Health and Care Bill

Lord Addington Excerpts

Lords Hansard - Part 2 & Report stage
Wednesday 16th March 2022 Lords Chamber

[Baroness Grey-Thompson (CB)]

My Lords, I draw your attention to my interests: I am chair of ukactive, and I have a number of interests in this area. I also sat on the Lords Select Committee.

I too am not going to rehearse the arguments we gave in Committee, but all the names added to this amendment have been involved in this space for many years. We have all been through various iterations of this, and we should be talking about physical literacy and physical activity, and slightly less about sport. That might be surprising considering my background, but as the noble Lord, Lord Moynihan, said, we have an obesity crisis and a generation of young people who are more likely to die before their parents, and there are a number of conditions that can be treated. Frankly, we have been tinkering at the edges of this for way too long. There have been programmes and lots of initiatives that have had some success, but if we are serious about the NHS and the health of the nation, we have to do things in a different way. I feel like I have been talking about this for about the last 30 years—the noble Lord has had a slightly longer time in sport than I have—but I will be interested to hear the Minister’s response in order to understand how we can genuinely make a change and stop going round in circles on this important issue.

[Lord Addington (LD)]

My Lords, the last shall probably be quickest on this. We have all, as is agreed, said that we need to do something that is coherent. This has not been coherent. We have had committees that met once every full moon, provided everybody had had tea of the right quality that day; thus was their infrequency. Nobody was prepared to ensure that something that was inconvenient for one department was done to ensure that another department fulfilled it. There just was not anything. The Olympics did not manage to make them work together. We need coherent leadership and a price to be paid—accountability—for not doing it. If the Minister can give us that, we will have taken a major step forward. I would of course prefer the amendment that has been tabled, but I will take half a loaf any day over no bread. Can the Minister assure us that there will be leadership and that a price will be paid, publicly paid, for not doing it? Without that, as we know, this will merely become a report with somebody else saying, “They should have had a meeting about it some time”. Let us bin this. I am fed up with making that speech, even though it does usually get me out of a lot of trouble.

[Baroness Blower (Lab)]

My Lords, this is a key opportunity to do something really significant for the health of the nation, from the youngest to the oldest, and for all the groups we refer to as “excluded.” This is a key moment. If the Minister can respond positively to the questions put to him by the noble Lord, Lord Moynihan, he will be doing a very good job for the nation.

Covid-19: Vaccinations for School Pupils

Lord Addington Excerpts

Monday 17th January 2022 Lords Chamber

[Lord Kamall (Con)]

I once again pay tribute to the noble Lord, Lord Boateng, for raising this issue and for the number of times he has raised similar issues about the developing world over the years. Since I became a junior Minister of Health, I have been involved in many meetings with the G7 and G20, and in bilateral meetings with other Health Ministers. This item always comes up on the agenda and is something that the British Government have pushed. We are leading donors to the international COVAX programme and are working across the world, with other countries and with manufacturers, to make sure that we get the vaccines to those who really need them. While we here in this country complain about third and fourth doses, for example, there are still many people in many countries who have not even had their first vaccine. In the longer term, that is not right for anyone.

[Lord Addington (LD)]

My Lords, would the Minister give us a little bit more of an insight into the general policy for vaccination of children at schools? Although we have problems here, we have a history of people resisting and giving bad information. Is there a coherent strategy that will come out for school-age vaccination that we can refer back to as a model for the future?

[Lord Kamall (Con)]

One of the important things we all have to learn, from what we have been through and are still going through, are lessons for the future—not only for future Covid vaccines there may need to be but for all vaccination programmes and, perhaps, future pandemics. One of the really important things about this is making sure we get the right information. We are working with schools to make sure teachers and parents have the right information and also know the risks. Many people will know that, over the weekend, 16 and 17-year-olds were called for their booster if there was a sufficient space since their last dose, and we are now looking at how we vaccinate 12 to 15 year- olds. We are looking in more detail at whether it is safe for five to 11-year-olds, but at the moment the advice is not there.

Health and Care Bill

Lord Addington Excerpts

2nd reading
Tuesday 7th December 2021 Lords Chamber

[Lord Addington (LD)]

My Lords, it has been a long debate and a lot of very interesting things have been said. I wish to concentrate on the health part of this Bill.

Most of the things that scream “health” to me are in the back of the Bill. There is the traditional subject of fluoridation. It is nice to know that that fight is still running. I would side with the noble Lord, Lord Stevens, whom I welcome to the House, and the noble Lord, Lord Rooker, on this one. I think there are few rounds left in it, but let us see whether we can win it now.

