Premature Deaths: Heart and Circulatory Conditions
Baroness Bull Excerpts(10 months, 2 weeks ago)
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Lord Markham (Con)
I am not quite sure that I agree with the word “refuse”, but I agree with the noble Lord that healthy food in all environments is a good thing. I know that the delay happened because it was originally planned for 2020 or 2021, I think, and then the pandemic got in the way. I freely accept that the review now needs to take place. We are not refusing to do it, because it is an important part of the armoury.
Baroness Bull (CB)
My Lords, many noble Lords have mentioned the importance of early years interventions, not smoking, diet and so on. Does the Minister agree about the importance of exercise and of cultivating the habit of exercise, not just in early years but ongoing throughout later years?
Lord Markham (Con)
Absolutely. These are all key parts of a good, healthy lifestyle for mind and body—for mental health as well. Social prescribing is important for all this as well.
Maternity Services
Baroness Bull Excerpts(10 months, 4 weeks ago)
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Baroness Bull (CB)
My Lords, like other noble Lords, I congratulate the noble Baroness, Lady Taylor of Bolton, on initiating this important debate and on her comprehensive introduction. It is a privilege—but, as has already been noted, somewhat daunting—to speak in this debate among so many acknowledged experts and long-standing contributors in this area.
The always excellent Lords Library briefing, already mentioned, highlights an issue raised by several noble Lords across the House: the experience of maternity services is not equal for everyone, and, once again, already marginalised communities and those in less privileged situations report a poorer experience of maternity services. I want to use this opportunity to highlight the experience of maternity services in England for another group who are not often included in these debates: women with learning disabilities.
The 2016 National Maternity Review set out NHS plans to improve maternity care and the care of people with learning disabilities. Despite this, the experience of maternity care for those women is still found to be consistently poorer than for the rest of the adult population.
A learning disability affects the ways in which people understand information, learn new skills and communicate. It may also mean a reduced ability to cope independently. Learning disabilities are often unique to the individual and can present in many forms, some obvious and some more covert in nature.
Of course, the general good principles of person-centred care apply to caring for people with a learning disability, but the challenges of pregnancy for women with learning disabilities, which include higher risks of perinatal complications and caesarean delivery, mean that midwives and other health professionals need particular skills and knowledge if they are to provide this person-centred care through pregnancy, childbirth and early parenthood. Without this specific skill set, the needs of these women cannot be met.
Significant emphasis needs to be placed on effective communication and the application of reasonable adjustments, to prepare parents and offer them practical and emotional support through their path to parenthood. People with a learning disability need to understand their midwife, and they need a midwife who understands their needs and knows how to provide the right support. That midwife may also need to educate and support other health and social care professionals they encounter on their journey to do the same.
The importance of continuity of care cannot be stressed highly enough when providing care to people with a learning disability. Equally important are the collaborative efforts of professionals to build a network of trust and care, which needs to be available through the parenthood journey, beyond birth, to best assist parents in bringing up their child and avoid those regrettable cases when children of parents with learning disabilities are removed from their parents’ care.
Public Health England’s 2016 recommendations and the Equality Act 2010 state clearly that people with learning disabilities should be provided with reasonable adjustments. If adjustments are not put in place to accommodate the complex and diverse needs of pregnant women with learning disabilities, they may be subject to a system that just does not work for them. One example is fast-paced appointments in which they are asked to absorb high levels of complex information and make informed choices at speed.
Writing in the British Journal of Midwifery in 2019, Samantha Vernon reported the findings of her research internship at the National Institute for Health Research into maternity services for people with learning disabilities. Her interest stemmed from her 19 years of clinical practice, in which she identified an increasing number of women with learning disabilities presenting for care in her trust but found no mention of learning disabilities in the 2019 NICE guidelines and no specific care pathway for women with learning disabilities.
