Health and Care Bill

Lord Naseby Excerpts

2nd reading
Tuesday 7th December 2021 Lords Chamber

[Lord Naseby (Con)]

My Lords, this is a watershed Bill at a watershed time for the National Health Service. I shall touch on a few issues but many more will come up in Committee. Before I do anything else, I offer my congratulations to Her Majesty’s Government on two dimensions. First, for the first time in my experience, Her Majesty’s Government, the NHS and the pharmaceutical industry have got together, worked endlessly and furiously—spending money, yes—and succeeded in producing vaccines that no other country has done at the same pace. That is a huge achievement. Secondly, I thank the NHS front-line staff and our new noble friend, who led them so well.

Of course there are problems. I declare an interest. My wife was phoned while at a party conference and asked to take over a practice because the doctor had disappeared. There were only about 600 or 800 patients. We scrubbed down the old butcher’s shop in Biggleswade and started up, and she built up as a full-time doctor the largest practice in east Bedfordshire. My son served in the Armed Forces as an Army doctor, so I know a little bit about that world.

The greatest thing for me as a marketing man is that, if you are going to solve the problem, you have to look at what is going wrong. I shall highlight a few areas. Frankly, the GP system today is not working. It is poor. The problem arose in 2014 when—I do not say anything party political here—GPs were absolved from looking after patients 24 hours a day, 365 days a year. They were given the opportunity to opt out. Some 90% did so. We went on to this new system and so it has developed. It is not a good system. The worst bit of it is that, when we hit a real crisis, as we have done, we see where it has all gone wrong.

I know it is wonderful to have all these magical technical things but triage is not working. You cannot get through to a doctor. How many people have told me that as a politician? You get through to a receptionist only after you have started at number 15 or 16 in the queue. There are no home visits. My dear wife got really bad Covid. Yes, 111 came out three times, but not once did we see our GP, although we had a couple of phone calls. She is recovered and well. Did we get a home visit afterwards? No. Does anyone who is elderly get a home visit? No, hardly anyone does. Even worse, yesterday’s newspaper said that 300,000 of our citizens are housebound. Every one of those is on a GP’s list, so I hope that every GP who covers those 300,000 people will be out next week ensuring that every one of them gets a jab.

Secondly, I have gone on about medical schools. I asked a Question about them in this Chamber on 26 October 2016. The point was made that medical school places were going to go up by 25%, with an additional 1,500 of them. Yes, that happened, but it was not enough. The crunch, as I said in my supplementary question to my noble friend Lord Prior of Brampton, the then Parliamentary Under-Secretary, was this:

“Today, 56% of the intake of medical students is female.”


That was five years ago; it is worse than that now. I have nothing against that—I am quite happy with 50/50—but, as I said then,

“70% of female GPs today work part-time, and a recent survey by the King’s Fund says that 90% of all medical students in training want to work part-time.”—[Official Report, 26/10/16; col. 197.]

Given the cost of £200,000-plus to train a GP, I proposed at that point that we have a situation, as in Singapore, where you have to sign on for four or five years to work in the NHS, which has paid for your career. I was told that that was perfectly “reasonable” and that the Government would consult on four years. Nothing has happened. If Singapore can work this, why on earth can we not? Our young people, male and female, after they have been given a superb education, should give back to society for four or five years. My son in the Armed Forces had to do that, so the precedent has been set.

One area that will need to be looked at is obesity. The Government are working with the industry, which has worked with the Government before. We need to have a situation where we look closely with industry, and not at the proposals that are currently in the Bill.

Health and Care Bill

Lord Naseby Excerpts

Committee stage
Friday 4th February 2022 Lords Chamber

[Lord Naseby (Con)]

My Lords, I apologise to the House that I did not take part in the Second Reading debate; I am afraid that my wife was in hospital at the time. I was a trainee and marketing manager with Reckitt Benckiser—Reckitt & Colman in its early days—which is obviously associated with Colman’s foods and Robinsons drinks. As my career developed, I changed from the company side to the advertising agency side and was responsible for a fair amount of food advertising for the next 15 years. I am particularly proud of Jacob’s Club biscuits, which are full of chocolate—more than any other chocolate biscuit. So, I suppose I have a heritage to declare in that area.

