Fracture Liaison Services
Lord Rennard Excerpts(2 weeks, 4 days ago)
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Lord Rennard (LD)
My Lords, it is a great pleasure to take part in a debate in which there is such strong consensus. The noble Lord, Lord Black of Brentwood, is again to be congratulated on raising this vital issue of fracture liaison services and asking the new Government about progress towards achieving the previous Government’s target of 100% coverage by 2030. In 2021 we were given the figure of 51%—or 63 out of 123—NHS trusts across England having fracture liaison services. There is now 100% coverage in Scotland, Wales and Northern Ireland, so it is disappointing if the figure is still the same 51% for England.
We have heard how osteoporosis affects 3.5 million people in the UK, causing more than half a million fractures each year, and that, according to the Royal Osteoporosis Society, two-thirds of the people who need treatment are missing out, leaving them vulnerable to further life-altering fractures—and we have heard how women are disproportionately affected. Both the Sunday Express and the Mail on Sunday have been mentioned for partnering with the Royal Osteoporosis Society to campaign for an end to the postcode lottery that leaves so many people without fracture liaison clinics.
The new Government have promised to roll out a plan to ensure that every part of the country has access to FLS. All the main parties in the general election promised this, but we have heard tonight that investment needs to be made now if the Government are to achieve the target by 2030.
We have heard how the Royal Osteoporosis Society has estimated that just a £30 million investment in fracture liaison services could prevent 74,000 fractures, including 31,000 hip fractures, over five years—but, we are all asking, will this expenditure take place and will it be soon? The issue of providing universal cover for fracture liaison clinics may not create such big headlines as those about cancer treatments or accident and emergency waiting times, but, as we have heard, the issue affects so very many people. The political will really must be there if we are to address the need to reduce the number of hip and other fractures.
I have always advised people that whichever party wins an election, the Treasury stays in power, and that the Treasury often adopts a very short-term approach demanding a rapid return on any investment. This approach needs to change across the health and care sector if we really want to move towards more prevention and needing less cure. As the noble Baroness, Lady Bull, said, fracture liaison services provide a relatively rapid return on that investment.
There are still considerable challenges. The clinical workload of those expected to undertake roles within the services is immense. Rheumatology services were hit enormously by Covid and years of underinvestment. We can work with multidisciplinary teams and new technologies such as AI in order to streamline care, improve efficiency and help clinicians to manage growing demand, achieving economies of scale, but technology alone is not the answer; we also need meaningful investment in preventive services.
Type 2 Diabetes: Continuous Glucose Monitors
Lord Rennard Excerpts(1 month ago)
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Lord Rennard
To ask His Majesty’s Government how they intend to monitor access to continuous glucose monitors for people with type 2 diabetes; and how such monitoring will take account of any inequalities based on deprivation and ethnicity.
Baroness Merron (Lab)
I could get used to that reception, but I am not sure that I will get used to three Questions and a repeat UQ. However, I thank your Lordships’ House.
More than 200,000 eligible people living with diabetes currently benefit from real-time CGM, or continuous glucose monitoring. CGM data-reporting systems are being developed to aid the delivery of rollout by integrated care boards. Alongside this, the data is collected as part of the national diabetes audit. From 2025-26, NHS England plans to publish that data routinely on the audit’s quarterly dashboard, which will provide the insights that ICBs need, including data on CGM uptake, variation and health inequalities.
Lord Rennard (LD)
Many more people with type 2 diabetes could benefit from this technology. People living in deprivation and people of black and south Asian ethnicity are more likely to develop type 2 diabetes, are less likely to receive essential diabetes care and experience worse health outcomes. However, according to Diabetes UK, only 24 of 42 integrated care boards in England have a policy for continuous glucose monitoring for people with type 2 diabetes that is in line with guidance from NICE. How will the Government ensure equal access to such monitors for people with type 2 diabetes?
