NHS: Health and Social Care Act 2012

Lord Brooke of Alverthorpe Excerpts

Monday 16th March 2015 Lords Chamber

[Earl Howe]

I do agree. That idea is being taken up by a number of the vanguard sites, which are looking at the new models of care that were foreshadowed by the five-year forward view. It is, I think, the shape of things to come.

[Lord Brooke of Alverthorpe (Lab)]

My Lords, it would be churlish not to accept the noble Earl’s remarks that there have been some changes which have been beneficial. But does he not agree that the public at large recognise that overall there have been many downsides? Many of those downsides have been hidden and continue to be hidden by politicians, who refuse to release the risk register that was drawn up prior to that Act going through.

[Earl Howe]

My Lords, we are back to that one. As the noble Lord knows, the strategic risk register for the department is something that we are entitled to keep confidential, as all Governments have done. The Cabinet took the decision that the transition risk register should remain confidential because of the principle of the need to preserve private space for civil servants when advising Ministers.

Health: Obesity

Lord Brooke of Alverthorpe Excerpts

Thursday 26th February 2015 Lords Chamber

Asked by

[Lord Brooke of Alverthorpe]

To ask Her Majesty’s Government what assessment they have made of the Local Government Association’s report Tackling the causes and effects of obesity.

[The Parliamentary Under-Secretary of State, Department of Health (Earl Howe) (Con)]

My Lords, we welcome the Local Government Association’s report, which provides a valuable contribution to this debate and demonstrates the contribution that local authorities can make and are making. This Government see local authorities as key to tackling obesity and other public health issues. Local communities know best how to tackle obesity, based on local understanding and need. To support this, we have given local authorities £8.2 billion of ring-fenced funding over three years for public health.

[Lord Brooke of Alverthorpe (Lab)]

My Lords, I am grateful for that reply, but as the Minister will recall from his reading of the report, LEAs say they are the people to do the job but they simply do not have the cash to do it. They have had a 40% cut in their grant aid over the past five years and they do not have the money available to carry out this work. Will he look again at whether, particularly with what is happening in Manchester, some freedom might be given for people at LEA level to raise additional funding themselves?

[Earl Howe]

My Lords, there is always scope to raise additional funding from charities and, indeed, from industry. Alongside the ring-fenced budget we have given to local authorities—it is the first time that this has been done for public health—we have a number of programmes in train which can work side by side with local authorities, such as the work going on in NHS England’s five-year forward view programme. Public Health England, in conjunction with the Local Government Association and ADASS, is commissioning work to support local authorities to take a whole-systems approach and look more widely in the way that the noble Lord has suggested. Public Health England’s Healthy Places programme is also relevant here, looking at how we can use the planning system to promote public health.

Alcohol: Impact on Accident and Emergency Services

Lord Brooke of Alverthorpe Excerpts

Wednesday 21st January 2015 Lords Chamber

Asked by

[Lord Brooke of Alverthorpe]

To ask Her Majesty’s Government what discussions they have had with the drinks industry about contributing to National Health Service accident and emergency costs.

[The Parliamentary Under-Secretary of State, Department of Health (Earl Howe) (Con)]

My Lords, the alcohol industry has responsibilities to reduce harm caused by its products. We have challenged the industry to deliver action through the responsibility deal. It is important to recognise that individuals also have responsibility for their behaviour. The Government set the legislative framework, and the United Kingdom has relatively high taxes on alcohol, which are the main way to compensate society for its costs. Our alcohol strategy seeks to prevent and reduce harm from alcohol.

