Food (Promotion and Placement) (England) Regulations 2021
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Baroness Brinton (LD) [V]
My Lords, I declare an interest as a vice-president of the Local Government Association. I thank the Minister for his introduction to these regulations. The comments of the noble Lord, Lord Brooke of Alverthorpe, as chair of the APPG on obesity, were particularly helpful.
These regulations sit behind recently revealed alarming figures showing that nearly a quarter of children are overweight or obese when they start primary school. That figure has risen to a third by the time they leave at 11. The Government are right to be concerned about the overconsumption of food and drink high in calories, sugar and fat, which leads to obesity and associated obesity illnesses. I will come on to the regulations shortly, but from these Benches we want to make two other comments.
First, the Conservatives in government have consistently cut public health budgets to local authorities over the last six years. The King’s Fund says that, on a like-for-like basis, the 2019-20 budget is 15% less than that of 2013-14, including a more than 5% cut to obesity services. In addition, the reduction in school nurses as well as health visitors over the last decade has meant that some of the vital early face-to-face advice on nutrition to parents of young children has gone.
Worse, some of the excellent work done by chefs such as Jamie Oliver and by the campaign of Henry Dimbleby—both of whom over the years encouraged much healthier eating in schools—has been reduced if not lost. In fact, recent reports say that high-fat, high-carbohydrate foods such as the dreaded turkey twizzler are re-emerging on to school menus.
The second issue from these Benches is the decline in fitness of our primary school children. This has been a long-standing problem, but the sale of playing fields and focus in the curriculum on core subjects have all led to a reduction of time when children can exercise, take up sports and essentially get the habit early, which will also impact on their weight. This January, Sport England noted that children’s activity levels were down in 2019-20—pre pandemic—with only 44% of children and young people meeting the Chief Medical Officer’s guidelines on taking part in sport and physical activity for an average of 60 minutes a day. Now is the perfect time, as restrictions have been relaxed, to increase the time that young children can undertake sports and exercise. Can the Minister say what influence the Department of Health and Social Care has with the Secretary of State for Education in remedying this matter and what plans there are to fund more opportunities for young children to participate in sport and exercise?
Turning to the regulations, I note that this follows a decade of trying to encourage large supermarkets to reduce salt and sugar in their own direct products, as well as encouraging their suppliers to reformulate. However, not all of them have achieved enough, nor have they changed their attitudes towards promotions.
If the Grand Committee will permit me an anecdote, one of my adult children used to work as a buyer for a major supermarket, and its department had been asked to go back to suppliers to ask them to reduce sugar, salt and fat. My son was responsible for, among other things, dairy products. Most products and many suppliers were happy to work with the supermarket to achieve reductions, but both sides were completely stumped by one product: brandy butter. It has not just sugar and fat, but alcohol too. On this occasion, it was agreed there was very little they could achieve, other than to highlight its very red traffic light and recognise that it was a truly seasonal product that was not part of people’s everyday habits. But it is good they were thinking about it.
While the public health responsibility deal has improved matters a little bit, it is not nearly enough. One key area remains obvious. That is the influence of promotions targeted at children and their parents, both in store and on television. Other speakers have referred to multibuys, end-of-carousel promotions and queuing eye-catchers—far too often, junk food and sweets. While the public health responsibility deal has helped a bit in those larger supermarkets, it is certainly not enough, and it is good that healthier choices will be much more visible in shops and that buy one, get one free and three-for-two offers on high fat, sugar and salt products will be restricted.
On food scope, it was worrying to read in the past few days that a high level of juice in baby and toddler food, which has a very high fructose content, is not labelled as high sugar because the juice is natural and not added, processed sugar. Most parents of babies and small children believe that such products are not high in sugar. Surely, this needs to be added to the formulation list for HFSS products. Is the department looking at this?
It is right that environmental health food authorities should be responsible for enforcing this in localities, but I ask, as others have, whether there will be extra funding for environmental health to be able to carry this out. We need to remember that members of environmental health have many other responsibilities too, including the vital role during the pandemic of test and trace, working with local resilience forums. The Government cannot keep loading extra responsibilities on to beleaguered local authorities without funding them properly. Will there be funding for this for the enforcement bodies?
From these Benches, we regret that the food sector has not responded well enough to remove the need for this regulation, but we believe that the long-term health implications for our children are being damaged by current custom and practice. But this cannot be done without other actions too: funding more sport and exercise opportunities and funding enforcement are just two critical elements. The minimum of another five years to implementation, as outlined by the noble Lord, Lord Brooke of Alverthorpe, is too slow. Can the Minister please ensure that these changes are speeded up?
Baroness Merron (Lab)
My Lords, I appreciate the intent behind these regulations and thank the Minister for his introduction to them. I want to comment on the current situation and raise a number of questions following on from those that we have already heard, because I feel that it is the detail of the regulations that is wanting rather than what they are about.
To emphasise the points that have already been made in this debate and have been heard in your Lordships’ House on many occasions, the UK has among the highest childhood obesity rates in western Europe. One in four children is overweight or obese when starting primary school, and the number is one in three by the time a young person gets to secondary school. These children are obviously more likely to become obese adults—let us remind ourselves that, at present, one in four adults is obese—and therefore at greater risk of conditions such as diabetes, heart disease, fatty liver disease, cancers and mental ill-health. As we know, the situation is worse in poorer communities. Indeed, one in three adults in the most deprived areas is obese, compared with one in five in the least deprived—a clear inequality if ever we saw one. The discrepancy among children is even more alarming: more than twice as many children are obese in the most deprived communities as in the least, and that gap has nearly doubled under this Government.
