Tobacco Control Plan

Lord Rennard Excerpts

Thursday 23rd February 2017 Lords Chamber

Asked by

[Lord Rennard]

To ask Her Majesty’s Government whether they will maintain their commitment to reducing smoking prevalence by publishing the latest Tobacco Control Plan for England without delay.

[The Parliamentary Under-Secretary of State, Department of Health (Lord O’Shaughnessy) (Con)]

My Lords, the Government remain committed to reducing the harm caused by tobacco. We should be proud of the progress we have made in reducing smoking rates to a record low in this country. Our new tobacco control plan will build on this success. We are at an advanced stage of development of the plan, and we will be publishing it shortly.

--- Later in debate ---

[Lord Rennard (LD)]

My Lords, in the north-east of England smoking rates have fallen by about one-third in recent years, thanks in part to the very cost-effective mass media campaigns run by Fresh North East, the regional tobacco control office. Nationally, though, funding for such cost-effective campaigns has been reduced to less than one-quarter of pre-2010 levels. Can the Minister reassure the House that the funding for such cost-effective campaigns will be restored in the new tobacco control plan?

[Lord O’Shaughnessy]

The noble Lord is quite right to highlight the effectiveness of mass media campaigns, and they will continue to be part of the new tobacco control plan. These include Public Health England’s Stoptober campaign and the health harm campaigns. The noble Lord gives us an example of an effective local campaign. I would also highlight the “16 Cancers” campaign in Yorkshire and Humber, which saw 740,000 smokers recalling the campaign and half of them taking a quit-related action.

Young People: Self-Harm

Lord Rennard Excerpts

Tuesday 6th December 2016 Lords Chamber

[Lord Prior of Brampton]

Unquestionably, there is more that can be done. Some of those sites, certainly some of the pornographic sites, are being addressed in the Digital Economy Bill that is going through the House at the moment. But we are working with the national council and the Samaritans, which in turn are talking to people at Google and YouTube and the digital providers to see what we can do in this area. We have also commissioned a new prevalence study to look at cyberbullying and all those sorts of issues, which will, unfortunately, not produce its results until 2018. So we are very much apprised of this, but, frankly, there is always more that we can do.

[Lord Rennard (LD)]

My Lords, over half of all adults with mental health problems first had them diagnosed in childhood, yet fewer than half of those people diagnosed in childhood were treated appropriately at the time. Does not the Minister think that something is seriously wrong when, according to the Royal College of Psychiatrists, 25 clinical commissioning groups are spending less than £25 a year on child mental health issues and 10 CCGs are spending less than £10 a year?

[Lord Prior of Brampton]

My Lords, I think something is seriously wrong, and something has been seriously wrong since 1948. Mental health has been a Cinderella service, and children’s mental health has been, if anything, even worse. We are committed to spending an extra £1.4 billion; we are spending more money on mental health liaison services in A&E departments; and we are putting in 56 new beds in CAMHS units to prevent the out-of-area treatments or what have you. But we have a huge way to go, frankly.

Cataract Operations

Lord Rennard Excerpts

Wednesday 16th November 2016 Lords Chamber

[Lord Prior of Brampton]

The cataract operation is a remarkable one. There is a huge variation in productivity around England: some surgeons are extremely fast, and in some hospitals the process has been streamlined. Interestingly, in India, where cataract operations are largely done by technicians not doctors, the cost per operation is below $10.

[Lord Rennard (LD)]

My Lords, does the Minister accept that greater use could be made of laser eye surgery for cataracts, as has been pioneered at Frimley Park Hospital? This could result in better outcomes for patients, reduce the risk of complications and, above all, reduce waiting times, which are unacceptable —up to 15 months—at present.

[Lord Prior of Brampton]

My Lords, I do not know enough about laser eye surgery to give the noble Lord a proper response, but I will investigate. The average wait time for a cataract operation is 12 weeks, and very few people wait for more than 18 weeks—but of course, that does not alter the fact that there are people who have not been referred for a cataract operation when perhaps they should.

