Health: Sugar Consumption

Lord McColl of Dulwich Excerpts

Wednesday 6th February 2013 Lords Chamber

[Earl Howe]

My noble friend asks a number of questions. I am sure he will have welcomed, as I did, the announcement a few days ago by two major manufacturers of sugary drinks that they were substantially reducing the sugar content of their drinks. This is in part a result of the engagement that we have had with the food industry, which, in public health terms, is taking on responsibility for the products that it makes.

While there are advocates for taxation, in 2012 my department reviewed the international evidence of the effect of taxation on people’s consumption of food and drink. There is very limited empirical evidence, certainly from literature, but also in practice that that has an effect on body weight or health outcomes. There is a range of possible unintended consequences, including swapping for other foods which may be even less healthy than the ones that we are trying to cut out.

[Lord McColl of Dulwich]

My Lords, is the Minister aware that the overeating habits of pregnant women can be programmed into the foetus, so that when born the children will not stand a chance unless people accept that the answer to the obesity epidemic is to eat less? Although exercise is important in reducing cholesterol, for well-being and so on, it has very little to do with the control of the obesity epidemic.

[Earl Howe]

My noble friend makes a good point, but in healthy children exercise is very important as a preventive measure for obesity and diabetes. The central point he makes is absolutely right. We look to healthcare workers, not only health visitors but also midwives, through programmes such as the Healthy Child programme and Start for Life, to get families and children off to the right start, so that they eat properly and live healthy lifestyles.

Diabetes

Lord McColl of Dulwich Excerpts

Thursday 10th January 2013 Lords Chamber

[Earl Howe]

The noble Lord is absolutely right that this is a major public health issue and one that impacts very seriously on the health and well-being of individuals, so it is a priority for us. We are committed to reducing the number of avoidable amputations among people with diabetes. In fact, progress is being made: although the number of amputations is going up, the rate is falling. However, we are under no illusion that this will be a growing problem because of the growing number of people with diabetes. All our work on improving completion of the NICE nine care processes for people with diabetes and improving timely access to specialist diabetic footcare multidisciplinary teams will support that aim, and the Diabetes UK Putting Feet First campaign has real potential to improve awareness of foot complications in diabetes.

[Lord McColl of Dulwich]

My Lords, does the Minister agree that the real way to reduce the number of amputations is to reduce the incidence of diabetes and that the way to do that is to do something about the obesity epidemic, which is the main cause of diabetes and one of the main causes of amputation? What is he doing to try to prevent that quango, NICE, misleading the nation and politicians, as it did, into believing that the answer to the obesity epidemic was to take more exercise when, although exercise is important, the real answer is to eat fewer calories?

[Earl Howe]

I agree with my noble friend about the importance of targeting obesity as a serious public health risk and one which leads to diabetes in many cases. I believe that, if my noble friend were to talk to NICE about its recommendations to prevent obesity, he would find that its line is slightly modified from the one that he has criticised. We should pay tribute to NICE for the good work it has done in the specific area of diabetes. The recommendations and guidelines it has issued have been very positive. There is, of course, a quality standard for diabetes, which is also excellent.

Health: Hearing Loss

Lord McColl of Dulwich Excerpts

Monday 17th December 2012 Lords Chamber

[Earl Howe]

My Lords, the Government fully recognise that hearing loss is not just a health issue. For example, it can lead to isolation and loss of independence; it can impact on education and employment; and it can impact in the various ways mentioned by the noble Baroness, Lady Wilkins, in her earlier question. We believe that health outcomes for people with hearing loss should be among the best in the world. To achieve that it is necessary to think and act differently. Therefore, we are developing a cross-government strategy to maximise the current effort to prevent hearing loss and to support those suffering from it. In particular, that will focus on identifying the potential better to join up services provided by the different agencies.

[Lord McColl of Dulwich]

We have a generation of deaf people in this country produced by loud noise and music. What about preventing it in the first place?

[Earl Howe]

My Lords, I am sure the Health and Safety Executive will take my noble friend’s comments to heart.