Among her conclusions, she recommends the broader use of a “passport” for pregnant women with learning disabilities—a document prepared with the antenatal team that goes with these women through their maternity journey to help all the health professionals they encounter understand the ways in which that person’s learning disability affects their interactions with obstetrics and midwifery services. This would include critical information, including on reasonable adjustments, updated as appropriate, and would reduce the need for patients to be questioned over and over again, thereby reducing stress and saving NHS time. I know that hospital passports are now recognised for use by people with learning disabilities but it is not clear how actively they are promoted in maternity services. Perhaps the Minister could comment on that.
Samantha Vernon’s other key finding, perhaps unsurprisingly, is that formal training on learning disabilities needs to be increased so that health professionals can recognise and support women with learning disabilities through pregnancy, childbirth and early years care. This aligns with Mencap’s research, which uncovered a patchy picture in which the number of hours devoted to this content and the level to which this learning is assessed varies widely. Its 2017 Treat Me Well campaign showed that 69% of registered nurses wanted more training about learning disabilities. A qualitative study from Dr Emma Castell in 2016 found that midwifes often felt inadequately equipped with the necessary skills and training to care for women who have learning disabilities.
These studies are from some years back and there have clearly been some improvements in the intervening years. In January last year, working with NHS England and supported by the National Institute for Health and Care Research, the University of Surrey’s Together Project published a toolkit and guidelines to support the delivery of good practice in maternity services for parents with learning disabilities. This was based on existing research, best practice reviews and several interviews with health and social care professionals, parents with learning disabilities, and their supporters and carers. It is a clear and accessible guide, with practical and implementable evidence-based actions that can be taken. Can the Minister confirm whether this toolkit is widely available across all maternity services?
People with a learning disability—including those who are pregnant—are protected by a legal framework that entitles them to reasonable adjustments, so that they can access services; adjustments to communication; support with decision-making; the right to a family life; and dignity in care. Yet Mencap’s experience of providing training across several hospital trusts leads it to conclude that attitudes towards people with a learning disability can vary. It reports that, in some healthcare professions, including at senior levels, there are misunderstandings about what a learning disability is; lack of awareness about health inequalities; low awareness of the support required and the need to adapt communication; and a need for guidance on the implications of and responsibilities under relevant legislation, including deprivation of liberty safeguards. This last point is particularly important for midwives looking after women with learning disabilities, who need to be able to understand and apply the Mental Capacity Act, the Equality Act and the Human Rights Act to ensure that the needs of the women in their care are met and their rights upheld.
The 2022 Women’s Health Strategy sets out the Government’s ambition for England to be
“the best place in the world to give birth through personalised, individualised, and high-quality care”.
If this goal is to be achieved, training for midwives must equip them with the skills and competencies to support all women, including those with learning disabilities, through and beyond pregnancy and childbirth. In responding to this important debate, can the Minister assure the House that this training is taking place? Perhaps he could outline what steps the Government are taking to ensure that the rights of parents with learning disabilities to access maternity services free from discrimination, where their rights are respected and they receive high-quality, person-centred care, are being upheld.
NHS App: Medical Records
Baroness Bull Excerpts(1 year ago)
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Lord Markham (Con)
The noble Lord is absolutely correct. Digital resource is well sought after. I was approving something just the other day which gives us more flexibility in that space, because sometimes you have to pay over and above to get people on it. As we all agree, this is vital to the future of what we are trying to do.
Baroness Bull (CB)
My Lords, as more people who are able to are switching between the National Health Service and private medical care for specific operations, is the Minister confident that relevant information is then transferred back to a single patient record? This will be very important if, for instance, somebody needs emergency care or is involved in an accident. Is the data all being kept in one place?
Lord Markham (Con)
Patient records is what the federated data platform is very good at, in terms of drawing data and information from all sorts of sources into one place, so it is always in the ownership of the person, the GP or the individual place. You can make your data available to the private care providers, if you are having an operation with them, for instance, but the data always remains within the NHS and in the ownership of the person.
In-patient Mental Health Care: Learning Disabilities and Autism
Baroness Bull Excerpts(1 year ago)
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Baroness Bull (CB)
My Lords, I thank my noble friend Lady Hollins for securing this important debate; we are so fortunate to have her expertise in the House, and I pay tribute to her tireless work over so many years. I have had the privilege of participating in other debates in her name on this subject since I joined your Lordships’ House. I do so not as someone with personal experience or expertise in this area but as someone who cares deeply about fairness, equality of opportunity and the protection of human rights for the more vulnerable in our society.