[Lord Brooke of Alverthorpe (Lab)]

My Lords, I am grateful for the pleasant words from the Minister, but I omitted to pick up on just what action the Government intend to take. Does he share the concern of his new CEO for the NHS, Sir Simon Stevens, that more than 1 million people are now presenting at A&E each year with alcohol problems? Not only that, but they are in the main accompanied by their friends and often family, who swell the numbers and are equally intoxicated. They are creating great difficulties for nurses, doctors and other A&E patients. Many of those people do not come from their home; they come from drinking establishments from which some of them have been ejected. Many of those establishments have personnel there looking after security for the protection of the interests of the drinks industry. If the drinks industry can pay for those people to protect its interests, why cannot it be required to pay to protect the interests of nurses, doctors and other people in A&E who are intimidated by people who are drunk?

[Earl Howe]

My Lords, alcohol-related attendances at A&E are certainly a matter of concern; we fully recognise that. Having said that, there is no evidence to suggest that current pressures in A&E departments are related to trends in alcohol-related attendances. We are taking a range of actions to prevent and reduce harm both nationally and in many local areas. We are certainly not just treating this as a financial issue. This is an issue to do with people’s health, and it is important. The industry is playing its part through the responsibility deal, which is already yielding some encouraging results.

Alcohol: Addiction

Lord Brooke of Alverthorpe Excerpts

Monday 12th January 2015 Lords Chamber

[Earl Howe]

My noble friend is absolutely right. More than 90% of liver disease is due to three main, preventable and treatable risk factors—alcohol, hepatitis B and C, and obesity. Alcohol accounts for 37% of liver disease deaths, but obesity is indeed a major factor in this.

[Lord Brooke of Alverthorpe (Lab)]

Will the Minister explain to the House why, when his Government came to power, they tore up the draft strategy on liver disease that had been prepared by the previous Government? What are they going to do to put one in place and, given the complaints we have heard, make sure that the growth in the number of deaths is reversed?

[Earl Howe]

My Lords, Public Health England has a programme of work to ensure that all the bases are covered. It is producing a report for government that will be published later this year. Over the next 18 months, there will be a longer programme of work on such things as a framework for liver disease, setting out the evidence base for the introduction of a minimum unit price for alcohol and using alcohol as the trail-blazer for a new whole-system approach that establishes what works and is clear on the return on investment, to enable government to take action based on evidence.

Alcohol-related Disease

Lord Brooke of Alverthorpe Excerpts

Wednesday 17th December 2014 Lords Chamber

[Earl Howe]

My Lords, we have acted on alcohol pricing. We have to look at this in the round and in relation to what is happening. Alcohol consumption per head has fallen in recent years. Reduced affordability of alcohol—influenced, I may say, by tax rises above the RPI each year to 2013—has certainly been one factor in that, we believe. We are committed to reducing alcohol-related harm. We have already banned alcohol sales below the level of duty plus VAT, meaning that it will no longer be legal to sell a can of ordinary lager for less than about 40p.

[Lord Brooke of Alverthorpe (Lab)]

My Lords, I declare an interest as a patron of the British Liver Trust, which was associated with the Lancet commission report. I am sure that the Minister will agree that deaths from liver damage related to alcohol are increasing, not decreasing. Although the Government have made changes to pricing, why is Public Health England stating that there needs to be significant movement on pricing and easy access to alcohol before there will be any effect not just on deaths but the wider problems that arise from alcohol harm?

[Earl Howe]

My Lords, I take it that the noble Lord is referring to minimum unit pricing, among other things. The long-term trend in alcohol-related deaths is indeed upwards, although there has been a dip over the past four years. Minimum unit pricing is a policy that is still under consideration. It has only ever been one part of the Government’s alcohol strategy, which includes a range of national and local actions, including partnership with industry, as I said, and increased powers for local communities to tackle harm. There are various ways in which we can address the problem, which the noble Lord rightly highlights.

NHS: Health and Social Care Act 2012 Reforms

Lord Brooke of Alverthorpe Excerpts

Wednesday 22nd October 2014 Lords Chamber

Asked by

[Lord Brooke of Alverthorpe]

To ask Her Majesty’s Government what is their assessment of the impact on National Health Service funds of the reforms introduced under the Health and Social Care Act 2012.

