Alcohol: Children’s Health

Lord McColl of Dulwich Excerpts

Monday 3rd April 2017 Lords Chamber

[Lord O’Shaughnessy]

Action is being taken. There are clear rules and mandatory guidelines around the promotion of alcohol. It is important to point out that alcohol is different from smoking, where there are extremely strict rules on promotion. Most people enjoy alcohol in moderation as part of their healthy, pleasurable, normal social life, so there is a difference. However, there are clear and strict rules around promoting, advertising or selling to children.

[Lord McColl of Dulwich (Con)]

Does the Minister agree that whereas the commonest cause of cirrhosis of the liver used to be alcohol, it is now the obesity epidemic, which could be cured by eating less?

[Lord O’Shaughnessy]

My noble friend is right. Of all the things we should do in our lives, we should eat less and drink less—as I am sure every Member of this House does.

National Health Service: Nurses

Lord McColl of Dulwich Excerpts

Wednesday 22nd February 2017 Lords Chamber

[Lord O'Shaughnessy]

In answer to the noble Lord’s first question, I think the figure is 22,227 EU nationals, so I hope that satisfies him on that point. Of course, they do a fantastic job, as do all NHS and care staff, and they deserve the highest praise. The noble Lord will also know that we are keen to reassure them of their status as part of the EU negotiations, but, of necessity, that has to be a reciprocal arrangement.

[Lord McColl of Dulwich (Con)]

Will the Minister support my attempt to find out what makes so many young nurses leave the profession?

[Lord O'Shaughnessy]

I thank my noble friend for that question. We should be looking at attrition rates in training and in the profession itself, and I would certainly be happy to work with him on that. I know he is particularly anxious about the turnover of nurses within certain training settings.

Hospital Beds: Availability

Lord McColl of Dulwich Excerpts

Thursday 9th February 2017 Lords Chamber

[Lord O'Shaughnessy]

A number of investigations and reviews into the future of health and social care are taking place. I quite agree with the noble Lord that a royal commission is not necessary. What we all need to do in government and through the arm’s-length bodies involved in healthcare is to make sure that we are providing the 2.7 million staff, who are doing a brilliant job every day in supporting our health and care services, with the money and assistance they need to continue to deliver world-class healthcare.

[Lord McColl of Dulwich (Con)]

My Lords, does the Minister agree that it is not so much a question of old people getting older, because old people have always got older; rather, the difference in the last 30 years is the grotesque increase in the number of young people getting fatter and fatter?

[Lord O'Shaughnessy]

There are some long-term public health challenges, involving not just obesity but alcohol. But there is also good news: fewer people are smoking. I think that sometimes, young people—I do not know if I count any more—

Pharmacies: Funding

Lord McColl of Dulwich Excerpts

Wednesday 2nd March 2016 Lords Chamber

[Lord Prior of Brampton]

The noble Lord raises an important point. There is no doubt that community pharmacies are vital to all people, but particularly to those living in isolated rural communities. There will be a pharmacy access fund based around isolation and local health needs of the population. We are consulting with the Pharmaceutical Services Negotiating Committee over that issue at the moment. I assure the noble Lord that we are fully aware of the issue he raises.

[Lord McColl of Dulwich (Con)]

My Lords, the Government’s plans will squeeze all pharmacies, resulting in the closure of the least-viable ones—which are often in the poorest districts where they cannot easily diversify. Why do the Government not undertake a means assessment to find out which pharmacies are essential? Closing pharmacies will put even greater pressure on overworked GPs.

[Lord Prior of Brampton]

I assure my noble friend that not all pharmacies will be squeezed equally, as he put it. A pharmacy access fund will ensure that greater resources go to those pharmacies which serve isolated communities in rural areas, and a pharmacy integration fund will ensure that we encourage pharmacies to work more closely with primary care.

Sugar Tax

Lord McColl of Dulwich Excerpts

Wednesday 3rd February 2016 Lords Chamber

[Lord McColl of Dulwich (Con)]

My Lords, will the Minister give us an assurance that when the new policy comes out to tackle obesity we will not fall into the trap of saying that the answer is exercise? You have to run for miles and miles to take off a single pound of fat.

[Lord Prior of Brampton]

My Lords, exercise may be a part of our strategy to tackle obesity, but certainly not the major part.

National Health Service: In-Patients with Learning Disabilities

Lord McColl of Dulwich Excerpts

Monday 18th January 2016 Lords Chamber

[Lord Prior of Brampton]

I tried to explain the difference between avoidable deaths and excess deaths earlier in my answers, without trying to make any political point about it. There is an important distinction to be made, and I hope that I made it. I agree with the noble Lord that this is a very serious issue, and the Government are approaching it in a very serious way.

[Lord McColl of Dulwich (Con)]

My Lords, is the Minister aware that clinicians meet regularly to discuss all their complications, and that these meetings are extremely valuable and relevant? Have politicians considered the possibility that they might meet every week to discuss their mistakes?

[Lord Prior of Brampton]

My Lords, I am sure that it would be a very long meeting. My noble friend is right that mortality and morbidity meetings are extremely important in hospitals. It would seem that practice is very variable across hospital trusts and I know that part of what Sir Bruce Keogh, the medical director of the NHS, is doing is trying to develop, along with Monitor and the CQC, a governance structure around mortality that all hospitals can learn from.

