Mental Health Services

Lord Addington Excerpts

Wednesday 25th February 2015 Lords Chamber

[Lord Addington (LD)]

My Lords, this is one of those debates where we find ourselves addressing the ground very close to the subject we are covering tonight, because we have been there before.

The primary thread through this is the fact that those who have stressful lives are going to experience a slightly higher occurrence of mental health problems. The noble Baroness, Lady Uddin, and I have taken part in several debates where we talked about people with disabilities and how they are going to have a slightly higher occurrence of mental health problems because their lives are more stressful. Every time that occurs, we are going to find more mental health problems. The problem is the fact that we have not, until very recently, acknowledged that this is what is going on. We have a historical problem which we are now starting to address. I do not know if we are coming up with more solutions with this Government, but at least we are acknowledging the problem and taking the first step.

Will the Minister give us some assurances about where we are improving training in recognising this problem? We have identified the fact that where people are under greater stress, anxiety and depression are going to be more common. What are we doing to make sure that those who are dealing with this recognise the underlying problems and intervene early? Every time we delay dealing with these problems, behaviour gets entrenched and educational problems become more pronounced.

The problem with the education system is that children and young people are on a conveyor belt. If they slip at any stage, they have to run very fast to catch up. Mental health will account for some of that slippage. When mental health issues occur with a special educational need, a situation is created where the child is under even more stress and dropping out is only the short-term survival mechanism. What are we doing to address this?

The noble Earl, Lord Listowel, addressed the point that care workers are undertrained to recognise this problem. They do not know what is going on. I think the Government have recognised that GPs do not have enough training to spot the problem early enough to push clients towards services. It may be the case that, as in many of these things, if you are going to have a problem, choose your parents well, and they will battle through for you. But, without that backing, children do not get that thrust to intervention and we end up with this point of crisis intervention and it tends to be papering over the cracks. Will my noble friend give the House some idea about the general strategy of making sure that there is greater awareness of the importance of early intervention? Without that we will carry on papering over cracks.

Autism

Lord Addington Excerpts

Wednesday 4th February 2015 Lords Chamber

[Earl Howe]

My Lords, part of this depends on the system working in a joined-up way between the National Health Service, local authorities and all the services upon which they depend. A great deal more training is going on, as I have mentioned. In December the Department of Health, the Association of Directors of Adult Social Services and Public Health England issued a new national autism self-assessment exercise, as I have mentioned. Much can be achieved, as we are impressing on local authorities, through low-level preventive support, and there are duties around prevention in the Care Act that local authorities now have in this area.

[Lord Addington (LD)]

My Lords, what is the relationship between the Department for Education and the Department of Health, particularly in spotting those at the higher-functioning end of the spectrum, for whom it may not become apparent that they have a problem until later in life rather than in the educational system?

[Earl Howe]

My Lords, the new statutory framework for children and young people with special educational needs and disabilities, SEND, is designed to improve the integrated working across health, education and social care so as to deliver improved outcomes for a child and his or her family. Clinical commissioning groups and local authorities will be working together according to that statutory framework.

Mental Health Services: Sign Language Users

Lord Addington Excerpts

Monday 2nd February 2015 Lords Chamber

[Lord Addington (LD)]

My Lords, in a short debate like this it is not uncommon when you come in at the end for much of what you want to say to have already been touched on, but in this debate I am afraid there has been the banging of guns and the falling of foxes all over the place. I am left with saying, as my noble friend who has already spoken has said, that much of what we are discussing here was touched on in our debate on mental health. I spoke then about the fact that all disability groups are overrepresented in the mental health sector—end of story. Anybody in those groups who has problems in the outside world and suffers more stress will have mental health issues, as night follows day; the question is what we do to ameliorate the situation.

The noble Lord, Lord Ponsonby, has rightly pointed to a particular group here, because the whole question is brought into focus when you look at a particular group: you see the specifics as opposed to the general. The whole spectrum here is made up of a series of specific points. British Sign Language users are going to have their own specific problems. They are specific, as the noble Lord, Lord Borwick, has just said, to a section of those who have hearing problems, such as hearing loss. The group has quite profound problems, and the question we are looking at here is how we make sure that they can access and receive support. Even if the noble Lord is right and they are a declining group, they are still going to have problems in the future that must still be addressed, because if you do not address them you store up problems, costs and inconvenience for the rest of society in an ongoing process. I therefore congratulate the noble Lord on raising this issue, because unless you concentrate on the problem in this way it becomes a generality, and I very much commend him for raising it.