There is no doubt that in-store promotions are incredibly effective in influencing what we buy. Research shows that we buy 20% more than we intended when faced by promotions. Cancer Research UK has shown that greater volumes of high fat, sugar and salt are likely to be purchased by those who are already overweight or living with obesity, so we see a correlation between promotions and obesity, and it is right that these regulations seek to tackle that. So, yes, it is right to take action to address this situation, not by limiting people’s freedom of choice but instead by supporting them to make healthier choices.
However, these regulations alone will not be enough, and it is this point that I want to emphasise to the Minister. We need a radical obesity strategy that goes much further, ensures that families are able to access healthy food and supported local leisure facilities, and ensures that poverty can be tackled. Without that, there will be no levelling up. All we will see is a continuing widening of the already considerable gap between those who have the means to manage their weight and those who do not.
Lord Kamall (Con)
Once again, I thank my noble friend for making that request. I always make it clear that it is important that we publish as much evidence as possible and let it be challenged; that is part of a healthy debate. If things do not work as intended, we should see what works and what does not. I am always very sensitive when someone says, “the evidence suggests”. We need to have that challenge but also make sure that we know what works. At the end of the day, we all want to see less obesity across our country, so surely it is important that we make sure that the evidence is there. Where something does not work, we will just have to try other ways.
On compliance, it is for local authorities to decide how best to enforce the requirements. Where an enforcement officer suspects that HFSS food or drinks may be inappropriately promoted, they should request further information to verify. If the product is in scope and has been promoted contrary to the law, an enforcement officer will consider what action should be taken.
Baroness Merron (Lab)
I thank the Minister; it is generous of him to give way. I would be very interested in how he sees the greater responsibility on local authorities. Picking up my question again, does he feel that local authorities are resourced suitably? Can they expect some recognition of this new and extremely important role, because the regulations require their co-operation too?
Lord Kamall (Con)
I thank the noble Baroness for that question. The Government are committed to ensuring that enforcement is proportionate and fair, and we intend to support local authorities and the judicial system on additional costs incurred as a result of enforcing the policy. Up front, I cannot say what those costs will be, but we want to understand what they will be to help enforcement.
I was asked whether we had watered down the policies for some products. We have excluded some products that are not among the highest sugar or calorie contributors to children’s diets or are not heavily promoted, but we will continue to keep the policy under review.
The noble Baroness, Lady Brinton, asked about weight management and other ways of tackling weight issues, including exercise. In March 2021, we announced an extra £100 million for healthy weight programmes to support children, adults and families in achieving and maintaining a healthy weight.
On infant foods, we will shortly consult on proposals to improve the marketing and labelling of commercial food and drink products for infants and young children. I acknowledge many of the concerns expressed by the noble Baroness, Lady Brinton.
The noble Baroness, Lady Merron, asked why we are using secondary legislation. The different legislative approaches being pursued reflect the current legislative framework and implementation routes available to the Government. For the promotion restrictions, we used existing powers in the Food Safety Act 1990 to lay secondary legislation before Parliament in July 2021. The statutory instrument has been subject to the affirmative parliamentary procedure.
On how we look at issues of inequality, noble Lords made a very fair point. Perhaps I may be so bold as to suggest that one issue for people I talk to in many of the communities that we are supposed to be reaching out to is that, for far too long, the public health industry has been dominated by white middle-class people who feel they know better than immigrant and working-class communities. It is really important that we understand those communities. As someone who comes one of the communities that have been patronised, I recognise that we have to make sure that we work with them and do not just sit in a place like this and assume that we know better. It is important that we really understand them. What is really good about the Office for Health Improvement and Disparities is that “disparities” are on the label, on the tin, which means that we have to look at how we address them.
There were some questions about why smaller businesses are exempt. I hope that I have answered them.
On people not being able to afford to eat a healthy diet, anyone who has watched daytime TV will know that some of those programmes can show you how to cook a meal very quickly and much more cheaply than is the case with many of the convenience foods that you can buy. The problem is how we translate that from the TV and entertainment to people’s lives in reality. In many ways, it means understanding families, where the decisions are made and what they have access to in many of their communities. Anyone who has been to many of the immigrant communities, for example, will know that there are plenty of shops that sell and openly display fresh food, but how do we make sure that we translate that into healthy diets?
On their own, these regulations will not be enough. We also have to look at how we translate all this into understanding people’s lives right at the family and the community level. It is our goal to improve children’s health and to reduce obesity. The shopping environment plays a vital role in the way products are marketed to us—for example, the pumping out of the smell of fresh bread from bakeries. We know that marketing people are experts in understanding consumer behaviours, with factors such as the location of products at the end of aisles affecting what we buy. The Government are committed to getting the right balance between stopping bad practice and working constructively with industry. We also want to evaluate the evidence of the restrictions once the policy is implemented.
We believe that retailers can play a vital role in creating a healthier food environment that does not promote the overconsumption of less healthy products. The Government hope that these regulations will enable us to achieve a healthier food environment and make progress to halving childhood obesity by 2030, and allow us all to live longer lives in good health. I commend the regulations to the Committee.
Public Health England (Dissolution) (Consequential Amendments) Regulations 2021
Baroness Merron Excerpts(3 years, 1 month ago)
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Baroness Merron
That this House regrets that the Public Health England (Dissolution) (Consequential Amendments) Regulations 2021 (SI 2021/974) have been introduced further to (1) the dissolution of Public Health England, and (2) the establishment of the UK Health Security Agency, via secondary legislation and without proper consultation or scrutiny.
