Alcohol: Minimum Unit Pricing

Lord Brooke of Alverthorpe Excerpts

Wednesday 28th February 2018 Lords Chamber

[Lord O’Shaughnessy]

The statistic mentioned by the right reverend Prelate is in a way even more alarming because 4.4% of the heaviest drinkers account for a third of all alcohol drunk. A lot of people are drinking sensibly, within the guidelines. We need a system capable of targeting those who are sensitive to both price and health interventions, among those drinking in a way that is very deleterious to their health. We are doing that for a range of interventions—public health and taxation. As I said, we will look at the progress of minimum unit pricing in Scotland as it takes place.

[Lord Brooke of Alverthorpe (Lab)]

My Lords, has not the Minister just made the case for minimum unit pricing? Could I remind him to cast his mind back to all the arguments advanced by his side against changes to tobacco and smoking—that everybody was going to be hurt by it if we increased the price? We had to increase the price for the benefit of everyone, and the same now applies to alcohol. All the evidence that he is getting from all his senior medical advisers is that he should introduce a minimum unit price. Why will he not move on this?

[Lord O'Shaughnessy]

I do not recognise the picture of obstruction about tobacco and smoking. This Government have done a huge amount, and smoking levels have never been lower. In terms of increased pricing, history tells us, if you go back hundreds of years—think about “Beer Street” and “Gin Lane”—that taxation has a really important role to play in promoting better drinking habits. That is the approach that we have taken with changes in duty for drinks that are particularly problematic, such as white cider. As I have said, we will look at how minimum unit pricing in Scotland progresses.

NHS: Charitable Donations

Lord Brooke of Alverthorpe Excerpts

Thursday 22nd February 2018 Lords Chamber

Asked by

[Lord Brooke of Alverthorpe]

To ask Her Majesty’s Government, further to the Written Answer by Lord O’Shaughnessy on 20 December 2017 (HL4078), why they have no plans to provide patients with the costs of their treatment in order to encourage charitable donations to the National Health Service.

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

My Lords, the NHS is based on the principle of access to treatment regardless of your means and according to clinical need. As a consequence, it is important that patients should not be exposed to the costs of care as it might deter them from seeking treatment. Where costs have been provided, such as the cost of missing GP appointments, this has been in an attempt to prevent waste.

[Lord Brooke of Alverthorpe (Lab)]

My Lords, does the Minister agree that we have a great gift in the NHS and that great gifts become even greater if one can make a return contribution to the giver? Why will the Government not reveal the cost of treatment to people—after they have had it, not before, and only to those people who request it—so that in turn they may make a voluntary contribution, either in full or in part, towards the cost of that treatment? Why is there such difficulty in encouraging people to play a greater part, to give more and to get more involved with the NHS in a way that the Government are refusing to do at the moment?

[Lord O'Shaughnessy]

I agree with the noble Lord that it is a gift. I also absolutely understand the sentiment behind what he is saying, which is a desire for people to contribute back to the NHS not just through the tax system. It is important to point out that there are more than 250 NHS charities, with an annual income of £400 million. One of the other great gifts we have in this country is people’s willingness to donate time and money not just to the NHS but to a range of health causes. So we do provide an opportunity for that and those gifts are supported by gift aid. With regard to itemising the bill, we worry about deterrence. Many users of the most expensive health services are older people. Itemising a bill could put some of them off and that would be the wrong thing to do.

NHS and Social Care: Winter Service Delivery

Lord Brooke of Alverthorpe Excerpts

Thursday 25th January 2018 Lords Chamber

[Lord Brooke of Alverthorpe (Lab)]

My Lords, I too am grateful to the noble Baroness, Lady Wheeler, for initiating this debate and to everyone who has participated in producing a set of solutions which, if they were brought together, would solve the problem. I feel sorry for the Minister, who has had little support from any quarter today for his problem.

Everyone knows that much more money is needed. There is a 2% gap that needs to be filled and one way or another we have to find measures—basically through taxation—to meet that need. We also need to look for other ways in which funds can be raised in which we might involve the wider public so that, in turn, we get a greater recognition—to pick up the point of the right reverend Prelate the Bishop of Carlisle—that there has to be more responsibility for the NHS across a broader front. It is not only an issue of the Government providing the money but of how we care for ourselves and each other, of how families care—or do not care—for the elderly, and of how families pay for the elderly or refuse to do so because they want to keep the house for themselves in due course. When these issues are raised, there is a row and people run for cover because they are far too difficult to address.