Health: Obesity

Lord McColl of Dulwich Excerpts

Monday 12th November 2012 Lords Chamber

[Earl Howe]

My Lords, this is a very important point. Dame Carol Black and I chair a network within the responsibility deal in the Department of Health which draws together employers from a range of sectors to address health in the workplace. It is a tremendously important opportunity if we can engage employers to realise that it is in their direct interest to ensure that their employees enjoy good health and lead healthy lifestyles.

[Lord McColl of Dulwich]

My Lords—

[Lord Foulkes of Cumnock]

My Lords—

[The Minister of State, Ministry of Justice (Lord McNally)]

I suggest that we hear from the noble Lord, Lord McColl.

[Lord McColl of Dulwich]

I congratulate the Government on rejecting the misleading advice of that quango, NICE, which misled politicians by denying that the answer to the obesity epidemic was to eat less. What plans are there to prevent NICE making such serious mistakes in the future?

Health: Diabetes

Lord McColl of Dulwich Excerpts

Tuesday 1st November 2011 Lords Chamber

[Earl Howe]

My Lords, we are completely committed to the NHS health check programme, so I can reassure the noble Lord that we are clear that it has a major part to play. It is a very cost-effective way of both preventing and detecting early those who are at risk of diabetes or who may have recently contracted it. Health checks are part of the current operating framework. It is true that the figures for the first quarter of this year were a little disappointing, but PCTs are fully engaged in the process.

[Lord McColl of Dulwich]

My Lords, will the Minister acknowledge that the main cause of diabetes is the obesity epidemic, which is due to overeating? Could he suggest to the quango NICE that it withdraw its advice about having a balance between “calories in” and exercise, given that exercise has so little to do with the obesity epidemic? You have to run miles to take a pound of fat off.

[Earl Howe]

My Lords, my noble friend is to be congratulated on his campaign on this issue. Of course, I agree with him that if you are obese a reduction in “calories in” will make the most difference to regaining a healthy weight. He is absolutely right. If there is a respect in which NICE needs to amend its guidance, I am sure that it will be listening.

Health: Obesity

Lord McColl of Dulwich Excerpts

Wednesday 19th October 2011 Lords Chamber

Asked By

[Lord McColl of Dulwich]

To ask Her Majesty’s Government what action they are taking to address rising levels of obesity.

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

My Lords, the Government are committed to tackling obesity, which has serious consequences for individuals, the NHS and the wider economy. The Government recently published A call to action on obesity in England, which sets out how obesity will be tackled in the new public health and NHS systems and the role of key partners.

[Lord McColl of Dulwich]

I thank my noble friend for that reply. Would he kindly consider launching a campaign comparable to that launched by my noble friend Lord Fowler in the 1980s, which was so striking and so very effective?

[Earl Howe]

I agree with my noble friend about the campaign launched by our noble friend Lord Fowler, which was extremely effective. We recognise that excess weight is a really serious problem. That is why we have set out what we believe is an ambitious approach to dealing with it. We are radically overhauling the public health system. We are working with business to go further and faster on making it easier for people to make healthy choices for themselves and their families. We are also continuing to invest in programmes such as Change4Life. The Government cannot solve the problem on their own but we can encourage and support a wide range of partners to play their part. The call to action sets out how we are going to do that.

Health: Non-communicable Diseases

Lord McColl of Dulwich Excerpts

Thursday 6th October 2011 Lords Chamber

[Lord McColl of Dulwich]

My Lords, I thank the noble Lord, Lord Crisp, for introducing the debate. As he has indicated, I intend to speak only about the terrible epidemic of obesity. It is the worst epidemic to affect this country for 100 years. It is killing millions, costing billions and the cure is free: eat less.

What a strange world. Half the world is dying of starvation; the other half is gorging itself to death. Obesity is a disease which wrecks the human body; it causes an enormous amount of distress, disease and suffering. In the United Kingdom there are over 2 million people suffering from diabetes as a result of obesity and a further 750,000 have diabetes but do not yet know it. So-called adult diabetes has reached epidemic proportions and now affects teenagers and young children. Parents seem to be unaware and unconcerned that their children are obese and there needs to be a great deal of education in this field.