Relevant document: 13th Report from the Secondary Legislation Scrutiny Committee
Baroness Merron (Lab)
My Lords, this regret Motion raises concerns about the lack of consultational scrutiny of the regulations introduced by secondary legislation associated with the dissolution of Public Health England and the establishment of the UK Health Security Agency. There is an important background to bringing this regret Motion before your Lordships’ House. The regulations are marked out by a lack of consultation and stakeholder engagement, the creation of a culture of blame for the shortcomings of government, confusion, and ongoing concerns about how the new arrangements will operate and be held to account.
In looking at how this came about, it is difficult to keep up with events, but, for the benefit of this debate, I will attempt to do so. In August 2020, during the parliamentary Recess, the then Secretary of State for Health and Social Care, Matt Hancock, announced in a press release that the Government were forming a new organisation, the National Institute for Health Protection, bringing together the existing health protection responsibilities discharged by Public Health England with the new capabilities of NHS Test and Trace, including the Joint Biosecurity Centre.
The press release advised that the new organisation was to be operational from 2021 and led by the noble Baroness, Lady Harding of Winscombe, who was appointed as the agency’s interim executive chair. This was followed by a Written Statement in March 2021, in which Matt Hancock announced the formal establishment of the UK Health Security Agency, which was previously the aforementioned National Institute for Health Protection, to take effect from 1 April 2021 and to be led by Jenny Harries, the Deputy Chief Medical Officer for England.
Later in the year, on 1 October 2021, the Government announced the launch of the UK Health Security Agency in a press release. On the same day, the Government also announced the launch of the Office for Health Improvement and Disparities, to be led by the incoming Deputy Chief Medical Officer for England. Confusion and obfuscation reigned throughout all of this, with the 2021 regulations—the subject of this regret Motion—being laid before both Houses of Parliament on 3 September 2021 and coming into force on 1 October 2021, as an instrument under the “made negative” procedure.
The House of Lords Secondary Legislation Scrutiny Committee noted in a report published on 16 September 2021that the regulations were “an instrument of interest”, due to the regulations making consequential changes to legislation that had referenced Public Health England. While Parliament was denied scrutiny and consultation was conspicuous by its absence, reaction to the dissolution of Public Health England was far from positive, with more than 70 health organisations, including the Academy of Medical Royal Colleges and the Faculty of Public Health, signing a joint letter.
The signatories were “deeply concerned” that the plans paid
“insufficient attention to the vital health improvement and wider functions of Public Health England”,
including necessary measures to target smoking, obesity and alcohol and to improve mental health. The signatories argued that it was a “false choice” to
“neglect vital health improvement measures”
to tackle Covid-19. I reflect that this is an observation repeatedly pursued in debates and Questions in your Lordships’ House.
Alexis Paton, chair of the Committee on Ethical Issues in Medicine at the Royal College of Physicians, argued that the decision to dissolve Public Health England was an attempt by the Government to save global face as a result of their response to the pandemic. Ms Paton stated that Public Health England had nearly 60 targeted programmes to improve health and well-being across the population, and that the loss of any of these services was too high a cost to pay. At the same time, the chair of the British Medical Association’s ruling council, Dr Nagpaul, queried the timing of this decision, questioning whether it was the right time for a major restructure, given the very immediate need to respond to the pandemic. Clearly, it was not the right time. The King’s Fund also stated that the Government’s decision to replace Public Health England with two new bodies would
“increase complexity locally and nationally”,
and indeed this is the case. There were also warnings that the restructuring of Public Health England would sap morale and focus and should have waited until the end of the pandemic.
I am grateful to the BMA for its views on this matter, including that the solution was not to reorganise in the middle of a pandemic but instead to restore funding and capacity, including increased support to local public health services. The BMA observes that previous reorganisations of public health services have not improved public health provision or the experience of the workforce, and that health inequalities have in fact worsened since the last reorganisations—even more so during the pandemic. Concerningly, the BMA also reports that morale is low, with widespread fatigue and burnout, while staff have also experienced inadequate consultation on the restructuring, despite the fact that they would have had so much to offer.
In a survey of public health doctors at the beginning of the year, over 60% said that they believed that the new form of organisation would actually worsen doctors’ ability to respond to public health challenges. Nearly two-thirds said that they were not confident that they would be able to contribute to the design of the new system, and almost three-quarters of respondents to a survey said that they had no confidence that the successor organisation to Public Health England would be sufficiently independent or able to speak truth to power. This is a serious charge sheet from those who work in the field and seek to improve the health of the nation by prevention rather than cure. I put it to the Minister that in the face of all this, it is hard to see how the new bodies could be independent or effective. They are not set up in statute and were created without parliamentary scrutiny or approval. I will be listening closely to the Minister’s response to the substance of this regret Motion. I beg to move.
Lord Howarth of Newport (Lab) [V]
My Lords, I want to take the opportunity of this debate, arising from the dissolution of Public Health England, to pay tribute to PHE and its chief executive, Duncan Selbie. I also want to ask the Minister to tell us more about the Government’s intentions regarding public health, a matter that certainly deserves consultation, as my noble friend Lady Merron has insisted, and more than the perfunctory scrutiny—or non-scrutiny—normally given to a statutory instrument.