Smoking-Related Diseases

Lord Rennard Excerpts

Wednesday 14th September 2016 Lords Chamber

[Lord Rennard (LD)]

My Lords, smoking-related diseases create a huge burden on British society, both in human and financial terms. Smokers know how dangerous it is, but quitting is not easy. My noble friend Lord Ashdown of Norton-sub-Hamdon reminded me earlier today that he used to quit smoking three times a day.

To reduce the burden of smoking-related disease, we must continue to apply downward pressure on smoking rates. The Government must publish a new, comprehensive, properly funded tobacco control plan without further delay. We know that smokers are four times more likely to quit smoking with the combination of behavioural support and the medication offered by local stop-smoking services. These services are among the most effective healthcare interventions, quadrupling the success rate of quitting, and are therefore very good value. However, in 2014-15 around 40% of local authorities in England cut budgets for these services.

Media campaigns are also highly cost-effective, because they are highly effective in encouraging smokers to quit and preventing young people starting to smoke in the first place. Mass media should also be utilised to deliver better information on e-cigarettes, which many smokers do not realise are much less harmful than smoking tobacco. In the debate before the Summer Recess the Minister said that Public Health England would be getting this message across in its quit smoking campaigns. But we are not spending enough on such campaigns. In 2015, we spent less than a quarter of the amount that we spent on them in 2009, and we know that if they are not properly funded they cannot be effective. I would therefore be grateful if the Minister would confirm what funding will be committed to mass media for this year.

There is also a threat to the successful work undertaken with our European partners in fighting the illicit tobacco trade—a threat caused by Brexit. We know that the tobacco trade has promoted smuggling and tax evasion by dumping large quantities of cigarettes in countries where there are low rates of tobacco taxation in order for them to be smuggled illegally into countries with higher rates of tobacco taxation such as the UK. EU-wide co-operation has meant that, while tobacco taxation has risen sharply in the UK since the start of the century, the number of illicit cigarettes in our markets has halved. So I was not surprised to see support for Brexit from some of those who lobby to promote the cause of the tobacco industry. We must not let them succeed.

Tobacco and Related Products Regulations 2016

Lord Rennard Excerpts

Monday 4th July 2016 Lords Chamber

[Lord Lansley (Con)]

My Lords, from my point of view, my noble friend Lord Callanan chose to talk very selectively about the record of the Conservative Party and the coalition Government in relation to tobacco control. I think he should bear in mind that Conservatives—myself, my noble friend Lord Young of Cookham—worked hard from the Opposition Benches in another place, and succeeded in securing the ban on smoking in public places. When we came into the coalition Government together, we implemented the ban on sales through vending machines and a progressive ban on displays in shops. I also initiated the consultation on standardised packaging, following discussions with Nicola Roxon, who was then Health Minister in Australia, which my successors have taken forward. The product of all that is that we have not only secured continuing reductions in the overall prevalence of smoking—albeit I could wish this rate was faster—but we secured, I think three years ago, recognition that we had among the toughest tobacco-control regimes anywhere in the world. That is right and we should strive to make that the case.

I know it would not be the effect of the Motion in the name of my noble friend Lord Callanan, but were it passed it would indicate your Lordships’ desire to withdraw the regulations if they could. That would be an entirely retrograde step. I will not go through all the ways in which the tobacco products directive helps to strengthen the tobacco control regime other than in relation to e-cigarettes, but it certainly does.

I will isolate one important point which has not yet been mentioned. Much of what we have done in recent years, from my point of view and that of my colleagues—Anne Milton when she was Public Health Minister, and I believe it was among Anna Soubry’s and Jane Ellison’s objectives subsequently—was to focus on reducing the initiation of smoking among young people. We have some 200,000 young people a year initiating smoking. That is what we have to bring down. We want to arrive at the point where the initiation of smoking is minimised. As part of that, we have to look frankly and critically at how electronic cigarettes and vaping can contribute to the reduction of smoking, through access to smoking cessation services. It is absolutely right and I do not have any brief against e-cigarettes in that respect. But, to pick up the final point made by the noble Lord, Lord Faulkner of Worcester, we have to understand what the social and behavioural impacts of large numbers of people continuing to smoke e-cigarettes in the long term look like. I am not sure that promoting it through advertising is necessarily the right way to go.