[The Parliamentary Under-Secretary of State, Department of Health (Earl Howe) (Con)]

My Lords, this Government have taken tough decisions to increase the NHS budget by £12.7 billion between 2010-11 and 2014-15. During this period, the Government’s NHS reforms will enable total administration costs to reduce by one-third in real terms, to release funding to NHS front-line services. Already, savings arising from the reforms released £1.5 billion last year and £1 billion in 2012-13 to front-line services.

[Lord Brooke of Alverthorpe (Lab)]

My Lords, did the Minister read, as I did, the headline “NHS reforms our worst mistake, Tories admit” in the Times last week? This was part of a devastating series of articles analysing what had happened to the 2012 reforms, along with the costs which had accrued or the savings which had failed to be achieved but could have been if the Government had not been diverted by the reforms. Who will be held responsible for this devastating and monumental failure in policy? It has been very costly to the country, especially at a time of austerity.

[Earl Howe]

First, let me make it clear that the Government have no regrets whatever about the NHS reforms. These reforms enabled massive savings to be made, all of which have been ploughed into the front line. Without investment in the cost of the reforms—which I concede were considerable—we would not have been able to realise these savings, nor would the NHS have been able to plough those savings back into the front line. This has enabled us to employ more than 7,700 extra doctors, and the NHS is now performing more than 850,000 more operations every year. That is the benefit of the reforms.

NHS: Cancer Diagnosis and Treatment

Lord Brooke of Alverthorpe Excerpts

Monday 13th October 2014 Lords Chamber

[Earl Howe]

My Lords, my noble friend mentions a particular type of radiotherapy, the CyberKnife. At present there is only limited research evidence of the clinical and cost effectiveness of stereotactic ablative body radiotherapy—the full name. Therefore, it is available only for certain patients with lung cancer. Having said that, NHS England has agreed to make £6 million available over the next few years for new clinical trials which will involve trials on prostate cancer, lung cancer, pancreatic cancer and biliary tract cancers. It is important that we generate that clinical evidence before encouraging the NHS to apply this form of radiotherapy to those cancers.

[Lord Brooke of Alverthorpe (Lab)]

Will the noble Earl give the House an indication of when the deteriorating waiting times for cancer treatment will be reversed?

[Earl Howe]

My Lords, clearly a lot of work is going on in the NHS to ensure that we are back on track with the cancer waiting times. Local area teams of NHS England are looking at the causes of those waits and whether there are diagnostic tests that are responsible for the dip in performance. But I can assure the noble Lord that we place a high priority on this area.

Health and Social Care Act 2012: Risk Register

Lord Brooke of Alverthorpe Excerpts

Wednesday 9th July 2014 Lords Chamber

Asked by

[Lord Brooke of Alverthorpe]

To ask Her Majesty’s Government whether they will publish the Risk Register drawn up for the Health and Social Care Act 2012.

[The Parliamentary Under-Secretary of State, Department of Health (Earl Howe) (Con)]

The Government’s position has not changed since the noble Lord asked the same Question last December. We are not proposing to publish the risk register. This decision is based on the principle that Governments and their civil servants need to be able to consider the risks associated with policy formation in private. It remains our view that a full and candid assessment of risks and their mitigating actions should be carried out within a safe space.

[Lord Brooke of Alverthorpe (Lab)]

My Lords, the logic of that is that no risk register should be released to the public and I do not believe that is the Government’s policy. Given the Secretary of State for Health’s recent encouragement and support for NHS whistleblowers, and as the original risk register was released into the public domain by a whistleblower, what would the Government do if the continuing cover-up was then blown by a whistleblower before the next general election?

[Earl Howe]

My Lords, I am sure the noble Lord would expect me to say that hypothetical situations are not in my domain, and that is true in this case. The Government’s position is that there is a balance to be struck between transparency of activity in government and the safe space required for effective policy-making. That is why, in November 2011, I laid out for this House a comprehensive list of the areas covered by the transition risk register, but also why, at the same time, the Government decided to withhold publication of the register itself.