With other parliamentary colleagues—including a good number from your Lordships’ House—in the All-Party Parliamentary Group on Arts, Health and Wellbeing, I worked for some years with Mr Selbie and others in his team at PHE. At a time when the Department of Health, NHS England and clinical orthodoxy were far from recognising the significance of the well-being agenda, social prescribing and the potential of the arts to support health and well-being, PHE was positive and far-sighted. During the three-year period of the inquiry which led to the publication of the APPG’s report, Creative Health, in 2017, PHE worked constructively and thoughtfully with us.
The three key messages in Creative Health, underpinned by evidence, were that the arts can help keep us well, aid our recovery and support longer lives better lived; help to meet major challenges facing health and social care, including ageing, long-term conditions, loneliness and mental health; and help to save money in the health service and social care. Duncan was one of a number of distinguished people, including Professor Sir Michael Marmot, who publicly endorsed the findings of Creative Health. He said:
“This is an impressive collection of evidence and practice for culture and health”.
The publication of Creative Health was, I think it is fair to say, a turning point in the recognition by the health establishment of the importance of social prescribing and the engagement of individual creativity in promoting health and well-being.
In a speech at the King’s Fund in November 2018, the then Health Secretary, the right honourable Matt Hancock, explicitly acknowledging the significance of the Creative Health report, said that from now on prevention must be fundamental to NHS strategy and social prescribing must be fundamental to prevention. He stressed the value of the arts and culture in social prescribing, and the NHS Long Term Plan of 2019 reaffirmed the centrality of prevention. Mr Hancock established the National Academy for Social Prescribing later in 2019.
Much has happened since then. While I can well understand that the new Secretary of State is preoccupied with Covid-19, the clinical backlog that Covid has so much worsened and the pressures on the NHS workforce, I would ask the Minister to reaffirm that the Government’s commitment to their prevention strategy is not diminished and that they continue to recognise the importance of personalised health and of the arts and culture in contributing to health and well-being.
I hope the Minister will also pay tribute to Duncan Selbie and PHE. When it was announced that PHE was to be abolished, I was shocked. It was hard not to believe that PHE institutionally and Duncan Selbie personally were being scapegoated for the Government’s own failures in the early stages of the pandemic. Of course, I wish the successor institutions well and look forward to working with them through the APPG and the National Centre for Creative Health. It is a shame, however, that Mr Selbie was cast aside.
I am concerned that the “build back better” plan envisages shifting the NHS towards prevention only as a long-term priority. However, integrated care systems surely offer an early opportunity for the NHS to work better with local authorities and the voluntary and community sector, including arts providers, on prevention. Will the Office for Health Improvement and Disparities be working with other government departments responsible for education, housing and employment in addressing the social determinants of health?
I hope we can be reassured this evening that the Government recognise their error in having reduced the public health grant by no less than 24% per head over the last six years, with terribly damaging consequences, and that the restructuring that has now occurred is intended to provide more, rather than less, support for public health.
Lord Kamall (Con)
Maybe it is because I speak rather quickly, but in my remarks just now I talked about the difference between the negative and affirmative procedures, and the affirmative procedure needing parliamentary scrutiny—so I do agree.
Baroness Merron (Lab)
My Lords, this Motion has given an opportunity to put dissent and concern on the record, and we have heard that through voices from across the House. I am left thinking as a result of this debate that any reorganisation, particularly one such as the one we have discussed, would have greatly benefited from proper parliamentary scrutiny. I literally regret that this was not the case.
I am grateful to noble Lords for their thoughtful contributions and consideration. I echo the words of my noble friend Lord Howarth of Newport in giving thanks and appreciation of Public Health England and the entire team, led by the chief executive as was, Duncan Selbie.
Improvement of the health of the nation and the equal chance to live a long, happy and healthy life is paramount. As my noble friend Lord Stansgate said, sidelining Parliament is not the way in which to tackle this advance. Similarly, my noble friend Lord Hunt highlighted the fact that there had been a shift of blame from Ministers to officials—which again, as we have heard in this House, cannot be an acceptable way forward. I hope that the Minister heard his noble friend, the noble Lord, Lord Lansley, who called for an inquiry and for Ministers to think again about the best way in which to manage public health responsibilities. I am sure that the Minister will listen to those words as well the others that we have heard today.
While I appreciate that the Minister has been left somewhat holding the baby on this one, I have heard what he has said. Although I am disappointed in many of the conclusions that he has drawn, I beg leave to withdraw.
NHS: Fracture Liaison Services
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Baroness Merron (Lab)
My Lords, there is no inevitability about osteoporosis and broken bones as the result of getting older, and yet osteoporosis affects 50% of all women, with those going through the menopause and after menopause experiencing it at a higher rate of incidence due to the reduction in oestrogen levels. Does the Minister acknowledge that two-thirds of women are not getting the treatment that they need, and that this was the case even before the pandemic? What steps are the Government taking to improve access by women to HRT and treatment for osteoporosis?
Lord Kamall (Con)
The noble Baroness raises an important point. A number of people are still waiting to be seen; NHS England is very much aware of the backlog and wants to address it. As a key part of the elective recovery plans, NHS England is working with a number of local integrated care systems to establish a greater number of clinics, as well as with community diagnostic centres, and is developing business cases. NHS England is also working with experts in the field of musculoskeletal health to improve patient pathways and to find new opportunities that, over time, will improve patient care and access.