I have supported a number of the amendments that my noble friends Lord Vaizey and Lord Moylan have tabled, and I also listened to my noble friend, in this case, on the Liberal Benches. But I will not talk about them because they have been more than covered; I will keep it quite simple.

We are thinking and talking about a major industry in the UK: the food and drinks industry—not the alcohol side. It has co-operated with previous Governments of both dimensions—or three dimensions, if you include the joint one with the Conservatives—so it has had a long history of involvement. It declares and has indicated that it is helping to reduce child obesity, and it has performed on this, so it is not as if it is resisting anything. It is very important that there is a good working relationship with a dynamic industry like this.

As I see it, the tragedy is this. The ISBA, IAB, IPA and the Food and Drink Federation have worked closely with previous Governments and succeeded in coming a long way in trying to tackle obesity. The industry has demonstrated that by the number of initiatives that have taken place, which have been mentioned already: projects like The Daily Mile and Eat Them To Defeat Them. It has put forward a proposal to Her Majesty’s Government, although I will not go into it because it is fairly technical: targeting filters, based on robust audience data. Some of your Lordships are particularly tech-oriented; I am not, but I am advertising-oriented. When an industry puts forward a proposal of a high-tech nature that will achieve the objectives that the Government of the day want, and set in the first place, it seems to me very strange when that approach is totally rejected.

It goes deeper than that, because unless Her Majesty’s Government listen to my noble friends and think long and hard about their amendments, this will undermine public health policy. Manufacturers have been working in partnership with government for years—over two decades—to reformulate products, reducing salt, sugar and calories and offering smaller portion sizes. Now, all of a sudden, my Government have decided that they will not work with the industry but will handicap it. That will even affect the future, because it will stifle the investment we want in this country, particularly at this time. Finally, this will undermine the Government’s ambition for the UK to be a digital leader.

I ask my noble friend on the Front Bench to have another look at what the industry offered. Yes, it is high-tech and yes, it is quite difficult for us normal humans to really get a hold on what it is about and how it actually works, but, after 25 years in the communications world before I entered the other place, I believe, and hope, that my noble friend on the Front Bench is broad-minded enough to go and have another look at what was on offer, before the sword of Damocles falls on this aspect of allegedly helping to reduce poverty.

[Lord Moynihan (Con)]

My Lords, the great Nicholas Parsons, who is the Chief Whip’s go-to source of quotations for today, also said:

“The saddest thing about getting old is seeing my cricket bat in the corner and wondering if I will ever play again.”


I am sure that Amendment 297C in my name and those of some colleagues, who I will come to in a moment, would have been warmly welcomed by him, as I hope it is across the Committee. If accepted by the Government, it will ensure that many more cricket bats are rehabilitated with a wipe of linseed oil and put to good use again.

I did not want to interrupt the excellent debate, so I have waited until this point to come forward with my amendment, but I say to the noble Lord, Lord Stevens, that if there was ever an amendment in this group to tackle obesity, this is the one. I declare my interests as set out in the register.

Amendment 297C stands in my name and those of the noble Baroness, Lady Morris of Yardley, from the Labour Benches, the noble Lord, Lord Willis of Knaresborough, from the Liberal Democrat Benches—who admirably chaired the National Plan for Sport and Recreation Committee, which recently published a unanimous report that recommended a requirement for a national plan for sport, health and well-being to be placed in primary legislation—and the noble Baroness, Lady Grey-Thompson, who has been campaigning with me for this change in the law for well over 20 years.

Of course, the Select Committee of your Lordships’ House ceased to exist on the publication of its report. However, unusually, after hearing 76 witnesses in public evidence sessions and reviewing 163 pieces of written evidence, in addition to four round tables, we were unanimous in our hope that this Health and Care Bill could be amended, to reflect the views from all sides of the House, to include a statutory responsibility on the Secretary of State for Health to draft and publish a national plan for sport, health and well-being. The Minister for Sport would be moved from DCMS to the Department of Health to oversee the process of preparing the national plan, presenting it to Parliament and undertaking the additional functions that the Minister for Sport’s office currently undertakes with a very small staff of just 33, who work on sport and recreation, as set out in the Minister’s written reply to me on 29 July. Despite DCMS’s good work, participation rates in sport and recreation in this country are lamentably low and add to the problems of obesity.

