Health and Care Bill

Lord Rennard Excerpts

Consideration of Commons amendments
Tuesday 5th April 2022 Lords Chamber

[Lord Hunt of Kings Heath (Lab)]

My Lords, I, too, support the noble Lord, Lord Crisp, in his amendment. My noble friend Lord Faulkner would of course have been in his place to speak in favour, but he is unable to be here, so perhaps I may make a few remarks which I think he might have made.

Going back to Report, the Minister suggested that the tobacco industry is already required to make a significant contribution to public finances through tobacco duty, VAT and corporation tax. But I do not think that states the case as accurately as possible, because we know that tobacco manufacturers are skilled at minimising the amount they pay. For example, between 2009 and 2016, Imperial Brands, the British company that is market leader in the UK, received £35 million more in corporation tax refund credits than it paid in tax. The largest amount of tax collected by the Government comes from excise tax and VAT. This, of course, is not paid by the manufacturer; it is passed on to the consumer. That was a point HM Treasury made in 2015, when the Government consulted but, alas, decided not to put an additional tax on tobacco products to pay for tobacco control.

My understanding is that, in total, smokers spend nearly £11 billion on tax-paid tobacco products, more than three-quarters of which goes to the Government in taxes. We know that the majority of smokers are not well off; they often suffer multiple disadvantages. We must compare that huge tax take with the pitiful amount that is actually spent by the Government encouraging people to stop smoking. It is certainly not enough to make England smoke-free by 2030.

I listened carefully to the Minister’s introductory remarks. The noble Lord, Lord Kamall, objected to the terms of the amendment of the noble Lord, Lord Crisp, because, he said, the independent review had not yet reported and therefore we were seeking to pre-empt what the review will say. I thought the noble Lord, Lord Crisp, responded to that incredibly well. I do not think he is seeking to pre-empt the review; his amendment asks the Government to consult on recommendations in the review if the Secretary of State thinks that it is required. It is left entirely in the Secretary of State’s hands to act according to whether he or she considers that the recommendations should be consulted on.

This is a sensible amendment, it points us in the right direction, and I hope that, even at this late stage, Ministers may be sympathetic.

[Lord Rennard (LD)]

My Lords, if I understood the Minister correctly in his introductory remarks, he was saying that the Government’s case against the amendment is that they do not want to consult on something to which they are not already committed. So what is the point of consultations if they are only on things to which the Government are already committed? Should the Government not consult on what they might do, and take into account the opinions of experts and others?

Amendment 85B, in the name of the noble Lord, Lord Crisp, has the support of these Benches. It is in accordance with my party’s policy but, more importantly, it is essential to the Government’s stated objective of reducing the prevalence of smoking to below 5% by 2030. The amendment does not require the Government to do anything that they do not want to do; it just asks them to consult on something which they have said that they would consider—namely, to make tobacco companies pay more towards helping save and prolong the lives of their customers.

Last year, I found myself outside the HQ of British American Tobacco. It is an enormous headquarters: it looked like a palace of which any Russian oligarch would be proud. This company makes huge profits that could be diverted towards ameliorating the damage done by its products. The amendment would mean taking action to help people live longer and more healthily, with fewer families living in poverty because of smoking.

I expect we will have more warm words from the Minister and from the Department of Health and Social Care, but I believe that Parliament wants to adopt the polluter pays principle in relation to tobacco. So I end with a quote from a great parliamentarian, John Pym, who, in 1628—I am sorry that I do not have the Hansard reference—said: “Actions are more precious than words”.

Health and Care Bill

Lord Rennard Excerpts

Lords Hansard - Part 1 & Committee stage
Monday 24th January 2022 Lords Chamber

We need Amendment 72 in order to provide greater certainty for patients to be able to choose elective care providers, to reduce the enormous backlog of treatment and to send a message to NHS staff about the rights of patients. I hope that the Minister will accept these arguments and will be able to answer my questions. I beg to move.