As the noble Lord, Lord Smith, said, I hope we can spend some time addressing the winter problems, but we see these problems all year round. I bore the House to death when I go on about alcohol and A&E and the costs involved. When the Minister took his job, he said that he was going to stamp down on drunkenness in A&Es. I would like to see some evidence of that because the papers were full of such issues over the Christmas period.

Substantial numbers of people go to hospitals and A&E when they should not be there. I am probably the only Peer here today who was in an A&E department on Christmas day, when we had a family incident. I was there at 10 o’clock through until three o’clock in the morning before the family member was moved into an acute assessment ward and kept in for five days. We were not overrun, to my surprise, by the number of people I had anticipated being in A&E. However, given the relatively small number of patients there, we were, to a degree, overrun by the number of friends and relatives who went along with them. There were four or five people with each patient, creating noise on mobiles, causing confusion and making it much more difficult to manage the A&E. Some simple things need to be addressed. Why do we need so many people going into A&E when it causes a delay in patients being dealt with?

Similarly, when we got to the ward there was very little management and it was difficult to determine who was in charge. People were coming in, shouting and screaming down their mobile phones, and patients were surrounded by four, five or six people spending three, four or five hours in there. If people wanted to make a complaint about it, there was nobody around who was able to address the issue and slow it down. Hospitals used to be about patients, peace, calm, serenity and recovery. During that week, I was in that hospital every day—my Christmas was lost—and my experience, in many respects, was that I was in a place of riot and chaos. It should not be like that in a hospital. It would cost very little money to put this right, but it needs addressing. I know it is a minor issue compared with what we have debated today.

I return to the topic of alcohol. Cheap booze is a source of many of the problems within A&E—not only at Christmas but throughout the year, from Thursday evenings through to Sunday—and that has to be addressed. It is amazing that the Chancellor is struggling to find money for the NHS and yet, on the other hand, he is freezing the regulator in terms of increasing the cost of alcohol duties. He is making alcohol cheaper on the one hand and on the other is struggling to find the cash to keep people well. We now have more people drinking less but certain categories of people drinking more. More people are now going into hospital with less alcohol being drunk, and the price of alcohol, in the main, is going down rather than up. Fairly simple action could be taken on that by adjusting taxes. This would put it right and we would have a good response all the way round. We should apply it across the board—for example, with sugar and a range of other issues. We should look at the polluters who cause the problem to see whether they could make a greater contribution.

At the end of the day, much of this comes back to public health campaigning and how we look after ourselves and each other. Regrettably, the amount of money which has been spent on public health has been cut over recent years. We need to review that and start looking at ways in which we can help people to look after themselves better in the future, live longer and lead better and happier lives than they are doing at the moment. That requires bold decisions, frankness and honesty, which, regrettably, so far the Government have not been prepared to engage in.

Nurses: Tuition Fees

Lord Brooke of Alverthorpe Excerpts

Wednesday 29th November 2017 Lords Chamber

[Lord O'Shaughnessy]

It is important to point out that there are 10,000 more nurses on wards than there were seven years ago. One of the things that we are trying to do is encourage nurses to return to practice—3,000 of those nurses have been on the return to practice programme. In regard to attracting them to hospitals, the main thing is that we need to train more nurses to fill those places so that we fill the demand that we know that we have from a growing and ageing population. That is why there are going to be 5,000 more funded nursing training places from 2018 onwards.

[Lord Brooke of Alverthorpe (Lab)]

My Lords, is it not necessary to offer the most attractive terms to get more nurses into training? Will the Minister reflect on the very helpful suggestion made by the noble Lord, Lord Forsyth, that there is a possibility that a fair number of these people will never repay the full amount? Will he tell the House what the estimated write-off is of the repayments that will apply to nurses? If it is a high figure, will he reflect on the answer that he gave to the noble Lord?

[Lord O'Shaughnessy]

I shall certainly write to my noble friend, and indeed all noble Lords, about the proportion of the write-off. Let us remember, however, why the student loans system exists. It exists because those people who earn enough over the course of their working lives end up paying more than those who do not. Therefore, if somebody has gone into nursing but has then gone on to work in another profession, earning more money and being able to pay it off, it is equitable that they pay it off. That was the policy of the Labour Government, and it has been adopted by the Conservative Government precisely on the point of equity. It is only right that the loan is written off for those who have not earned enough but, for those who have earned enough, that they pay it off.