Our rationale for encouraging the Prime Minister to make such a move was more than the obvious natural fit that sport and recreation sit more appropriately with health and well-being than with data protection, cybersecurity and the TV licence fee; more than the natural policy fit between sport and health; more than an attachment to a department on the fringes of government, established courtesy of David Mellor’s charm in persuading his good friend John Major to create the department in the first place; and more than a recognition that a Minister at the heart of government could position sport and recreation where it should be: an essential component of a fit and healthy nation, as part of preventive care, health and well-being.

The purpose of our amendment is to create a catalyst for change. The status quo simply does not work. We heard evidence from the Deputy Prime Minister of New Zealand, where the Minister of Finance is responsible for setting out a well-being budget that fully includes and embraces sport and recreation in that portfolio.

In the context of the UK, the three key elements of our amendment include focusing on outcomes that meet the needs of present generations, at the same time as thinking about the long-term impacts for future generations; taking a holistic—not the current siloed—approach to the subject; ensuring that society is fitter, healthier and happier; and increasing sports participation rates by at least 10% per annum, which happens on the continent, as opposed to the static levels of participation since 2005 in this country and the major lost opportunity to deliver a participatory sports legacy from London 2012. We face a crisis of obesity, as we have heard in this excellent debate. We have to take action now. We also face a crisis of inactivity, and we need a national plan.

Secondly, we need to break down departmental and agency silos and work across government to assess, develop and implement policies that improve sport, health and well-being. Efforts to increase levels of participation as a percentage of the population have simply failed, and that should be the most important outcome for the Minister for Sport at DCMS. In our view, it requires the major clout that comes with a central, large department of state to co-ordinate and deliver cross-departmental initiatives. There is hardly a department of state now that does not have to promote policies in sport and recreation—including, for example, the Department for Transport, which recently announced a £2 billion package to create a new era for cycling and walking, equal to the total amount of money spent by Sport England on all sport and recreational activities, outside Covid, over the last eight years.

Thirdly, we need to track progress with broader measures of success, including the health of people, communities, the environment and public finances. This is exactly what the Prime Minister said when launching the office for health promotion on 29 March last year. Our amendment backs the Government’s announcement of that day, which stated:

“New Office for Health Promotion will lead national efforts to improve and level up the public’s health … It will help ministers design and operationalise a step change in public health policy”.


Above all, it said that the

“New approach will see action across government to improve the nation’s health by tackling obesity, improving mental health and promoting physical activity”.


The Prime Minister had this to say:

“The new Office for Health Promotion will be crucial in tackling the causes, not just the symptoms, of poor health and improving prevention of illnesses and disease.”


Backing his words is all we are asking for. He went on:

“Covid-19 has demonstrated the importance of physical health in our ability to tackle such illnesses, and we must continue to help people to lead healthy lives so that we can all better prevent and fight illnesses.”


The then Health and Social Care Secretary, Matt Hancock, said:

“Good physical and mental health are central to our happiness and well-being. Yet so much of what keeps us healthy happens outside of hospital and the health service. By establishing the Office for Health Promotion we will bring health promotion into the heart of Government, working to the Chief Medical Office, so we can level up the health of our nation, working across national and local government.”


For reasons unknown, the cross-governmental approach to improving the nation’s health by tackling obesity and promoting physical activity was quietly dropped last summer. The office for health promotion was reorganised and rebranded as the Office for Health Improvement and Disparities, which retained all the objectives of the office for health promotion, save the essential component of promoting physical activity. Let us add that essential goal, so strongly backed by the Prime Minister and the Government at the time. This amendment would do that, and would add this core objective to the work of the OHID.

In the interests of time, I will not argue the case for all the issues that need to be covered by a national plan, some of which are set out in the amendment. I also will not go into detail, further than to say that my noble friends and colleagues who have worked on this, not least the noble Baroness who will follow me, will cover some of those issues in this debate in Committee. In conclusion, the case is admirably set out in detail by the noble Lord, Lord Willis, and his committee, in the excellent, unanimous Select Committee report. In that spirit, I commend the amendment standing in our names to the Committee.

