Health: Obesity

Lord McColl of Dulwich Excerpts

Thursday 26th February 2015 Lords Chamber

[Earl Howe]

Yes, my Lords, that is being factored in, but I do not think that we should confuse that point with a certain sort of fatalistic approach to obesity. There are things that people can do with their lifestyle to influence their own states of health in all sorts of areas and we have to help people understand what those things are.

[Lord McColl of Dulwich (Con)]

Does the Minister agree that this report is a model of its kind? It is brief and free of waffle and it emphasises the important point that obese people do not need to increase their activity one iota in order to lose weight; all they have to do is to eat less.

[Earl Howe]

I agree with my noble friend. We should recognise that increasing physical activity is important for our health, but for people who are overweight and obese, eating and drinking less has got to be the key to weight loss.

Health and Social Care (Safety and Quality) Bill

Lord McColl of Dulwich Excerpts

Friday 6th February 2015 Lords Chamber

[Lord McColl of Dulwich (Con)]

My Lords, I thank Jeremy Lefroy for starting this Bill and the noble Lord, Lord Ribeiro, for bringing it here so expertly.

I would like to address one or two aspects and look back to how we dealt with them in the past. First, on the issue of protecting the public from avoidable harm, as a young house physician, the first problem I came across was a situation where a number of young ladies had attempted suicide—which of course was a criminal offence in those days. I was astonished to see the police hovering around, insisting on interviewing them. I explained to the police that the patient was not completely compos mentis and was in no fit state to be interviewed by anyone, certainly not the police. This created a great deal of trouble for me and I was summoned before the senior superintendent of the hospital and the local inspector of police. They harangued and shouted at me. I realised that they were just common bullies—and that one of my jobs was to protect patients from bullies.

We then came across the problem of operating on the wrong patient or operating on the wrong side. As a young surgeon I thought that there must be a way of preventing this, so I used an indelible pen to write the name of the operation at the site of the operation. Sometimes this presented problems, and arrows had to be put in to show roughly where it was, but it worked well. However, one day I went into the operating theatre and the anaesthetist said, “I wish you’d make up your mind which operation you’re doing on this patient”. I replied, “Look, I have written on his groin ‘right inguinal hernia’”. He said, “Yes, but look at this”, and he pulled the sheet down to reveal a dotted line across the front of the patient’s neck with a big arrow pointing at it, and on his chest, in big letters, were the words, “Cut here”. It was a tattoo that he had had put on 20 years before. Apart from that, the system worked very well indeed.

We developed at Guy’s Hospital something that had been done in many other hospitals. We would meet every week to discuss all the complications and deaths that had occurred in the previous week. Surgeons, junior staff, students, nurses and even some administrators would come. It was the most amazing and enjoyable meeting of the whole week, and it was relevant to what was going on. You could not hide anything because people knew what was going on. Complications would be presented, and we were very fortunate in having a very senior surgeon to chair these meetings. He had a good sense of humour and he was both brilliant and humble. When some poor junior surgeon would stand up and explain a complication for which he was responsible, the chairman would say, “That’s nothing, old chap. Only the other week…”, and he would go on to describe a complication for which he had been responsible. What he was cleverly doing was creating an atmosphere that was friendly and unthreatening, thus encouraging people to be absolutely honest. It was a great learning experience. It became rather like the general confession and was just as therapeutic.

We are all fellows of the Royal College of Surgeons, the Royal College of Physicians, the Royal College of General Practitioners and so on—but what is fellowship? Fellowship is sharing experiences, both good and bad. That is part of the fun of medicine. Another thing about those meetings was that they did not cost anything and we did not have bureaucrats from above directing and inspecting us. Local accountability is the answer.

The second thing I want to talk about is the appropriate sharing of information and the question of identification of patients. Years ago, I suggested that one solution to the problem of sharing information would be to give the patient his or her medical records. This was objected to on the basis that people could not be trusted and that they would lose them. A friend of mine gave away 20,000 medical records over a period of 20 years, and only three were lost. One was lost in a fire, one in a flood, and the third was eaten by the dog. That is a pretty good loss rate when we consider that some medical records departments were losing around 20% of their records at any one time.