The Joint Committee on Human Rights has made clear that the detention of individuals in the absence of individualised, therapeutic treatment risks violating their right to liberty and security. It found that rights to private and family life and to freedom from inhumane and degrading treatment are frequently under threat for people with learning disabilities and/or autistic people detained in in-patient units.
The Government’s 2019 manifesto committed to addressing this through reform of the Mental Health Act 1983—an important Act, but one that has failed to keep pace with changes in understanding of and attitudes towards mental health since it passed into law 40 years ago. Like other noble Lords across the House, I was deeply disappointed that the Bill failed to find a place among the legislative priorities for this Government’s last Session. In its absence, we need to know what urgent action they will take now and in future to end the human rights scandal of this inappropriate and unnecessary detainment in in-patient care.
NHS data from October 2023 reveals that there are 2,035 people with a learning disability and/or autistic people in in-patient mental health units. Over half have been there for more than two years, and under half had a date planned for them to leave hospital. As my noble friend told us, Mencap’s analysis of the data suggests that, at the current rate, the ambition to reduce the number of in-patients by half will not be met until 2029—a full five years after the target date.
The statistics are startling, but they are also sterile. Each number represents a person locked away from family, friends and the day-to-day opportunities and experiences that most of us are privileged to take for granted. With an average stay for current in-patients of 5.2 years, inappropriate detention in mental health hospitals is devastating not just to the person locked away but to the people who love them and want to see them thrive. The reality, as we have heard, is that too many autistic people and people with a learning disability are held in mental health hospitals not because they need in-patient mental health treatment but because of the sustained failure over many years to invest in the right community support.
The shape of the support required for those individuals to return safely to community life is set out clearly for commissioners in NICE guidance and in Building the Right Support. For example, it requires care providers with the right skills, suitable housing, intensive support services to help prevent and manage crisis situations and appropriate respite. Having a service model is one thing, but implementing it is another. Eight years on from its introduction, too many families still face issues in accessing the support that will enable successful discharge into the community or, better still, prevent the need for admission in the first place. The future of Building the Right Support is unclear. Looking beyond March 2024, can the Minister say what will happen to the associated action plan, the delivery board and the national targets? How is this being communicated across the health and care system?
At yesterday’s Oral Questions, we heard once again about the woeful underinvestment in social care and the social care workforce. One effect of this is that people with a learning disability and/or autism struggle to access the right care packages and the support of staff with the appropriate skills and expertise for their needs. During the passage of the Health and Care Act, I was part of a cross-House coalition arguing for the importance of reforming and fixing social care for working-aged disabled adults and addressing the issues facing the workforce. Our amendments to address this did not make it into the Bill and, on top of this, the Government have delayed implementation of much of their social care reform programme. The hard-working and overstretched social care workforce remains on its knees. Will the Government commit to creating a national workforce plan for the social care sector that identifies and addresses the skills and the funding gap, so that people with a learning disability and/or autistic people can receive the care and support they need in the community, and reduces the likelihood of their being admitted to an in-patient unit?
Lack of suitable housing is also a key factor, and it is the other main reason cited in NHS Digital data each month for delayed discharge. What assessment has been made of the capital funding required to enable the discharge of people from in-patient units? Are the Government monitoring the provision of suitable housing to meet their needs? Without the right housing, alongside social care, too many people will continue to end up in crisis situations that see them inappropriately admitted, or readmitted, to in-patient units.
I have no doubt that we all share the same ambition: that people with a learning disability and autistic people should be able to live fulfilling lives in the community without fear of being admitted, potentially for long periods of time, to in-patient units—places where there is often excessive use of restrictive interventions, including physical and chemical restraint, and increased risk of abuse and neglect.