We should enable smokers to access e-cigarettes and vaping, and do everything we can through the public health budget. Noble Lords will know—I will go into it on another day when more time allows—that my objective in creating a separate public health budget with local authorities was to maximise and protect our preventive activity, not to see it subsequently reduced. I deplore that fact because we were making considerable progress with smoking cessation services, as we should. But we also have to ensure, in addition to the use of e-cigarettes in a way that reduces smoking, that we do not create a new mechanism which might entrench in young people an expectation that they should initiate any kind of smoking, be it through vaping and using e-cigarettes or, even worse, through smoking tobacco. For that reason I agree entirely with many other speakers that it would be undesirable to support my noble friend’s Motion, and I hope that the Minister will agree that we should reject it.

[Lord Rennard (LD)]

My Lords, the noble Lord, Lord Lansley, is to be greatly congratulated on his tremendous record of achievement in this area, and his advice this evening should be followed very carefully. I must declare my interest as a former director of Action on Smoking and Health. There is a consensus in the debate that using e-cigarettes is much safer than smoking. Together with other clean nicotine products, they have an important role to play in cutting tobacco consumption and improving public health, but I do not agree with the e-cigarette trade body brief which has been circulated. It claims that nicotine is not itself dangerous. As the noble Baroness, Lady Hollins, pointed out so effectively, we have to recognise that nicotine is a known toxin that is poisonous when swallowed and is also addictive.

I do not want to see e-cigarettes subject to more regulation than is necessary, but I do want to see them subject to all the appropriate regulation necessary to support public health objectives. We know that the best chance of success for people seeking to quit smoking is to use smoking cessation services as well as alternative nicotine products in order to help reduce withdrawal symptoms. The regulatory regime required for e-cigarettes and related products must be one that supports their use by smokers trying to quit. It is also right to discourage their use by children and young people who have never smoked. Both these objectives are supported by the regulations being introduced.

I agree with the many noble Lords who have said that we need a public information campaign to reassure smokers that electronic cigarettes are less harmful than normal smoking but, as the Motion in the name of the noble Lord, Lord Hunt, points out, there have been major cuts to the media campaigns to persuade smokers to quit. That is very regrettable because such campaigns can be highly cost effective in supporting quitting. We know that alternative nicotine products for smokers have most public benefit when they are used together with expert behavioural support. That is one reason why we need to make sure that such products can be available on prescription for people seeking help to quit tobacco products. Our approach to e-cigarettes, therefore, must be to treat them not as an exciting new social drug or as a cash cow for e-cigarette companies, many of which are owned by the tobacco industry, but as a potentially important means of improving public health and reducing the toll of death and disease caused by smoking.

The regulations under discussion are not perfect, but they include important steps in tobacco control that must not be lost and must be part of a tobacco control strategy that must be properly resourced to produce real public health dividends.

Health: Diabetes and Obesity

Lord Rennard Excerpts

Thursday 30th June 2016 Lords Chamber

[Lord Prior of Brampton]

My noble friend is absolutely right that specialist diabetic nurses have a huge role to play in helping to identify and then manage and treat people with type 1 and type 2 diabetes. I am sure that that role will grow over time.

[Lord Rennard (LD)]

My Lords, projections show that, in 20 years, 40% of the UK population may be defined as being obese and one-third as overweight. Is it not therefore important that we introduce restrictions, very shortly or even now, on the marketing of junk food to children?

[Lord Prior of Brampton]

My Lords, that issue will be addressed in the obesity strategy, which comes out later this year. The levy that has been announced will, I think, lead to the reformulation of high-sugar fizzy drinks, which is a start in the right direction. It is largely a question of diet, as the noble Lord said, but also exercise and many other factors, which will be in the obesity strategy that comes out later in the year. Clearly, making it more difficult for young people to access junk food will be an important part of that strategy.