Then we come to technology, and here I must declare an interest as chairman of a company called Microlink, which deals with technology. There is a lot of interesting stuff out there that can be of some assistance to those with varying degrees of hearing loss. As has already been said, there are dozens of ways in which you can play with language and translate it. There are things that can be used, and we have probably only just started to touch on this. There is something that can translate language into text; I use it myself as a dyslexic. There are dozens of bits of technology out there.

However, as was pointed out to me with considerable force when I started doing research on this, the deaf community across the spectrum is already using an incredibly widespread piece of technology called texting. This had not occurred to me at all. Mobile phones? I am part of the generation that regards a phone as something you talk to. I am apparently in the stone age here. Phones that you can text on that use a simpler, less elaborate grammar are actually a very common way of communicating in the deaf community. Do health workers and mental health workers actually know—the noble Lord, Lord Ponsonby, spoke about the same problems—that this is a way of establishing communication that might well mean that you find an easier path through to therapy than using sign language interpreters? It might well be some form of back-up to the primary talking cures for all forms of mental health treatment, which are generally regarded as better, longer lasting, more maintainable than simply pumping somebody full of drugs, even if drugs have to be used at the same time. Unless there is some way of bringing all these things together to get the best outcome, we are going to miss a trick.

Unless we learn to use the technology coming through, which is increasingly available—here I am probably shooting my own company in the foot—we will incur more on-costs. A little awareness training—asking people in casualty if somebody comes in who is in a very distressed state, “Have you tried communicating with them by text?”—may well relieve some of the stress, it may identify some of the symptoms more quickly. Could not a little bit of guidance here and there be worked in?

There are other forms of communication. My favourite one is called the UbiDuo. I like not only saying the word but the fact that it is instant typing to another screen that translates straightaway. The whole thing is about the size of a traditional laptop, so you can carry it around. That would be more appropriate for those who have good written skills, but there are lots of established pieces of tech that we are not getting the best out of. For the foreseeable future, we will need councillors who are skilled at using the specific sign language, with its rules of grammar, nuance and cultural references, but we may well need to support them and take some of the stress off them by using technology at the same time.

When all is said and done, the technology is generally cheaper. If we concentrate on that and make a funnel through to those very valuable—at times, irreplaceable—people, we will surely be doing all of us a favour.

Learning Disabilities: Premature Deaths

Lord Addington Excerpts

Wednesday 30th July 2014 Lords Chamber

[Earl Howe]

My Lords, the specification for the mortality review function is under development, and we all wish to see that work proceeded with rapidly. Data to support the function will be needed from both national and local sources. Work is under way with NHS England, the Health & Social Care Information Centre and Public Health England to derive data to underpin both the mortality review function and the NHS Outcomes Framework. However, it is important that this should take full account of wider developments in the collection and sharing of patient data, and this will inevitably impact on the pace of progress. As I am sure the noble Baroness recognises, it is vital that we get that right.

[Lord Addington (LD)]

My Lords, my noble friend will undoubtedly remember that we had a discussion in this House on the problems of the deaf in trying to access healthcare, and how that leads to other problems. Will there be a pan-disability look into this problem? It is clear that those who have problems communicating in forms of consultation with the NHS get bad results from it.

[Earl Howe]

My Lords, many of the issues that apply to those with learning disabilities also apply to others with different disabilities, and the work currently going on in the context of the noble Baroness’s Question will, I think, have a beneficial impact across the piece.

Olympic Legacy (S&T Report)

Lord Addington Excerpts

Wednesday 11th December 2013 Grand Committee

[Lord Addington (LD)]

My Lords, this is one of those papers that when you pick it up and read it makes you think, “Oh!”. I have raised sport and exercise medicine on numerous occasions, and the noble Lord, Lord Hunt, and the noble Earl, Lord Howe, have been dragged in. My approach has always been about enhancing general medicine and making sure that people are encouraged to take up sport, because they are put back together again quickly to carry on with the rest of their lives and to carry on with sport.

