednesday 20th November 2013 Grand Committee

[Lord McColl of Dulwich (Con)]

My Lords, I, too, support these amendments, and my name is attached to Amendment 264. I should declare that I have a history as regards smoking as I used to be a chain smoker but gave it up when I was six. About 15 years ago in your Lordships’ House I introduced an amendment to ban smoking in public places. I put it on the back of a criminal justice Bill, which is a convenient way of moving things. I was amazed that the House was full right up to midnight when my amendment was discussed. I fondly imagined that everyone had come to listen to my wisdom, but little did I know that the House had filled with smoking barons waiting to pounce. However, I got my own back on them because at the end of the debate I thanked everyone for their contributions and, instead of saying, “I beg leave to withdraw my amendment”, for some reason or other I said, “Amendment not moved”. They all looked very puzzled because we had just spent hours discussing it. However, the noble Baroness on the Woolsack quickly said, “Amendment not moved”, passed on and they lost the opportunity to vote. They were furious and I was very pleased. As a professor of surgery, of course, I fully back any move to reduce the amount of smoking and I am convinced that these amendments would do that.

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

My Lords, this has been an instructive debate and let me say immediately that I have listened carefully to all the contributions, both today and on Monday. Perhaps I may start by addressing Amendment 263. I should say at the outset that I have enormous sympathy with the aim of this amendment, which is to protect children’s health from the harm that can be caused by second-hand smoke, and I am grateful to the noble Baronesses, Lady Finlay and Lady Massey, and the noble Lord, Lord Faulkner, along with my noble friend Lady Tyler for bringing this important issue to our attention.

We all agree that we do not want to see children exposed to second-hand smoke anywhere. The evidence of the harm caused by second-hand smoke is clear, but many children continue to be exposed to it, both in the family car and in the home. The question posed by this debate is whether legislation is the most proportionate and viable means of addressing the problem. We need to consider that question carefully and I must say that, while supporting the spirit of the amendment—which I certainly do—the Government are not convinced that creating new criminal offences is the right approach.

Of course, in some people’s minds there are civil liberties considerations, which might include what is often perceived as state intrusion into people’s private space. That is a complex area worthy of a debate on its own, but of course I acknowledge that any arguments on that score need to be balanced against the need to protect children. Since 2007, evidence shows that smoke-free legislation has been effective in reducing exposure to second-hand smoke in virtually all enclosed work and public spaces, public transport and work vehicles. Compliance with the law is high and we now benefit from clean air at work, in pubs and restaurants, and on public transport. However, it does not automatically follow from that that it is right to extend the scope of legislation to cover private cars.

There are many practical issues to be considered, particularly around effective enforcement, which is not something that we have heard much about during the course of the debate. Smoke-free legislation in England is enforced by local authority environmental health officers. They do not hold powers to stop vehicles or to detain people in vehicles that are already stationary. Consequently, it would be very difficult for them to take effective enforcement action without the assistance of the police. Since this is a public health issue rather than one of road safety, I expect that such an additional duty on top of their many other responsibilities would be a cause for concern for the police. The Chartered Institute of Environmental Health has identified other practical difficulties around enforcement. These include accurately identifying which vehicles are required to be smoke-free. For example, small children may not easily be visible from outside the vehicle. Further difficulties include obtaining evidence of smoking, identifying the driver and passengers, and proving the age of the child.

I hope that the Committee agrees that there would be real practical difficulties in effectively enforcing such an offence. If we cannot credibly enforce the law, then the credibility of the law itself is called into question. That is why the Government firmly believe that, rather than focus on what would be a complicated and resource-intensive enforcement process, we should continue the non-legislative approach that the evidence shows is working; namely, encouraging positive and lasting behaviour change among adults who place children’s health at risk. My noble friend Lord Storey urged us to do this. Our comprehensive tobacco control plan states:

“Rather than extending smokefree legislation, we want people to recognise the risks of secondhand smoke and decide voluntarily to make their homes and family cars smokefree”.

That is why Public Health England, building on last year’s success, ran another hard-hitting marketing campaign in June and July this year. The campaign aimed to encourage smokers to stop and think before smoking in front of children, whether in the home or in the car. It also encouraged smokers to order an NHS smokefree kit with tips on making the home and car entirely smoke-free spaces, together with support to help quit smoking altogether.

This year’s campaign is currently being evaluated, but emerging findings are encouraging. They show that the campaign has been successful in raising awareness and in changing attitudes and behaviour, with almost three-quarters of those surveyed agreeing that smoking out of an open door or window was not enough to protect children from second-hand smoke. Of those surveyed, 37% reported that they had taken action to reduce their children’s exposure to second-hand smoke, compared with 29% in 2012. In addition, 73% agreed that the adverts made them realise that smoking out of an open window was not enough to protect children, and there were nearly 85,000 orders for smokefree kits. That is an increase of 48% on the 2012 campaign.