Another thing we started doing was inviting patients to keep their operation note so that they could take it with them. One day I had to operate on a patient who had been operated on in Edinburgh in 1935. It was a complicated operation in the abdomen. I asked the patient if he had any idea what the surgeon had done. “Yes, I do”, he said, and he pulled from his pocket a piece of paper with the most beautiful diagram of all the plumbing that had been operated on inside his abdomen. The patient had kept the piece of paper safe for all those years.

The third thing I would like to talk about is something that has been aired quite a bit: will the Bill leave healthcare workers reluctant to treat or operate on poor-risk patients? Some years ago we conducted a big research project in four London hospitals. We measured the quality of care by what the doctors were doing to the patients—process—and the outcome of that. The third method was to ask a friendly, knowledgeable person in each of the four hospitals to put the consultants in order of merit. The three systems gave the same answer. People in a hospital know what is going on.

To make it fair, we measured 12 variables to find out whether the patient’s contribution to his illness would have any effect on the result of the operation. We recorded blood pressure, anaemia and other things, including marital status—whether they were married or had a stable relationship. Strangely enough, the only one of those variables that had any effect on the outcome of treatment was whether or not they were married or had a stable relationship. That was not an original finding; it had been established for some time.

The fourth thing I will talk about is the whole culture of blaming other people for what is going on. Of course, in medicine we have been guilty of this. If we could not establish the diagnosis in a patient, there was a tendency to say, “Ah well, it is in the mind. It is psychiatric”. Of course, that is quite wrong. Psychiatric diagnosis should be a positive thing, not a diagnosis of exclusion. We must not blame the patients for what is going on.

Of course, one thing that has happened in recent years is the obesity epidemic, and what have they done? They have blamed the people who closed the playing fields for children not getting enough exercise. But of course the obesity epidemic is simply due to people eating too much. That is perfectly straightforward.

The Bill concentrates on the vital overarching duty to protect the health, safety and well-being of the public —and these things we must continue to fight for.

--- Later in debate ---

[Earl Howe]

I would be happy to do so.

[Lord McColl of Dulwich]

Before the Minister sits down, could I ask him about the WHO checklist? When I go into an operating theatre, the operation cannot start until that list is completed by the surgeon, the anaesthetist and the nurses. Could that be put into regulations?

[Earl Howe]

My Lords, I am sure that anything is possible, but I would hesitate before giving a commitment along those lines because it seems to me too granular to be included in statutory regulations rather than in guidance or best-practice manuals.

NHS: Accident and Emergency Services

Lord McColl of Dulwich Excerpts

Thursday 15th January 2015 Lords Chamber

[Lord McColl of Dulwich (Con)]

My Lords, I thank the right reverend Prelate for initiating this important debate. He has set exactly the right tone—let us keep petty party politics out of this and concentrate on the patients. It is important to stress that the staff in A&E departments—nurses, doctors and administrators—are doing a very good job indeed under difficult circumstances. Having worked a lot myself in accident and emergency departments, I know only too well how difficult it is. Patients come in, one is not sure what is going wrong with them, and it takes a little while to sort them out.

There were some political shenanigans some years ago when there were complaints about people waiting on trolleys far too long in casualty. I produced a paper when I worked in No. 10 entitled Off Your Trolley. The answer was that if you are really ill and they do not know what is wrong with you, stay in the casualty department where all the expertise is—the expert equipment and the doctors and nurses—until an accurate diagnosis has been made. If it worries people that they are on trolleys, they should take the wheels off after 20 minutes and the trolleys will then constitute a bed, so people will not fuss about it.