This report is a fairly academic paper, and I feel that it misses some of the point. You do not play a sport or push yourself to keep fit; that is a by-product. If we could all stay fit by jogging 2.3 miles every third day or whatever it is, everybody would be happy. We would have the medical benefits. We could get on with it without trouble, but we do not. We know we do not. We need an incentive and a reason to take the exercise to get the benefit. This report slightly missed the point that you do sport because it gives you a buzz. Enjoyment is not quite the right word. Sport at various levels gives you a buzz, a feeling of achievement, the competition and the thrill. Exercise sometimes provides you with another good feeling: the chance to get outside. These feelings are going on. Although the report mentions the psychology, I do not think it got under the skin of why you are doing it.

Having said that, the report is right about the fact that we do not co-ordinate, in trying to make sure that we get the benefit of the health agenda—and, presumably, the preventive health agenda—and the saving that the nation gets. The two bits do not speak to each other.

I have come to the conclusion that sports are slightly worse than political parties for wanting to sit in darkened rooms talking to each other about themselves—only slightly, but probably worse. They do not like people intervening on what they do, and change is usually forced on them—usually by a failure to perform at a certain level, to achieve an increase in numbers or, classically, to compete at the level to which they aspire or that they are used to. So when the report says that the science of elite-level sport is unclear, that does not surprise me very much. I suspect that the art of coaching and getting the best out of people is at odds with scientific method. The psychology involved, and the signs that you are responding to what goes on around you, are probably not approached best by this. There is also resistance to intervention. Sharing—and we are much better at sharing now than we were before, probably because we have to take on funding from outside government, and it is taken seriously—still has not gone into the culture.

One obvious thing that I had not even thought about until this report came out is that, if you are an elite-level sportsman, you do not want to be experimented on. It is a bit of a no-brainer. Who does want to be experimented on, to be perfectly honest? They want to be treated, helped, supported—yes. But they will take on a revolutionary new course of action only if they absolutely have to. That is a very logical point of view to take. It is always going to be anecdotal when slight changes in practice occur.

I am increasingly aware that I am not qualified in my own sporting life. Although I flirted with the top of my sport, I am totally aware that we were amateurs; although we did not think that we were amateurs, we absolutely were. I remember the shock when a first-class rugby club got its first diet sheet. Those days are long gone. But having worked a little bit with the elite level, I can say that trying to change the culture of behaviour, when people’s whole lives have been dominated by trying to achieve performance, is something that acquires scientific language, if nothing else. Trying to identify exactly what you are getting out of it is a very important factor here. To get benefit for wider society in terms not just of health but of community support and interaction is another very important point that is not covered here.

Sports medicine has important lessons to teach ordinary medicine. It is a simple fact that a sportsman knows that, if you get a bump, you get it treated quickly; you do not go to your GP and wait three weeks for a physio appointment, because then you would find that a muscle was weakened or that there was a slight imbalance in how you walked that has led into an imbalance in your entire body, which means that you might have to take time off work. The noble Lord, Lord Hunt, said that it was a very sensible idea to get more physios involved in accident and emergency, when I raised this issue a few years ago. We are still not quite there yet, because we do not take soft tissue injuries seriously enough. Sport has already taught us, and given us examples, that you should intervene early on those things to stop them becoming chronic. We have simply not adopted that yet.

I have always been something of a fan of having sport more closely linked to the Department of Health so that we can get those benefits together, especially preventive stuff. Certainly, exercise is a factor in controlling weight and gives you an incentive not to carry extra weight—by which I mean surplus weight. My rants against the body mass index are well recorded here, and I think that we will leave the subject there. But a sensible approach to how to control weight and stay healthy is something that probably should be led by the Department of Health.