The right reverend Prelate the Bishop of Chester rightly suggested that this is a global issue. I agree. We are, however, considered to be a leader in tobacco control internationally. The World Health Organisation has assessed us to be number one in Europe in this area, and through the Framework Convention on Tobacco Control we share this good practice as much as we can.

The noble Lord, Lord Palmer, suggested that the Government ought to introduce an offence of proxy purchasing. I know that shopkeepers and others are interested in making it an offence to buy tobacco for young people under the age of 18. I am sympathetic to that concern, but even were such an offence to be introduced, it would not stop family and friends sharing cigarettes with children. Therefore, we get back to the argument about behaviour change, which I think is more relevant here.

The noble Baroness, Lady Howarth, made an interesting point about this being considered as a road safety issue. I agree that any activity such as smoking—getting out a cigarette, lighting it, disposing of hot ash or stubbing the cigarette out—is likely to distract the driver, particularly if carried out in a moment that is critical for road safety. However, there are a host of things drivers do that have the potential to be equally distracting, be it eating, drinking, adjusting the radio, consulting directions or whatever it may be. First and foremost, it is the driver’s responsibility to drive safely at all times. Section 41D of the Road Traffic Act 1988 already provides a perfectly adequate offence if a driver fails to maintain proper control of a vehicle while driving. While a specific offence has been created for driving while using a hand-held mobile phone, the Government do not believe that there is any need to introduce a new and separate offence of smoking while driving.

I welcome the debate on this important issue and I can assure noble Lords that we shall consider carefully the findings of this year’s marketing campaign and decide what further action may be needed. I can assure the Committee that the Government will continue to work to protect children from second-hand smoke in family cars and in the home. We are not complacent but we remain to be convinced that legislation is the most effective and proportionate way of achieving this.

Health: Sugar Consumption

Debate between Lord McColl of Dulwich and Earl Howe

Wednesday 6th February 2013 Lords Chamber

[Earl Howe]

My noble friend asks a number of questions. I am sure he will have welcomed, as I did, the announcement a few days ago by two major manufacturers of sugary drinks that they were substantially reducing the sugar content of their drinks. This is in part a result of the engagement that we have had with the food industry, which, in public health terms, is taking on responsibility for the products that it makes.

While there are advocates for taxation, in 2012 my department reviewed the international evidence of the effect of taxation on people’s consumption of food and drink. There is very limited empirical evidence, certainly from literature, but also in practice that that has an effect on body weight or health outcomes. There is a range of possible unintended consequences, including swapping for other foods which may be even less healthy than the ones that we are trying to cut out.

[Lord McColl of Dulwich]

My Lords, is the Minister aware that the overeating habits of pregnant women can be programmed into the foetus, so that when born the children will not stand a chance unless people accept that the answer to the obesity epidemic is to eat less? Although exercise is important in reducing cholesterol, for well-being and so on, it has very little to do with the control of the obesity epidemic.

[Earl Howe]

My noble friend makes a good point, but in healthy children exercise is very important as a preventive measure for obesity and diabetes. The central point he makes is absolutely right. We look to healthcare workers, not only health visitors but also midwives, through programmes such as the Healthy Child programme and Start for Life, to get families and children off to the right start, so that they eat properly and live healthy lifestyles.

Diabetes

Debate between Lord McColl of Dulwich and Earl Howe

Thursday 10th January 2013 Lords Chamber

[Earl Howe]

The noble Lord is absolutely right that this is a major public health issue and one that impacts very seriously on the health and well-being of individuals, so it is a priority for us. We are committed to reducing the number of avoidable amputations among people with diabetes. In fact, progress is being made: although the number of amputations is going up, the rate is falling. However, we are under no illusion that this will be a growing problem because of the growing number of people with diabetes. All our work on improving completion of the NICE nine care processes for people with diabetes and improving timely access to specialist diabetic footcare multidisciplinary teams will support that aim, and the Diabetes UK Putting Feet First campaign has real potential to improve awareness of foot complications in diabetes.

[Lord McColl of Dulwich]

My Lords, does the Minister agree that the real way to reduce the number of amputations is to reduce the incidence of diabetes and that the way to do that is to do something about the obesity epidemic, which is the main cause of diabetes and one of the main causes of amputation? What is he doing to try to prevent that quango, NICE, misleading the nation and politicians, as it did, into believing that the answer to the obesity epidemic was to take more exercise when, although exercise is important, the real answer is to eat fewer calories?

[Earl Howe]

I agree with my noble friend about the importance of targeting obesity as a serious public health risk and one which leads to diabetes in many cases. I believe that, if my noble friend were to talk to NICE about its recommendations to prevent obesity, he would find that its line is slightly modified from the one that he has criticised. We should pay tribute to NICE for the good work it has done in the specific area of diabetes. The recommendations and guidelines it has issued have been very positive. There is, of course, a quality standard for diabetes, which is also excellent.