Things have improved enormously in this service from the days when I first worked in casualty. I remember once going through the accident and emergency department of a hospital that shall be nameless, where there was a man groaning on a trolley. I went up to him and asked how he was, and he said, “I’m in terrible pain in my shoulder, it’s dislocated, I’ve been here for three hours and I have not seen anyone”. I said, “I could put you in a very comfortable position where you’d be free of pain. Would you like that? I’m not working in the department, but we can get on and do it”. So I put him on his face with his arm hanging over the side of the trolley and the moment when he was in that position he said, “Ah, I’m free of pain”. I said, “Now you’re free of pain, the muscles will relax and the thing may go back on its own, without any anaesthetic—so you go off to sleep and I’ll come back in half an hour and see how things are”. When I came back, he was sound asleep and snoring, so I crept up on him and very gently manipulated the arm. Suddenly, clunk, it went back—and he woke up and said, “Oh, it’s gone back”. I said, “Yes, you can go home now, but perhaps we ought to tell somebody what we’ve been doing”. Things are much better than that now, because we have rapid assessment. Somebody senior goes around the A&E departments, assessing things quickly, so that sort of thing no longer happens.

There has been an enormous increase in the number of people attending, and we do not know why. As we do not know why, it is quite wrong to start blaming any group of people. It is very demoralising if you are a doctor, nurse or administrator working for the NHS and people start attacking and accusing you of this and that when they really do not know the cause of the increase in the work. What is true is that more resources are being put in and more staff are being recruited, which is good news. But we must stop blaming people and pointing the finger. The blame culture has to go, and we have to be more constructive.

What is the answer? Preventive medicine is one of the great emphases in the Department of Health, and it certainly helps. We have the worst epidemic that we have had for 95 years in this country—the obesity epidemic—and we need to get people thinned down. They have to eat less and take more exercise. We have to improve people’s health, which will tend to reduce the problem. But we also have to have an alternative way of funding the NHS.

Alcohol: Addiction

Lord McColl of Dulwich Excerpts

Monday 12th January 2015 Lords Chamber

[Earl Howe]

My Lords, the Royal College of GPs has a special focus at the moment on giving advice to GPs. We are also dramatically increasing the number of health visitors, who are, of course, highly instrumental in influencing the behaviours of mothers-to-be and young mothers.

[Lord McColl of Dulwich (Con)]

My Lords, does the Minister accept that although alcohol was until recently the commonest cause of liver disease, the commonest cause is now the obesity epidemic, which is killing millions of people? Some 13 million people in this country are suffering from obesity—far more than are suffering from alcohol problems.

[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.

Children: Obesity

Lord McColl of Dulwich Excerpts

Monday 20th October 2014 Lords Chamber

[Earl Howe]

My Lords, first, I commend the all-party group for its report. Tackling obesity is one of our major priorities, as it is for Public Health England. We have a well developed and wide-ranging programme of actions to tackle obesity. We have set a national ambition for a downward trend in excess weight in children. We are delivering the programme through initiatives such as Change4Life, the National Child Measurement Programme, school sports funding and the School Food Plan, and through voluntary partnerships with industry. As regards co-ordination, Public Health England is a leader of the public health service and numerous government departments are contributing to the anti-obesity agenda. We have a Minister for Children, and we have already established the Obesity Review Group, which brings together a range of experts and delivery partners from across the system to try to co-ordinate efforts to meet our national ambitions.

[Lord McColl of Dulwich (Con)]

My Lords, will the Minister acknowledge that the Department of Health and NICE misled Parliament and the nation in saying that the obesity epidemic was due to lack of exercise? Will the Minister acknowledge that in fact obese people do not need to increase their activity one iota in order to lose weight? All they have to do is to eat or drink fewer calories.

[Earl Howe]

My Lords, although physical activity can have a role in maintaining a healthy weight, the Government agree with my noble friend that its health benefits are nevertheless subsidiary in those who are obese to the need to eat and drink less. My noble friend may be interested to know that NICE is currently consulting on its draft public health guideline on maintaining a healthy weight and preventing obesity among children and adults. It currently expects to publish this guideline in February next year.