The 2024 target to reduce the numbers in in-patient care by 50% is an important step, but it is a step towards a broader ambition. However, I struggle to see how real progress can be made unless we get social care reform back on track. This means making sure that the social care system works for all those who need it, not just those who develop care needs in later life but working-age adults with long-standing needs, who rarely find themselves front and centre in discussions about social care reform.
I noted earlier that, in October, there were 2,035 people with learning disabilities and/or autistic people in in-patient mental health units. I am sure we would all agree that that is an unacceptably high number, but it is also surely a low enough number that, in a civilised, compassionate and relatively affluent society, if the will was there, the development of individualised pathways back into community-supported living could be an achievable goal. The right to enjoy a “gloriously ordinary life” should not be too much to ask.
King’s Speech
Baroness Bull Excerpts(1 year, 1 month ago)
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Baroness Bull (CB)
My Lords, it is a privilege to have been present at the first King’s Speech in over seven decades and to take part in this debate. I declare my interests as set out in the register.
With the spotlight currently on the Covid inquiry and the mistakes made, damage done and lessons to be learned, it was heartening to see the opening of the Speech set government plans in the context of the long-term challenges that Covid has created for the UK. Unfortunately, optimism that it might include necessary measures to address the pandemic’s wickedly long tail faded as the pages turned.
To understand the real damage wrought by the pandemic, we need not to look back but to the future: to the challenges of long Covid for individuals and the NHS, to the impact of isolation and loss on mental health, and to the future success of a generation of children whose education was so severely disrupted by lockdowns.
Most children lost half a year of schooling through Covid. That is about 5% of their overall learning. The effect of this will echo through their lives, on career options, earning potential and, by extension, tax revenues available for public services. As ever, children from disadvantaged backgrounds suffered the most.
The full-blown pandemic may be behind us, but its impact on young people’s education goes on. Many have simply not returned to the classroom, which is a scenario described by the Children’s Commissioner as
“the issue of our time”.
In the last autumn term before the pandemic, 4.7% of all children were absent from school. In 2023, the figure was 7.5%. Persistent absence, which is when a child misses at least 10% of possible sessions, has also risen sharply, from 13.1% to 24.2% over the same period.
There is nothing in the gracious Speech to tackle this, despite strong evidence linking school absenteeism with various life-course problems, including risky behaviours, teenage pregnancy, psychiatric disorders, delinquency and substance abuse. The commissioner’s latest report highlights the link between absence and attainment; the likelihood that persistently absent children will end up not in education, employment or training; and the fact that 81% of children entering the criminal justice system have a history of persistent absenteeism.
The causes of absenteeism are complex and diverse, but it does seem to be a particular issue where additional vulnerabilities are present, particularly in children with special educational needs, physical disabilities and behavioural, emotional and social difficulties. This means that the failure to deal with absenteeism is another route by which the already disadvantaged are disproportionately affected, and that the gap between the more and less fortunate in our society grows ever wider. As the gracious Speech was silent on this issue, can the Minister perhaps tell the House how the Government plan to tackle this epidemic of absenteeism and the causes that lie behind it?
The introduction of the advanced British standard makes it into the gracious Speech, with a promise that increasing the number of subjects at key stage 5 to a minimum of five, expanding overall taught hours and introducing maths and English as mandatory until 18 will
“ensure young people have the knowledge and skills to succeed”.
It is unclear whether the evidence supports those assertions. Studies from Switzerland and Germany suggest that increasing instruction time has, yet again, the effect of widening the gap between high- and low-performing students and benefits only the students who already do better at school. It also flies in the face of OECD principles for curriculum redesign, one of which is to allow for flexibility and choice for teachers and students.
Of course, numeracy—and, indeed, financial literacy and budgeting—are important skills for employment and for life. But improvements need to be targeted across all stages of education. The key question is what kind of maths is to be included post-16, given that so many students achieve excellent results in GCSE maths but go on to struggle with A-level. It is vital, too, that reforms carefully consider the impact on the 6% of UK children who suffer from dyscalculia, a specific learning disability that impacts the ability to understand, learn and perform maths and number-based operations.