The report is interesting because it starts to open a door to what is going on. When you open a door you do not know what you will find, but here was a corridor leading to interesting places which was perhaps felt to be irrelevant to sport, at least at the moment. It is an interesting start but to think that the Olympics would change the culture overnight was a total misconception. It will not be the only misconception about the Olympics. My noble friend and I have been sitting on a committee which looked at this issue and we got the impression that many people felt that, once the Olympics arrived, the days would be longer, the summers warmer and we would be guaranteed to win gold medals not only for the next 20 years but for the next 30 years.

This has been an interesting start to a debate that needs to go further, and for that I thank all noble Lords who sat on the committee.

Mental and Physical Health: Parity of Esteem

Lord Addington Excerpts

Thursday 10th October 2013 Lords Chamber

[Lord Addington (LD)]

My Lords, this is one of those debates in which, having put down your name to speak, by halfway through you are convinced that you do not have much to contribute. However, the main thing that attracted me to the debate in the first place was that it concerned parity of esteem between mental health and physical health. It has always struck me that the two are absolutely inseparable: you cannot remove one from the other. This is not just about the healthy mind and the healthy body; it is about the fact that you cannot access either one without paying attention to the other.

As has already been said in the debate, we had the problem that mental health was something that happened to other people and thus was something that did not concern us. We removed ourselves from it as a society. It is only over a comparatively recent time that we have started to realise that it is a mainstream problem. The similarities between that and some of the work I have done in other fields—for instance, on hidden disabilities, particularly dyslexia—are many. If what I do is normal or what I perceive to be normal, everything else will not be addressed. There are two things going on: the perception that it is nothing to do with me—I do not understand it, and I do not want to understand it because it is unpleasant—and the idea, as has been referred to in the debate, that we all know exactly what the mentally ill are like. They are basically people running around with meat cleavers and chasing around or shrieking at people on buses; they are not people who are in a state of depression. I almost said “unhappiness”, but it is being depressed, or functioning below par. Perhaps it is making the lives of those around them unpleasant; not fulfilling their greatest function; not interacting with family members. With depression, the field is far too wide to cover everything. That person is more than likely to be the standard person who has a mental health problem; he is not somebody who is in any way dramatic. That person is also going to be very bad at getting over the fact that he is ill and suffering from a long-term condition. As has been mentioned before, the life expectancy of those with mental illness is considerably lower than those without it.

So how do we get into this? Part of the work, clearly, has already been done by the noble Lord, Lord Bragg, who started off by saying that this is not that unusual, please open your minds to the possibility that this could be a very normal part of life. Furthermore, the rest of us will have to work a little harder, first, to take on new ideas and, secondly, to access the potential of those people to get the best out of it for us—the economy and the selfish principle within it. If those people are to have an episode of depression, for example, they will get over it, particularly if we give them the correct help and understanding and do not decide, “Oh, they have had a bout of depression. They will never be able to hold a job again”. If we can get over that, we will do well. We will benefit from that as a society. In my work outside dealing with hidden disabilities, I have found that embracing small changes in attitude and approach benefits the whole of society, not just that person. That process is not easy.

I must make a small confession to the noble Baroness, Lady O’Neill. When I first heard in my work with disabilities that mental health was to be put in with disabilities, I was a little frightened. I thought, “Wait a minute. With illness, you either get better or you die. It is not something that is with you for life”. I was rapidly disabused of that, because the prejudice that goes with it will be with you for life, as with cancer, which has been mentioned. The idea that it marks you out as different and other is incredibly important. I came to the conclusion: “It ain’t a perfect fit, but it—putting them together—is definitely the best show in town”.

We must try to get this across and start to engage with the rest of society about it. On the similarity between physical conditions and mental ones, I discovered many years ago, backed up by my personal experience, that many things that we do to prevent physical ill health work for mental ill health. There is lots of evidence, as Mind has recognised, that physical exercise releases hormones that help with many conditions. If you are physically healthy, you are considerably less likely to suffer from many forms of mental ill health. Encouraging physical activity can help many mental health conditions. The interrelationship between the two types of health is so close that it is ridiculous that we have to go through this process, but we clearly do.

The Government have taken this on board and are moving forward. I hope that we are not merely travelling with the tide but trying to inject some pace ourselves—running up a sail or putting an oar in the water—to go a little faster than general public opinion. There is a time lag within government and certainly in legislation. When Parliament becomes aware of a problem and then has to do something about it, it tends to jump ahead on the problem. I hope that we are seeing the first stage of that here. I am reasonably convinced that we are, but unless the Government now act and use the tide of public opinion, we will always lag behind.