Baroness Merron (Lab)
The noble Lord makes a very fair observation. Work is going on in a wider equality monitoring programme exploring how to keep an eye on equality repercussions, including ethnicity, by reference to protected characteristics in the Equality Act 2010. Importantly to the point he raised, the review includes consideration of how NHS ethnic group categories can be updated. The outcome of the review—this is the point I really want to emphasise—will ultimately guide a process of reducing inequalities, but I accept his challenge and his point.
Diets: Fat
Lord Rennard Excerpts(1 month, 3 weeks ago)
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Lord Rennard (LD)
My Lords, I am a type 2 diabetic. I overcome some embarrassment about my weight to say that I have lost more than 30 kilos over the past 30 years. More importantly, I have kept it off.
Self-evidently, however, I need to lose more weight. My diabetic control has been very difficult and required major lifestyle changes, but they were not enough. So, in the past four months, I have been assisted in improving my diabetic control and reducing my weight by a further few kilograms with the help of Mounjaro, a drug from Eli Lilly. Since being diagnosed with diabetes in 1994, I have always had great support from St Thomas’ Hospital. It advised me a few years ago that a typical type 2 diabetic like me, in their 50s and 60s, can be expected to put on an average of between one and two kilos every year. Over a decade or two, that gain of between 20 and 40 kilograms is likely to have catastrophic health consequences requiring significant and costly medical intervention.
For many people struggling with their weight and diabetic control, these new injections give great hope, but we should not see any of the different injections becoming available as a silver bullet to achieve weight loss. We should recognise first that they are helpful in improving diabetic control, which can be very difficult, as your pancreas becomes less and less effective at producing insulin and your sugar levels rise. The associated weight loss with these drugs is also helpful, but such treatment is far from appropriate as a first resort and some people struggle with unpleasant side-effects from them.
However, we should never accept an approach towards obesity or diabetic control which says little more than, “Pull your socks up, make yourself eat much less, but eat more fat”. This approach will lead only to the obesity crisis in many of the more affluent countries becoming even greater. It will result in great damage to the health of their populations, their health systems and their economies. The Atkins diet is now widely discredited after the demise of the author of the books on it.
The British Dietetic Association says that fat plays an important part in our diet and that people need a small amount of it. But it has warned against a high intake of saturated fats, which are often found in processed foods and associated with weight gain, making diabetic control harder, causing joint problems and some cancers.
The questions for us to discuss should be about how to take strong steps to help prevent people becoming obese in the first place and how to help them achieve and maintain healthier lifestyles, manage their diets better, and adopt healthier lifestyles, including regular exercise.
As the excellent report from the Select Committee on Food, Diet and Obesity, chaired by my noble friend Lady Walmsley, suggested last week, we need a broad range of measures to tackle the obesity crisis. I would begin with healthy, nutritious, and free school meals and stopping the proliferation of fried chicken and burger shops in close proximity to schools. We need, as the Select Committee says, to reduce the prevalence of marketing and advertising of unhealthy ultra-processed foods, especially to children. We need also to promote health education and physical activity in schools and after school.
Poverty must also be recognised as a significant factor in many people having unhealthy diets and suffering from health inequalities. Poor parents struggle to provide healthy diets for their families. Healthier foods are more than twice as expensive per calorie as less healthy foods. One of the most important poverty-relieving measures would be to scrap the two-child limit for universal credit or tax credits. I am disappointed that this was not in yesterday’s Budget.
In conclusion, we need to follow medical advice and look at evidence over time about the use of injections assisting diabetic control and weight loss. We cannot simply let people think that they can just resort to expensive weekly injections provided by the state. But nor can the state ignore the tremendous costs of obesity and diabetes.
Smoking
Lord Rennard Excerpts(10 months, 3 weeks ago)
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Lord Rennard
To ask His Majesty’s Government what progress they have made towards the ambition of creating a “smokefree” generation by 2030.
The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Markham) (Con)
Smoking is responsible for around 80,000 deaths a year in the UK, costs our country £17 billion a year and puts a huge burden on the National Health Service. That is why we will shortly introduce the tobacco and vapes Bill to Parliament in the coming weeks, to create the first smoke-free generation and further crack down on youth vaping. The Bill will be informed by our recent consultation, which we will publish soon.