Public Health Grant to Local Authorities
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Lord Kamall (Con)
I thank my noble friend for that very important question. We continually assess our preparedness plans for infectious disease outbreaks and pandemics to ensure that they remain as robust as possible. This assessment includes, as appropriate, incorporating lessons learned from exercises that test the readiness of our plans and from our experience in responding to pandemics, disease outbreaks and other types of incident in the UK. The UK Health Security Agency will be dedicated to ensuring that we are protected from all future threats, including pandemics.
Baroness Merron (Lab)
My Lords, areas of greater deprivation have disproportionately borne the brunt of cuts to the public health grant, despite many people in these areas having poorer health. In Blackpool, ranked as the most deprived upper-tier local authority in England, the per capita cut to the grant has been one of the largest, at £43 per person per year. Can the Minister explain to the House how and why these decisions are made, and will he ensure that fairness in funding is restored for those who need it most?
Lord Kamall (Con)
The noble Baroness raises a very important point about needing to tackle disparities across our nations. The ring-fenced grant that we provide to local authorities to spend on public health services comes with a condition that they consider the need to reduce health inequalities in their areas. Also, the grant’s distribution is heavily weighted towards areas facing the greatest population health challenges. Per capita grant funding for the most deprived decile of local authorities is nearly 2.5 times greater than that for the least deprived. In addition, noble Lords will be aware of the new Office for Health Improvement and Disparities. The pin-light focus of that office is on health disparities and how we tackle them.
Alcohol Duties
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Lord Kamall (Con)
The Office for Health Improvement and Disparities, as well as many other bodies, will continue constantly to review the impact of this change in taxation. In addition, the Government remain committed to supporting those who are most vulnerable and most at risk from alcohol misuse. Alcohol is a cross-cutting issue affecting several government departments. A strong programme of work is under way to address alcohol-related harms and their impact on life chances, including an ambitious programme to establish specialist alcohol care teams in hospitals and support for children of alcohol-dependent parents. There are a number of other alcohol harm reduction strategies that are too numerous to list now, but I am happy to write to the noble Baroness.
Baroness Merron (Lab)
My Lords, alcohol-misuse experts have warned that the Government’s reforms of alcohol taxes are undermined by their failure to address the issue that alcohol from high-strength beverages may remain cheaper, in many cases, because the price per unit of alcohol is lower in many of those high-strength beverages. What plans do the Government have to introduce minimum alcohol pricing? Does the Minister share my concern that the Chancellor, in the Budget, appeared to be investing more in Prosecco than in the public health budgets that we need to see to cover the cost to society of alcohol harm.
Lord Kamall (Con)
The World Health Organization and a number of other organisations have criticised the current system of taxation of alcohol, and urged the Government—and the EU when we were a member of it—to move toward taxation based upon the volume of alcohol. To answer the noble Baroness’s specific question, there are no current plans to implement minimum unit pricing in England, but the Government continue to monitor the impact of minimum unit pricing as evidence emerges from Scotland and Wales. It has been in place in Scotland for more than three years, and the Scottish Parliament will not consider its extension until April 2024. In all my conversations with various public health experts, one of the things that they make quite clear is that this has to be evidence-led, and we want to look at evidence from elsewhere.
Health Incentives Scheme
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Baroness Merron (Lab)
My Lords, I thank the Minister for answering questions on the Statement, which was first made on Friday, before the Government began press releasing new—and some not so new—spending commitments, and eventually published their full Budget yesterday. I must admit to having been somewhat bemused when I read this Statement. It felt like being taken on something of a gentle canter around the issues. To put it mildly, it is more than unusual to see the announcement of an app and wrist-worn devices making the grade for the substance of a parliamentary Statement presented to both Houses.
I make this point because it is important to say that, on any measure, the Government have decimated the budgets necessary to tackle the underlying causes of poor health and the inequalities that arise from and contribute to its incidence and effects. As we know, poor health has many costs—social, economic and personal—and I regret that the Statement is a fig leaf for inaction. Although the Prime Minister and the Secretary of State have acknowledged that stark health disparities exist, the Government repeatedly fail to face the target, let alone hit it.
The pandemic has highlighted just how important it is to have a healthy and resilient nation. Preventing and treating disease is vital for reducing further unnecessary deaths from disease and lessening the burden on the NHS as it contends with the enormous backlog in healthcare caused by the pandemic. However, the Budget presented contradictions, as funding will be mostly focused on a curative rather than preventive approach, which would have prevented obesity and non-communicable diseases happening in the first place. Public health experts and practitioners alike agree that investment in the prevention of disease could make the single biggest difference to the nation’s resilience and health, so can the Minister explain the reason for this omission from the Budget? Does he agree that failure to invest in public health will harm the Government’s levelling-up agenda?
Specifically, we were disappointed not to see any further public health funding in the Budget to allow local authorities to deliver key prevention services, such as smoking cessation and weight management. It is well documented that locally provided public health services are highly effective and cost effective. Can the Minister tell your Lordships’ House why this was ignored?
We on these Benches have campaigned for many years against this Government’s short-sighted cuts to public health funding. A reduction in spending of a quarter in this area has led to growing obesity in our population, loss of smoking cessation services, a ticking time bomb of poor sexual health, and overburdened drugs and alcohol services. Of course, any savings made by those cuts has been hoovered up by the impact on the rest of the health service.