[Lord Rennard (LD)]

My Lords, I support Amendments 109 and 226 in this group, both of which are in my name and that of the noble Lord, Lord Hunt of Kings Heath. I will address them from the perspective of people with diabetes and with the support of the Juvenile Diabetes Research Foundation and Diabetes UK.

It is just over 100 years since insulin was discovered. Before 1921, a type 1 diabetic would live for no more than a year or two from when the condition became discernible. In the 1920s, my father, a World War I veteran, developed diabetes, and he was very fortunate that this was the decade in which insulin was discovered. It was so successful that it enabled him to have a long and happy life—indeed, I was born when he was 71, and my younger brother was born when he was 73.

Much progress has been made in the treatment of diabetes over the last 100 years, but we are not making the most of technological developments relating to insulin use and diabetes management. I have struggled with these issues myself, and I have learned much about them since I became dependent on insulin in 1994. I personally have enormous reason to be grateful to the diabetic team at St Thomas’ Hospital, just over the river from us, but not everyone with diabetes gets that standard of care, and progress with the adoption of the most recent technology is simply too slow.

There have been great developments in wearable medical technology, such as insulin pumps, flash glucose monitoring and continuous glucose monitoring. We are making progress with such innovations and in NICE’s obtaining approval for them, but they are often not widely accessible. Access to technology, including linking a person’s insulin pump and a continuous glucose monitor, may help a person to self-manage their condition in the absence of routine NHS support. The long-term cost savings are demonstrated by the wider use of such technology in insurance-based systems, where the outlay must be justified by reducing the costs of later complications, which can be very considerable.

Diabetes probably now takes up 10% of the NHS budget, and 80% of the cost of diabetes relates to complications, with the largest costs arising from excess in-patient days, cardiovascular disease and damaged kidneys and nerves. The latest technology may enable parents of young people with type 1 diabetes to obtain a full night’s sleeping soundly, knowing that their child’s glucose monitor will issue an alarm and wake them up if they experience a severe high or low-glucose episode. New technology has been shown to support blood glucose stability and to lower average blood sugar levels, reducing potential health complications and hypos or hypers, which can lead to coma or even death if not treated. There are great benefits to physical and mental health from better long-term control of blood sugar levels.

Research by JDRF shows that barriers to the uptake of this technology include the fact that many clinicians are not trained in it and that the pressure on appointments means that there is often not time to discuss treatment options. Amendment 109 would require NHS England’s oversight framework for integrated care systems to include a metric on the percentage of diabetes patients in their area accessing diabetes technology. An embedded requirement that would better support the prescription of technology would incentivise better training for clinicians and encourage more time to be provided in appointments to discuss technological treatment options and any potential fears or concerns of the patient.

Amendment 226 concerns the promotion of self-management using the latest technologies. We need it in order to reduce the number of people with diabetes suffering from complications, which may include sight loss and problems with their feet, presently resulting in around 6,000 amputations per year. When in hospital, people with type 1 diabetes require five times more secondary care support than people without diabetes, so it is essential that the NHS invests in technology that can significantly reduce the instances of hospitalisation and adverse health outcomes for people with type 1 diabetes.

[Lord Lansley (Con)]

My Lords, I thought those were very interesting and helpful remarks from the noble Lord, Lord Rennard. They serve to remind us of the importance of self-management in securing the best possible outcomes for patients. I just add the thought that, when the Government promulgate regulations relating to patient choice, one of the things we want to include is shared decision-making between clinicians and patients. In my observed experience, that too can deliver better outcomes. I think we have made significant progress in recent years in encouraging shared decision-making, and I hope we will see that come forward.

In moving Amendment 72, the noble Lord, Lord Warner, touched on a range of issues. I will not go down one or two paths, but I highlight that we will need to think hard about the interconnections between the question of patient choice and how far patients continue to be given choice. We need to ensure that it is not just talked about in the constitution or in regulations that say it is generally a good thing. For choice to happen in practice, subsequent clauses in the Bill relating to procurement, such as Clause 70, need to enable a choice of providers. The noble Lord made that perfectly clear.