Sport, of course, is important, but green spaces and sports centres do not influence the physical activity of children. Social inequalities are no longer a major factor in obesity. All children are at risk, regardless of family income or postcode, as the noble Lord, Lord Crisp, mentioned. Obesity leads to inactivity rather than the other way round. Obesity comes first. Reducing the intake of calories, rather than physical activity, is the key to weight reduction. Most obesity starts before children go to school; Professor Terence Wilkin and Linda Voss, of the Peninsula Medical School, have done a lot of work on the subject and found that 90 per cent of excess weight in girls and over 70 per cent in boys is gained before the child ever gets to school.

What else does obesity cause? The arteries become silted up with fatty material, called atheroma. As noble Lords know from their Greek studies, atheroma means porridge. It may be Greek porridge, but it is not Scottish porridge. It silts up the arteries and can cause heart attacks, strokes and blockage of the arteries of the leg, leading to amputation. Blindness is another result, as are high blood pressure and cancer. The excessive weight wears out the joints, so people need their knees and hips replaced. Obesity leads to cirrhosis. We always think of cirrhosis in terms of alcohol poisoning, but now the commonest cause seems to be obesity, so we have a big problem.

An even greater problem with this epidemic is that politicians refuse to admit that the cause of obesity is overeating. The Minister stated in Question Time on 12 September that his reason for refusing to believe that overeating was the main cause was that he was following the advice of NICE. Indeed NICE stated that:

“A person needs to be in ‘energy balance’ to maintain a healthy weight—that is, their energy intake (from food) should not exceed the energy expended through…exercise”.

This obsession that Ministers have had for some years that it is a balance between what you eat and how much you exercise is the crucial mistake. The real balance is between calorie intake and the total expenditure of energy in the body. We have to run miles to get rid of a pound of fat and, bearing in mind that as little as 25 per cent of the calories we eat go on exercise, where do the other 75 per cent go? They go on the numerous activities of the body over which we have no control. The heart beats several million times in a lifetime, the kidneys filter a vast quantity of blood—about 360 pints over 24 hours—and there are myriad other activities in other organs, such as the liver, pancreas, bones and the alimentary tract. Where do those who believe that the energy from food is all used up in exercise imagine the energy comes from to run the heart, the pancreas, the liver and so on? Perhaps they imagine they run on air—perhaps hot air.

What could the Government do to encourage the food industry, canteens and restaurants to serve smaller portions of food? There is a company called Cook, which has 50 outlets and prepares meals of the right size—meat, two vegetables and gravy. They are cooked, frozen and then stored. They can be heated in five minutes, giving an instant meal of the right size, the right quality and the right price.

During the war, we had no obese people. We had the right quantity of food and the right kind of food. The only people who were obese were those who used the black market, and we children used to point our accusing fingers at them. Surely most mothers who are making their babies and children obese do not realise the terrible damage that they are doing, condemning them to a life of hardship, suffering and early death.

Bearing in mind that most obese people cannot exercise because they are so overweight, all they have to do to lose weight is eat less. The noble Lord, Lord Soulsby of Swaffham Prior, has given me permission to tell your Lordships the following story. As you know, he cannot exercise because he is confined to a wheelchair, but he decided to take three stone of weight off. He used a really revolutionary technique: he took three stone of weight off by eating less. There are no mysteries, only mysterious people.

Telling obese people that they have got to exercise is demoralising because they cannot. Most of them realise that it is nonsense to say so. What hope is there of dealing with this very serious epidemic if Ministers deny its cause? Exercise is of course very important—it is ideal for the functioning of the heart and control of cholesterol, and it gives one a sense of proportion and well-being—but it does not deal with the obesity epidemic. Of course I recognise that it is not the job of politicians to tell people how to live their lives, but it is surely the duty of government to speak the truth and give a lead. By continuing to stress that exercise is the answer, politicians are misleading the public.