NHS: Hospital Waiting Times

Lord McColl of Dulwich Excerpts

Thursday 10th July 2014 Lords Chamber

[Earl Howe]

My Lords, the noble Lord knows of the economic constraints that this country has to contend with at the moment. Despite that, the Government are increasing the NHS budget over the course of this Parliament by £12.7 billion. That should indicate to the noble Lord the priority that we are giving to the NHS.

[Lord McColl of Dulwich (Con)]

My Lords, the Minister mentioned that the strain on the NHS is due to old people getting older, but is it not true that the strain is due to young people getting fatter and fatter? Is it not true that the Department of Health misled the nation by saying that the obesity epidemic—the worst for 90 years—is due to a lack of exercise when really it is due to people eating too much?

[Earl Howe]

My noble friend is a very eloquent advocate of this particular issue and he is of course right.

NHS: General Practitioners

Lord McColl of Dulwich Excerpts

Wednesday 26th February 2014 Lords Chamber

[Earl Howe]

The noble Baroness is quite right. The NHS is seeing an extra 1 million patients in A&E compared to three years ago. Despite the additional workload, it is generally coping very well although we know that departments are under strain. This is not just about A&E, as the noble Baroness will be aware, but about how the NHS works as a whole: how it works with other areas, such as social care, and how it deals with an ageing population and more people with long-term conditions. Dealing with all that means looking at the underlying causes, and that work is going on at the moment in NHS England.

[Lord McColl of Dulwich (Con)]

Does the Minister agree that it was very unfortunate indeed that certain politicians, who shall remain nameless, said to the general practitioners: “We know what you’re doing. You should have been working but you were on the golf course and, from now on, we’re going to pay you only for what you do”? The general practitioners thought this was a rather good idea, because it resulted in a substantial pay rise.

[Earl Howe]

My Lords, there is no doubt that the general practitioners bit the Government of the day’s hand off, 10 years ago, and they had every reason to do so with the money that was being offered to them. However, while a feature of that contract was the quality and outcomes framework, which was a good idea in itself, it has resulted in a lot of box-ticking for GPs and it is that element which we have drastically reduced in the contract for next year. That will be helpful in freeing up GPs’ time.

Public Health Responsibility Deal

Lord McColl of Dulwich Excerpts

Tuesday 14th January 2014 Lords Chamber

[Earl Howe]

My Lords, I shall take that request away and write to the noble Lord.

[Lord McColl of Dulwich (Con)]

Does the Minister approve of the letter, which will shortly be sent to all Members of this House and of another place, asking them to measure their waist and to ensure that it is less than half their height? That would apply to quite a few Members opposite, who are clearly eating too much of the gross national product.

[Earl Howe]

My Lords, we should welcome any measure that encourages us all to improve our diet, to reduce physical inactivity and to be aware of what we need to do to keep our weight under control. I do welcome that letter.

Children and Families Bill

Lord McColl of Dulwich Excerpts

Wednesday 20th November 2013 Grand Committee

[Baroness Howe of Idlicote (CB)]

My Lords, we have heard time and time again both here and in the other place of the clear benefits that plain packaging on cigarette packs would bring to children’s future prospects. Indeed, we have already had clear evidence from other countries of the benefits of taking this measure, as we have just heard, and I need not repeat it. We have also been told of the serious and life-limiting impact that passive smoking in cars can have on young people’s lives. Children often do not know the true risks of passive smoking in vehicles until they have already been exposed to it and certainly cannot be expected to make informed decisions about smoking, particularly not those from the most vulnerable backgrounds. For many the very real risks are not understood until, crucially, they are already addicted.

The knowledge that more than 200,000 children in the UK started to smoke in 2011 should alone be quite enough to urge us to take this preventive action. Awareness campaigns and sharing information are crucial measures, and will continue to be so, but we can see that they are clearly not enough. Surely, we have a responsibility to protect children from something which we already know is devastating. Therefore, I strongly support this group of amendments.