The clause relating to payment systems—Clause 68, if my memory serves me correctly—still needs to have a “money follows the patient” approach. It is not me saying that these are all good things; they were put in place by the Blair Government, not the coalition Government, who did not do away with them but entrenched them.

I am worried. I will just make this point about Clause 70, the effect of which is to repeal Section 75 of the 2012 legislation. Included within that was that one of the requirements of the procurement regulations would be to support the right to patient choice, and the Government are proposing to repeal that.

The Minister may well, perfectly correctly, say, “That may be so, but we have the power in this Bill to set regulations relating to patient choice”, but this is separate, and, in the event, we may find that the link is broken between procurement and payment and patient choice. The net effect would be that patient choice is vitiated. I am worried, for exactly the reasons that I think the noble Lord, Lord Warner, is worried, that what has been around for some 18 years in one form or another—the expectations on the part of patients that they can exercise choice—may not be able to be exercised in practice because the preference of the NHS in many of these localities is to operate as a monopoly and not to give any opportunities for that choice actually to function.

Our debate on this group would be far better and easier to have—and might not even be needed—if the Government published the regulations under Clause 68 in draft so that we can see what they are proposing to do. They have not done it; between now and Report they could do it. When we get to Report, we are going to have a very difficult—certainly from my own personal point of view—set of conversations about how patient choice is to be exercised, how the NHS is to get best value from its procurement, and how trusts and providers are to be paid appropriately, rather than simply go back to block budgets. How do we get out of that debate? The answer is: let us see what the regulations the Government are proposing—in this case relating to patient choice—actually look like, and let us see it before Report.

Health and Care Bill

Lord Rennard Excerpts

Committee stage
Thursday 20th January 2022 Lords Chamber

[Lord Rennard (LD)]

My Lords, I draw the Committee’s attention to my registered interests in healthcare equipment. I have added my name to Amendment 50, moved by the noble Lord, Lord Black of Brentwood. The noble Lord, Lord Hunt of Kings Heath, demonstrated clearly, as have others, that it simply cannot be said that the amendment is unnecessary.

The recent report on fracture liaison services from the APPG on Osteoporosis and Bone Health makes important reading. It shows clearly that the health and independence of tens of thousands of older people who suffer from osteoporosis are threatened by great inconsistencies in accessing vital services and treatment. Far too many people are suffering multiple fractures before their condition is properly diagnosed. Much unnecessary pain is caused and more permanent disability results from failures to diagnose osteoporosis in thousands of cases. Those failures add significantly to the future costs of the NHS and care system than would have been the case with early diagnosis.

The Committee has already heard from the noble Lord, Lord Black, of the significant cost savings to the NHS where a fracture liaison service is in place. The Royal Osteoporosis Society estimates that extending fracture liaison service provision to cover the whole population would require a modest initial investment of about £27 million in England and £2 million in Wales. There should be much more long-term cost-benefit analysis of provision such as this, and it would more than justify those sums of expenditure.

There are many examples in preventive healthcare where focused interventions dramatically improve outcomes for patients and cut long-term costs. We need to raise awareness of conditions such as osteoporosis, provide more education and training for healthcare providers about diagnosing it and increase support for people who suffer from it. Osteoporosis is a long-term condition. It is more prevalent than many people realise and we should all recognise that a spinal or hip fracture is equivalent to a heart attack or stroke in terms of its clinical implications. Fractures are often preventable through use of pharmacological treatments supported by lifestyle modifications, which include appropriate exercise and smoking cessation as well as nutritional supplements such as calcium and vitamin D.

There needs to be much greater public awareness of how to maintain or improve bone health, particularly for the most at-risk populations. The introduction of integrated care boards will provide an opportunity to better co-ordinate and integrate fracture prevention and osteoporosis care. It is currently too dispersed across different parts of the system, as so often our short debate on this group of amendments has shown is the case. For fracture liaison services we need universal access. We need a clear mandate from government that the new boards have a specific responsibility to provide fracture liaison services for the whole population.