When it comes to advertising restrictions for unhealthy foods, this should have happened a long time ago, and we have been talking about it for an awfully long time. Talking about the lobbying on this, I can remember at a party conference being entertained to dinner by somebody who tried to convince me that if you did not serve full-fat, fizzy drinks to children and offered them just water, they would, lemming like, leap on to the roads to get those drinks and be run down in their thousands. It is not a very good argument, and I did tell them that by the end of the meal.

I would like to look at something which is not really in the Bill, namely the wonder drug when it comes to health, which is exercise. The Bill does not address it very much, but the fact is that exercise in most forms is one of the things that improves your health and your resilience to infection later in life. The Bill does not do very much to encourage it. The Department of Health has the political muscle and goes into all other parts of government in certain ways—so why are we not pushing it from the Department of Health and why are we not using this Bill as a vehicle for it?

While it is a wonder drug, it also has a wonderful sugar-like quality—among all the varieties of exercise and sport, there will usually be one for you if you keep at it. However, just saying, “Go out there and do it” does not work; we know this, and it is a fact that the Government are starting to address. We have had an Agriculture Act encouraging farmers to turn bits of land into footpaths, but that will not help if we have not encouraged the rest of government to make them accessible. Are we making a car park or a bus route available? Are we getting various bits of government to talk to each other?

Sports have a small crisis coming up due to lack of activity caused by the pandemic. We are losing adult players who provide the administration and coaching for younger players. There has been a fall-off, and many sports are struggling to get them back in; my own rugby union is suffering from this. Can the Government do something coherent to help? Surely there must be a way to put something in the Bill to support exercise. This is done on a voluntary basis, and—let us face it—mainly funded by those taking part. Am I the only person here who has paid subs to join a club and paid match fees?

We need to make sure we get something in here to help us. A little encouragement and help—a little cohesion between bits of government—is required to get the best out of this opportunity. I look forward to Committee, when I will be encouraging noble Lords to put something in the Bill to make the situation easier. We are missing out the biggest assist we could have for public health: making exercise, recreation and sport easier to do. They have survived this long because people enjoy doing them. If any Government cannot cash in on that, heaven help them.

People with Learning Difficulties and Autism: Detention in Secure Settings

Lord Addington Excerpts

Thursday 28th October 2021 Grand Committee

[Lord Addington (LD)]

My Lords, this is one of those occasions when I almost feel like saying, “You’ve heard the noble Baroness, and that’s about it”, but I will indulge myself by following on from much of what she said, particularly about training and staff.

Looking around this room, I see many people who have done more on autism than I have, but anybody who has realises how difficult it is for somebody with autism, especially at the lower-functioning end, to interact with the outside world. Some can get through it and make you understand what they are doing, if you give them the time and if you have some training. I have less experience of learning disabilities but, if we stick with autism as a factor, these are people who have communication and perceptual difficulties, meaning that they cannot interact well with you. If they have got themselves in a position where people cannot cope, often because they are becoming adults and their demands on society and their expectations are realistically higher, you must have people who are properly trained to interact with them.

If you do not have those people and everything gets terribly difficult and occasionally frightening, pushing them away into a darkened corner is a perfectly understandable response. I can see why people do it. It is wrong, damaging and expensive, but people do it. However, once you are shoved away into a corner—and the point that the noble Baroness made about opening up everything is probably one of the keys here—if you do not know what is going on, how can you possibly intervene to change it? The idea that you should open up is key.

The Government have accepted that the situation that we had a few years ago at Winterbourne View is unacceptable, and they have made some progress, so congratulations for that. Whenever congratulations come, as the Minister has been here long enough to know, then comes the criticism behind it. It is not there yet, and it is about getting people not only outside but sustained outside.

So how are we doing with training? Has it become the norm that a person in a controlled unit is trained in how to de-escalate a situation without reverting to a chemical cosh or physical restraint? What is the relationship in the numbers between those people? I recently had a conversation with a young man of about 23 who went to a unit training in how to deal with this type of person, and he said that they spent most of their time in arm locks, and he was one of the oldest people working in that environment. This cannot be right. Do we have a situation where people are trained to do the communication, de-escalate and ensure that you can have a civilised conversation? Are they there on all occasions? If they are not, you are just playing Russian roulette and something will escalate and go wrong. That is almost a guarantee. Once something goes wrong and you have the problems that I have inarticulately described, somebody will be even more frightened than you or I would if we were being contained. Trauma and its effect on mental health are almost guaranteed; it is just a matter of how bad it will be in individual cases.