NHS: Unsafe Hospital Discharges

Lord Rennard Excerpts

Wednesday 15th June 2016 Lords Chamber

[Lord Prior of Brampton]

I cannot give the noble Lord a reason off the cuff. It is very much a part of the better care fund. There is a CQUIN for 2016-17 that is focused on delayed discharges. One of the fundamental purposes underlying the STPs and the vanguards, which are a critical part of taking the Five Year Forward View into a serious plan, is to reduce delayed discharges and improve the relationship between acute care and social care.

[Lord Rennard (LD)]

My Lords, given that those nine cases were considered to be representative of the problem, does the Minister agree that it might be cost-effective to make greater use of voluntary sector organisations such as Age UK in better preparing people who are frail, elderly and on their own for going into hospital, and then looking after them when they are leaving, to avoid unnecessary, expensive and painful readmissions to hospital?

[Lord Prior of Brampton]

The third and voluntary sectors have a potentially huge role to play. I was talking this week to the chairman of the Chelsea and Westminster Hospital about the plans he had for involving the voluntary sector far more in discharge planning, particularly for frail and elderly people. I agree entirely with the noble Lord’s sentiments.

Health: Treatment Rationing

Lord Rennard Excerpts

Tuesday 26th April 2016 Lords Chamber

[Lord Prior of Brampton]

The noble Lord has encapsulated well the recommendation of the report of the Royal College of Surgeons, which is that all decisions about individual patients should be taken on clinical grounds as they affect the particular patient.

[Lord Rennard (LD)]

My Lords, does the Minister accept that the reduction in expenditure on public health of £200 million a year may make it harder to reduce the prevalence of tobacco smoking and obesity, and that in these circumstances patients referred to smoking cessation courses or weight management courses may find it more difficult to get the support they need? In those circumstances, they may need more guidance and support on how to challenge the decisions of CCGs, if they are being discriminated against unfairly and in breach of national guidelines.

[Lord Prior of Brampton]

My Lords, the success that this country has had on smoking reduction has been pretty exceptional. The strategy on obesity that the Government will announce soon will mark a new priority in addressing the problems of obesity. I do not think there is any evidence to suggest that the reductions to which the noble Lord referred are having any discernible impact on the number of people receiving support on smoking cessation and obesity reduction before surgery.

Health: Neural Tube Defects

Lord Rennard Excerpts

Monday 21st March 2016 Lords Chamber

[Lord Prior of Brampton]

My Lords, I am not going to argue the science, because the link between folate levels and neural tube defects is fairly well proven. Although our decisions should be informed by scientists and doctors, I do not think that they should be determined by them. The balance between individual responsibility and state responsibility is best left to political judgment.

[Lord Rennard (LD)]

My Lords, given that the Minister accepts the link between a lack of folic acid in the diet and neural tube defects, why will he not look again at the advice from, for example, the Royal College of Obstetricians and Gynaecologists, the Food Standards Agency and the BMA that we should be putting folic acid into food products, as is done in many other countries, including the United States of America?

[Lord Prior of Brampton]

Fortifying bread with folic acid is not a silver bullet that would cure all babies with neural tube defects. The estimate is that it would have an impact on between 15% and 30% of babies. Some 965 babies suffer from neural tube defects a year, so we are talking about fortifying flour for the whole population in order to reach about 120 babies.

General Practitioners: Appointments

Lord Rennard Excerpts

Thursday 17th March 2016 Grand Committee

[Lord Rennard (LD)]

My Lords, I declare my interests as in the register. There is of course much controversy at present concerning what I will call the Government’s preoccupation with the weekend working practices of junior hospital doctors but it seems to me that many people in need of medical support would have preferred the Government to keep concentrating on issues such as strengthening out-of-hours services for GPs and using modern technology to enable people more easily to interact with a GP.