Health and Care Bill

Lord Rennard Excerpts

Lords Hansard - Part 1 & Committee stage
Thursday 13th January 2022 Lords Chamber

[The Lord Bishop of Carlisle]

My Lords, I will speak on behalf of my noble friend the right reverend Prelate the Bishop of London. She has added her name to Amendment 65, and we on these Benches support the other amendments in this group that seek to reduce health inequalities. As we have heard, these amendments would help to ensure that the Bill does not forget the underserved and disadvantaged in our society, many of whom have been mentioned already.

In the Christian and Jewish faiths, there is a Biblical concept—shalom—which embodies a sense of flourishing, generosity and abundance. Shalom can be summarised as experiencing wholeness, or a state of being without gaps. This is reflected in the World Health Organization’s definition of health, which is about not only the absence of disease but mental, physical and social well-being. It is a vision for individuals and for the whole of society. Our efforts to design a more holistic health service are, in effect, aimed at achieving that sort of shalom. We see this clearly in the decision made to place 42 integrated care systems across the country. What is not yet apparent is the relationship of these systems and boards to the wider community.

This Bill must seek to involve local communities—and not just professionals—in the reduction of health inequalities. These amendments highlight the monitoring of both physical and mental inequalities, take account of the experiences of young people and children and place more emphasis on the strength of local interventions to help reduce and prevent health inequalities. I commend them wholeheartedly to your Lordships’ House and to the Minister.

[Lord Rennard (LD)]

My Lords, I rise in support of these amendments, in particular Amendment 66 in my name and those of the noble Lords, Lord Young of Cookham and Lord Faulkner of Worcester.

This amendment would expand the duties of integrated care boards. We want them to exercise their functions with respect to reducing inequalities relating to

“modifiable risk factors, such as smoking.”

Our aim is to help the Government achieve their manifesto commitments to reduce health inequality, level up and increase healthy life expectancy by five years by 2035. This amendment would mean that integrated care boards would have a responsibility to reduce inequalities in access to health services and the outcomes achieved. They would also be responsible, in consultation with partners such as local health and well-being boards, for drafting joint five-year plans to explain how they would discharge their responsibilities, including those to reduce inequalities.

At present, there are significant inequalities in both patient access to health services and in the outcomes achieved. The biggest causes of inequalities in health outcomes are behavioural risk factors, such as smoking, obesity and alcohol. As the noble Lord, Lord Young of Cookham, said, smoking alone is responsible for half the difference in life expectancy between the richest and poorest in society. It is a greater source of health inequality than social position and it remains the leading cause of premature death in this country.

We all hope that the integrated care systems will contribute significantly to reducing inequalities in smoking and other behavioural issues, but they are likely to succeed only if addressing such modifiable risk factors becomes a core function of the NHS, working in collaboration with local authorities. Amendment 66 would ensure this.

The difference in healthy life expectancy between those living in the most and least deprived areas of England is around 19 years for both men and women—in other words, almost two decades. Let us look at one place in particular. As measured by the index of multiple deprivation, Blackpool is, sadly, top of the table of the most deprived local districts in the country. Over the last decade it has consistently had one of the highest smoking rates in the country, at over 20%. Most distressingly, more than 20% of mothers in Blackpool are smokers at the time they give birth. So our amendment is needed because the recently published NHS inequalities strategy—which is impressive in parts—does not address the behavioural causes of health inequalities. In fact, it says nothing about them at all.

The Government’s inequality strategy sets out five clinical areas that are crucial to improving health outcomes for the poorest 20% in society. They are chronic respiratory disease, serious mental illness, early cancer diagnosis, maternity and—last but not least—identifying people with high blood pressure who need to be pre-treated to prevent heart attacks and strokes. In all these areas, behavioural factors such as smoking, obesity and alcohol very significantly increase the dangers to health. If appropriate action is taken, it can greatly improve patient outcomes and, at the same time, reduce pressure on our NHS.

To take just one example, chronic respiratory disease is caused primarily by smoking. It is estimated that smoking is responsible for 90% of chronic obstructive pulmonary disease, but one-third of patients diagnosed with COPD carry on smoking. There is nothing in the NHS England inequalities strategy about this, and no target for reducing smoking rates among those with chronic respiratory disease. Yet stopping smoking is the most effective and cost-effective treatment. Only by quitting smoking can those with COPD prevent further decline in lung function.