We are dealing with a normal process here, a normal part of society. Unless the Government not only take the administrative steps but add to public awareness, we will be missing an opportunity to deal with a problem that will be with us for a long time. It is not going to go away, and unless we take coherent and sensible action now, we will be dealing with it for ever, normally within our prisons and hospitals.

Health: Active Lifestyles

Lord Addington Excerpts

Monday 17th December 2012 Lords Chamber

[Lord Addington]

My Lords, this is one of those subjects where, whichever department answered for the Government, it would be the wrong one in regard to half of the points made. The Department of Health probably stands the best chance. Indeed, I would be in favour of the Department of Health covering sport. I say that because it is one of those subjects that touches every aspect of our lives. Whenever we talk about it, we always go round a little circuit. We talk about the DCMS because it is in charge of sport and the Department for Education because sport education should start early in schools. However, in my opinion schools are not that great at it. To be perfectly honest, I could have a nice 20-minute rant about how dreadful many of the examples of school sport are, but I will not do so tonight.

Let us take, for example, the football match from “Kes”. I am afraid this House is one of the few places that will understand the predicament of pupils who are frozen to death and disinterested, watching four or five players kicking each other and the ball in a small circle with the goalkeeper doing tricks as the ball sails past him. This is what most people experience at school. My sport, Rugby Union, has a worse reputation with those who are not interested. “Let’s cower and freeze to death on the wing while the big boys roll around in the mud”, is how someone described the experience to me.

What do we do about this? No one department can deal with it. If the Department of Health takes a lead, it must decide whether it is encouraging a lifestyle or using sport as a treatment. Which is the driver? Encouraging it as a lifestyle would probably have far greater results. If we look at what has improved health quality in our society, medical treatments come nowhere near clean water, clean air and a decent diet. Doctors and medicines cannot touch those things when it comes to life expectancy and the quality of life. That is the way it is. Everyone must be encouraged from an early age. We must ensure that those who are enthusiastic and creative have better access.

When it comes to policy on sport for young people, all Governments try hard and all get it half-right and then stop until something else is tried. The current idea of bringing clubs into school sport is a good one. It builds on some of the better ideas of the previous Government. There is a continuation of policy there that I do not think either side wants to admit to, but it is late at night and nobody is paying any attention, so let us admit that now.

Schools do not have the breadth of talent or forward thinking in their sports to encourage people to adopt a sport so that it becomes a creative process. It should not be about status. Competitive sport is not about saying, “We have played eight games and won so many”. Competitiveness in sport makes it enjoyable and fun. It comes, for example, from learning how to move a ball into a space to allow someone else to carry on and run with it. The competitive nature comes when someone tries to stop you. That is the essence of it. Whether you record it as a competitive match for the school or say, “They had a kick about and learnt new skills”, it is still a competitive experience.

One of the problems with our coaching and youth in sport has often been that we put far more emphasis on whether results have been recorded than on how well the pupils played and how their skills can be developed in later life. All the major sports develop short games that are more accessible to people in their clubs and schools. What I call prep-school culture has a lot to answer for. Are we going to encourage people to make pitches available? Then, for instance, there are places such as parks where these skills can be used casually. An informal kick-about every week is infinitely better than one organised game once a month. Is the Department of Health going to encourage all the tiers throughout government to make sure that that kind of thing is available? This is a big ask and it will not happen overnight. It will not happen within one Parliament; it will take many Parliaments, and there will have to be a process of building it up to get it into the culture. The will is there but whether we have the drive and the focus to make sure that it continues is a question that all of us involved in politics and public life have to deal with.