Children are already concerned about what this means for them. I have been lobbied by a 10 year-old relative who argued cogently and passionately that her educational experience and outcomes would be impacted by these reforms, given her learning style and needs. Significant improvements have been made in the teaching of children with dyslexia and other reading disabilities, but despite the Department for Education’s assertion:
“All teachers are teachers of special educational needs and disabilities”,
there is currently no formal requirement for maths teachers to learn about dyscalculia as part of their training. Regardless of whether the advanced British standard is progressed, does the Minister agree that training needs to be updated so that maths teachers can recognise dyscalculia and better support students affected by this condition?
I shall finish by echoing concerns already expressed around the House about the absence from the gracious Speech of a mental health Bill. This is a bitter blow for the 2,000 people with a learning disability and/or autism currently locked away in mental health in-patient units, who often receive poor-quality, and sometimes horrific, treatment, as has been revealed in numerous undercover investigations and Select Committee reports.
Our understanding of mental health has changed a great deal since the Mental Health Act received Royal Assent in 1983. There has been some updating, but legislation still lags behind ambition, and the fact that laws currently allow people to be detained for no other reason than that they have a learning disability or autism is, in itself, evidence of the need for change. So I hope the Minister will be able to tell the House why the Government chose to omit this Bill from the gracious Speech. There is widespread agreement, and cross-party consensus on the need for reform. Surely the Government should be using the last Session of this Parliament to deliver a manifesto commitment on which they were elected—not once, but twice—to bring this Bill before the House?
Domestic Violence and Brain Injury
Baroness Bull Excerpts(1 year, 2 months ago)
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Lord Markham (Con)
It is a good point, and there are already some very good examples, such as in Cambridge, where the ICB has a single front door to make sure that all facilities, whether it is neurologists, psychologists, physios or speech therapists, are there and available. The noble Baroness is correct: there are lessons we can learn and roll out straight away, and we are looking to do that.
Baroness Bull (CB)
My Lords, research projects in Glasgow and at Drake Hall prison in Staffordshire have shown a very high percentage of female prisoners to have traumatic brain injuries that have been sustained as a result of domestic violence. Is it now routine to screen female prisoners for brain injuries as they enter the Prison Service?
Lord Markham (Con)
My understanding is that it is not routine at the moment. I know there is some conflicting research as to how much screening should be used as a regular tool. I must admit that I do not fully understand the reasons behind some of that, so I was not quite persuaded as to why that was. It is something on which I want to do more research to understand. I will happily write to the noble Baroness to give her more information.
Food: Two-For-One Offers
Baroness Bull Excerpts(1 year, 5 months ago)
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Lord Markham (Con)
To me, that is a great example of how working in co-operation to allow people to make the right choices is the best way. For instance, 78% of shoppers have said that they are in favour of not having unhealthy items at the till because they know that they give in to pester power. That is why this has been focus of what we have done.
Baroness Bull (CB)
My Lords, notwithstanding the interesting “legal but harmful” point made by the noble Lord, Lord Naseby, I think that most of the House would agree that reducing high-fat, sugar and salt content is a good idea. However, the Minister has at least twice mentioned reduction of calories. Does he acknowledge and recognise that while one way to address obesity is calorie reduction, it is not an appropriate message for everybody and it certainly is not the sole cause of obesity across this country?
Lord Markham (Con)
The noble Baroness is correct; this is a complicated area, and a number of measures need to be taken. The best thing is the promotion of healthy foods, and the fresh fruit and veg initiatives that we have talked about today are perfect examples of that.
Long Covid
Baroness Bull Excerpts(1 year, 7 months ago)
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Lord Markham (Con)
I take issue with the statement of failure to deal with it. We pioneered this space. We set up 90 specialist adult centres and 14 specialist centres for kids. We have invested £314 million and 80% of people are seen within eight weeks of being referred. That shows that we are taking this seriously. The noble Lord is absolutely right that we want to ensure that we get as many people into work as possible. In the case of long Covid, we are definitely doing that.