Of course, much progress on these issues was being made prior to the general election and I am seeking some reassurance in this debate that that progress will continue. Just prior to the general election, it was announced that GPs in more than 1,400 practices across England would receive £550 million of government funding to reorganise their services so that surgeries could be open from 8 am to 8 pm, seven days a week. My good friend Norman Lamb, who was then the Care Minister, told me he hoped that some of this funding would lead to much greater use in those practices of patient consultations by videolink, email and telephone, together with a greater provision of online booking services. I hope that the Minister will be able to tell us about progress since that announcement last March.

That funding, however, was directed at slightly fewer than one in five GP practices in England so I hope that we might also hear more today about how the remaining 80% of GP practices can be supported in improving access for their patients. This is both very important in terms of improving patient care and essential if we are to avoid the crisis in our hospitals getting even worse. I would like to hear from the Minister about how the £250 million infrastructure fund, which was first announced in the 2014 Autumn Statement, is helping to improve and provide more integrated health centres and more use of technology. The Government’s press release at the time claimed that they would help to fund additional services, including on-site pharmacists, speech therapists, minor surgery and diagnostic tests. It was also intended to make it easier for GPs to return to the profession following a career break, encourage more medical students to take careers as GPs, and enable GPs considering retirement to work reduced hours in the interim. This timely debate will allow the Minister to describe, I hope, progress on these issues over the past 12 months.

However, we need to go much further and be much bolder in using new technology to improve access to GPs. Ten years ago I visited India and looked at the provision of health services in remote rural areas, where access to a GP, let alone a hospital, was bound to be extremely difficult. I was very impressed by the use of webcams in specially equipped vehicles that could tour rural areas and with the help of a trained nurse allow some basic tests to be undertaken and a face-to-face conversation to be held with a GP or even a consultant. This made me think about how we could do much more in this country, using new technology, to let people talk to a GP without necessarily visiting the surgery. As technology develops, those GPs or other people, including carers and family members, can monitor certain conditions remotely.

My own Fitbit tells me how many steps I have walked each day, and what my heart rate and my sleeping pattern are. While I do not wish to share this information with anybody else, it is easy to do so. I acknowledge at this point that it was active intervention by my own GP’s practice that led me to undertake a more active exercise regime and improve my own diabetic control. In time, I expect that my blood pressure and glucose levels will be monitored remotely by health professionals.

For some elderly or housebound residents, this could be a good way for GPs to help keep an eye on them without clogging up their surgeries, while enabling the professionals to determine properly whether or not an appointment is really necessary. At the moment, getting an appointment when needed is often very difficult. Getting access to a doctor at night is usually extremely difficult, but this was not always so. Something has gone wrong when people feel the need to turn up at A&E if they can or call an ambulance when they should really have been seen by a GP at a surgery or in their home.

These problems are well illustrated in the recent report by the Public Accounts Committee in the House of Commons, which highlighted the following facts. There are simply not enough GPs to meet demand. Deprived areas are particularly short of GPs and nurses. Finally, there is much variation in patients’ experience of getting and making appointments, with people who work full-time among those who are most disadvantaged.

It is also clear from that report that information about basic facts, such as services provided at GPs’ surgeries and the availability of those services, is sometimes difficult to obtain. The report also makes it clear that the Department of Health and NHS England do not have the data that they need to make well-informed decisions about how to improve access to general practice or where to direct their limited resources. In the long run, these issues come down to improving the way in which we try to do things, endeavouring to make efficiency savings. But without a doubt, funding is the major issue.

The results of the most recent general elections show people’s reluctance to pay higher levels of taxation and politicians’ reluctance to ask them to do so. This is in spite of the fact that people now expect a pension from the state for a much greater proportion of their lives than ever before; with this comes the probability of them needing greater provision of health and social care. Improving access to GPs and funding the health and social care services that we need may require the introduction of a hypothecated tax in future. I believe that all parties should be considering this option if they are to be honest about addressing these problems. I would welcome the views of the Minister on that.