King’s Speech

Baroness Jay of Paddington Excerpts

Thursday 9th November 2023 Lords Chamber

[Baroness Jay of Paddington (Lab)]

My Lords, I follow other noble Lords, in welcoming and supporting the measures to reduce smoking, but like the right reverend Prelate, I am most concerned this afternoon about the lack of any broad-based public health programmes in the gracious Speech. Public health, after all, is central to successful healthcare in this country and, indeed, to the overall health of the nation, yet it has been neglected for many years and is neglected again. I repeat my welcome for the tobacco products Bill, but one Bill does not create a strategy. In every area we look at, the need for a broad-based programme to meet the public health crisis we are facing is urgent. In every problem you look at—from obesity to sexual health, from children’s dentistry to disease caused by damp housing—the situation is getting worse and worse. At the same time, we have seen the capacity of the NHS fall. Sadly, it has become a struggling health sickness service, rather than a positive health service. If we want the NHS to be renewed and restored to its proper role, we must primarily focus on avoiding preventable disease and promoting healthy living through cross-government programmes.

At the Labour conference last month, the shadow Health Secretary, Wes Streeting, promised that a Labour Government would deliver a prevention-led revolution. He insisted that a broad revolution, putting prevention first, could be delivered through social, economic and environmental change. This, he said, must lead to less illness and therefore less pressure on the NHS. Now there is no doubt that achieving this type of change is complex, difficult, expensive and long term. But under the Conservative Government, many prevention initiatives have been greeted with the cliched expression, “a nanny state” calling for intervention in our private lives. I understand that even the new anti-smoking Bill, which has the Prime Minister's personal endorsement, has already been criticised by his own MPs on this basis.

In the last 13 years, many of the specialised institutions that focused on promoting good health have disappeared or been marginalised. The Government abolished Public Health England, which had a global reputation for its expertise and research. The grandly titled Office for Health Improvement and Disparities has been recently set up, but so far no grand practical statement of environmental activity has been announced. Today, many of the responsibilities for public health have been devolved to local authorities; at first sight that seems a good idea as so many services that can affect people’s general health are provided at a local level. However, the Treasury’s public health grant to local authorities has been reduced by a staggering 26% in the last years; not surprisingly, basic services have suffered badly or completely collapsed. Apart from the financial cutbacks, the connections between organisations commissioned by individual councils and the health service can be weak and can reduce vital capacity. Services have sometimes been outsourced to independent bodies, which do not have the necessary expertise to deliver them. This has been recently drawn to my attention in relation to HIV and other sexually transmitted infections. There has recently been an alarming increase in many of these infections, some of which are growing by as much as 50%. These must require medical care, which is often lacking in an outsourced clinic. For example, only half the clinics can now offer face-to-face appointments for individual advice and treatment—they simply cannot deliver good practice.

However, even if the Government have somewhat neglected the needs of good public health, it is encouraging to see the current level of parliamentary interest and engagement with these issues. The well-established All-Party Group on Health in all Policies has been able to broaden the discussion about reducing health inequalities and promoting healthy lives in ways that go way beyond traditional concerns about, for example, working conditions and safety. The Levelling-up and Regeneration Act 2023 could have been an opportunity to put some of these policies into legislation, specifically in the area of poor housing. There were several attempts to amend the Act in this way but all failed, although it must be remembered that the health effects of inadequate housing already cost the NHS about £1.4 billion a year. In this House, the noble Lord, Lord Crisp, with his vast experience in public health, pursued his amendment on healthy new homes to the point of ping-pong proceedings and still he did not succeed. In final exasperation he said:

“I have taken the key message that the Government do not want to … ensure that new homes and neighbourhoods promote health, safety and well-being. I think this is extraordinary.”—[Official Report, 23/10/23; col. 437.]


I must say that I agree with him.