Smoking, obesity and alcohol are also causally linked to cancer and hypertension. People with mental health conditions die on average 10 to 20 years earlier than the general population. Smoking is the single largest factor in this shocking difference. The question we must therefore ask today is this: given that modifiable behaviour risk factors are core to all five identified clinical focus areas, why are they not included in the NHS England inequality strategy? Perhaps it is because the Government do not see addressing these population-level health risk factors as a core responsibility of the NHS.

Health and Care Bill

Lord Rennard Excerpts

2nd reading
Tuesday 7th December 2021 Lords Chamber

[Lord Rennard (LD)]

My Lords, last Friday, we had an excellent Second Reading debate on the Private Member’s Bill of the noble Lord, Lord Young of Cookham, on cigarette stick health warnings. As the noble Lord, Lord Kamall, said then, we have made progress over the past two decades, with a range of measures to help smokers quit and to prevent future generations using tobacco. But there is much more to be done. Smoking is responsible for the half the difference in life expectancy between the richest and the poorest in our society. There are still over six million smokers in the UK, and at current rates of decline we will miss the Smokefree 2030 deadline by five years nationally and by 17 years in the most deprived communities. So, further measures are necessary if we are to reduce health inequalities and increase healthy life expectancy, both of which are government manifesto commitments.

The detail of what is required is set out in the latest report from the All-Party Parliamentary Group on Smoking and Health, of which I am a member. I am pleased that the Government have committed to considering its recommendations for the forthcoming tobacco control plan. However, as the Minister told us on Friday that publication of the plan has been delayed from July 2021 to some time in 2022, amendments to this Bill are needed to accelerate progress in reducing smoking prevalence and to deliver the Government’s Smokefree 2030 ambition.

The Minister will not be surprised to hear that I and others will table amendments to this Bill to consult on the introduction of a “polluter pays” levy on tobacco manufacturers, to fund lifesaving measures to help smokers quit and prevent youth uptake, to close loopholes in existing regulations and to ratchet up regulation of tobacco through measures such as the proposal from the noble Lord, Lord Young, to put health warnings on cigarettes themselves.

In all debates about health and social care, we spend a great deal of time discussing the costs of the increasing demands upon the system, but probably too little agreeing measures to curb the rising level of those demands. Better education and greater information about health issues is vital, but funding for public health issues has not been protected in recent years in the same way as the costs for treating the consequences of illnesses. Personally, I wish there had been much better education about diet and greater understanding of the importance of physical education in my youth. I should have learned more about issues connected with diabetes before I was diagnosed with the condition.

Across the UK, the number of people diagnosed with diabetes has doubled in the last 15 years and it is estimated that the costs associated with it account for 10% of NHS expenditure. We need to support the provisions in the Bill on restricting the advertising of less healthy food and drink and recognise the importance of these measures in reducing the significant harms that can come from diabetes. People struggling with obesity and diabetic control, children especially, are not helped by the advertising of foods that are high in fat, sugar or salt. We need to strengthen nutrition labelling requirements.

For people with diabetes who need insulin, which includes all type 1 diabetics, we need to address the short-termism that denies many of them access to continuous glucose monitoring systems and technology such as insulin pumps that can help them to maintain good diabetic control. Complications from poor diabetic control can include heart attacks, strokes and amputations, as well as kidney damage, loss of eyesight and mental health problems.

In 2017, the report produced by the Medical Technology Group showed that

“80% of the cost of Type 1 diabetes is spent on treating complications—many of which are avoidable.”

We all know that the NHS is under many great pressures, but we can reduce those pressures by reducing the number of people in hospital and by looking to increase investment in technologies that help people with diabetes to improve their control.