--- Later in debate ---

[Baroness Finlay of Llandaff (CB)]

My Lords, it is a great pleasure to follow the noble Baroness, Lady Northover, because I would like to pick up almost where she ended, on raising the age for the sale of tobacco. That measure has been successfully implemented in the United States, where smoking among 18 to 20 year-olds has been reduced by nearly a third as a result, so I support Amendment 270.

On Amendment 271, which affects the sale of nicotine products to children, it is rather horrifying to realise that it is not illegal for free samples of e-cigarettes to be given out to those under 18, even though it is illegal for them to be sold to those under 18. Amendment 271 would cover this. It would also cover the novel nicotine products, such as Japan Tobacco International’s widely advertised nicotine pouches—I do not particularly want to use their name because I do not want to advertise them. Unlike e-cigarettes, the marketing of these products is currently completely unregulated, despite the high levels of nicotine, which is an addictive substance. A quick search on the internet to look at the questions around them reveals that it is admitted that they are highly addictive, that they could affect the development of the brain and that they could result in mood changes in the user as well, possibly making them emotionally volatile. These are loopholes in the law, which can easily be fixed by our Amendment 271.

In Amendment 278, the noble Lord, Lord Rennard, seeks to ban all flavours in smoked tobacco. Again, this is another gaping legislative loophole which has allowed tobacco manufacturers to flout the current flavour ban.

I have led on Amendment 279, which relates to the packaging and labelling of nicotine products such as e-cigarettes. A cursory search online for these reveals that widely available electronic cigarette e-liquids feature cartoon characters in garish, appealing colours, with child-friendly descriptors, including sweet names such as gummy bears. Such branding is clearly unacceptable; it is targeted at the young. It is therefore deeply disappointing to discover that an amendment giving the Government powers by regulation to prohibit child-friendly packaging was voted down by them in the other place. The Minister said then that the Government

“are committed to ensuring that our regulatory framework continues to protect young people and non-smokers from using e-cigarettes.”—[Official Report, Commons, 22/11/21; col. 88.]

The Government can prove their commitment by supporting Amendment 279, which requires the Secretary of State to consult and report to Parliament on e-cigarette packaging, in particular the branding elements designed to be attractive to children.

[Lord Naseby (Con)]

My Lords, I have never smoked and I have no wish to smoke, but I am a marketing man by profession. We have here a legal product, the consumption of which has been steadily falling, particularly in recent years, in every age group throughout the country.

Health and Care Bill

Lord Naseby Excerpts

Lords Hansard - Part 2 & Report stage
Monday 7th March 2022 Lords Chamber

In the meantime, zealous Lords have other amendments in this group saying that what the Government really need to do—so clear is their understanding of business requirements—is move ahead more rapidly with this and have a hard deadline against which it must all be brought into effect, irrespective of the consequences for jobs, businesses and prosperity, and all to save three calories a day. So, that is my story. I am sure that the Grenade company is watching this now on parliamentlive.tv. I ask my noble friend: when I speak to the company tomorrow, what comfort can I offer? I beg to move.

[Lord Naseby (Con)]

My Lords, I support my noble friend on these amendments. Of course, this is an extension of the debate that we had on the eighth day in Committee on the Bill. I want to look at the central problem behind the case history that my noble friend has outlined so clearly this evening. We need to remind ourselves that we are dealing with the food industry, one of the largest industries in the United Kingdom.

To the best of my knowledge having contacted all the trade associations, all parties want to reduce childhood obesity. There is no argument about that anywhere and, in the case of this industry, there are several areas of trade association activity, through ISBA, the IPA, the Food and Drink Federation and—of particular relevance to digital advertising—the IAB, which has worked very closely with DCMS. In a sense, that is part of the problem, because my noble friend on the Front Bench is not speaking on behalf of DCMS but about the Health and Care Bill on behalf of the DHSC.

The IAB, representing all food manufacturers dealing with digital advertising, has worked very closely with DCMS. It has kept it up to date on the latest developments, but DCMS has not engaged or worked with the industry in finding a solution. The industry has worked constructively for a long time to propose a tech-based solution that would achieve the Government’s objective of a further reduction in the number of HFSS advertisements that are viewed by children. This proposed solution would use proven, targeted technology and includes an element of advertising campaign evaluation which would be future-proof—this is important—and ensure that it continues to improve. The irony is that the industry wants to work with the Government on this matter, but so far the Government are sadly ignoring this industry’s expertise and dismissing its proposals.

