Covid-19: Obese and Overweight People

Lord Robathan Excerpts

Thursday 4th June 2020 Lords Chamber

[Lord Bethell]

The noble Baroness, Lady Brinton, is entirely right. The review has done an excellent job of laying a path for greater understanding of the disease and is informing the PHE response. GPs already have a very clear work plan for advising BME communities on the threat of diabetes, in particular, and on obesity and healthy living for all circumstances. This will be redoubled during the epidemic that we are experiencing.

[Lord Robathan (Con)]

I welcome the Minister’s statement and indeed the leadership shown by the Prime Minister, but we need to take this further and show leadership from everybody in positions of authority and in politics. I particularly home in on health professionals and teachers because, for too long, there has been, I regret to say, a large number of very overweight people in the NHS and in our schools, setting a very bad example to children and people in hospital. People must be encouraged to take personal responsibility. I am afraid that they know what makes them fat, they need to be told what makes them fat and, dare I say it, they need to be shamed for eating and drinking too much.

[Lord Bethell]

My noble friend is right that personal responsibility and the leadership of those in areas of responsibility are incredibly important. Shame is not a policy that the Government particularly endorse, but I will confess to personally having a sense that I need to lose a stone in order to be match fit for the winter. I commit to my noble friend to undertake this arduous and difficult task over the next three months and will account to him on what progress I have made.

Covid-19

Lord Robathan Excerpts

Thursday 23rd April 2020 Lords Chamber

[Lord Bethell]

The noble Baroness, Lady Ritchie, addresses a very difficult problem. The programme we are looking at, announced earlier today with the change to our guidelines, is the testing of asymptomatic carers and residents in care homes. It is a natural and growing concern that the disease may be present in an asymptomatic form. We are determined to get the infection out of our care homes and the NHS.

[Lord Robathan (Con)]

My Lords, this lockdown is hugely damaging to the country, particularly to the future prosperity and education of our young people. Nobody knows, as the Minister has just said, how many people have had or have this ghastly virus and recovered. Many suggest that it is several million, possibly many millions. If that is the case, it leads to another suggestion: the mortality rate may be less than 1%. Some say—I am not an expert on this at all—that it is as low as 0.1%. If that is the case, what implications would that have on the Government’s policy of balancing the future well-being of this country and its people with dealing with this ghastly health crisis?

[Lord Bethell]

The noble Lord, Lord Robathan, makes a fair point. I reassure him that we are investing in a massive 20,000-person surveillance by the ONS to get to the bottom of the mystery which he describes. Every piece of evidence we have from every country around the world suggests that the number of people who have been through the disease is a tiny proportion of the population, and that the amount of recovery and antibody immunity in the country is likely to be in single figures. This is one of the great challenges of the virus and the situation it presents to us.

Coronavirus Bill

Lord Robathan Excerpts

2nd reading & 2nd reading (Hansard) & 2nd reading (Hansard): House of Lords
Tuesday 24th March 2020 Lords Chamber

[Lord Robathan (Con)]

Noble Lords will be familiar with the profound words of John Donne written in 1624. That was a time of recurrent outbreaks of bubonic plague, so he knew about death and the plague:

“No man is an island entire of itself … any man’s death diminishes me … And therefore never send to know for whom the bell tolls; it tolls for thee.”


Each death from Covid-19 is a tragedy for the individual, obviously, and for every bereaved family, and we should mourn every death because anyone’s death diminishes us.

I attended two very informative briefings by the Chief Medical Officer, Chris Whitty, earlier this month. He was calm, balanced and logical. He inspired confidence. I understood—I think—the concept of herd immunity. I understood why it would be counterproductive to close schools and why it was unnecessary to ban large gatherings. I understood the concept of flattening the curve to prevent the NHS being swamped. All that seemed pragmatic and sensible.

The weekend before last, everything changed after an Imperial College study and modelling exercise estimated that there would be 250,000 deaths unless we changed tack and policy. A quarter of a million deaths is a very large number. I also understand the international situation, where other countries are taking more extreme measures that, to a certain extent, put the Government under pressure. These deaths are largely among the elderly, the frail and the sickly—people with what I have learned to call “underlying health conditions”. Each one is an individual to be valued. I also understand that it is likely that 80% of us sitting here today will contract the virus, and I have a mere 16 months before I reach my allotted span, according to the psalmist in Psalm 90, of “threescore years and ten”—memento mori.