Baroness Bull (CB)
My Lords, the Minister will know that evidence shows that the risk of long Covid increases with each subsequent reinfection, and that most adults were last vaccinated in the autumn, which means that their immunity is waning and that they are vulnerable to new infection. For many, this will be their second or even third case of Covid. Given that the living with Covid strategy is to manage Covid like other respiratory illnesses, what consideration have the Government given to adopting a similar vaccination strategy as they do for flu, in that those not eligible for free vaccinations could be offered the option to buy a vaccination? Have the Government made any assessment of the impact that such a strategy would have on the number of reinfections and therefore the rates of people suffering with long Covid?
Lord Markham (Con)
I thank the noble Baroness. I think we all accept that this is a complex area where, naturally, we are being guided by the science. Our vaccination strategy has been focused on the highest-risk groups. On allowing other people to pay over and above, as with flu, I think it is best that I come back in correspondence.
Stroke Rehabilitation and Community Services
Baroness Bull Excerpts(1 year, 9 months ago)
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Lord Markham (Con)
During the pandemic this was one of the areas that probably did not get enough time, for all the good reasons that we understand. Therefore, I am pleased to see that these pathways are being set out so that we can get back to the standards that we need. I believe this is something that we will see happening now.
Baroness Bull (CB)
My Lords, the Minister will know that stroke survivors, once in the community, face challenges with long-term rehabilitation and higher levels of depression, anxiety and loneliness than the rest of the community. What assessment have the Government made of arts-based therapies—I declare an interest as I am an adviser currently with King’s College Hospital—to address the whole patient as they recover from a stroke?
Lord Markham (Con)
We are very much believers in the importance of social prescribing. I was at a reception just yesterday given by the Alliance of Sport, talking about the importance of active lifestyles for people’s mental health and recovery, and in the criminal justice system. It is something that we agree on the importance of. I will come back in more detail on the arts.
Communications Act 2003 (Restrictions on the Advertising of Less Healthy Food) (Effective Date) (Amendment) Regulations 2022
Baroness Bull Excerpts(1 year, 9 months ago)
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Baroness Bull (CB)
My Lords, I support the regret Motions from the noble Lord, Lord Allan of Hallam, and the noble Baroness, Lady Merron. At the noble Lord’s invitation, I will kick a slightly different ball into the open goal.
I share the Government’s concerns about levels of obesity in the UK, but the failure to adequately explain or justify both the delay to and the rationale for these regulations is further evidence that the Government’s strategy to tackle obesity is disjointed, partial and careless of unintended consequences, and that it falls far short of the integrated public health approach that will be required if we are to meet this major public health challenge.
Research in obesity and eating disorders has often followed separate paths, but it is increasingly recognised that eating and weight-related problems need to be seen on a spectrum that goes from diagnosable eating disorders, through to disordered eating behaviours such as fasting, vomiting or laxative use, to body dissatisfaction, binge eating, being overweight and obesity. Studies show that individuals often present with more than one problem concurrently or move between different problems at different times in their lives, so eating disorders and obesity cannot be seen as separate and distinct issues. There is a raft of risk factors common to both: poor body image and low self-esteem; weight-related teasing; the modelling of poor eating behaviours at home; the stigmatising attitudes of teachers or sports coaches; and the socio-cultural norms around body shape that underpin everyday life. Any of these can increase the risk of both eating disorders and obesity in adolescence and adult life.
The interactions between the two mean that any strategy to address them needs also to be integrated. This is especially important when it comes to messaging. Many campaigns position being overweight and obesity as issues of personal responsibility and choice, shaming and stigmatising people, rather than acknowledging and addressing societal and environmental factors, as well as the powerful impact of genetics, epigenetics, metabolism and biology.
In 2020, 100 obesity specialists from around the world signed a statement in which they explained:
“The assumption that body weight is entirely under volitional control, and that voluntarily eating less and/or exercising more can entirely prevent or reverse obesity is at odds with a definitive body of biological and clinical evidence developed over the last several decades.”
Yet that same year, just months later, the Government produced an obesity strategy underpinned by the assumption that everybody is able to make the choice to modify behaviour and change their weight status. Not only does this stigmatise those who cannot, it can have negative consequences for people for whom the message is not intended. It can cause or exacerbate incipient or established eating disorders, promoting unhealthy dieting or inducing body dissatisfaction.