Health: Hearing Loss

Debate between Lord McColl of Dulwich and Earl Howe

Monday 17th December 2012 Lords Chamber

[Earl Howe]

My Lords, the Government fully recognise that hearing loss is not just a health issue. For example, it can lead to isolation and loss of independence; it can impact on education and employment; and it can impact in the various ways mentioned by the noble Baroness, Lady Wilkins, in her earlier question. We believe that health outcomes for people with hearing loss should be among the best in the world. To achieve that it is necessary to think and act differently. Therefore, we are developing a cross-government strategy to maximise the current effort to prevent hearing loss and to support those suffering from it. In particular, that will focus on identifying the potential better to join up services provided by the different agencies.

[Lord McColl of Dulwich]

We have a generation of deaf people in this country produced by loud noise and music. What about preventing it in the first place?

[Earl Howe]

My Lords, I am sure the Health and Safety Executive will take my noble friend’s comments to heart.

Health: Obesity

Debate between Lord McColl of Dulwich and Earl Howe

Monday 12th November 2012 Lords Chamber

[Earl Howe]

My Lords, this is a very important point. Dame Carol Black and I chair a network within the responsibility deal in the Department of Health which draws together employers from a range of sectors to address health in the workplace. It is a tremendously important opportunity if we can engage employers to realise that it is in their direct interest to ensure that their employees enjoy good health and lead healthy lifestyles.

[Lord McColl of Dulwich]

My Lords—

Health: Diabetes

Debate between Lord McColl of Dulwich and Earl Howe

Tuesday 1st November 2011 Lords Chamber

[Earl Howe]

My Lords, we are completely committed to the NHS health check programme, so I can reassure the noble Lord that we are clear that it has a major part to play. It is a very cost-effective way of both preventing and detecting early those who are at risk of diabetes or who may have recently contracted it. Health checks are part of the current operating framework. It is true that the figures for the first quarter of this year were a little disappointing, but PCTs are fully engaged in the process.

[Lord McColl of Dulwich]

My Lords, will the Minister acknowledge that the main cause of diabetes is the obesity epidemic, which is due to overeating? Could he suggest to the quango NICE that it withdraw its advice about having a balance between “calories in” and exercise, given that exercise has so little to do with the obesity epidemic? You have to run miles to take a pound of fat off.

[Earl Howe]

My Lords, my noble friend is to be congratulated on his campaign on this issue. Of course, I agree with him that if you are obese a reduction in “calories in” will make the most difference to regaining a healthy weight. He is absolutely right. If there is a respect in which NICE needs to amend its guidance, I am sure that it will be listening.

Health: Obesity

Debate between Lord McColl of Dulwich and Earl Howe

Wednesday 19th October 2011 Lords Chamber

[Lord McColl of Dulwich]

To ask Her Majesty’s Government what action they are taking to address rising levels of obesity.

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

My Lords, the Government are committed to tackling obesity, which has serious consequences for individuals, the NHS and the wider economy. The Government recently published A call to action on obesity in England, which sets out how obesity will be tackled in the new public health and NHS systems and the role of key partners.

[Lord McColl of Dulwich]

I thank my noble friend for that reply. Would he kindly consider launching a campaign comparable to that launched by my noble friend Lord Fowler in the 1980s, which was so striking and so very effective?

[Earl Howe]

I agree with my noble friend about the campaign launched by our noble friend Lord Fowler, which was extremely effective. We recognise that excess weight is a really serious problem. That is why we have set out what we believe is an ambitious approach to dealing with it. We are radically overhauling the public health system. We are working with business to go further and faster on making it easier for people to make healthy choices for themselves and their families. We are also continuing to invest in programmes such as Change4Life. The Government cannot solve the problem on their own but we can encourage and support a wide range of partners to play their part. The call to action sets out how we are going to do that.

NHS: Cost-effectiveness

Debate between Lord McColl of Dulwich and Earl Howe

Monday 12th September 2011 Lords Chamber

[Earl Howe]

No, I do not. There are plenty of examples of quality costing less because the system gets it right first time. We see this time and again, for example in the Quit programme. The simplest example is that if we can treat patients correctly in hospital and keep them in for the shortest amount of time, we save a great deal of money.

[Lord McColl of Dulwich]

My Lords, on the subject of cost-effectiveness, does my noble friend agree that we are in the middle of the most serious epidemic to afflict this country for 100 years—namely the obesity epidemic? The cure is free: you just have to eat less. Why does the Department of Health insist that exercise is important in this equation?

[Earl Howe]

My Lords, the department takes its cue from NICE. I am sure that my noble friend will agree that exercise is never irrelevant to the question of obesity. I think that my noble friend's difficulty centres on how relevant it is in relation to reducing calorie intake. No doubt the debate on that will continue.