[Lord McColl of Dulwich (Con)]

My Lords, I, too, support these amendments, and my name is attached to Amendment 264. I should declare that I have a history as regards smoking as I used to be a chain smoker but gave it up when I was six. About 15 years ago in your Lordships’ House I introduced an amendment to ban smoking in public places. I put it on the back of a criminal justice Bill, which is a convenient way of moving things. I was amazed that the House was full right up to midnight when my amendment was discussed. I fondly imagined that everyone had come to listen to my wisdom, but little did I know that the House had filled with smoking barons waiting to pounce. However, I got my own back on them because at the end of the debate I thanked everyone for their contributions and, instead of saying, “I beg leave to withdraw my amendment”, for some reason or other I said, “Amendment not moved”. They all looked very puzzled because we had just spent hours discussing it. However, the noble Baroness on the Woolsack quickly said, “Amendment not moved”, passed on and they lost the opportunity to vote. They were furious and I was very pleased. As a professor of surgery, of course, I fully back any move to reduce the amount of smoking and I am convinced that these amendments would do that.

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

My Lords, this has been an instructive debate and let me say immediately that I have listened carefully to all the contributions, both today and on Monday. Perhaps I may start by addressing Amendment 263. I should say at the outset that I have enormous sympathy with the aim of this amendment, which is to protect children’s health from the harm that can be caused by second-hand smoke, and I am grateful to the noble Baronesses, Lady Finlay and Lady Massey, and the noble Lord, Lord Faulkner, along with my noble friend Lady Tyler for bringing this important issue to our attention.

We all agree that we do not want to see children exposed to second-hand smoke anywhere. The evidence of the harm caused by second-hand smoke is clear, but many children continue to be exposed to it, both in the family car and in the home. The question posed by this debate is whether legislation is the most proportionate and viable means of addressing the problem. We need to consider that question carefully and I must say that, while supporting the spirit of the amendment—which I certainly do—the Government are not convinced that creating new criminal offences is the right approach.

Of course, in some people’s minds there are civil liberties considerations, which might include what is often perceived as state intrusion into people’s private space. That is a complex area worthy of a debate on its own, but of course I acknowledge that any arguments on that score need to be balanced against the need to protect children. Since 2007, evidence shows that smoke-free legislation has been effective in reducing exposure to second-hand smoke in virtually all enclosed work and public spaces, public transport and work vehicles. Compliance with the law is high and we now benefit from clean air at work, in pubs and restaurants, and on public transport. However, it does not automatically follow from that that it is right to extend the scope of legislation to cover private cars.

There are many practical issues to be considered, particularly around effective enforcement, which is not something that we have heard much about during the course of the debate. Smoke-free legislation in England is enforced by local authority environmental health officers. They do not hold powers to stop vehicles or to detain people in vehicles that are already stationary. Consequently, it would be very difficult for them to take effective enforcement action without the assistance of the police. Since this is a public health issue rather than one of road safety, I expect that such an additional duty on top of their many other responsibilities would be a cause for concern for the police. The Chartered Institute of Environmental Health has identified other practical difficulties around enforcement. These include accurately identifying which vehicles are required to be smoke-free. For example, small children may not easily be visible from outside the vehicle. Further difficulties include obtaining evidence of smoking, identifying the driver and passengers, and proving the age of the child.

I hope that the Committee agrees that there would be real practical difficulties in effectively enforcing such an offence. If we cannot credibly enforce the law, then the credibility of the law itself is called into question. That is why the Government firmly believe that, rather than focus on what would be a complicated and resource-intensive enforcement process, we should continue the non-legislative approach that the evidence shows is working; namely, encouraging positive and lasting behaviour change among adults who place children’s health at risk. My noble friend Lord Storey urged us to do this. Our comprehensive tobacco control plan states:

“Rather than extending smokefree legislation, we want people to recognise the risks of secondhand smoke and decide voluntarily to make their homes and family cars smokefree”.

That is why Public Health England, building on last year’s success, ran another hard-hitting marketing campaign in June and July this year. The campaign aimed to encourage smokers to stop and think before smoking in front of children, whether in the home or in the car. It also encouraged smokers to order an NHS smokefree kit with tips on making the home and car entirely smoke-free spaces, together with support to help quit smoking altogether.