Health: Liver Disease

Lord Brooke of Alverthorpe Excerpts

Tuesday 6th May 2014 Lords Chamber

Asked by

[Lord Brooke of Alverthorpe]

To ask Her Majesty’s Government whether they will produce a strategy to reduce liver disease.

[The Parliamentary Under-Secretary of State, Department of Health (Earl Howe) (Con)]

My Lords, improving outcomes for people with liver disease is a priority. Public Health England has a wide-ranging programme aimed at tackling its three major causes—viral hepatitis, alcohol abuse and obesity—through strengthening local action, promoting healthy choices and giving appropriate information to support healthier lives.

[Lord Brooke of Alverthorpe (Lab)]

My Lords, I gather from that that the Government are not prepared to consider introducing a strategy, which is a great pity given that liver disease is now the fifth biggest killer and we have some of the worst figures in the whole of Europe. How does the Minister see a more general approach, rather than a specific target in a strategy, producing a change in the terrible figures which we now see in the number of deaths, given that the deprived areas of the country where most of them occur, such as Manchester, had a reduction in the funding to commissioners and GPs for this purpose last month?

[Earl Howe]

My Lords, as the noble Lord is aware, NHS England is responsible for the overall national approach to improving clinical outcomes for people with liver disease. At the moment, it has no plans to produce a strategy specifically for liver disease, but it is adopting a broad strategy to reduce premature mortality, including mortality from liver disease. There is a major emphasis in the work being done by NHS England and Public Health England on prevention. They are supporting clinical commissioning groups and local authorities with a suite of tools to help them maximise the best possible outcomes for their local communities, such as local authority profiles. That can help local authorities and CCGs indentify the significance of liver disease in their area compared to the rest of the country, and the actions they could take to tackle it.

Alcohol: Calorie Labelling

Lord Brooke of Alverthorpe Excerpts

Thursday 13th March 2014 Lords Chamber

Asked by

[Lord Brooke of Alverthorpe]

To ask Her Majesty’s Government, further to the answer by Earl Howe on 11 February (HL Deb, col. 535), whether they will publish a list of the alcohol producers and retailers who have pledged themselves voluntarily in the Responsibility Deal to display the calories and sugar content of the drink on the labels of their alcohol products.

[The Parliamentary Under-Secretary of State, Department of Health (Earl Howe) (Con)]

My Lords, we welcome companies such as Sainsbury’s, which have taken action in this area. While there is no responsibility deal pledge to voluntarily display energy and sugar content on the labels of alcohol products, we will continue to consider what more can be done through the responsibility deal to improve public health, including through consumer information.

[Lord Brooke of Alverthorpe (Lab)]

I am truly grateful to the noble Earl for the efforts he has been making to try to persuade the drinks industry and the supermarkets that they have to accept some responsibility for the damage to health that alcohol causes. From the pledges he has been given by the producers and the supermarkets, can he say how many have as yet actually displayed calories and sugar on the labels of their lagers and beers? While I acknowledge that progress is happily now being made with wine, will he say what he intends to do, given that Tesco and Morrisons have now publicly stated that in no way will they go down this route?

[Earl Howe]

My Lords, I mentioned Sainsbury’s, which is setting a very good example in this area, but I can tell the noble Lord that Waitrose and the Co-op have also taken steps to display calories on their own-brand alcohol labelling. Naturally, we hope that others will follow their lead. As yet, none has, and it is a pity that Tesco has said that it will not, but we will continue to work on this issue. Work is also going on at a European level, and the noble Lord may like to know that the UK pressed for mandatory energy declarations during negotiations on the EU Food Information for Consumers Regulation. It met with significant resistance, and we did not succeed, but we are still pressing for that.