Children and adolescents are especially vulnerable to this kind of messaging, particularly those who are prone to anxiety. The simplistic portrayal of foods as good and bad, healthy and unhealthy, is risky for children, because they may not yet be at the developmental stage needed to appreciate the nuances involved. Many pre-adolescents report healthy eating initiatives at school as the trigger for an eating disorder, internalising messages such as “fat is bad” in a literal way, impervious to the importance of fat in their neurological development—of course they would be impervious to that; they are children. Children have a degree of cognitive inflexibility, and it can lead them to adhere very strictly to rules. In susceptible children, this can result in obsessive preoccupation with reducing calories, avoiding foods or increasing exercise to burn off what they have eaten.
The current obesity strategy, developed at speed as the links between Covid and obesity became clear, is far from the integrated approach that is needed to address these complexities. Its policies focus mainly on physical activity, diet and weight control and seem to have been designed in consultation with experts in obesity but with little or no input from specialists in eating disorders or body image. In my conversations with officials and Ministers about food labelling regulations, I was astonished at the levels of disconnect between eating disorder and obesity research, policy and clinical practice, and I found it hard to avoid the conclusion that concerns from an eating disorder perspective had been sacrificed to the perceived greater needs of the obesity crisis.
It is completely understandable that the Government have focused their attention on tackling obesity, given its increased prevalence, the long-term health consequences and the burden to both the NHS and the public purse. But it is regrettable that so many aspects of the strategy were not thought through: the complex interactions with other weight-related or eating-related issues; the particular risks to children; and, as the Secondary Legislation Scrutiny Committee has highlighted, the practicalities of implementation and the impact of this further delay on young people’s health.
Obesity is a major public health challenge, and it requires an integrated public health approach, one that balances risks and benefits and focuses on better education, healthcare and policies that modify the environment in ways that support healthier behaviours. The current patchwork of policies, with its partial focus and unexplained delays, is not going to be the answer.
Baroness Bennett of Manor Castle (GP)
My Lords, it is a pleasure to follow the noble Baroness, Lady Bull, who set out so clearly that we have to get away from blaming individuals for the fact that we have, as a society, a deeply damaging and disastrous relationship with food. Perhaps going even further than the noble Baroness, I stress that what is behind that is a broken food system—that what is supplied into the system is deeply unhealthy and damaging in all kinds of ways. It is both what is presented to people and what comes into the system that are problems.
It might be fairly said, as the noble Baroness just did, that tonight we are talking about partial, inadequate measures—and I offer the Green group’s support for both these regret Motions—but they are, at least, measures to do something. We can look at another partial, inadequate measure that has come into effect and we are starting to see the results of: the Soft Drinks Industry Levy Regulations 2018. It is very small and partial, but a recent study published in PLOS Medicine showed that we have seen an 8% reduction in obesity in girls aged 10 and 11 as a result of that. There is a gender aspect that I do not think anyone yet fully understands. It is a limited state of progress, but it is better than heading in the opposite direction.
Looking where we are now, here is one figure that is truly shocking: last year, 660 under-fives were admitted to hospital with obesity given as the primary cause of their admission. That is what our broken food system is doing. Restrictions on advertising were hard fought for and much discussed during the Health and Social Care Bill, and I remember sitting in your Lordships’ Chamber over what I suspect was many hours. Yet here we are today, and I cannot help reflecting on an earlier discussion in your Lordships’ House in which it was suggested that the Scottish Government were bringing in the bottle return scheme far too quickly. That was a three-year delivery from the regulations being passed to them being implemented. That was something Westminster could not imagine.
Looking to the general public, one of the things I have found again and again on that issue and issues tackling obesity is that people say, “We heard the government announcement, but it does not seem to have happened.” People think that once the Government have announced something it is happening, and the Government use that, announcing things again and again that never get delivered. It really is past time that we should be seeing the delivery here. I will finish with a question to the Minister: what is the higher priority here, the health of the nation or the profits of broadcasters?