However, it is not callous or uncaring to point out that last year 623,000 people died in the UK. On average, every day 1,700 people die. As of this morning, there have been 335 deaths from the coronavirus outbreak. Therefore, this is not the Black Death, the great plague of 1665, the Spanish flu nor war. It is a very real health crisis which should be taken very seriously indeed, but I suggest that it should also be kept in proportion. Referring to war, which people have been doing, the Blitz spirit was best summed up by the slogan “We never closed”.

The Chief Medical Officer thinks that there are many thousands more cases than the 6,650 confirmed today. My right honourable friend Jeremy Hunt, former Health Secretary and chairman of the Health Select Committee in the Commons, yesterday suggested that there were 300,000-odd cases in the UK. My untutored and entirely anecdotal guess is that there are very many more. For instance, my son at Sandhurst has had it; my daughter, 50 miles away in Oxford, has it, as has my niece in Gloucestershire; three out of 12 jurors in the trial of the alleged murderers of PC Harper have self-isolated; and there are lots more cases besides, of which we all know. They have not been tested but it seems likely that the number of additional cases is huge. Therefore, what are the implications for herd immunity and what is the likely percentage of deaths?

Now we have in this Bill draconian and oppressive restrictions. I understand the impossible position of the Government, but how long will this lockdown be imposed? The Imperial College study, which so worried the Government, says that

“this type of intensive intervention package … will need to be maintained until a vaccine becomes available (potentially 18 months or more)—given that we predict that transmission will quickly rebound if interventions are relaxed.”

It goes on to say that

“experience in China and now South Korea show that suppression is possible in the short term”,

but

“it remains to be seen whether it is possible long-term”.

I am not an epidemiologist, nor a doctor, but I have questions on government policy. Do the Government have any real idea of the numbers infected and, now, possibly developing immunity? I understand that a test for antibodies is being developed. How long will the restrictions be in force? Three weeks was mentioned yesterday. Will it be 18 months or more? Will a lockdown be effective? Will it work? And will the numbers rebound if the lockdown is lifted? Therefore, will it really achieve its stated aim of preventing transmission and saving lives in the long term?

Will these measures lead to a recession or, much worse, to another global depression? We should remember the lives destroyed in the desolation of the 1930s and, indeed, the rise of extremist parties. Will younger generations—our children, with their future in front of them and not already behind them, as in my case—think that the impact on the long-term good and prosperity of the country, on their education and on their standard of living and quality of life is worth it, especially if these oppressive restrictions do not beat the virus and people continue to die? These are rhetorical questions, because nobody knows. Only time will tell—perhaps six months, a year, or many years.

Perhaps this will be seen as a contrary view. I wish my noble friend the Minister and the Government well in this hugely difficult crisis but certainly do not like this legislation. The restrictions and closing down of our country are disproportionate. I will not oppose this, but giving these powers to the state is unprecedented outside wartime; they are draconian in so many aspects and based on a premise that may turn out to be incorrect. In my 68 years, I have learned that it is very rarely the case that the gentleman in Whitehall knows best.

Government Vision on Prevention

Lord Robathan Excerpts

Tuesday 6th November 2018 Lords Chamber

[Lord O'Shaughnessy]

On the question of trust and social licence, which is a very good expression, KPMG published a report in September which found that the NHS was the most trusted organisation in the country when it came to looking after people’s data. That is a very precious thing and we must not lose it, so a number of steps are being taken to try to reinforce that degree of trust. We have introduced a national data opt-out and very recently had the national data guardian Bill, which puts the National Data Guardian on a statutory footing to provide that security and statutory guidance to government, so that we can ensure we build on that trust. On investment in skills, we have commissioned Eric Topol to carry out a review of the skills needed in the workforce to adopt new technology, which will report soon. We also have to recruit new professions: it turns out that bioinformatics is one of the most important things to have in taking advantage of that. We do not currently train enough people in that field but we need to ensure that we do, so that every patient and every clinician can take advantage.

[Lord Robathan (Con)]

My Lords, in commending this Statement may I pick up on what the noble Baroness, Lady Walmsley, said about the obesity epidemic? I think that she used that word. Does my noble friend agree that all of us, be it in Parliament or as health professionals or teachers, have a role in setting examples to others? Does he also agree that young people and others look to us to see what we do? If we eat or drink too much, or if we smoke, they may follow. Does he also think that health professionals should perhaps be less understanding when people are grossly obese and tell them that, if they do not lose weight, they will die early and cost the NHS a huge amount through diabetes and other diseases?