Obesity is at a crisis level in this country. Two-thirds of adults are above a healthy weight; half are obese. A new IPPR report says that multiple disadvantages were “conspiring” to drive down health outcomes and prevent life expectancy from growing across parts of England. Hundreds of thousands of children in England are growing up overweight or obese because of widening health disparities across the country. Their excess weight means that they will face a higher risk of serious conditions, such as type 2 diabetes, heart disease or cancer, later in life. The IPPR analysis found that as many as one in 12 cases could be avoided if health outcomes in the worst parts of England were improved to match the best. This does not make pretty reading.
We are of course not going to argue against measures that attempt to help the public improve their health, but like the obesity strategy that precedes it, the latest pilot announced in the Statement is tinkering around the edges. We need to acknowledge that tackling obesity is about tackling poverty. People in the poorest communities are twice as likely to be obese as those in the best off. This scheme is about encouraging people to make healthy choices, but the cost of living crisis will make that even harder for too many people. How is someone supposed to make healthy choices if they simply cannot afford to?
According to a report by Broken Plate, the poorest fifth of UK households would need to spend 40% of their disposable income on food to meet Eatwell Guide costs, as opposed to just 7% for the richest fifth. Therefore, if poverty limits someone’s food choices, their exercise choices and their time, can the Minister tell the House why this does not feature in the heart of the Government’s plan to tackle this scourge?
Whatever this pilot achieves, and whatever their obesity strategy achieves, it will be completely undermined by the £20 a week cut to universal credit, which, despite yesterday’s announcement, will push millions on to cheaper, less healthy alternatives. Can the Minister tell the House what will happen to the health of adults and our children? Will those who are invited to join this pilot come from the communities that will benefit most? They are the people who have suffered most from the cuts to public health. Will the Minister commit that this scheme and the obesity strategy will be followed by the restoration of moneys cut from the public health grant?
Lord Scriven (LD)
My Lords, from these Benches I thank the Minister for coming to answer questions on the Statement. These Benches welcome anything, including innovation, that targets the poor health and loss of life years that obesity brings. However, this is really the emperor’s new clothes, because it has to be set in the wider context of the detriment of poor health, public health budgets and poverty. Public health budgets have been decimated, so that many issues connected to the determinants of health cannot be dealt with. Low pay has become the norm for so many in our country. School budgets for extra activities, such as physical activity, and timetabling have caused problems, and food and drinks industry standards also have to be addressed. Tackling obesity is about tackling the lack of opportunity and tackling poverty. Innovation with a wristband is like asking somebody to learn the Green Cross Code they have a motorway to get across. It is not going to be successful.
As a country, we have to start early: we have the second-largest child obesity problem in the whole of Europe. So what are the Government doing to ensure that daily sport as an activity is available in every state school, so that every child has some daily activity? What is the Government’s response to the report by the Association for Physical Education with regard to children’s health and, in particular, with regard to swimming?
Diet at home and in school is important. The Jamie Oliver Foundation Bite Back report basically found that healthy options in schools were more expensive. What are the Government doing to ensure that fresh, healthy food is available at an affordable price in every school in the country? How are the pilots being chosen? The correct areas are the areas of deprivation, because that is where the highest incidences of obesity are. What are the criteria? How are they being selected? How are areas being offered the chance to become part of the pilot? This must be seen as a healthy eating and exercise approach, and not a weight-loss problem. There are far too many citizens in our country who suffer with eating disorder issues. So what are the Government doing to ensure that it is this framework of healthy eating and healthy lifestyles, rather than being seen purely as weight loss?
With regard to the wristband and the data, who will have access to the data? Where will it be stored? What precisely will the data be used for? Will any private sector organisation have access to the data and its interpretation, and, if so, what conditions are in place to ensure that we do not have the problem that we had with DeepMind, where it was used for purposes over and above what was anticipated?
Finally, talking of the private sector, HeadUp Systems is noted in the Statement. This is a company that has a £30,000 turnover and made an £11,000 loss last year. So how, and on what criteria, was HeadUp Systems chosen? What role will it have? Which other private sector organisations were asked to provide the support that HeadUp Systems is doing? What Ministers or officials did members of HeadUp Systems approach or have access to? If there is a contract, what is its value and on what basis was it given to HeadUp Systems?
People with Learning Difficulties and Autism: Detention in Secure Settings
Baroness Merron Excerpts(3 years, 1 month ago)
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Baroness Merron (Lab)
My Lords, I thank the noble Baroness, Lady Hollins, for her sensitivity, her work on this crucial matter, and today for her use of her voice in giving voice to those who do not have a voice. The manner in which this debate has been conducted has spoken volumes.
When people are in the wrong environment, they suffer trauma, deep unhappiness, ill health, abuse of their human rights and lack of dignity—the list goes on. I ask myself: why is it that those who have learning disabilities and/or autism are seen to be less worthy of the right environment than those who do not? My noble friend Lord Touhig said that we should be ashamed of the years of failures and that this is a stain on British society. I agree with him because we are judged as a society on how we treat those in greatest need, to whom we owe the most.
The noble Lord, Lord Crisp, spoke of people getting stuck and their situation deteriorating because of the so-called care environment in which they have been put. This is not acceptable. It is a sorry and lengthy catalogue, which I hope the Minister will today commit to put an end to—a sorry catalogue of missed targets. Every figure that we refer to is not just a figure; each one of that number represents a person—and not just a person but their family, friends, colleagues and communities. They all carry that suffering along with the person.
I found myself shocked, as I am sure many noble Lords did too, by what I understand of the situation. The noble Baroness, Lady Bull, made a very good point that shocking though the figures are, they are actually small enough to make an impact. I hope the Minister will outline to the Committee today how he will undertake, with his colleagues, to put an end to this outrage once and for all.
