European Union (Withdrawal) Bill

Lord Patel Excerpts

Committee: 8th sitting (Hansard - continued): House of Lords
Monday 19th March 2018 Lords Chamber

[Baroness Chalker of Wallasey]

My Lords, I, too, thank the Faculty of Public Health for its briefing. Perhaps I may cast this issue a little wider and refer to the immense work done both by the Liverpool School of Tropical Medicine and the London School of Hygiene & Tropical Medicine. What they have laid down in public health has often been taken as a whole by other institutes of public health both across the European Union and far wider.

We have always been really quite fortunate in this country. Many will ask why I as a constituency Member many years ago had an interest in public health. “We don’t have cholera here,” I remember being told. “We don’t have the various diseases we read about in far-off places”. The reason we do not have them is our high standards of public health. It is a very simple thing to say, but it is fundamental. That is why I believe this modest amendment from the noble Lord, Lord Warner, is very important. It does not interfere with the Brexit process, wherever one comes from. It lays down something that has been basic and good in this country for well over a century. I shall not go into the history of the women pioneers who established public health standards, but we owe it to our history and to our outstanding progress in taking public health standards into a wider world to make sure that what we maintain in this country will not only be maintained but be enhanced in the time after we leave the European Union. I do not know of any branch of medicine that does not pay considerable tribute to the standards of public health developed in this country. I believe that this is a non-intrusive amendment and one that the Government will be very grateful to have on the statute book in the proper way in the future.

[Lord Patel (CB)]

My Lords, I shall speak very briefly to this amendment and point out two crucial things. One is the importance of cross-border co-operation. The second is the importance of UK/EU collaboration.

Cross-border co-operation is critical to addressing health threats. The EU has a number of technical agencies relevant to health; for example, the European Centre for Disease Control, the European Food Safety Authority, the European Medicines Agency and the European Monitoring Centre for Drugs and Drug Addiction. They gather data and undertake monitoring, surveillance, trend analysis and risk assessment. They provide alert mechanisms for Governments and key stakeholders. They contribute to shared learning across borders and offer a platform for co-ordinated European responses to crises within the EU and globally; for example, during the Ebola crisis and pandemic influenza outbreaks. These mechanisms are critical for public health. Noble Lords might be interested to watch the BBC Four programme at 9 pm this Thursday on the effect of pandemic flu and how many it might kill without co-operation—good watching.

EU co-operation has also incentivised work on antimicrobial resistance, which requires a global response. Infectious diseases remain a major threat to the UK health system and economy. Repeated threats of infectious diseases from overseas in recent years have highlighted the necessity of arrangements that enhance co-operation between the UK and EU to protect the health of the UK population. Since infectious diseases know no borders, collaborative work to develop robust systems for surveillance and preparedness is critical. It is thought that there are currently five major infections threatening the world and each may have a more devastating effect than Ebola had or that pandemic flu may have.

Our proximity to Europe means that infectious diseases in the UK are regularly imported from Europe, and vice versa. Outbreaks of measles in England and Wales have been repeatedly linked to ongoing outbreaks in countries in eastern Europe, while cases of hepatitis A have been linked, with approximately 4,000 cases identified to date that probably came from Europe. Further diseases regularly emerging from Europe include legionella, an often severe form of pneumonia, and food-borne sources of infection, eloquently spoken of by the noble Lord, Lord Rooker, on his amendment last week. As we leave the EU, it is important that we reassure our European partners that we recognise our international obligations in relation to health protection.

Our arrangements for international health protection have been shaped in tandem with the EU. The European Centre for Disease Prevention and Control is tasked with strengthening Europe’s defences against infectious diseases. It works in partnership with our national health protection bodies, such as Public Health England, to strengthen continent-wide disease surveillance. The ECDC’s work includes risk assessment; being a hub for data analysis and interpretation to enable disease surveillance across borders; carrying out scientific analysis; and co-ordination between national public health agencies during outbreaks and emergencies. These are things we do not do just now; we do not need to because the ECDC does them.

As a member of the EU, the UK currently benefits from a number of specific ECDC systems which enhance the UK’s ability to detect in real time and manage infectious disease threats. Examples include the Early Warning and Response System, the European Surveillance System, the Epidemic Intelligence Information System and the Threat Tracking Tool. The ECDC has significantly more capacity to manage public health threats than individual national surveillance systems. An example is the fact that the ECDC took the lead on the enhanced infectious disease surveillance required for the 2012 London Olympics.

In summary, I welcome the Government’s commitment to maintain participation in EU co-operation on disease prevention and public health. It is important for the UK to continue to play a leading role in promoting and ensuring public health globally. This amendment would reinforce that commitment more tangibly, and I support it.

[Baroness Blackstone (Ind Lab)]

My Lords, I support the amendment moved by the noble Lord, Lord Warner. I associate myself with the words of the noble Baroness, Lady Chalker, about the great history of public health in this country, but there is still a great deal more to be done. We cannot be complacent. We know that few areas of public policy are of more concern to our population than healthcare. Many people fear that their well-being is being threatened by a lack of investment in all areas of health and they desperately need reassurance. The NHS and access to good healthcare come close to the top in many public opinion surveys about what concerns the electorate.

Particular importance is attached to public health, although that term is not always used. Public health is not just about treatment, it is about prevention—more than anything else, perhaps. It should not be cut, as has happened recently. As has already been said, investment in this area has been incredibly important in reducing smoking and cutting the number of teenage pregnancies, to give just two examples. We may no longer have cholera but the challenges continue: appalling air pollution, alcohol consumption that is too high, drug abuse, poor diets, lack of exercise—all these have dire consequences, leading to very high levels of obesity, health inequalities and widespread physical and mental illness.

As has already been said, well-being is created not just by high-quality public health provision but by good housing and good schooling, creating happy and fulfilled children enjoying learning, with opportunities for post-school education and training, and decent conditions of employment which reduce stress. Leaving the European Union poses dangers for economic growth and therefore for the funding of all these public services, as well as threats to rights at work which derive from European Union directives.

I am particularly concerned about mental health, which has not been mentioned so far. Although additional investment was pledged in November 2017 for mental health services, the historic underinvestment is so great that hugely more needs to be done. Mental health problems cause 23% of all illness in the UK but mental health care receives only 11% of health spending. There is a huge disparity here. Two-thirds of people with common problems such as anxiety and depression receive no appropriate treatment, compared with a quarter of those with physical health illnesses. This was evidence given to us on the Select Committee on the Long-term Sustainability of the NHS.

To tackle the massive amounts of undetected and untreated mental ill-health requires more trained staff and more understanding and knowledge of the causes of mental illness and what constitutes effective treatment. I fear that greater economic uncertainty as a result of Brexit reduces the likelihood of these resources being available. Substantial support for research into mental health has been secured from European Union programmes, with large tranches of funding since 2014 through Horizon 2020. Brexit jeopardises all this—just another example of the dire consequences of leaving the European Union which people were completely unaware of when they voted in the referendum.

I conclude by asking the Government to give serious consideration to this amendment, which recognises the enormous importance of protecting our citizens’ physical and, indeed, mental health as a matter of principle, alongside the other issues of the security of our nation and the prosperity of our people.