This year’s campaign is currently being evaluated, but emerging findings are encouraging. They show that the campaign has been successful in raising awareness and in changing attitudes and behaviour, with almost three-quarters of those surveyed agreeing that smoking out of an open door or window was not enough to protect children from second-hand smoke. Of those surveyed, 37% reported that they had taken action to reduce their children’s exposure to second-hand smoke, compared with 29% in 2012. In addition, 73% agreed that the adverts made them realise that smoking out of an open window was not enough to protect children, and there were nearly 85,000 orders for smokefree kits. That is an increase of 48% on the 2012 campaign.

The right reverend Prelate the Bishop of Chester rightly suggested that this is a global issue. I agree. We are, however, considered to be a leader in tobacco control internationally. The World Health Organisation has assessed us to be number one in Europe in this area, and through the Framework Convention on Tobacco Control we share this good practice as much as we can.

The noble Lord, Lord Palmer, suggested that the Government ought to introduce an offence of proxy purchasing. I know that shopkeepers and others are interested in making it an offence to buy tobacco for young people under the age of 18. I am sympathetic to that concern, but even were such an offence to be introduced, it would not stop family and friends sharing cigarettes with children. Therefore, we get back to the argument about behaviour change, which I think is more relevant here.

The noble Baroness, Lady Howarth, made an interesting point about this being considered as a road safety issue. I agree that any activity such as smoking—getting out a cigarette, lighting it, disposing of hot ash or stubbing the cigarette out—is likely to distract the driver, particularly if carried out in a moment that is critical for road safety. However, there are a host of things drivers do that have the potential to be equally distracting, be it eating, drinking, adjusting the radio, consulting directions or whatever it may be. First and foremost, it is the driver’s responsibility to drive safely at all times. Section 41D of the Road Traffic Act 1988 already provides a perfectly adequate offence if a driver fails to maintain proper control of a vehicle while driving. While a specific offence has been created for driving while using a hand-held mobile phone, the Government do not believe that there is any need to introduce a new and separate offence of smoking while driving.

I welcome the debate on this important issue and I can assure noble Lords that we shall consider carefully the findings of this year’s marketing campaign and decide what further action may be needed. I can assure the Committee that the Government will continue to work to protect children from second-hand smoke in family cars and in the home. We are not complacent but we remain to be convinced that legislation is the most effective and proportionate way of achieving this.

Mental and Physical Health: Parity of Esteem

Lord McColl of Dulwich Excerpts

Thursday 10th October 2013 Lords Chamber

[Lord McColl of Dulwich (Con)]

I thank the noble Lord, Lord Layard, for initiating this important debate. As a medical student I was rather surprised to hear professionals refer to patients with psychiatric conditions as “nutters” and “away with the fairies”, among similar comments. As the noble Lord, Lord Layard, said, we do not ridicule people with heart failure or cancer; why do we do it with mental illness? This made me rather interested in psychiatry and I did think of entering that profession, or trying to enter it, but that came to an end when I presented a patient to a psychiatrist, who shall be nameless, having spent a lot of time taking a history from the patient and writing it all up carefully. I started presenting it to the psychiatrist and half way through, he started laughing. I said, “What’s the joke?”. He said, “He’s a psychopath”. I said, “I know he’s a psychopath but what exactly is the joke?”. “Well, we can’t do anything for him.” I thought that was totally inappropriate and I learnt later that the psychiatrists call that “incongruity of affect”. Anyway, that put me off psychiatry.