The message is absolutely clear: this is the most serious epidemic to affect this country for 100 years; it is killing millions and costing billions; it will wreck the NHS for sure. The answer is simply to eat less. When obese people reduce their weight, then they can begin to exercise to keep fit—but not to solve the obesity epidemic.

I have been to see the director of NICE to reason with him, and he has now admitted that its advice is wrong. I have also been to see the Chief Medical Officer, and she has admitted that the advice is wrong. So the Minister is out on a limb. When will he listen to the Chief Medical Officer and NICE?

NHS: Cost-effectiveness

Lord McColl of Dulwich Excerpts

Monday 12th September 2011 Lords Chamber

[Earl Howe]

No, I do not. There are plenty of examples of quality costing less because the system gets it right first time. We see this time and again, for example in the Quit programme. The simplest example is that if we can treat patients correctly in hospital and keep them in for the shortest amount of time, we save a great deal of money.

[Lord McColl of Dulwich]

My Lords, on the subject of cost-effectiveness, does my noble friend agree that we are in the middle of the most serious epidemic to afflict this country for 100 years—namely the obesity epidemic? The cure is free: you just have to eat less. Why does the Department of Health insist that exercise is important in this equation?

[Earl Howe]

My Lords, the department takes its cue from NICE. I am sure that my noble friend will agree that exercise is never irrelevant to the question of obesity. I think that my noble friend's difficulty centres on how relevant it is in relation to reducing calorie intake. No doubt the debate on that will continue.

Health: Obesity

Lord McColl of Dulwich Excerpts

Monday 4th April 2011 Grand Committee

Asked By

[Lord McColl of Dulwich]

To ask Her Majesty’s Government what steps they are taking to reduce obesity in the United Kingdom.

[Lord McColl of Dulwich]

My Lords, the purpose of this debate is to draw attention to the most serious epidemic to affect many parts of the world. The obesity epidemic will soon involve half the population of this country. It is killing millions of people, costing billions of pounds and the cure is free: eat less and live. The results of obesity cause great distress and suffering and include cancer, arthritis—which often needs joint replacements—and type 2 diabetes, which leads to blindness, loss of limbs, heart attacks, strokes and very much more disability.

The best measure of obesity is the body mass index, BMI, which is the weight in kilograms divided by the square of the height in metres. In terms of body mass index, 20 to 25 is healthy, 25 to 30 is overweight, above 30 is obese and over 40 is morbidly obese.

How is it that intelligent, well meaning leaders of this country have allowed themselves to be hoodwinked into believing the false information about obesity that it is all to do with a balance between the calories that we eat and the exercise that we take? Of course, they have been aided and abetted by NICE—or, under its more recent name, the National Institute for Health and Clinical Excellence. In its document on obesity of January 2010, NICE stated:

“A person needs to be in ‘energy balance’ to maintain a healthy weight – that is, their energy intake (from food) should not exceed the energy expended through … exercise”.

There is its crucial mistake, because the real balance is between calorie intake and the total expenditure of energy in the body.

The simple fact is that only 20 per cent of the calories we eat or drink are used up in exercise, which means that diet is five times more important than exercise in controlling weight. Put another way, if we were successful in doing something which has never been achieved before—namely, getting the population to double the amount of exercise that they do in a day—it would increase energy expenditure only by 20 per cent. If, on the other hand, every plate of food was reduced by half, this would reduce the calorie intake by half.

We have to run 17 miles in order to reduce our weight by one pound of fat. Bearing in mind that as little as 20 per cent of the calories we eat or drink is used up in exercise, where does the remaining 80 per cent of the energy go? It is consumed by numerous activities over which we have no control: the heart beats 2.5 billion times in a lifetime, the kidneys filter 4.5 metric tonnes of blood and there are a myriad of activities in other organs of the body such as the liver, the pancreas, the bones and the alimentary tract. As regards those who believe that the energy from food is all used up in exercise, where do they imagine the energy comes from to run the heart, liver, pancreas, brain and so on? Perhaps they imagine that they run on air—perhaps hot air.