Cigarette Stick Health Warnings Bill [HL]

Lord Rennard Excerpts

2nd reading
Friday 3rd December 2021 Lords Chamber

[Lord Rennard (LD)]

My Lords, almost exactly 20 years ago, I described in this place how 300 lives were being lost each day in this country because of smoking tobacco. I asked then what the scale of public outcry demanding action would be if a similar number of lives were lost as, say, the result of a plane crash occurring every single day. My speech was in support of my noble friend Lord Clement-Jones’s Tobacco Advertising and Promotion Bill, a Private Member’s Bill which he successfully steered through all its stages and which, when it became law, largely banned tobacco advertising.

Measures of tobacco control such as that have been shown to be effective and significantly reduced rates of smoking in this country. The facts have refuted the many self-interested and bogus claims made over many years by the proponents of the tobacco industry. However, further action is needed because smoking remains a leading cause of premature death, now killing around 250 people every day in the UK. To put that in perspective, 151 people died yesterday as a result of the Covid pandemic. People should be horrified to hear that smoking is likely to have killed more people last year than Covid-19.

We need this Bill to help reduce the appeal of cigarettes to children and young people and to encourage existing smokers to quit. Who could seriously disagree with those aims, given that half of all people who smoke will die because of the habit and most people who take up smoking do so when they are young?

The warnings on cigarette packs have helped to inform smokers of the serious dangers associated with the habit and helped some of them to quit, but evidence shows that the effectiveness of pack warnings wanes over time, and new measures are needed to grab the attention of those who continue to smoke.

It is a terrible thing, as the noble Lord, Lord Young of Cookham, referred to, that many children have access to individual cigarettes. This means that a health warning on individual cigarettes is necessary to help prevent young people taking up the habit. Warnings on cigarette sticks are a logical next step, following the successful introduction of warnings on cigarette packs.

Reducing the number of children and young people who take up smoking is vital if we are to reduce health inequalities. Half of the difference in life expectancy between those in the poorest communities and those in the most affluent in this country is accounted for by smoking tobacco. Tackling this issue is a must if levelling up is ever to be a meaningful and not meaningless slogan. Around two-thirds of adult smokers take up smoking as children. Currently, 280 children take up smoking every day in England. Only a third of these children will presently succeed in quitting during their lifetime, and another third will die of a smoking-related disease.

The Bill’s proposal should not be seen in isolation, but as part of a comprehensive strategy for delivering the smoke-free by 2030 ambition, which is government policy and to which we all subscribe. The detail of all that is required was set out in the latest report from the All-Party Group on Smoking and Health, of which I am proud to be a member. I am pleased that the Government have committed to considering its recommendations for the forthcoming tobacco control plan, but we are still waiting to hear when we will see the details of that plan, publication of which is not yet in sight.

We cannot afford to wait before acting. The Health and Care Bill presents a perfect opportunity to enact measures to reduce the prevalence of tobacco smoking and, in particular, to reduce the number of children and young people who become addicted to it. The Government’s Bill could provide for the introduction of dissuasive cigarettes, as suggested in this Bill. Further amendments could provide for a complementary package of proposals to address the loopholes in existing legislation, strengthen tobacco regulation still further and provide the funding for tobacco control measures, which are desperately needed if the Government’s stated ambition of being smoke-free by 2030 is to be achieved.

In the meantime, we should signal strong support for this Bill, as we did 20 years ago for my noble friend Lord Clement-Jones’s Tobacco Advertising and Promotion Bill. As I said then:

“There are many terrible things in this world: natural disasters and those made by man. Sadly, there is nothing we can do about many of them. But smoking-related deaths and illnesses are terrible things about which we can do something, by supporting the Bill.”—[Official Report, 2/11/01; col. 1685.]

Smoking Cessation: Prescription of E-cigarettes

Lord Rennard Excerpts

Tuesday 2nd November 2021 Lords Chamber

[Lord Rennard (LD)]

My Lords, e-cigarettes are undoubtedly part of the way forward to achieving a smoke-free Britain. But why has it taken so long to get to this point and to begin fulfilling what was in the 2017 tobacco control plan and to adopt the recommendations of the 2018 Select Committee, chaired by Sir Norman Lamb, which highlighted the significant benefits of having medicinally licensed e-cigarettes which could be prescribed? How do we know that licensing will now proceed in a timely manner?