The figures that shocked me were not just that there are over 2,000 people with a learning disability and/or autism in in-patient units or that there are 210 children there, but that the number of people in units has gone up by 40 from the end of September. So we have seen no sign of change. The figure that really tells the story that we are here to address is that the average length of stay for people with a learning disability and/or autism in in-patient units is 5.4 years. That is 5.4 years that no person will ever get back.
We have heard in the debate about the thousands of reported incidents of restrictive interventions—physical and chemical restraint. The most recent data show that in one month alone, July 2021, we saw over 4,000 reported incidents, 930 of which were against children. I go back to the point that has been made repeatedly in this debate, which I ask the Minister to address: much of this is because of the environment, nothing else. How can it be justifiable when we know, as the noble Baroness, Lady Hollins, said, that the costs of keeping somebody in an inappropriate environment are no less than to keep them in a caring, happy and appropriate environment? The finances do not stack up, so can the Minister address how the finances are worked out, as well as the quality?
We find ourselves in a shocking situation. We know, for example, that the mental health White Paper, issued in January 2021, took the important step that learning disabilities or autism will no longer be grounds for detention under the Act, but can the Minister update us on the timetable for bringing forward the legislation? We know that recently, in June, the Government published the results of the consultation on the White Paper, and there were positive responses on the necessity for these reforms. It would help to know, first, when that legislation will come forward but, secondly and key to this debate, when and how will there be a grip on this and by what means will the Minister measure the right progress having been made to protect and advance the interests of every individual about whom we are speaking today.
Coronavirus Act 2020
Baroness Merron Excerpts(3 years, 1 month ago)
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Baroness Merron (Lab)
My Lords, we do not oppose the renewal of the Coronavirus Act. As the Minister himself acknowledged, the pandemic is not over and many of these measures remain necessary. These provisions include: powers around the emergency registration of healthcare workers, which is important in ensuring that we can get workers who have retired from the healthcare system back into it, and participating in the vaccination programme; provisions for sick pay from day one, rather than day four, to help those required to self-isolate; and derogations that make it possible for remote participation in court proceedings to take place.
Not opposing the extension has been made easier, I should say, given that some of the more concerning and draconian measures have been removed from the Act. This includes Schedule 21, which contained the power to detain potentially infectious persons and has been used for a number of prosecutions, every one of which was found to be unlawful by the Crown Prosecution Service. A year ago, the Joint Committee on Human Rights said that these powers “ought to be repealed”. We, too, have long called for those powers to be removed from the Act and it is right and proper that they have been. However, we would question whether some sections which are also set to be removed should be.
We are disappointed, for example, that the powers in Section 78 to enable local authority meetings to take place remotely have been removed from the Act. Surely it should be the case that local authorities should decide for themselves if they would like to continue online meetings, especially as we approach a challenging winter, with the Health Secretary warning that cases could well rise to 100,000 a day. I look forward to the comments of the Minister as to why that intervention on the organisational arrangements of councils is being made.
Nevertheless, the Coronavirus Act itself is not the legislation that put us into three national lockdowns and imposed the regime of local lockdowns, the three-tier system, travel restrictions or mask-wearing mandates. Indeed, I am sure from this debate that I am not the only one who has lost count of the number of SIs laid under the Public Health (Control of Disease) Act 1984, the legal basis for coronavirus restrictions in England. I note that no changes to the public health Act are planned. Over the past 18 months, the House has repeatedly expressed its concern, as we have heard today, about the myriad regulations that have been introduced with limited scrutiny, bypassing Parliament and leading to executive dominance. These concerns have been further exacerbated by the Government’s reliance on the “made affirmative” procedure, meaning that, all too often, Parliament has not been given the opportunity to debate or scrutinise regulations before they became law.
That includes the health protection regulations that we are also debating. They were laid on 22 September and came into effect on 27 September. We fully support the provisions to amend the definition of “fully vaccinated” to include those who have received doses of two different approved vaccines or clinical trials. We also support the extension of the requirements for those who test positive for coronavirus and who are unvaccinated to self-isolate, and the extension of local authorities’ enforcement powers to 24 March 2022. However, I do not understand why this legislation was laid under the “made affirmative” procedure. I should be grateful for the comments of the Minister when he responds. After all, the department knew that the original expiration deadline was approaching and has long acknowledged that cases could rise to 100,000 this autumn or winter, thus necessitating continued self-isolation and enforcement powers.
While this is of course a rather straightforward SI, the Minister’s predecessor—the noble Lord, Lord Bethell —failed to make the case when introducing far more onerous Covid regulations that were laid using the emergency “made affirmative” procedure to implement coronavirus policies. Many of these regulations were laid at the 11th hour—a point made by my noble friend—despite being in press releases days, even weeks, in advance. They included mask-wearing requirements and the system of mandatory quarantine backed by criminal sanction, which gave the police the power to enter people’s homes; it also allowed individuals to be detained and searched, and have their belongings seized. These are not minor changes to the law.
Although we understood the need for the Government to respond quickly in the initial phases of the pandemic because of the emergency, it is unjustifiable to continue doing so without scrutiny where pandemic management has moved from reaction to control. I hope that the Minister can assure the Committee that the Government will do much better if, or when, they reintroduce some restrictions in respect of the management and control of the spread of coronavirus.