I turn to the idea of using sport and activity as a treatment. It would appear that exercise is the wonder drug. I have recently heard it described as aspirin and cannabis, but there is always a wonder drug and activity seems to be it. As has been said before, if you are active, it is better for you, even if you suffer from things such as arthritis. Nobody ever thought of that. We all know about cardiovascular problems and the need to control one’s weight at a healthy level. I am glad to see in the briefing that people are now referring to a “healthy weight”, as opposed to body mass index based on an inactive person in the 1950s. I declare my interest as an old rugby player. Using physical activity would seem to be a very useful, cheap and self-regulating treatment, but can it be done without education, or access to a version of it, possibly being taken up in later life? It will be difficult, as you do not willingly do something that is boring and unpleasant. This has to be tackled in a creative way. Indeed, the Royal College of Physicians says, “Well, doctors aren’t used to this, especially those who were trained a long time ago, or even a few years ago. They don’t know who to refer to, what pathways to use or who they should trust to do it”. That is the culture.

I have bored noble Lords with the idea of somebody who is physically active dealing with a lack of trust or the serious need for physiotherapy to be given at an early stage. I think that at some time all sportsmen of my generation and those who are a bit younger have said, “I’ve hurt myself, doctor”, and have been told to rest. When they say, “Won’t that mean that the muscles get weaker and the tendons shorter?”, the answer is, “Well, rest a bit more then”, which means that the doctors do not know what they are talking about. Getting doctors to admit that and to refer patients to somebody who does know what they are talking about would be a huge step forward. It is happening more often and it is very important to make sure that that culture is maintained.

I could go on for much longer but there are only so many minutes available. Effectively, unless we promote activity wisely and well, we will waste a huge opportunity to save everything from money to a little bit of personal misery for people. Social interaction can be encouraged through activities, and mostly group activities. Unless we do this and unless the Government give us an idea of how they intend to drive this forward across government, we will miss our targets. Indeed, if all political parties can come up with a coherent answer and if we can achieve something that the Olympics taught us—that sport does not have to be very political—we can probably go forward. However, it will not happen quickly and we will not do it if we have three different camps shouting at each other.

Autism

Lord Addington Excerpts

Wednesday 5th December 2012 Lords Chamber

[Earl Howe]

My Lords, I shall gladly take that idea away with me. The noble Lord is right about the structures for delivery. Local authorities in England are responsible for the delivery of services and support for people with autism, and the NHS is the body that we are relying upon to identify those with autism and diagnose their needs. The two must work together.

[Lord Addington]

My Lords, will the Minister tell us a little more about the problems of being the lead department and trying to relate to other sections of government? How good, for instance, are the links with various stages of education in order to allow not only for people with the most acute forms of autism but for those at the higher-functioning end of the spectrum, such as those with Asperger’s? How is that developing and have we done any work in that field?

[Earl Howe]

Yes, my Lords, the autism strategy is a cross-government strategy and is already having an impact in areas such as employment and education. It includes activity to help adults with autism into work. The mandate to the NHS Commissioning Board particularly mentions those with learning disabilities and autism and their need to receive safe, appropriate and high-quality care. From 2014, when necessary, young people up to the age of 25 with special educational needs, which would include autism, will have an education, health and care plan. I assure my noble friend that work is going on across government in this area.

Autism Act 2009

Lord Addington Excerpts

Monday 26th March 2012 Grand Committee

[Lord Addington]

My Lords, I thank my noble friend for raising this subject. I also thank the Minister for taking this on. One feels that something as difficult as being the lead department on this issue should fall on the shoulders of someone who has not been quite so heavily worked over the past few weeks—but I am afraid that that is the way these things fall.

Every time I have spoken about autism, I use a quote about it being a three-dimensional spectrum; that is, it crosses in all ways. When you know about autism, you generally know about one autistic person and then you meet another autistic person. This is true of most hidden disabilities, but is probably more true of autism than any other.

--- Later in debate ---

[Lord Addington]

My Lords, to continue with the speech that I was making, a quote I often use about autism is that it is a three-dimensional spectrum. I am now going to fulfil a promise I made in September last year, when a councillor, Claire Young, gave me that quotation in a meeting run by the National Autistic Society at the Liberal Democrat conference. I know the words; I do not really understand, certainly not as well as others in this debate, exactly what they mean. I have a perception, because I have some experience of those who have worked with autism and of speaking to those who have it, but I will never know as well as they do exactly what autism means: the idea that it is difficult to assess, deal with and help.