[Lord O'Shaughnessy]

My noble friend brings to mind the quote—I forget who it was by—saying that children never listen to their parents but have never failed to imitate them. There is a point about setting an example, which I agree with. I do not quite agree with the force of his opinion about how health professionals should speak to people suffering weight problems of that kind. These things can be genetic or epigenetic; there can be all sorts of causes. The most important thing is to get people on board with losing weight and motivate them to do so. We have lots of good understanding about how to do that, which is at the heart of the obesity strategy.

--- Later in debate ---

[Lord O’Shaughnessy]

I agree with my noble friend. There is a strong desire for the Green Paper to be cross-government and therefore, like the vision document, take us into areas that go well beyond the remit of the Department of Health and Social Care. My noble friend Lord Farmer has published an interesting paper on the impact of family stress, marriage breakdown and other things on childhood outcomes. It is quite disturbing. Clearly making sure that we support families in all their forms is a critical part of giving children the best chance in life.

[Lord Robathan]

Since my noble friend thinks I am a bit harsh, does he not agree that the ghastly photographs on cigarette packets of people suffering from diseases caused by smoking have contributed to the reduction in disease from smoking and that therefore we should perhaps be a little bit harsher in explaining to people that they will die early if they do not take control of their own lives?

[Lord O’Shaughnessy]

I do not disagree with the content, in a sense, of what my noble friend said, but I think it is important that we communicate it in a way that will motivate people rather than terrify them into inaction. The difference with smoking is that there is no good or safe amount that you can smoke whereas there is clearly a good and safe amount that we can eat and drink and for sugar and salt intake and so on. It is about striking the right balance.

Veterans: Mental Health

Lord Robathan Excerpts

Tuesday 7th November 2017 Lords Chamber

[Lord O'Shaughnessy]

For the drug in question, Lariam is the brand name and mefloquine is the generic name. There are indeed alternatives available, and only 1% of antimalarial drugs prescribed to the Armed Forces are of mefloquine. There are instances when alternatives are not available, which may be because of a particular response to individual drugs or because the prescribing details are different—mefloquine is given on a weekly basis, for example—but the proportion is only 1%. The Defence Committee set out several recommendations, one of which was that there should be face-to-face risk assessments before prescribing. That figure is now up to 89% of the total; for the remaining 11%, the problem may be about recording rather than their not happening. The rate is much higher than it has been historically.

[Lord Robathan (Con)]

My Lords, I was prescribed Lariam in 1985. When I came back from Kenya in 1986, I was specifically told that it was linked to suicide. When I became a Minister, I asked for this to be investigated, but unfortunately I was pushed off elsewhere before the results came in—it happens the whole time. Can my noble friend look again at this, because the threats from taking Lariam are often worse than the threat of getting malaria?

[Lord O'Shaughnessy]

I am glad to see that my noble friend is still in very good shape. It is important for me to point out that a link between mefloquine and severe and persistent psychiatric symptoms has not been established. What I can talk about is what the NHS is doing to make sure that there is proper treatment of and care for veterans and those serving in the Armed Forces. The MoD is now giving on a six-monthly basis a report to the House of Commons Defence Committee on its actions. As I said, that includes increased risk assessments and so on. This is constantly under review, not just in the government department but in the MHRA, which is the licensing authority with responsibility for drug safety.

Alcohol: Children’s Health

Lord Robathan Excerpts

Monday 3rd April 2017 Lords Chamber

[Lord O’Shaughnessy]

The noble Lord is not quite right on that. Public Health England’s evidence review identified a negative impact, and that constitutes research. It looked at the evidence, which is that advertising and marketing to young people has a negative impact on their drinking behaviours. There are stringent rules, particularly around advertising, which is policed by the Advertising Standards Authority, to make sure that that does not happen.

[Lord Robathan (Con)]

My Lords, while we all wish to see responsible supermarket advertising, is it not the case that law already exists to prevent the sale of alcohol to children? Surely this law should be enforced and parents held responsible if their children are drinking illegally.

[Lord O’Shaughnessy]

As my noble friend points out, there are very strict rules around the sale of alcohol to children under the age of 18, and tough punishments exist for anyone who is doing so.

