The Long-term Sustainability of the NHS and Adult Social Care

Lord Brooke of Alverthorpe Excerpts

Thursday 26th April 2018 Lords Chamber

[Lord Brooke of Alverthorpe (Lab)]

My Lords, like other noble Lords, I am grateful to the noble Lord, Lord Patel, and his Select Committee for producing their wide-ranging and influential report. Nye Bevan said that the NHS will last as long as there are folk with the faith to fight for it. Without doubt the noble Lord, Lord Patel, and the Select Committee have demonstrated that they have faith ,and they are ably supported by the right reverend Prelate the Bishop of Carlisle.

I shall confine myself to the Government’s response to the part of the Select Committee’s report headed “Public Health, Prevention and Patient Responsibility” and Recommendations 29 to 31. While longevity for both sexes has gone up, worrying evidence is now starting to emerge that in some locations it is not only stalling but possibly starting to reverse. Mental health illnesses are also greatly on the increase. There are social factors behind the causes, but a major problem, which we fail to address head on, is the unhealthy lifestyle habits that have developed in recent years in both adults and children.

As other noble Lords have said, 63% of adults and nearly one-third of children in England are classed as overweight or obese, rates of smoking are still at 17% and 10.5 million people are drinking at levels that pose some risk to their health, which has a knock-on effect with illnesses such as diabetes, cancer and heart disease. This in turn puts significant strain on NHS resources. As the noble Lord, Lord Ribeiro, indicated, it is estimated that alcohol alone costs the NHS £3.5 billion a year, and obesity is going up and is now estimated to cost about £5.1 billion a year.

These costs and the related illnesses and diseases can be reduced. While the rate of smoking is still far too high, great changes have been achieved in a relatively short time through very effective public campaigning and by having Governments who have been prepared to take tough decisions on issues such as pricing, marketing and availability.

I turn to the Government’s comments on obesity, where some very tough decisions need to be taken. I am pleased that they are being positive. In their response they set out a range of actions, all of which are to be applauded, but are they enough and sufficiently hard-hitting to achieve their objective?

The Government said that they will monitor change in the prevalence of childhood obesity through various schemes, including the national child measurement programme and the Health Survey for England. More detailed assessments will be carried out next year and in 2020, but when we check on this we find that we have been doing this since 2006. To my surprise, we have been weighing and measuring the height of 1 million children aged 4 and 11 every year since 2006 when the problem was first identified, and we are now talking about doing further assessments in 2019 and 2020. This review was set up with two key purposes. The first was,

“to provide robust public health surveillance data on child weight status: to understand and monitor obesity prevalence and trends at national and local levels, inform obesity planning”.

This was back in 2006. The second was,

“to provide parents with feedback on their child’s weight status: to help them understand their child’s health status, support and encourage behaviour change where it will help a child achieve a healthy weight, and provide a mechanism for direct engagement with families”.

What have we done with all this data that has been collected? This is not a mandated programme. Local authorities are only encouraged, they are not required. As we know, local authorities have suffered cuts to their income of close to 70% over recent years, so is it any surprise that after running this programme since 2006 we find obesity is now worse than it was when we commenced this exercise virtually at the turn of the century?

We now find ourselves in the position where overweight is becoming the norm with parents and even health professionals, and they are struggling to identify overweight children by sight. True, the Government have an obesity plan. The sugar tax is greatly welcome, as is the reformulation of food, which they are working on. I believe further changes are likely to come, restricting children’s exposure to junk food and advertising, as reported in the Times earlier this week. We see Members from all parties coming together at last and recognising that the only way we can make a movement is by working together and not engaging in the usual feuding.

There are a number of initiatives, all with the best of intentions. Frankly, though, many of us believe there is a case for this all to be brought together with an overarching national campaign involving all schoolchildren. Here I look across at the noble Lord, Lord Saatchi; maybe this is an area where he could bring his particular expertise to bear. We should be endeavouring to engage 8 million children in this programme in the 24,000 schools around the country, not just a small element, as we have done since 2006. They need to be weighed and then, in turn, to be given the facts, full support and encouragement, with the involvement of their parents, to try to persuade them to lead healthier and more fulfilling lifestyles than they engage in at the moment.

I regret that the present obesity plan does not have a central focal point; it is a whole range of different small initiatives. We need some major pulling together of the threads with a strong lead being given. As I mentioned to the Minister last week, for some reason broadcasters are not involved in the plan or even mentioned in it, but they should be. Why are they not? The BBC, with its national and regional TV, radio and online facilities should be spearheading a flagship programme and related co-ordinated activities for the health not only of our youngsters; if we can run an anti-smoking campaign that affects parents, as that one did, we can do the same to see movement on obesity. Is it possible? Yes, it is. We need willingness, power and determination.

Even if the Government are not prepared to move on this, I hope that, in looking at the report, we can stand up and start to push people in a direction where we involve a massive number of them in tackling a major epidemic that cannot be left untackled any longer.