Lord Rennard (LD)
My Lords, all parties have agreed on the need to reduce the prevalence of smoking in this country to below 5% by 2030, so the Bill to prevent young people ever becoming smokers is vital. Does the Minister accept that we need to do more to help the over 6 million people in this country who are addicted smokers, most of whom are struggling to give up smoking and want to? They are damaging their health and that of others affected by smoking. Does he agree that allowing integrated care boards to make further cuts to tobacco dependence treatment budgets will not help us to achieve this target?
Lord Markham (Con)
I thank the noble Lord. Actually, Khan recommended four major things to achieve that in his report Smokefree 2030. The first was to increase the anti-smoking spend that the noble Lord refers to. As part of this, we propose to increase that spend from £70 million to £140 million—so we are doing absolutely what the noble Lord suggests. The second was to increase the age of sale, which of course this legislation is all about. The third was to promote vaping to help quit smoking. Again, the legislation will do that. The fourth was to increase NHS prevention methods which, again, we will do from here. So it is very much a range of measures to stop people ever smoking but also to stop many who are currently smoking by helping them to quit.
King’s Speech
Lord Rennard Excerpts(1 year, 1 month ago)
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Lord Rennard (LD)
My Lords, in the seven minutes in which we are asked to speak today, seven people will have hospital appointments because of their smoking habit. The Department of Health and Social Care estimates that this amounts to around 450,000 hospital appointments in England every year. In the seven hours we expect to debate today, around 700 GP appointments will be made because of smoking. Cancer Research UK estimates that around 900,000 GP appointments are made every year because of smoking. In England alone, nearly 200 people will die every day because of smoking.
The tobacco manufacturers try to suggest that the frequent ill health and the 50% death rate of those who smoke are a simply a matter of their personal choice, but smoking tobacco has consequences for many other people beyond those trapped by nicotine addiction.
Aged 16, I was woken by my younger brother, as our mum had overslept and we were late for school. I got up, but I could not wake her. She was just 53, and she never woke up. She was a heavy smoker and severely disabled. She died of hypertensive heart disease, and smoking was a significant contributory factor in her death. She did not choose to die that way; she was addicted. She did not choose for her children to become orphans and for us to lose our home—and becoming homeless at that time was not a “lifestyle choice”. So, yes, the issue is a personal one about the consequences of smoking: it is not a choice but an addiction, and one which the vast majority of smokers, having started in their youth, come to regret.
There was little in the gracious Speech to inspire anyone, including those on the Government Benches. Change is not change when little more is promised than bland slogans about a brighter future but with the same people and the same policies. But praise must be given where praise is due; and the latest in a lengthy line of successful measures to help reduce the prevalence of tobacco smoking is to be heartily welcomed. Lives will be saved; people will be healthier and wealthier, and the whole country will benefit.
This year, the cost to the public purse of early deaths due to smoking will be £31 billion. This year, the cost of lost productivity due to smoking will be £38 billion. This year, the cost due to smoking in terms of lost tax receipts, increased social security spending and extra costs to public services such as the NHS will be more than £9 billion, and that is after the tax receipts from tobacco are taken into account.
Meanwhile, the tobacco companies continue to make enormous profits. This year, the four biggest tobacco companies in the UK will make around £900 million in profits. It is no wonder that they spend so much money on desperate tactics to deceive people about every single measure that we have ever introduced to reduce the prevalence of tobacco smoking. We should listen instead to medical advice. Sir Chris Whitty, the Chief Medical Officer for England, spoke recently about the plan to gradually raise the age at which you can be legally sold tobacco. He said:
“The overwhelming majority of the medical profession, the nursing profession and all the health charities support this”.
He described claims from the tobacco industry that the policy would not work as “bogus”. He told the BBC:
“As a doctor I’ve seen many people in hospital desperate to stop smoking because it’s killing them and yet they cannot—their choice has been removed”.