Obesity

Lord Robathan Excerpts

Thursday 26th May 2016 Lords Chamber

[Lord Prior of Brampton]

My Lords, I think that the announcement of the sugar levy on sugary drinks has meant that that part of the industry has been forewarned of what is coming in the strategy. Already there are signs from some of the manufacturers that they are reformulating their products—which is the whole purpose of a levy rather than a tax.

[Lord Robathan (Con)]

My Lords, would my noble friend not agree that our noble friend Lady Jenkin is quite right to stress individual responsibility, which the Government must encourage? Of course there should be education, but individual responsibility will lead to people losing weight.

[Lord Prior of Brampton]

My Lords, of course my noble friend is right that individual responsibility is critical to this. But we have to make it easy for people to make the right choices by providing the right information. Particularly for children, we have to make it easier for them and their parents to make the right choice.

Health: Treatment Rationing

Lord Robathan Excerpts

Tuesday 26th April 2016 Lords Chamber

[Lord Prior of Brampton]

My Lords, I cannot answer the noble Lord’s question now, but I agree to his request to write to him and will place a copy of my letter in the Library.

[Lord Robathan (Con)]

Does the Minister not agree that everybody in this country must know that smoking and being overweight are bad for them? Does he not think that individuals should be encouraged to take greater personal responsibility for their health, rather than less?

[Lord Prior of Brampton]

There is clearly a balance between the obligations of individuals to take responsibility for themselves and the obligation of society to help people to do so. Getting that balance right has characterised the success we have had in reducing smoking in this country and which I hope we will have in reducing obesity as well.

Sugar Tax

Lord Robathan Excerpts

Wednesday 3rd February 2016 Lords Chamber

[Lord Prior of Brampton]

My Lords, as the noble Baroness will know, there are plans for later this year to have compulsory labelling of sugar content on packaging. However, I am not aware that there are any plans to have pictures of well-known athletes on the packaging as well.

[Lord Robathan (Con)]

My Lords, does the Minister agree that the issue of obesity, which is indeed a scourge, is largely one of individual and, in the case of children, parental responsibility?

[Lord Prior of Brampton]

My noble friend is partly right. It is of course a matter of individual and parental responsibility, but I think we have an obligation in our country to make the right choice as easy as possible, and for too many people the wrong choice is far too easy to make.

Oral Answers to Questions

Lord Robathan Excerpts

Tuesday 24th February 2015 Commons Chamber

[George Freeman]

I pay tribute to my hon. Friend for his tireless work on this matter. I know that he recently met the Secretary of State to discuss it and that he has been very active locally and here in Parliament. He is right that local community hospitals can play a key role in supporting patient convalescence, providing particularly good care in the community close to home, which is convenient for elderly patients, and relieving pressure on acute hospital beds. You do not have to take it from me, Mr Speaker; take it from Simon Stevens, the chief executive of NHS England. He recently said:

“A number of other countries have found it possible to run viable local hospitals serving smaller communities than sometimes we think are sustainable in the NHS…The NHS needs to abandon a fixation with ‘mass centralisation’”.

I hugely welcome that.

[Mr Andrew Robathan (South Leicestershire) (Con)]

18. With reference to the recent Francis report, if he will investigate (a) the case of Meirion Thomas at the Royal Marsden hospital and (b) cases where staff have been disciplined or required to sign confidentiality agreements.

[The Parliamentary Under-Secretary of State for Health (Jane Ellison)]

The Government welcome any individual who has the courage to shine a light on malpractice, wrongdoing or patient safety issues in the NHS, and the House will be well aware that that is something the Secretary of State has very much championed. Professor Thomas has a right to express his views on the health service and on wider issues, and I understand that the trust has confirmed that. The Department is not responsible for investigating cases involving individual members of staff, but I want to be clear that confidentiality agreements cannot be used to prevent individuals from making a protected disclosure in the public interest.

[Mr Robathan]

I am glad to hear that, and I note that the Secretary of State has had dealings with Professor Thomas. However, I think it is very important that this is looked at closely in the light of the Francis report. If it is the case, as is said in media reports, that Professor Thomas has been forced to sign a confidentiality agreement—a so-called gagging order—I think that is disgraceful and shows a very dire state in the NHS in the Royal Marsden. Perhaps the Minister would like to comment on that.

[Jane Ellison]

I can only reiterate this Government’s complete commitment to openness when it comes to patient safety and say again that confidentiality agreements cannot be used to prevent individuals from making a protected disclosure in the public interest.