Having got a legal responsibility to follow a coherent strategy led by one department, it is important that the others all join in with it. I have a briefing that suggests that although people at Jobcentre Plus have read the relevant leaflet, young people with autism are reporting back that they still have problems accessing the service. This is pretty typical of anybody who deals with a disability of any description: “I have read the leaflet, I know what is in it, and I know what is going to happen”. They are not trained well enough to be flexible and to understand that there is a spectrum of needs, and you must go from one level to another. This is not unusual to autism; it is just that autism may present a set of problems that are very difficult to access, possibly because the person with high-functioning autism may have difficulty explaining their situation, as been put to me by many people. If this is true, you must make sure that the person who is providing the service is properly trained. A leaflet is not good enough.

I have dealt with this before. In the Welfare Reform Bill, we finally got from my noble friend Lord Freud something that I had been after for about 12 years, that is, that the person who makes an assessment must be trained in the disability that they are assessing. This correlates to the Act that we are talking about today. It is part of the continuum. Let us not forget that the Autism Act would not have been necessary if all the other pieces of legislation that merely referred to disability had provided these solutions. When we looked at the online copy of the guidance, 10 Ministers in the previous Government, representing at least half-a-dozen departments, had all signed up to it. That was an admission, shall we say, from the Treasury Bench— I think that that is a good and fair way of putting it, and I do not think it was disagreed with by anybody—that you must co-ordinate.

Autism presents unusual and unique problems. It is not the only set of original and unique problems. That is why I said that I did not envy the Minister his task. He and his department may well be lumbered with breaking the ground for more efficient support for all disability sectors, because this is clearly the way that it should have happened in the first place.

I have also been encouraged to talk about the SEN Green Paper. The noble Lord, Lord Touhig, has mentioned education. Another truism of mine is that if you are a disabled person, choose your parents well and you will get the best out of the system. As I have said before, I still do not think there is a better combination than a lawyer and a journalist. They are the people who will point out that you are breaking the law and then let the world know about it. Too often it requires that degree of pressing and attacking to get people to move. If this legislation works, they will no longer be necessary. You will not be dumped at the end of one process, waiting to be picked up again by another. That continuation is vital. Not only is it important to receive some form of support at school, but also to be handed over to the college or university sector. As I have bored the House before with my findings on the discrepancy between the apprenticeship system and the university system in the way that some disabled groups, with exactly the same people potentially, are dealt with, I will not go into it again here. That type of disagreement and lack of continuity or progress is frequent, sometimes within the same department.

Will the Minister give us an idea of how the Government are monitoring this and of the type of problems they are addressing? This would be very helpful because we are going through a cultural shift and if there are no problems, it means they have not been looked for. They will be there: everybody here knows that the best way to find that one does not have a problem is not to look for it. If the Minister can tell us how the Government are identifying these problems and what they are doing to look for them, I will be much happier about this. It is not the Autism Act’s implementation; implementation across the board and the establishment of good practice for other groups are vital here. I wish my noble friend well in answering this, but it is not easy.

Health: Obesity

Lord Addington Excerpts

Monday 4th April 2011 Grand Committee

[Lord Addington]

My Lords, the noble Lord, Lord McColl, is consistent. I remember that we have crossed swords on this subject several times. The idea that exercise is a bad way of controlling weight is odd because fundamentally it misses the point. Exercise may make you gain weight. If you take exercise that uses muscle—for instance, my own sport of rugby union or rowing—you will get bigger. If you take these exercises your body will become more dense and solid; if you run, your body will become more solid and you will add extra muscle. The old adage is that if you go to the butchers and ask for a pound of fat and a pound of muscle you will discover which is the smaller unit—it is just there.

We can jump around here but the idea is that you are carrying too much fat. The body mass index is probably the worst measure of obesity and fitness because it throws up the anomaly of the sportsman emerging as the person who is going to die tomorrow. According to the body mass index, I did not make it to 30; neither did anyone else who played my sport at any level; and when Pinsent and Redgrave won their last combined gold medal they were heavily overweight and just missed being obese. These men are six foot five, so you can see how bad it is.