The sad thing is that there are politicians in all parties and people in many well meaning organisations who have also been misled. Most of their publications have adopted the mantra that exercise and diet are the solution to obesity but few, if any, emphasise that diet is five times more important than exercise. Politicians persist in believing that the issue is about having a balance between diet and exercise because that is what the quango NICE says in its publications.

When one examines what NICE published in January 2010, one sees that it recommends exercise and diet on seven pages and on three other pages it puts it the other way round, as diet and exercise. Nowhere does it state that reducing calorie intake is much more important and effective in reducing weight. On page 21, it recommends that obese adults should take more exercise even if it does not lead to weight loss. If treatment is not working, why not try another treatment such as eating less, which is five times more effective? But perhaps the most impractical advice in this paper was that people who have lost weight may need to do an hour and a half of exercise a day to avoid regaining weight. I must say that I would have been very disappointed if any of my medical students had produced a document such as this. But there is good news. I went to see the director of NICE, who has now admitted that the institute got it wrong. I look forward to politicians accepting this new advice that diet is five times more important than exercise.

Why are people willing to turn a blind eye to this problem while millions of people suffer as a result? By saying that taking exercise is the answer, we avoid upsetting the millions of obese people whose excessive weight often prevents them exercising and we give them a good excuse to stay as they are. We deceive them by avoiding the heart of the matter which is that we need to eat less. Of course, those in the food industry are delighted to hear that lack of exercise and sports facilities are to blame for the obesity epidemic as that lets them off the hook.

I have been asked not to be negative about exercise because all the political parties have been campaigning to increase activity and they do not want this momentum to be torpedoed. I understand that. I would never be negative about exercise because it is of great importance for the integrity of the heart and the control of the wrong sort of cholesterol. Exercise also gives a sense of well-being and high morale, but that does not alter the fact that what we eat is five times more important than exercise when we are dealing with weight control.

The subject of obesity is beset with a number of red herrings. Many people believe that obesity is due to genetics, hormones, brown fat, psychological factors, sexual abuse and so on. These factors may help to explain why people eat too much but they are certainly not the cause of obesity. Those factors were around during the war when food was rationed but there was no obesity then, apart from those miscreants who were indulging on the black market.

Over the years, I have had many obese patients who have assured me that they eat very little and sometimes they were speaking the truth. Their obesity was due to their alcohol intake. Noble Lords will perhaps know that three cocktails such as mai tai will contain 1,000 calories. That is another hazard for the unwary.

There is a good deal of confusion about childhood obesity, which is now a very serious problem and getting worse. The organisation Change4Life has estimated that there are 1 million obese children under 16 in the UK, and around the world there are 2 million children under five who are overweight. We are beginning to see earlier and earlier the complications of obesity in these children, such as type 2 diabetes, heart disease, high blood pressure and cancer.

Again we are bedevilled by the obsession that exercise is the solution, but reliable long-term scientific research clearly shows that overeating is responsible and that it starts in the first five years of life. There was a misleading article in the Daily Telegraph on 8 November 2010 headed, “Exercise, not diet, key to obesity”. This was based on a Norwegian study which was fundamentally flawed. However, the same article mentioned the reliable work of Professor John Speakman of the University of Aberdeen, who presented unique data using state-of- the-art technology. He found that rising obesity levels were due to increasingly excessive food intake. The overall physical activity levels have been constant over the past 25 years while weight levels have soared due to the greatly increased calorie intake.

Professor TJ Wilkin of the Peninsula medical school has carried out a unique study, published in Archives of Disease in Childhood in 2009, that included annual measurements of physical activity and body composition over 12 years. This shows that obesity leads to inactivity, but inactivity does not lead to obesity. Furthermore it concluded that the pathway to obesity seems to be,

“set early in life, long before school age”.

This questions the rhetoric around school meals, computer screens, PE time, playing fields and physical activity, which, of course, is unstructured in early childhood. A recent meta-analysis incorporating 15 reports on over 13,000 children concluded that a nine year-old child subjected to intense pressure for 18 months would lose on average just three ounces, or 80 grams.

