Queen’s Speech

Lord Rea Excerpts

Wednesday 3rd June 2015 Lords Chamber

[Lord Rea (Lab)]

I wish to talk about two aspects of health—the health of the NHS and the health of the population which the NHS serves. The health of the NHS was summarised recently in a letter to the press by David Nicholson, the former chief executive of the NHS, and nine distinguished clinicians, including my noble friend Lord Turnberg, as in early terminal decline and in dire financial straits.

Social care is at the heart of the problem due to savage cuts. This is leading to queues in A&E, delays in discharge, lack of community services and joined-up care, and increased difficulty in getting access to GPs. Overall the share of GDP spent on health has fallen from 8% to 7%, below that of many other developed countries. I remind the Minister and the noble Lord, Lord Prior of Brampton, that it was the decision of a Labour Government in the early years of this century to match the EU average of 8% of GDP spent on health. That allowed long waiting lists to fall and public satisfaction with the NHS to rise to its highest ever level. One per cent of GDP is in the same area as the £22 billion per annum extra calculated by Simon Stevens, in his five-year forward view, to be necessary to keep the NHS working. To raise this sum through savings is pie in the sky without decreasing effectiveness and patient safety.

There are ways of raising this sum which would be politically acceptable—for instance, an earmarked health tax. This was mentioned by the noble Lord, Lord Fowler, and should certainly be on the agenda even if the Treasury might not like it. It should be remembered that several international studies have pointed out that the NHS is very cost effective. It will become less effective if it is not adequately funded.

Central to the role of the NHS is the state of health of the nation. It is well known that chronic non-communicable diseases—obesity, diabetes, heart disease, stroke and cancer, to name the most common—cause the greatest burden on the health and social services of developed, and now less developed, countries: “Hunger persists but the world as a whole got fat”, to steal a quote from Margaret Chan, the director-general of the World Health Organization. These conditions are seldom curable because they are part of a degenerative process although their symptoms can be alleviated and life prolonged by a galaxy of medical and surgical treatments that are now available.

However, as we have discussed before in your Lordships’ House, this is expensive and is one of the main reasons for the relentless increase in the costs of the NHS. To prevent or delay the onset of these diseases must be the way forward. We now know many of the underlying causes or risk factors for non-communicable disease—physical inactivity, unsuitable diet leading to obesity, excessive alcohol consumption and, particularly, tobacco smoking. The list is familiar but repeated health education campaigns aimed at informing people and helping them to avoid these risk factors and live more healthy lives have so far been disappointing—apart from tobacco legislation, which has had beneficial results.

Campaigns to encourage people to alter their behaviour are, of course, counteracted by promotion of unhealthy products as well as other less easily assessed social factors. These are well described in the House of Lords Science and Technology Select Committee’s report of 2012, Behaviour Change. The food and tobacco industries fully understand the power of these subtle, sometimes subliminal, factors in shaping behaviour and huge resources are put in to promoting their often unhealthy products. Margaret Chan—as you can see, I am a fan of hers—has spoken of the influence of not only big tobacco but “big food, big soda and big alcohol” on behaviour and of the need for,

“all sectors of government to consider the health impact of their policies”,

as:

“The determinants of health are exceptionally broad”.

It is a matter of regret, therefore, that the cross-departmental Cabinet Committee on the impact of policies on health has been allowed to wither on the vine. It was perverse of the Government to ask the food and alcohol industries to join a Responsibility Deal to advise on measures to make their products healthier when their least healthy products are often the most popular and profitable—for example, carbonated soft drinks. However, it is perfectly possible for the food industry to make healthy products while still making a profit. But without regulation it is very unlikely that they will at the same time stop marketing their profitable less healthy products.

A recent study has shown that so far, after four years, the Responsibility Deal has had no overall effect on improving the nutritional quality of the food that is marketed. I join many voices in calling for Her Majesty’s Government to seriously consider bringing in regulations to restrict the sale and promotion of these obesogenic food and drinks.