I am aware that I have an inferior medical knowledge but burning fat is probably the worst way to judge the way in which you use calories in exercise—I know I am sticking my neck out in saying this—because you burn up the calories when your body repairs the muscles, over a longer period of time, after exercise has put up your metabolism. This is fundamentally what your body does and different types of exercise will burn it at different rates.

It is also true that you have to take account of the number of calories going in and the number going out. If you live a sedentary life, it is absolutely obvious that you do not need extra calories. Exercise burns up calories, basically by rebuilding, reconditioning or changing muscle. You might burn off 15 calories by keeping fit in the gym but if, for example, you lift weights, you will burn off far more calories by rebuilding your muscles afterwards. However, if you are heavily overweight and eat far too much or eat the wrong thing sat in front of a TV screen, you are going to get heavier.

The fact is that, if we do not take exercise and we sit in front of a TV screen, the vast majority of us will eat or drink cups of tea laced with sugar. The same point applies to sugar in tea as it does to sugar in alcohol. If we spend a great deal of time being sedentary, most of us will consume calories at the same time. Many of us do not have the will-power to sit still for hours doing nothing without consuming calories. We live in a society where these no-need-to-cook, at-your-fingertips calories are easily available: you go to a supermarket and, after you have been good and bought the things that you have to cook, you buy lots of things that you do not have to cook. That is one of the barriers that we face.

How do we try to bring about a balance? The Government’s responsibility deal is a way forward, and I hope that we can get a bit more out of that than we have from some of the other schemes that we have had in the past. Primarily, we are not asking everyone to stop eating convenience foods, but we are trying to make those convenience foods potentially less lethal. However, how this will work, I do not know. Improvements have been made but are they happening quickly enough? There is no silver bullet. The previous Government tried hard to tackle the problem. They made people look at the problem but people still tend to be getting heavier, so which combination is right?

Total abstemiousness may be desirable but it is not something that we follow. Let us face it: we would not have to maintain sports grounds if we all did. Fast food is available to us and it has always been a part of our culture. History shows us that fish and chip shops and pie shops have always been there. All the things we like, such as salt and fat, are available and they give us a nice hit. We have to take that on board and try to educate people further. If people like these types of snacks, we have to try to make them less fatty.

Exercise plays a very important part for many people. If you are active and a reasonably keen amateur sportsman, then, apart from anything else, you are probably going to take slightly better care of yourself. Why would you not do so? Even if you only want to get from the third to the second team in your particular sport, then losing a couple of pounds and eating slightly better may have a part to play in that. When you are playing or running around training one, two or three nights a week, you are not sitting on your behind in front of a TV screen or in the pub. We must look at the issue in the round. The incentive to control your diet is increased by exercise. If you do not eat a great deal and are not carrying an extra few pounds of fairly soft tissue or fat, then, even if you just want to walk gently up a hill on a Sunday, it will be easier and more fun. Everyone enjoys the view more when they are not gasping for breath at the end of their walk and do not have incredible pain in their muscles. That is a fact.

I repeat: we have to look at things in the round. Physical activity and access to physical activity will help, if only as an incentive to eat better. Unless we make sure that that there are incentives to take part in social and physical activity and to think about the foods that we eat and the amount we eat, we are going to miss our targets. Let us make sure that, when we talk about diet, we talk about it in terms not just of consumption of calories but of the correct cycle of calories for activity.

I leave noble Lords with this. Everybody is gobsmacked by professional athletes—not by the amount they train but by the amount they eat. An Olympic gold medallist—I think it was Phelps in the last Olympics—said that he had to eat 4,000 calories a day. That is eight gold medals-worth of burgers. It means that people can actually eat a great deal and be very fit and healthy. I suggest that we need to look at this in the round and not get obsessed by any one activity.

[Lord McColl of Dulwich]

Before the noble Lord sits down, would he recognise that I did not actually run down exercise? I specifically said it was a good thing. Also, how does he explain the scientific fact that only one-fifth of the calories we eat are expended in exercise?

[Lord Addington]

My Lords, quite simply, if it is expended in exercise, it is not expended in the rebuilding of muscle. Rebuilding muscle is an important part of exercise—not the actual taking of exercise.