We have a situation where we all accept that something should happen. We are even reasonably agreed on what should happen, which is getting a person out to live as independently as they can with enough support to do it. What action are the Government taking to make sure this happens and that, when something goes wrong when they are living independently, we can intervene and correct it without getting into more conflict, fear and trauma? That is what is required. It is the fact that you can communicate with that person.

Across the disabilities sector, this is a very common structure. If you have somebody who does not quite fit into the bracket you are talking about, and you try to make them fit, putting square pegs in round holes—we can throw our own clichés at it—we will always get this trauma, lack of communication and outcome. This leads to things such as legal costs, lack of things and other greater costs. Will the Government please give us an idea of what they are doing to make sure that staff are trained to intervene and guide people towards correct—or perhaps I should say better—solutions?

People have a right to live independently and securely. With a little help, most of this group can do it, at least for long periods of time. If the Government are not making that intervention, they are probably wasting money, first and foremost. Can the Government give us an assurance that they are taking steps to make sure that this waste of money, which leads to a lack of human dignity and human rights, is being corrected? Without it, they are offending everybody at every level.

Body Mass Index

Lord Addington Excerpts

Thursday 22nd April 2021 Grand Committee

Asked by

[Lord Addington]

To ask Her Majesty’s Government what assessment they have made of the effectiveness of Body Mass Index as a medical guideline.

[Lord Addington (LD)]

My Lords, this is a subject of which I have spoken in the past, but what inspired this debate in my name was the report and subsequent publicity from the House of Commons Women and Equalities Committee, chaired by Caroline Nokes MP. The report points out that on an arbitrary line with an ideal point in the middle, when it applies to people, most are not at that middle point. When that is used to identify health, you are effectively saying that a lot of people are not healthy. That idea is suggested as a good guide to what one should be—I have spoken about it in the past. However, not everyone is in the middle. The guide says that one should be X height and X weight.

The report spoke about the damaging effect of body image, predominantly among the female population, particularly the young. It is yet another thing that says, “This is what you should weigh, look like and be.” But it should not be just like that. It is worth remembering that in the current environment this applies also to males. It is increasingly applied to all young people and, indeed, the whole population. There is an accepted norm. The internet has exacerbated a situation that has always been there.

Most of us in this debate will have spoken about retouching photographs and making sure that they are idealised versions of people. That is now taken to a new level. Some of the work that we have been doing was referred to in a debate on a Private Member’s Bill last week regarding restricting plastic surgery. These issues are adding to the problems, but if this approach is taken as a medical guideline, you are getting the wrong information on which medical procedure might be taken. Given the information that is put out, along with the press coverage, we should be worried.

I wish that I could have given some of my time to other noble Lords taking part in this debate. With conditions such as anorexia, someone can be told, “You are not light enough to receive help for that eating disorder, because you don’t hit a certain point on the graph.” Regardless of what that person’s frame or exercise patterns have been, by taking that decision, one is actually making someone’s medical condition more difficult to treat because somebody is looking at the guideline and saying, “This is where you should be.” This is a difficult situation for everybody. Certain medics will be better at this than others.

Here, I should probably say why I took an interest in this issue in the first place. According to this measure, I, like everybody I played rugby with, was dead a while ago. As somebody who once had somebody put a hand on his shoulder and say, “You were born to play prop forward,” I possibly have a bit of an axe to grind. To use myself as an example, I once had a neck injury and a chap—he became best man at my wedding and I was best man at his—looked at me and said, “You’ve got a neck injury? What neck?” We have to carry a bit of this.

This approach does not work for people like me. We are constantly told to lose weight. I remember being told by a doctor when I was having a check-up for some insurance, “Well, according to this, you are too heavy,” and in the same week being shouted at by a coach, “You’re not eating enough for my exercise programme.” Of the two, I know which one I listened to. But if you take this type of information that pays absolutely no attention to physique or exercise pattern, you will get bad answers, which do not help with any form of general public health pattern. You cannot say, “This is what you should be.”

I know that we are trying to move slightly away from this approach. I have heard people say, “Take certain measurements and get the relationship across.” If you do a calculation like that, you are still going to get it wrong, even if it is slightly more accurate slightly more often. Medical professionals should be looking at somebody individually. If they cannot do that, they should withhold an opinion. I know that it is more convenient to look at a chart and say, “You are X height, you should be X weight,” but it does not work. It never has.