I had the privilege of working in the advertising industry for 25 years, and I have seen these sorts of developments in other fields. When you have an industry working with government on an area that is important to both parties, it is a tragedy that Her Majesty’s Government, through DCMS, are not working. Yes, it is new technology, and the Government might feel happier if there was some experimental work in special test markets or whatever, but the sad thing is that this technology is there, and is proven, but still Her Majesty’s Government are refusing to use it and are seemingly—perhaps I am being too critical from the outside—unable to understand whether it will work. This is hugely frustrating for any company in this market.

I am sure my noble friend on the Front Bench is aware that the Prime Minister wants this country to lead digitally, and here we are on the frontiers of this area where we are leading, yet we cannot move forward. If the Government have reservations—and it is difficult for someone from another department, in this case the Department of Health and Social Care, who has therefore not been party to what has been going on—would it not be more sensible to have another look and evaluate it properly with those who really understand how it works and how it is developing? If the Government are still not convinced, I suppose we will have to try again later. As someone who comes from that industry—I have no involvement now and am not speaking for any particular party—I want to see companies in this area, like the one my noble friend described this evening, to be able to succeed in future.

Finally and frankly, the Government’s blunt and disproportionate advertising ban will not be effective. When there is another system on the table, my noble friend ought to take it back, have another look at it and see whether it will help everybody.

[Lord Black of Brentwood (Con)]

My Lords, I am speaking to Amendment 151A in my name and to four other consequential amendments which relate to the responsibility of online platforms for enforcing the ban on HFSS advertising. The amendments have been signed by the noble Baroness, Lady Merron, the noble Lord, Lord Clement-Jones and the noble Viscount, Lord Colville of Culross, a cross-party group which underlines how important the issue is, and I am grateful to them.

I declare an interest as a director of the Advertising Standards Board of Finance and deputy chairman of the Telegraph Media Group, and note my other media interests as set out in the register. I am also a vice-chairman of the APPG on ITV.

I intend to be very brief as these issues were discussed at great length in Committee. Indeed, over a marathon three-hour session, when many noble Lords raised concerns about the implementation of the proposed ban, they noted that it would not be effective as structured: it was not proportionate, it was an infringement on freedom of expression, and it was unfair and unbalanced because it penalised broadcasters and publishers and did not provide for any enforcement by the platforms—Google, Facebook, and others—where the vast majority of HFSS advertising sits.

Health and Care Bill

Lord Naseby Excerpts

Lords Hansard _ Part 1 & Report stage
Wednesday 16th March 2022 Lords Chamber

[Lord Rennard (LD)]

My Lords, I speak in support of these amendments, to which I have added my name, and which are in accordance with my party’s policy.

In Committee, there was almost universal support for dealing with health inequality issues, and there was widespread recognition that, as the noble Lord, Lord Crisp, said, half the difference in life expectancy between the richest and the poorest people in this country is caused by smoking. There are many ways in which we can further reduce the prevalence of smoking, and those of us who are members of the APPG on Smoking and Health set them out during the course of our debates.

However, we are concentrating today on just one key principle which is necessary if the Government’s target of reducing the prevalence of smoking to 5% or below is to be achieved by 2030. That principle is finding the funds to support smoking cessation and tobacco control measures through a levy on the tobacco companies. This would help to ameliorate the terrible damage done by their products, which includes shortening the lives of half the people who use them.

The funding for local authorities to pursue tobacco control policies such as smoking cessation services and enforcement and for national mass media campaigns has been cut significantly. Without the proposed levy, the NHS will face greater costs in future in dealing with the many issues, such as lung cancer and heart disease, which arise in part because of smoking tobacco.

Last month, together with other officers of the APPG on Smoking and Health, I had the pleasure of meeting Javed Khan, chair of the Government’s independent review into smoking. He listened carefully to all our proposals, particularly on the levy, and certainly understood the necessity of funding being found. The Government have asked him to say what the most impactful interventions that could be taken forward in the new tobacco control plan would be. He told us that if nothing different is done, the Government’s smoke-free target will not be met. He promised that his recommendations would be “bold and brave”, as I hope they will.