The Bill has support from the British Heart Foundation, Cancer Research UK, the Royal Society of Public Health, the UK Faculty of Public Health, Asthma + Lung UK, and Alzheimer’s Research UK, among all the many organisations putting public health above the vast private profits of the tobacco companies. However, using their well-funded front organisations, the tobacco companies are orchestrating their usual deceptive and devious techniques to try to protect those profits. They have a few champions, such as Liz Truss and the Institute of Economic Affairs, which helped her to crash our economy—and Boris Johnson, whose judgment and integrity are well known, who says that the plan is a ban.
The plan is not a ban on smoking, because no smoker will be banned from their habit. What will be made illegal is underage sale, in the same way that a few years ago we extended the minimum age for someone who can be sold cigarettes from 16 to 18. The plan will extend this further year by year. The measure offers great hope to everyone below the age of 14, for whom it will never be legal to be sold cigarettes. The evidence is that such measures will not increase the illicit market. When the age of sale increased from 16 to 18 in 2007, it had no negative impact on this market, which continues to fall.
The issue of moving to a more smoke-free Britain, and seeking to be smoke-free by 2030, does not involve a choice between restricting sales of tobacco and more public health activity to help smokers quit. We need both. Two-thirds of those people trying just one cigarette, usually as children, go on to become daily smokers, and daily smokers are addicted smokers. The plan to limit cigarette sales further has strong public support; it does not divide the Government and the Opposition Front Benches—and I hope that pressure from the tobacco lobbyists will be firmly resisted across both Houses, as it clearly has been in this House today.
Osteoporosis: Early Detection
Lord Rennard Excerpts(1 year, 11 months ago)
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Lord Markham (Con)
I agree with my noble friend that prevention is always better than cure. The beauty of these processes is that I get to swot up, and I learned that the second largest bed-intake cause is actually a fractured femur from osteoporosis, so he is correct. We have a target that 95% of patients will get a check within six weeks by March 2025. It is good that musculoskeletal services are now part of the national improvement programme, but we clearly need to make sure we are on top of that.
Lord Rennard (LD)
My Lords, a year ago the Minister’s predecessor said to the House that he hoped NHS England would ensure that effective fracture services were universal. However, unlike in Scotland and Wales, that is not the case in England. Is not part of the problem with healthcare in this country that the Government struggle to resource treatment and pay for those who provide it while failing to invest in prevention and public health initiatives? What action are they taking to ensure that osteoporosis is given sufficient priority by recognising that it needs to be considered in parity with other long-term conditions?
Lord Markham (Con)
The noble Lord refers to the fracture liaison services. It is the responsibility of all ICBs to roll out those services or their equivalent. Regarding the numbers that he cited, I should say that 51% of ICBs have a fracture liaison service in that shape or form and the others have different versions of it, and they are all responsible for rolling those out. At the same time, they are also responsible for musculoskeletal services, to make sure that we have nationwide provision for it.
Tobacco Control Plan
Lord Rennard Excerpts(2 years ago)
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Lord Markham (Con)
I agree with my noble friend. The key age group to attack, so to speak, is 16 to 18-year-olds, which is often when the smoking habit begins. We must look seriously at every step we can take to reduce smoking in that age group. I am also aware that 18 is the age of consent, of being able to do lots of things, and changing that for smoking would obviously be quite a radical step, but everything is on the table as we review the best way forward.
Lord Rennard (LD)
My Lords, the Health Foundation recently published figures showing that the budgets for tobacco control and smoking cessation have been cut in real terms by 41%. Is not part of the answer to funding treatment for addiction to tobacco, alcohol and gambling the extension of the “polluter pays” principle? What is the argument against a levy on the very large profits of the tobacco companies, in order to pay towards helping their customers who want to quit?
Lord Markham (Con)
There are a number of ways we can tackle this, price, obviously, being one of the main ways, along with taxation. The noble Lord will be aware that we increase the tax by 2% every year, and cigarettes prices here are now the highest in Europe. We are still providing funding of £73 million per year to help 100,000 people stop smoking. But it is not always money that counts. Anti-smoking campaigns, branding restrictions and taxation are all other elements which are proving successful.