It is not surprising that people with psychiatric problems feel isolated and abused and find it very difficult to talk about their problems, so all credit to Alastair Campbell, Stephen Fry and others who have spoken openly about their own illness. This has encouraged others to do the same. There is, of course, great misunderstanding about so much of mental illness. Take, for instance, Alzheimer’s. Over the years I have been consulted by many people, some of them in this House, about their relatives with Alzheimer’s and how they find it so irritating that they keep asking the same question and so on. The principles are quite simple: you do not ask a patient with Alzheimer’s any questions and you do not argue with them. When they do things that seem very inappropriate, you ask the question, “Does that matter in terms of eternity?”. I remember that once a patient was frying bacon in honey. I was just a very junior registrar in cooking, and I was not sure if this might be some recent recipe. The meal was delicious; it was impossible to clean the frying pan afterwards, but that did not seem to matter. I have also found it important that they have as much independence as possible. That sometimes means taking risks, but it is well worth it.

In the old days, in the 1950s and 1960s, I found it very difficult to get psychiatrists to come to the accident and emergency department. I do not know why that was, but they would never come. One day I was in trouble and I needed help in A&E. I rang the psychiatric department and a lady answered the phone. When I explained that I was in difficulty and asked her to come and help, she said, “I would be delighted to come”. I nearly fell on the floor; I had never had that response before. She was terrific. Her name was Ros Furlong, and she became a very distinguished psychiatrist. I mention that because it seemed to me that when women started coming into psychiatry, it changed things. Mind you, if you go back to 1945 or 1946, before there were many women in medicine, medical schools were a bit of a rough house. On one occasion a lecture was about to start and ex-Wing Commander Twistington-Higgins said to ex-Able Seaman Smith, who was wearing bell-bottomed trousers, “Smith, you’re improperly dressed”, whereupon ex-Able Seaman Smith stood up, picked up the ex-wing commander and knocked him straight out. However, when women came into medicine, the whole thing became rather more civilised.

My wife had Alzheimer’s for the last five years of her life. I pay tribute to the Maudsley Hospital, which was superb in all its help, especially Professor Simon Lovestone, who is a brilliant psychiatrist and a most kindly man. I got to know him quite well, and I told him the story of how I wanted to be a psychiatrist but was put off by the psychiatrists themselves. He said, “My experience is exactly the reverse”. He had wanted to be a surgeon but he met a psychiatrist called Colin Godber, who was a psychogeriatrician—the crème de la crème of the psychiatric world. Colin Godber asked him if he would like to come and visit a patient at home. They went there, the patient prepared a nice cream tea and then played the piano for half an hour, and then they went home. He said to Colin, “He didn’t seem to be much of a patient”. “Oh no, he wasn’t the patient,” said Godber, “It was his wife. I looked after her, and this week is the anniversary of her death. She died two years ago, and on the anniversary I always go and have tea with him”. Simon Lovestone was so amazed by this that he said, “That’s what I want to be; I shall be a psychiatrist”. It worked the other way round for him.

As the noble Lord, Lord Layard, has mentioned, one-third of the population has had a psychiatric illness. I have often wondered why that is so. A group of 50 ladies in their 40s met, and they all had eating disorders. Each of them told their story, and all of them as children had been sexually abused. At a meeting in No.10 Downing Street some years ago, there were 20 of us in a room discussing this very problem. Without thinking, I said, “Of course, at least 10% of children are sexually abused”. They were horrified and just would not believe it. In fact, one of them said, “There are 20 of us here. Do you mean that two are involved?”. I said, “Well, it does go across the board”. We now know that it is much higher than 10%. We know that one in four women is abused in one way or another, which means that millions of men are smashing up millions of women. It also means that millions of other people know about it and do nothing.

Mental health and well-being is a priority for this Government. The overarching goal is to ensure that mental health has equal priority with physical health and that everyone who needs it has timely access to the best available treatment. We have enshrined in law the equal importance of mental health alongside physical health. The Health and Social Care Act 2012 sets out the equal status of mental and physical health. We have made improvements in mental health and treating mental disease is a key priority for NHS England. One of NHS England’s 24 objectives is to put mental health on a par with physical health and close the gap between the two. On 29 June the Royal College of Psychiatrists published Whole-person Care: from Rhetoric to Reality, which is well worth reading. There is so much to be done in this field and we all have a role to play in encouraging the population to do its bit towards helping with this problem.