Child Health: Play

Lord McColl of Dulwich Excerpts

Monday 12th October 2015 Lords Chamber

[Lord Prior of Brampton]

I wonder whether Members of this House might like to set an example in that regard as well by running a mile a day. There is no doubt that exercise is good for you. Not only is it good for all the problems associated with weight but there is plenty of evidence to suggest that exercise helps with mental health problems. Whether you are running or on your bike, I am wholly in favour of it.

[Lord McColl of Dulwich (Con)]

My Lords, although exercise is very important in terms of the heart and so on, the real answer is to eat fewer calories. We may criticise politicians of one party, but does the Minister realise that politicians of all three parties kept on saying that the answer to the obesity epidemic was exercise when it was nothing of the kind? It was eating fewer calories.

[Lord Prior of Brampton]

Clearly, my noble friend is right: nutrition and diet are fundamental to the whole debate about obesity. That does not alter the fact that exercise is also very good for you.

Health: Detection Dogs

Lord McColl of Dulwich Excerpts

Thursday 17th September 2015 Lords Chamber

[Lord McColl of Dulwich (Con)]

Is the Minister aware that diagnosis may be helped not only by dogs, but by ants in India? One way in which to detect diabetes is to get the patient to urinate up a wall, and if the ants crawl up the column of urine it means that there is diabetes because sugar is there, and ants like sugar. It is a very cheap way to diagnose diabetes.

[Lord Prior of Brampton]

I seem to remember a noble Baroness asking a question about ferrets climbing up someone’s trousers. Now we have ants climbing up people’s trouser legs. We are open to all sensible suggestions.

Health: Lymphoedema

Lord McColl of Dulwich Excerpts

Wednesday 9th September 2015 Lords Chamber

[Lord McColl of Dulwich (Con)]

My Lords, I am grateful to the noble Lord, Lord Hunt, for introducing this debate on the subject of lymphoedema, which arises when the lymphatics fail to regulate the fluid balance in the tissue spaces. That results in oedema, usually of the arms and legs. For example, normally in the legs there are four or five lymph channels each measuring one millimetre in diameter travelling up the inside of the leg to the lymph nodes in the groin, and from there they go up into the chest where the lymph is discharged into the veins in the chest.

Lymphoedema can be due to underdevelopment of the lymphatics, known as primary lymphoedema, which usually manifests itself in a person’s 20s or 30s. But if the lymph channels are completely absent, the symptoms of the condition appear much earlier. That is due to a genetic fault. Secondary lymphoedema is where there is a blockage in or removal or disease of the lymphatics, and is far and away the commoner of the two. The blockage can be due to cancer infiltrating the system or to worms—a condition called filariasis, which is quite common in the Far East. It is transmitted by mosquitoes, but noble Lords can be reassured: one has to be bitten many times by many mosquitoes before one gets the disease. The condition is common in Sri Lanka, but in the old days of the British Empire it was pretty well eliminated by reducing the mosquito population, which also reduced the incidence of malaria.

Lymphoedema occurs when the lymphatics are removed in certain cancer operations such as the old radical mastectomy or operations where the lymph node system is removed or reduced. As I mentioned, primary lymphoedema is due to underdeveloped or—rarely—absent channels. The first symptom is a slight swelling of the front of the foot. But if that is not dealt with, the whole leg can become enormously swollen and the skin grossly thickened—maybe as much as a centimetre in thickness. The legs become huge and very heavy, which makes it difficult for the patient to walk. To reduce the symptoms, an operation was designed by the surgeon Mr Charles, where the skin is resected, all the subcutaneous tissue is removed and then the skin is put back. The cosmetic results are not good, but the procedure does enable the patient to walk. That kind of radical surgery is rarely necessary these days.

As the noble Lord, Lord Hunt, has already emphasised, the important point is to have early diagnosis so that the swelling can readily be reduced by elevation and the use of close-fitting elastic stockings. The treatment has to continue for life and it is important that the patient understands this. The elastic stockings have to be applied before the patient gets out of bed, and this requires a lot of attention to detail. It is also important to avoid infections of the skin because they can make the condition worse by interfering with the underlying lymphatics. Elevation, compression, massage and physiotherapy are extremely important.

It should also be stressed that primary lymphoedema due to the genetic affection of the lymphatics is actually fairly rare. People are critical of doctors if they do not diagnose the condition right away, but it should be pointed out that the initial symptoms of puffiness can be due to a hundred and one different conditions. Primary lymphoedema is not often seen in general practice but, as I say, people are critical if doctors do not spot rare diseases immediately. However, a GP may not see one of these cases in a lifetime.

We have heard a lot of discussion about teaching on this subject in hospitals and medical schools. Of course they teach it. Swelling of the ankles is a very common condition and there are many different reasons for it; they are gone into in some detail. Discussion about a national strategy would be interesting, but what one must really emphasise is that diagnosis has to be made early on. There are computer-assisted ways of helping in diagnosis which alert the doctor as early as possible when someone comes into the surgery with, say, a puffy ankle or front of the foot. Diagnosis can be made early and suitable treatment started right away. Lymphoedema of the arms is usually due to previous cancer surgery and is less common today as radical surgery for cancer of the breast has been replaced by more conservative surgery along with radiotherapy and chemotherapy.

Early diagnosis must be encouraged before the swelling becomes severe, and effective treatment must be initiated in the form of elevation, physiotherapy, compression, exercise and meticulous attention to detail to prevent infection. Also, of course, obesity should be avoided; it is the greatest epidemic affecting this country for 95 years.