Bereavement Support
Lord Rennard Excerpts(2 years, 1 month ago)
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Lord Rennard (LD)
My Lords, I lost my father at the age of three and lost my mother just before I was 17. At that point, my schoolfriends did not know what to say, my teachers’ concern was confined to my academic progress, and when I was suffering from the consequences of bereavement while at university, I found no sympathy or support from staff. Recently, half of the respondents to a Childhood Bereavement Network survey said that they had little or no support from their educational setting after bereavement. What can be done to improve access to bereavement services, to improve the training of education professionals in helping young people manage their lives after bereavement, and to help children better understand the process of dying and managing their emotional feelings in those difficult circumstances?
Lord Markham (Con)
I thank the noble Lord, and I agree. I have to admit that when I was a child, I failed a friend, because I did not know what to say. As I mentioned, the DfE is part of this working group and we are training 10,000 early years practitioners in this space to try to ensure that they can provide the training that is needed in schools. The number of schools supported in this way is increasing, but today it is still only 35%, so clearly there is more work to be done. The noble Lord can rest assured that we take this very seriously.
Ambulance Delays
Lord Rennard Excerpts(2 years, 1 month ago)
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Lord Markham (Con)
I agree with the noble Baroness that social care is a key solution to all this. As I said, that is what is behind the 13% of beds that are currently blocked and the £500 million spend in this area. However, we can be more innovative. That is what the virtual ward initiative, which I saw working so well in Watford, is about; it has reduced reattendance rates after 90 days from 46% to around 8% for COPD patients. This is an area where we need focus and innovation, and which is very much top of my agenda.
Lord Rennard (LD)
My Lords, as the Minister has already suggested, part of the problem is unnecessary call-outs to ambulance services for people who do not need admission to hospital. Care homes regularly call on ambulance services to lift their fallen residents, even though more than 45% are uninjured and do not require transportation to hospital. If care homes had the right equipment to lift people safely, an ambulance may not be needed after a fall. Some ambulance services are providing this kind of equipment to care homes, from their own resources, to reduce the number of unnecessary call-outs. Should we not ensure that all such homes and blocks of sheltered accommodation have access to this kind of equipment, which would get people up more quickly, reduce the number of call- outs and save money?
Lord Markham (Con)
Many noble Lords have talked today about what is a whole-system problem, which the noble Lord has mentioned in terms of care homes. It is all about treating people in the right place, with the right equipment, so I absolutely agree with this approach. It is the approach that we are taking to make sure that people are treated in the right place, so I will take the noble Lord’s suggestion back to the department.
Childhood Obesity
Lord Rennard Excerpts(2 years, 2 months ago)
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Lord Markham (Con)
I thank the noble Lord. The figures to which he refers are a mixture of the pricing of these so-called “buy one, get one free”-type promotions and their positioning in a supermarket. In fact, the data shows that as much as a 50% increase in sales can be driven by where these promotions are placed in a supermarket. That is why the focus now is on what changes will be made on 1 October to reduce the purchase of a lot of the types of food groups we are talking about by moving them away from prominent areas. Once we see the results of those changes, we will be in a position to review some of the pricing and promotions to which the noble Lord refers.
Lord Rennard (LD)
My Lords, this morning, this month’s Chancellor reversed nearly all last month’s Chancellor’s tax changes. Meanwhile, increasing levels of childhood obesity are adding considerably to the cost to the NHS of treating conditions such as diabetes. Can the Minister confirm the commitment to the soft drinks industry levy, which has been successful in reducing the level of sugar in soft drinks and provides funds for sporting activities in schools and school breakfast clubs?
Lord Markham (Con)
My Lords, as the House will be aware, the tax on sugar in drinks has reduced consumption of sugar by 44%, so I totally agree with the sentiment. We have been successful in this. We are looking to improve in the area of sugary food, where we have managed to reduce some of that content by as much as 13%.