The obesity epidemic is killing millions, costing billions and the cure is free. Will Her Majesty’s Government embrace the essential fact that reducing food intake is five times more effective than exercise?

[Lord Addington]

My Lords, the noble Lord, Lord McColl, is consistent. I remember that we have crossed swords on this subject several times. The idea that exercise is a bad way of controlling weight is odd because fundamentally it misses the point. Exercise may make you gain weight. If you take exercise that uses muscle—for instance, my own sport of rugby union or rowing—you will get bigger. If you take these exercises your body will become more dense and solid; if you run, your body will become more solid and you will add extra muscle. The old adage is that if you go to the butchers and ask for a pound of fat and a pound of muscle you will discover which is the smaller unit—it is just there.

We can jump around here but the idea is that you are carrying too much fat. The body mass index is probably the worst measure of obesity and fitness because it throws up the anomaly of the sportsman emerging as the person who is going to die tomorrow. According to the body mass index, I did not make it to 30; neither did anyone else who played my sport at any level; and when Pinsent and Redgrave won their last combined gold medal they were heavily overweight and just missed being obese. These men are six foot five, so you can see how bad it is.

I am aware that I have an inferior medical knowledge but burning fat is probably the worst way to judge the way in which you use calories in exercise—I know I am sticking my neck out in saying this—because you burn up the calories when your body repairs the muscles, over a longer period of time, after exercise has put up your metabolism. This is fundamentally what your body does and different types of exercise will burn it at different rates.

It is also true that you have to take account of the number of calories going in and the number going out. If you live a sedentary life, it is absolutely obvious that you do not need extra calories. Exercise burns up calories, basically by rebuilding, reconditioning or changing muscle. You might burn off 15 calories by keeping fit in the gym but if, for example, you lift weights, you will burn off far more calories by rebuilding your muscles afterwards. However, if you are heavily overweight and eat far too much or eat the wrong thing sat in front of a TV screen, you are going to get heavier.

The fact is that, if we do not take exercise and we sit in front of a TV screen, the vast majority of us will eat or drink cups of tea laced with sugar. The same point applies to sugar in tea as it does to sugar in alcohol. If we spend a great deal of time being sedentary, most of us will consume calories at the same time. Many of us do not have the will-power to sit still for hours doing nothing without consuming calories. We live in a society where these no-need-to-cook, at-your-fingertips calories are easily available: you go to a supermarket and, after you have been good and bought the things that you have to cook, you buy lots of things that you do not have to cook. That is one of the barriers that we face.

How do we try to bring about a balance? The Government’s responsibility deal is a way forward, and I hope that we can get a bit more out of that than we have from some of the other schemes that we have had in the past. Primarily, we are not asking everyone to stop eating convenience foods, but we are trying to make those convenience foods potentially less lethal. However, how this will work, I do not know. Improvements have been made but are they happening quickly enough? There is no silver bullet. The previous Government tried hard to tackle the problem. They made people look at the problem but people still tend to be getting heavier, so which combination is right?

Total abstemiousness may be desirable but it is not something that we follow. Let us face it: we would not have to maintain sports grounds if we all did. Fast food is available to us and it has always been a part of our culture. History shows us that fish and chip shops and pie shops have always been there. All the things we like, such as salt and fat, are available and they give us a nice hit. We have to take that on board and try to educate people further. If people like these types of snacks, we have to try to make them less fatty.

Exercise plays a very important part for many people. If you are active and a reasonably keen amateur sportsman, then, apart from anything else, you are probably going to take slightly better care of yourself. Why would you not do so? Even if you only want to get from the third to the second team in your particular sport, then losing a couple of pounds and eating slightly better may have a part to play in that. When you are playing or running around training one, two or three nights a week, you are not sitting on your behind in front of a TV screen or in the pub. We must look at the issue in the round. The incentive to control your diet is increased by exercise. If you do not eat a great deal and are not carrying an extra few pounds of fairly soft tissue or fat, then, even if you just want to walk gently up a hill on a Sunday, it will be easier and more fun. Everyone enjoys the view more when they are not gasping for breath at the end of their walk and do not have incredible pain in their muscles. That is a fact.