I expect that we will soon get some soothing words from the Minister. But before he replies to this debate, I ask him to consider how, in “Hamlet”, King Claudius has to admit that

“words without thoughts never to heaven go”.

I hope the Minister will give us not just warm words about tobacco control but confirm that the Government have thought about the tobacco levy and will undertake a formal consultation on it.

[Lord Naseby (Con)]

My Lords, I hasten to say to your Lordships that I do not smoke and have never smoked. In considering the amendments before us this afternoon, it is worth giving some of the official statistics rather than the aspirational ones. Smoking rates in England continue to decline year on year and that has been a trend for the last 30 years. According to the Office for National Statistics in 2021, smoking rates in England have declined significantly, from 20% in 2011 to 12% in 2020. The decline in the number of smokers has resulted in a reduction in the cost to the NHS of treating the impact of smoking. In 2015, Public Health England estimated that the total smoking-related cost to NHS England was £2.6 billion a year, when 18% of the population smoked. This figure and the corresponding cost to NHS England over the last five years have declined further, given the 12% smoking rate in England in 2020. According to NHS data published in 2019 on smoking, drinking and drug use among young people, the number of young people aged 11 to 15 smoking has declined dramatically, from 16% to just 5% in 2018. According to the Office for National Statistics in 2021, only 12% of 18 to 24 year-olds in Great Britain smoke, a major reduction from 26% in 2011 and the lowest smoking rate across all age groups except the over-65s.

By way of background, according to the most recent HMRC tax gap data, illegal smuggling and consumption of illicit tobacco cost Her Majesty’s Government £2.3 billion in lost revenue in 2019-20, a figure that remains unchanged from the fiscal year 2016-17, which reinforces the fact that the Government’s anti-illicit tobacco strategy is not working. It ought to be working, when you have a situation where a group of companies is working with the Department for Health and has done over many years. Frankly, it is a sad reflection on the status of HMRC that this illicit tobacco importation is increasing. You have only to look at what is happening in Dover or any of our other ports today to see why it is increasing. It is a pathetic and embarrassing performance at Dover at the moment, the net result being not just tobacco but illegal alcohol and so on coming in.

Now we look at the idea of a levy, something that has never been in the manifesto of a Conservative Government to the best of my knowledge. A levy on any company prescribed by government, even companies trading locally, certainly does not fit into the basic elements of our financial and economic strategy. If it was just a levy on cigarettes, there might be half a case, but this is on anything to do with tobacco. Most of all those other products have no effect on people’s health—they are a matter of enjoyment—but this idea goes across the whole lot. It has not been thought through.

It is all very well my noble friend Lord Young on the Back Benches saying that there was a consultation in 2015 on a levy on tobacco manufacturers’ profits and the Government concluded that it would be unworkable, but that was because we were in the EU so it has all changed now. I say to my noble friend on the Front Bench: I would have thought he had enough on his hands without introducing a complicated levy, but that is my personal view. There was an exchange between the Exchequer Secretary and the then shadow Exchequer Secretary, confirming

“that our position regarding the 2015 consultation stands. A levy would be a complex”—

this is not going to change—

“and costly way of raising money to fund tobacco control measures and would be unlikely to provide a stable revenue stream.”

I say to my noble friends on all sides of the House that tobacco manufacturers already invest hundreds of millions of pounds every year in R&D and highly skilled jobs to bring to market alternative smoke-free nicotine products. Some of your Lordships may use e-cigarettes, nicotine pouches or heated tobacco products. Further tax increases on manufacturers as a whole will have the effect of reducing that investment, which is not a very clever way forward.

--- Later in debate ---

[Baroness Walmsley (LD)]

My Lords, I do not recall anybody suggesting in the debate that tobacco companies should be made illegal. I hope that the noble Lord, Lord Naseby, is not suggesting that, just because the number of smokers is going down, nothing more should be done. I thought I heard the noble Lord, Lord Crisp, suggest that, if we carry on at this rate, it will be another 25 years before we get to where we need to be.

[Lord Naseby (Con)]

I was suggesting that we do carry on because the evidence is there in government data, not in a forecast from the noble Lord, Lord Crisp, or some minor operation that he—

[Baroness Penn (Con)]

I remind noble Lords that only short questions of elucidation are allowed on Report.