We all know that the pandemic is not over. We see tens of hundreds of new recorded Covid infections every day. We know that there are hundreds of people in hospital, many of whom are in the ICU. We also know that, on average, over 100 people are sadly dying of this dreadful disease every single day. The Minister will be well aware that the NHS Confederation, the BMA and local councils have called on the Government to implement plan B immediately. It contains the measures that we already support and are familiar with, such as mask wearing and allowing working from home. The Prime Minister should never have abandoned these measures; it is extremely concerning to hear that he is not following the advice of SAGE. My noble friend Lord Hunt expressed concern about the downgrading of SAGE’s role. I would welcome the Minister’s comments on that.
It appears that there has been little learning in government of the lessons from the early stages of the pandemic when delays undoubtedly, regrettably and tragically cost thousands of lives. Indeed, we know that plan B will not be enough to prevent another lockdown. Let us look at some of the current practices. I refer the Minister to one particular aspect of test and trace: the messages sent to people who have been in contact with somebody who has tested positive for Covid. Can he tell the Committee what impact those messages and their wording, which I would suggest is not carefully constructed, have had on compliance? Also, what assessment has been made of the user experience of the people receiving those messages? How often is the messaging reviewed?
The noble Lord, Lord Naseby, talked about the power of communication. I suggest to the Minister that, for any of us who are in receipt of these messages, the advice on what to do is, at a minimum, confusing. It is overly directive on the matter of self-isolation and takes a considerable time to establish that self-isolation is not necessary if one has been double-vaccinated. I would be grateful for the Minister’s comments on that.
Furthermore, the Government must get a grip on the stalling vaccination programme: it has left almost 5 million people at a greater risk of catching Covid, as they are yet to receive their booster jabs and are at the mercy of waning efficacy. The Government have said that the vaccination programme will continue to be our first line of defence; yet on current trends, we will not see completion of the booster programme until spring 2022. This seems rather slow.
We note also that the rate of vaccination for children is shamefully low as well. Vaccines for 12 to 15 year-olds in the UK started on 20 September and, to date, only 15% of 12 to 15 year-olds in England have received one shot. With hardly any protective measures and delayed vaccination, the return to school last month has seen record numbers of children becoming infected. For the last three weeks, we have seen an average of 10,000 new five to 14 year-olds testing positive for Covid every single day. Thousands are missing school, and this cannot continue.
As we approach a difficult winter, it seems that Ministers have failed to put in place the necessary measures to improve ventilation in businesses, public spaces and schools, despite better ventilation having been proven to reduce transmission of Covid. They have also failed to provide for proper sick pay and to fully resource local contact tracing teams, which would also help reduce the spread of the virus. This is no time for complacency. We urge the Government to act on vaccines, ventilation, sick pay and masks.
COVID-19: Type 2 Diabetes
Baroness Merron Excerpts(3 years, 2 months ago)
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Baroness Merron
To ask Her Majesty’s Government what steps they are taking to support people at high risk of developing type 2 diabetes who have gained weight during the COVID-19 pandemic.
The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Kamall) (Con)
My Lords, helping people to achieve and maintain a healthy weight is one of the most important things we can do to improve our nation’s health, as I am sure many noble Lords agree. Our world-leading strategy to meet this challenge was published in July 2020 and reflects the significant work undertaken over recent years to halve childhood obesity and create a healthier environment to help people maintain a healthy weight.
Baroness Merron (Lab)
My Lords, new NHS research reveals that people seeking help to lose weight are significantly heavier now compared with those who sought help pre-pandemic. With type 2 diabetes closely linked to obesity and local public health services shown to be highly cost-effective in helping people to lose weight, what assessment has the Minister made of the link between the cuts in funding and the increasing levels of obesity and diabetes, and will the NHS evidence now drive the Government to commit to reversing public health grants and properly funding services that are essential to tackling obesity?
Lord Kamall (Con)
I am sure that noble Lords will agree that it is really important that we tackle these issues and respond to the weight increases over the Covid-19 lockdowns. In March, the Government announced £100 million of extra funding for healthy weight programmes to support children, adults and families to maintain a healthy weight. Additionally, more effort has been put into providing access to information.
Drugs: Black Review
Baroness Merron Excerpts(3 years, 2 months ago)
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Lord Kamall (Con)
I thank the noble Baroness for her question and for her point that it is important to continue to invest in drug treatment services, but also to make sure that we stop drug users from engaging with drugs in the first place.
Baroness Merron (Lab)
My Lords, among some 32 recommendations, Dame Carol stressed the importance of getting more people into treatment who require it, diverting people away from the criminal justice system, and ensuring that service users are given a wider package of support for housing, employment and mental health. With drug-related deaths in England and Wales rising for the eighth year in a row in 2020, what conclusions might be drawn about the effectiveness or otherwise of the current cross-government approach to tackling addiction? Can the Minister assure the House that wisdom will prevail such that funding for substantive health support services to tackle addiction will be announced in the comprehensive spending review?
Lord Kamall (Con)
The Government have committed to answering in full the recommendations of Dame Carol Black’s review. In terms of joined-up thinking across government, the Government established the new Joint Combating Drugs Unit—the JCDU—in July 2021 to co-ordinate, and drive a genuinely cross-government approach to, drugs policy. The JCDU brings together different government departments, including those that the noble Baroness mentioned—the Department for Health and Social Care, the Home Office, the Department for Levelling Up, Housing and Communities, the Department for Work and Pensions, the Department for Education and the Ministry of Justice—to help tackle drugs misuse across society by adopting a cross-government approach.