I have done some work on this in the past. This approach was invented in the late 1950s, I think, although the noble Lord may have better information. It was thought that it would do as a general guideline. We have got bigger since, with higher protein diets, and are slightly taller and bigger-framed. It is out of date even for an active person who is not carrying any muscle mass. If you are any form of athlete or taking any form of physical activity, you will acquire some muscle mass and muscle is much heavier than fat. Get a person healthy and fit and make sure that they do not hit your medical targets: why do we still have this? It does not seem to work at any conceivable level. It is telling people to attain to something and repeating the messages, “Nobody is perfect” and “Do something else”. It encourages damaging behaviour. It gives wrong information to medical professionals, who often look at somebody and say, “Ignore it.” Why are we still using it? Can we not just take it out and ask for assessments? An assessment is looking at somebody and assessing their activity patterns. Otherwise, we are going to continue to have these problems.

This is either wasting printing paper or slowing certain people down from getting the help and treatment that they need. Adhering to it makes it more difficult to get early treatment for eating disorders. Everybody knows that you must get in early, establish the patterns of behaviour and convince that person to change those patterns of behaviour. Anything working against that should be removed.

I could go on at length, but the danger of being totally self-indulgent is looming towards me, so I will conclude my remarks by asking the Government just a couple of questions. First, if this was proposed to the Government now, would they use it? Would they take and use an arbitrary level that does not correctly assess anything other than for a small percentage of the population? Secondly, if the Government would not take on something like that now, what would they recommend to doctors to assess health and well-being in the general population? Would it be easier to administer or not? The answer is probably not, but a bit of effort might help us to get a better public health outcome.

Botulinum Toxin and Cosmetic Fillers (Children) Bill

Lord Addington Excerpts

2nd reading
Friday 16th April 2021 Lords Chamber

[Lord Addington (LD)]

My Lords, this is one of those debates where it is very difficult to find somebody who disagrees with the central thrust of what is proposed. The main thing we can say is, why on earth was this not done earlier? I hope that the noble Baroness, Lady Wyld, will accept my congratulations and pass them on to everybody who worked on this Bill in the other place, and to all those who did the prior spadework. This should have happened already. We are patching up a hole here, not dealing with some new problem. The noble Baroness, Lady Bull, described very well—much better than I could—the pressure of social media.

This is not new. When I first came here all those years ago, we were talking about photoshopping images in magazines. However, it is more intense now. It is also not an exclusively female problem. The body image issue generally affects both sexes, but due to fashion, it affects girls predominantly. Can we please make sure that we keep this under review? The Government should be doing more of this—but they should be doing more of many things. I therefore hope that the House and indeed Parliament as a whole will keep an eye on what is going on here.

I had one or two other points to make but my noble friend Lady Walmsley—I am very glad to be on the same team as her—did an excellent job of saying everything I was going to say, and more succinctly.

I conclude by asking the Minister to make sure when he sums up that we get an idea of the Government’s overview of this subject. Can he confirm that where these procedures are needed for a medical problem, whether physical or psychological, they will still be available? Their unavailability is the only conceivable objection I can see to this measure being adopted.

I hope that we will all give this Bill a great round of applause—a metaphorical one—so that it gets through quickly, because it will make life a little bit safer and better for people. Even if such a botched procedure is only temporary, that still involves more trauma, which will add to any problems that made the person go there in the first place.

Health Protection (Coronavirus, International Travel) (England) (Amendment) (No. 7) Regulations 2021

Lord Addington Excerpts

Monday 22nd March 2021 Lords Chamber

[Lord Addington (LD)]

My Lords, I totally agree with the initial thoughts of the noble Baroness, Lady Thornton. She described this as a rear-view mirror approach to legislation and that has caught it absolutely squarely. As a fellow person on the front of the Sunday Times, I do not think the Minister should take this personally. He is now representing a Government who have consistently got this wrong. There is confusion throughout the system. We do not know where you should go or what happens when you come back, or what will happen if you go somewhere and break the rules. My noble friend Lady Walmsley described how people are breaking rules because they cannot afford not to do so. This is a degree of confusion. I hope the Minister will take the message back to the Government that we have had enough.

The Motion today is justified—as would be a vote. I hope that the Minister can give us a clear understanding of the Government’s thinking. At the moment it seems to be a series of reactions based on almost nothing. The noble Baroness, Lady Altmann, got it right when she described a sieve letting water through. If we are to have a sieve, let us block up as many holes as possible or do away with it altogether; I think blocking up the holes is the way forward.