I repeat: we have to look at things in the round. Physical activity and access to physical activity will help, if only as an incentive to eat better. Unless we make sure that that there are incentives to take part in social and physical activity and to think about the foods that we eat and the amount we eat, we are going to miss our targets. Let us make sure that, when we talk about diet, we talk about it in terms not just of consumption of calories but of the correct cycle of calories for activity.

I leave noble Lords with this. Everybody is gobsmacked by professional athletes—not by the amount they train but by the amount they eat. An Olympic gold medallist—I think it was Phelps in the last Olympics—said that he had to eat 4,000 calories a day. That is eight gold medals-worth of burgers. It means that people can actually eat a great deal and be very fit and healthy. I suggest that we need to look at this in the round and not get obsessed by any one activity.

[Lord McColl of Dulwich]

Before the noble Lord sits down, would he recognise that I did not actually run down exercise? I specifically said it was a good thing. Also, how does he explain the scientific fact that only one-fifth of the calories we eat are expended in exercise?

[Lord Addington]

My Lords, quite simply, if it is expended in exercise, it is not expended in the rebuilding of muscle. Rebuilding muscle is an important part of exercise—not the actual taking of exercise.

NHS: Global Health

Lord McColl of Dulwich Excerpts

Monday 20th December 2010 Lords Chamber

[Lord McColl of Dulwich]

My Lords, I, too, congratulate the noble Lord, Lord Crisp, on initiating this debate, and I admire the outstanding work that he has been doing on this vital subject. His natural modesty precludes him detailing his extensive work. He is, in fact, joint chairman of the Global Health Workforce Alliance, which is giving a new impetus to the subject nationally and internationally. His report, entitled Global Health Partnerships, graciously gives credit to the many initiatives in this field, especially to THET, which was set up by that pioneer Professor Eldryd Parry.

Medical students have for years spent several months of their clinical training working in developing countries and gaining valuable insight into global medicine. King’s, Guy's, St Thomas's, St. George's and UCL are already running courses on the subject. A great deal is going on, but much more could be done. We can encourage more partnerships to be set up between medical schools in the UK and developing countries, for instance the new medical schools in Ethiopia. The medical schools and hospitals here need to make it easier for our graduates to go to those countries for longer periods, not only to enjoy invaluable new clinical experiences but to help medical students abroad to achieve their goals. They can increase their help to the medical students out there by demonstrating physical signs, new ways of teaching, how to get the best out of their libraries, data collection and so on.

There is unprecedented interest among medical students in helping to develop this field, and good organisations are at work, as outlined by the noble Lord, Lord Crisp. The Royal College of Obstetricians and Gynaecologists recently drew attention to the need for the NHS to help to plan the work abroad of junior doctors. In Guy’s Hospital in 1972 we set up a comprehensive surgical training programme involving a large part of the south-east of England. One of the years of the seven-year programme had to be spent abroad, and that proved very popular.

With the hospital ship part of the charity Mercy Ships, we not only provide free surgical treatment to the poorest of the poor but we teach the local surgeons the kind of operations that are appropriate in their country given their available resources. For instance, in Togo this year three Togolese eye surgeons were taught the best way of removing cataracts without the need for the expensive equipment that is used in the West and cannot be afforded in Africa. Now one surgeon is at work in the north of Togo, one in the south and one in between, so they cover the whole country.

An example of the excellent work done by many of the doctors in global health is a junior trainee at Guy’s Hospital called Abigail Boys. She works for Mercy Ships intermittently and has done so for the past six years. She came across a 13 year-old girl in Ghana whose tumour of her face was too complicated for Mercy Ships to cope with, so she raised thousands of pounds to bring her to the Royal London Hospital, where she had an amazing 11-hour operation, which was carried out successfully by the distinguished surgeon Iain Hutchison, whose wife enhances the Benches opposite. So long as our future surgeons are going to be like this young lady Abigail Boys, who is so passionate about helping the developing world, we can look forward to an ever-increasing participation in global medicine.