Meanwhile, our very active Peers for the Planet organisation is urging an even broader approach to public health, which I support. It argues that the crises of climate change and threats to nature have a profound impact, and there are calls for the WHO to declare this a global health emergency. As far as the UK is concerned, the effects of higher temperatures have already been observed. In 2022, heat-related mortality in this country was up by as much as 42%, which is well over the five-year average. The very respected journal the Lancet has suggested that we should act immediately in this country on cleaner energy, improved air quality and access to green space. It is a vast agenda, but it should not be overwhelming. It needs a new clear strategic approach by the Government and resources to match. Given their record, I do not expect the present Government to give priority to this in the last months before a general election. On the other hand, the Labour Party has already published ambitious plans for its prevention and revolution in health. I am confident that there will be manifesto commitments on public health in all social policy. We can then have a programme that both improves health and renews the NHS. I look forward to discussing a new approach in the debate on the next gracious Speech.

Covid-19 Regulations: Assisted Deaths Abroad

Baroness Jay of Paddington Excerpts

Tuesday 10th November 2020 Lords Chamber

[Lord Bethell (Con)]

The noble Baroness is entirely right; Covid has, in a very sad way, thrown a spotlight on the circumstances of those dying alone. That is one of the harshest and most heart-breaking dimensions of this awful pandemic. It throws a spotlight in particular on the way in which the law is applied in this country. The collection of data is a very important component of our review of this important area and I will definitely ensure that the indication given by my right honourable friend in the other place is picked up back at the department.

[Baroness Jay of Paddington (Lab) [V]]

My Lords, I am generally encouraged and relieved by the Government’s responses on this Statement, particularly the point made in the Commons by the Secretary of State that assisted dying must be considered in the general discussion of good end of life care. I hear the Minister say that a formal review is not planned, but when the Government come to look at the concerns about death and dying that have been thrown up by the pandemic, will they ensure that the questions of proper personal choice at the end of life will be both included and emphasised?

[Lord Bethell (Con)]

Well, this is an extremely complex issue. As the noble Baroness alluded to, there is a wide variety of issues at stake, including values issues, questions of faith and, as she rightly said, questions of personal choice. There are the components here for an important national debate. I acknowledge the comments of several noble Lords already that we are approaching the moment when that debate seems more relevant than it has ever done. When that debate takes place, certainly personal choice will be an important part of it.

Hospitals and Nursing Homes: Do Not Resuscitate Notices

Baroness Jay of Paddington Excerpts

Thursday 1st October 2020 Lords Chamber

[Lord Bethell (Con)]

My Lords, it is completely unacceptable for any group of people to have blanket DNACPR provisions apply to them. The adult social care winter plan published on 18 September reiterates that and makes the position crystal clear. The General Medical Council is providing additional support and guidance to clinicians on how to meet the needs of patients and relatives, and the Resuscitation Council UK is creating a large amount of resources to provide training. The CQC is monitoring the situation extremely carefully.

[Baroness Jay of Paddington (Lab) [V]]

My Lords, the distressing circumstances of the pandemic have once again highlighted the difficult and sometimes controversial issues about end-of-life treatment in general and individual choices. Will the Government set up a long-proposed review to examine all these issues, particularly to improve real patient choice?

[Lord Bethell (Con)]

The noble Baroness is entirely right. The Covid epidemic has shone a spotlight on the awful arrangements around end of life at a time when contagious disease presents a threat to all those present in a nursing home or hospital. Our thoughts and prayers go out to all those who have lived through such an experience or will face one in the near future. I note the noble Baroness’s call for a review. There is no current plan for one but I will carry the idea back to the department.

Covid-19: Rise of Positive Tests

Baroness Jay of Paddington Excerpts

Wednesday 9th September 2020 Lords Chamber

[Lord Bethell (Con)]

My Lords, we are deeply concerned about the BAME incidence of this horrible disease. We have put in place extensive new marketing arrangements targeted at BAME audiences. We have targeted our testing arrangements through mobile testing and door-to-door availability at that communities that have been hardest hit, and there are guidelines to NHS trusts to put in place the necessary safety arrangements for those with a BAME background.

[Baroness Jay of Paddington (Lab) [V]]

My Lords, following the Government’s statement that the rise in infection rates is due largely to increased spread of the virus among young people, what strategies do the Government propose to adopt to ensure that returning students, for example, and others, comply more stringently with public health regulations?