[Lord Kamall (Con)]

The MHRA has been quite clear that it wants to be in a position to license a product as soon as possible—it says 18 to 24 months. Noble Lords may well want to push the MHRA on that, and that is part of your Lordships’ role. But it is important that we make sure that, when we license a product, both consumers and public health experts can have faith in it.

COVID-19: Type 2 Diabetes

Lord Rennard Excerpts

Thursday 21st October 2021 Lords Chamber

[Lord Kamall (Con)]

I am beginning to wish I had eaten a full breakfast. With any strategy or programme, we always have to be careful about unintended consequences. As we focus more on obesity and make more people aware of healthy living and healthy eating, it is important to have the right balance and to be aware of the impact this can have, so that we are not creating more problems, concerns and anxieties for those who suffer from eating disorders.

[Lord Rennard (LD)]

My Lords, one in three deaths during the first period of the pandemic were among people with diabetes. Obesity accounts for most of the risk of developing type 2 diabetes and, even without the problems of the pandemic, a type 2 diabetic, such as me, at my age, is expected to put on one or two kilos every year. Will the Minister now look to reverse what the King’s Fund says is, in real terms, a £1 billion cut in local authority public health budgets since 2015, and at providing even more support for programmes such as GP referral to fitness classes, which can help people manage their diabetes more effectively?

[Lord Kamall (Con)]

As well as looking at the important role that funding can play, it is important to do better with the money available. There are many things we can do to make sure that the programmes we have are more effective, but I repeat that we have to make sure that they work and we have to look at the evidence. When discussing the evidence internally in the department, I have been told that many of these programmes will be reviewed after five years to make sure that they are effective and do not lead to unintended consequences.

Folic Acid

Lord Rennard Excerpts

Monday 26th April 2021 Lords Chamber

[Lord Bethell (Con)]

I hear the frustration loud and clear and reassure the noble Baroness that we are working on this at pace.

[Lord Rennard (LD)]

My Lords, in response to numerous questions and debates on this subject over the years, no Minister has ever produced a satisfactory explanation of why we do not add folic acid to flour. Would it have made any difference if the folic acid suppliers had had the Prime Minister’s mobile phone number?

[Lord Bethell (Con)]

No.

Alcohol Harm Commission: Report 2020

Lord Rennard Excerpts

Thursday 22nd April 2021 Grand Committee

[Lord Rennard (LD)]

My Lords, introducing minimum unit pricing for England was a key recommendation of the commission. A strong evidence base for this was provided by a wide range of organisations, including the Children’s Society, the Association of Directors of Public Health, Cancer Research UK, the British Medical Association and several local authorities. A 50p minimum unit price in England has been estimated to lead to almost 22,000 fewer hospital admissions and 525 fewer deaths per year when in full effect. This would save the NHS £1.3 billion annually. As hospitals deal with the consequences of Covid-19, freeing up capacity is essential. People who live in poverty are more vulnerable to the effects of alcohol abuse. It is estimated that nine in 10 lives saved by minimum unit pricing would be from low-income groups. Yet the spokespeople for some business groups and right-wing organisations oppose minimum unit pricing, citing their previously rarely expressed concerns about poverty, when their real concerns are simply about profits. We need to remember that alcohol has a major impact on the public’s health.

Alcohol can cause over 200 conditions including cancer, heart disease, liver disease, stroke and mental health problems. When I asked a Question about this issue three years ago, the noble Lord, Lord O’Shaughnessy, then the Health Minister, cited evidence that

“in 10 years, minimum unit pricing could on an annual basis reduce alcohol-related deaths by 356, alcohol-related hospital admissions by 28,515, and crime by 34,931 crimes.”—[Official Report, 28/2/18; col. 654.]

But we were told to wait for more evidence from Scotland and elsewhere. We now have that evidence. The policy is working in Scotland; it is being introduced in Wales. We should not have to wait any longer in England.