Brexit: Mental Health Research Funding

Lord Brooke of Alverthorpe Excerpts

Thursday 23rd November 2017 Lords Chamber

Asked by

[Lord Brooke of Alverthorpe]

To ask Her Majesty’s Government whether they intend to match the current European Union contribution towards United Kingdom mental health research funding after the United Kingdom leaves the European Union.

[The Parliamentary Under-Secretary of State, Department of Health (Lord O’Shaughnessy) (Con)]

My Lords, the Government have made clear that UK businesses and universities should continue to bid for competitive EU funds while we remain a member of the European Union and that we will work with the Commission to ensure payment when funds are awarded. The Government will underwrite the payment of such awards, even when specific projects continue beyond the UK’s departure from the European Union. This will include mental health research funded by the Horizon 2020 programme.

[Lord Brooke of Alverthorpe (Lab)]

My Lords, does the Minister recall the Government’s promise in the May manifesto:

“We will make the UK the leading research and technology economy in the world for mental health”?


I am reassured by some of the Answer he gave, but he has not given a firm commitment that this will continue after Brexit. Will he give such a commitment; and given the promise that was made in the manifesto, will he outline how the Government intend to increase the amount of research that will be undertaken in mental health in the future?

[Lord O'Shaughnessy]

In our future partnership paper we have set out that we want an ambitious agreement on science and innovation and that we will continue, albeit in a new form, to collaborate with the European Union on health research, including mental health research. On honouring the bids that were underwritten, I should point out that that applies not just to bids or projects that are taking place but to bids that have been submitted up until exit day, so there is a long lead time. It is also important to point out what the Government have been doing domestically. For example, the National Institute for Health Research has increased by over 50% the amount of funding that it puts into mental health research, so the Government have been going a long way in increasing the amount of funding in this area.

Young Women: Self-Harm

Lord Brooke of Alverthorpe Excerpts

Thursday 16th November 2017 Lords Chamber

[Lord O'Shaughnessy]

I congratulate the centre the noble Earl works for on its anniversary. He is absolutely right about the pressures of adolescence. Unfortunately, the causes of self-harm are not well understood. One of the hypotheses is that the motivation appears to be stress relief, which is an incredibly disturbing idea. I am aware of Lucy Crehan’s work from my previous work in schools. I do not think you can link school accountability with the kind of pressures we are describing today and how they manifest in self-harm. We want schools to be successful. It is vital that children are well educated. It is also true that that can be done in a number of ways. The best schools, including ones that I have been involved with in the past, practise something called positive education which emphasises not only the academic aspect but also character and well-being. I think that is the approach that we need to follow.

[Lord Brooke of Alverthorpe (Lab)]

My Lords, if I may bring the Minister back to his area of responsibility, is he aware of recent research indicating that at primary level, references by doctors to mental health services are least in the deprived areas in the country and those are the areas where the self-harming is rising most of all? Can he tell the House what steps he is taking to halt that and move it in the other direction?

[Lord O'Shaughnessy]

I would be interested to see that evidence. It is not something that I have seen. All I can say is that mental health funding has increased by more than 8% in the last couple of years so there is more money going into it but clearly it is vital that it is properly spread.

Child and Adolescent Mental Health Services

Lord Brooke of Alverthorpe Excerpts

Monday 30th October 2017 Lords Chamber

[Lord O'Shaughnessy]

That is an incredibly important point because good relationships are very influential on young people’s mental health, and the Green Paper will look at the role of family conflicts. My noble friend will be pleased to know that the Department for Work and Pensions is launching a programme to reduce parental conflict in conjunction with the Early Intervention Foundation. I hope that it will have some positive benefit in reducing parental conflict, which is, of course, one of the causes of mental illness.

[Lord Brooke of Alverthorpe (Lab)]

Does the Minister accept that there is a wide variation in the offering of services between one geographical location and another? Will the Green Paper which is being prepared address this, and how quickly will it be resolved?

[Lord O'Shaughnessy]

The noble Lord is right about variation, sadly. We had the CQC thematic review on mental health provision at the end of last week, which showed that 80% of specialist in-patient care is good or outstanding but that that is true of only two-thirds of community care provision, with around a third either requiring improvement or inadequate. That is clearly not good enough. Patchy provision is absolutely one of the things that we need to deal with. The best way of doing that is by expanding both the number of children being treated and the size and quality of the workforce, to help us to meet our targets.