Lastly, on another point that has been made, if we are to have some form of vaccination passport to allow some activities, when will we hear about it? Many activities, including certain types of sport, will depend on it. I look forward to hearing what the Minister has to say.

Osteoporosis: Treatment

Lord Addington Excerpts

Tuesday 9th February 2021 Lords Chamber

[Lord Bethell (Con)]

My Lords, we do a lot of work on prevention. Vitamin D is made available and we have fracture liaison services to look at those who present themselves with a fracture to diagnose osteoporosis. A vast amount is already done. I am sure that more could be done, but this is an elusive and difficult to diagnose condition, which relies on those who fear that their bone density may be low presenting themselves to their GP for diagnosis.

[Lord Addington (LD)]

My Lords, it is quite clear that preventive healthcare can assist here, through not only vitamin D but exercise patterns. Have the Government considered getting a comprehensive exercise plan for the over-50s that will encourage them to undertake activity that improves muscle mass and bone density, both of which protect against this?

[Lord Bethell (Con)]

My Lords, last year we launched a massive campaign, the Better Health campaign, to encourage healthier living with respect to both eating habits and fitness—I can report to the House that I have committed myself to that campaign and it is bearing some good fruit. We are spending hundreds of millions on marketing, we have engaged dieting services for those who wish to be involved in them, and we have mobilised a huge number of exercise regimes, including the park runs. These are bearing up well, but I encourage all those who wish to have a healthier life to do more.

Cannabis Oil

Lord Addington Excerpts

Tuesday 12th January 2021 Lords Chamber

[Lord Bethell (Con)]

The noble Baroness puts a very reasonable challenge to the life sciences arrangements in the UK. We are blessed with major pharmaceutical companies, and a lively and exciting biotech industry, all of which are well plugged into the regulatory authorisation process. This is a novel, exciting, patient-led and innovative area. For those reasons, it has not had the financial backing of either business or the financial institutions to put in place the very simple, straightforward requirements of clinical trials, which are there for patient safety in the first place, not for government box-ticking. We are working extremely hard to try to resolve this Catch-22 situation and I hope very much indeed that we will be able to announce news on that shortly.

[Lord Addington (LD)]

My Lords, it is nice to hear that the Government are taking this problem seriously. If these drugs are effective, would it not be a good idea to encourage the demand side of this equation, where doctors prescribe them, by pointing out what the drugs allow a child with epilepsy, for example, to do—that is, lead a normal life, get educated, get qualified and be able to have a job—and the cost to the state if they do not?

[Lord Bethell (Con)]

The noble Lord alludes to an important, although frustrating, point. If I may gently push back, the truth is that there is a large amount of very persuasive anecdotal evidence, some of which we have heard today. It is completely compelling—it is just not scientific. Patient safety relies on extremely rigorous clinical trial regimes; that is why we have safe medicines in the UK. It is simply not possible to persuade front-line clinicians to make prescriptions on the basis of anecdote rather than clinical study.

Covid-19: Charitably Funded Hospices

Lord Addington Excerpts

Wednesday 28th October 2020 Lords Chamber

Asked by

[Lord Addington]

To ask Her Majesty’s Government, further to the impact of the Covid-19 pandemic, what action they are taking to make sure that charitably funded hospices have sufficient funding to continue to operate.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Bethell) (Con)]

My Lords, hospices play an often unseen but hugely valuable role in providing patient care. That is why we provided more than £150 million of extra funding to hospices during the first peak, when hospices across the nation cared for 170,000 patients, thereby helping to protect the NHS and continuing to provide high-quality end-of-life care. We recognise that the second wave presents challenges for hospices. We thank Hospice UK, Marie Curie and all the other groups for their engagement on this important challenge.

[Lord Addington (LD)]

My Lords, it is nice to hear the Government thanking the hospice movement. Some 80% of hospices think that they will have to make redundancies. The voluntary sector takes on more than 75% of hospice treatment. If the Government are not going to fund hospices, will they take on the work themselves or are we just going to let people suffer at the end of their lives?

[Lord Bethell (Con)]

The noble Lord is entirely right. Some £1.54 billion is spent on hospices each year. Of that, £1.2 billion is charitable; I pay tribute to those from the hospice movement who were recognised in the recent Birthday Honours List for supporting that fundraising. Let me assure the noble Lord that the challenge he describes is recognised in the department. The Minister responsible will meet key hospice stakeholders, including from Marie Curie, Sue Ryder, Hospice UK and Together for Short Lives, on 4 November when the challenge that he describes will be discussed.