Health and Care Bill

Lord Rennard Excerpts

Lords Hansard - Part 1 & Committee stage
Thursday 13th January 2022 Lords Chamber

[The Lord Bishop of Carlisle]

My Lords, I will speak on behalf of my noble friend the right reverend Prelate the Bishop of London. She has added her name to Amendment 65, and we on these Benches support the other amendments in this group that seek to reduce health inequalities. As we have heard, these amendments would help to ensure that the Bill does not forget the underserved and disadvantaged in our society, many of whom have been mentioned already.

In the Christian and Jewish faiths, there is a Biblical concept—shalom—which embodies a sense of flourishing, generosity and abundance. Shalom can be summarised as experiencing wholeness, or a state of being without gaps. This is reflected in the World Health Organization’s definition of health, which is about not only the absence of disease but mental, physical and social well-being. It is a vision for individuals and for the whole of society. Our efforts to design a more holistic health service are, in effect, aimed at achieving that sort of shalom. We see this clearly in the decision made to place 42 integrated care systems across the country. What is not yet apparent is the relationship of these systems and boards to the wider community.

This Bill must seek to involve local communities—and not just professionals—in the reduction of health inequalities. These amendments highlight the monitoring of both physical and mental inequalities, take account of the experiences of young people and children and place more emphasis on the strength of local interventions to help reduce and prevent health inequalities. I commend them wholeheartedly to your Lordships’ House and to the Minister.

[Lord Rennard (LD)]

My Lords, I rise in support of these amendments, in particular Amendment 66 in my name and those of the noble Lords, Lord Young of Cookham and Lord Faulkner of Worcester.

This amendment would expand the duties of integrated care boards. We want them to exercise their functions with respect to reducing inequalities relating to

“modifiable risk factors, such as smoking.”

Our aim is to help the Government achieve their manifesto commitments to reduce health inequality, level up and increase healthy life expectancy by five years by 2035. This amendment would mean that integrated care boards would have a responsibility to reduce inequalities in access to health services and the outcomes achieved. They would also be responsible, in consultation with partners such as local health and well-being boards, for drafting joint five-year plans to explain how they would discharge their responsibilities, including those to reduce inequalities.

At present, there are significant inequalities in both patient access to health services and in the outcomes achieved. The biggest causes of inequalities in health outcomes are behavioural risk factors, such as smoking, obesity and alcohol. As the noble Lord, Lord Young of Cookham, said, smoking alone is responsible for half the difference in life expectancy between the richest and poorest in society. It is a greater source of health inequality than social position and it remains the leading cause of premature death in this country.

We all hope that the integrated care systems will contribute significantly to reducing inequalities in smoking and other behavioural issues, but they are likely to succeed only if addressing such modifiable risk factors becomes a core function of the NHS, working in collaboration with local authorities. Amendment 66 would ensure this.

The difference in healthy life expectancy between those living in the most and least deprived areas of England is around 19 years for both men and women—in other words, almost two decades. Let us look at one place in particular. As measured by the index of multiple deprivation, Blackpool is, sadly, top of the table of the most deprived local districts in the country. Over the last decade it has consistently had one of the highest smoking rates in the country, at over 20%. Most distressingly, more than 20% of mothers in Blackpool are smokers at the time they give birth. So our amendment is needed because the recently published NHS inequalities strategy—which is impressive in parts—does not address the behavioural causes of health inequalities. In fact, it says nothing about them at all.

The Government’s inequality strategy sets out five clinical areas that are crucial to improving health outcomes for the poorest 20% in society. They are chronic respiratory disease, serious mental illness, early cancer diagnosis, maternity and—last but not least—identifying people with high blood pressure who need to be pre-treated to prevent heart attacks and strokes. In all these areas, behavioural factors such as smoking, obesity and alcohol very significantly increase the dangers to health. If appropriate action is taken, it can greatly improve patient outcomes and, at the same time, reduce pressure on our NHS.

To take just one example, chronic respiratory disease is caused primarily by smoking. It is estimated that smoking is responsible for 90% of chronic obstructive pulmonary disease, but one-third of patients diagnosed with COPD carry on smoking. There is nothing in the NHS England inequalities strategy about this, and no target for reducing smoking rates among those with chronic respiratory disease. Yet stopping smoking is the most effective and cost-effective treatment. Only by quitting smoking can those with COPD prevent further decline in lung function.

Smoking, obesity and alcohol are also causally linked to cancer and hypertension. People with mental health conditions die on average 10 to 20 years earlier than the general population. Smoking is the single largest factor in this shocking difference. The question we must therefore ask today is this: given that modifiable behaviour risk factors are core to all five identified clinical focus areas, why are they not included in the NHS England inequality strategy? Perhaps it is because the Government do not see addressing these population-level health risk factors as a core responsibility of the NHS.

Health and Care Bill

Lord Rennard Excerpts

2nd reading
Tuesday 7th December 2021 Lords Chamber

[Lord Rennard (LD)]

My Lords, last Friday, we had an excellent Second Reading debate on the Private Member’s Bill of the noble Lord, Lord Young of Cookham, on cigarette stick health warnings. As the noble Lord, Lord Kamall, said then, we have made progress over the past two decades, with a range of measures to help smokers quit and to prevent future generations using tobacco. But there is much more to be done. Smoking is responsible for the half the difference in life expectancy between the richest and the poorest in our society. There are still over six million smokers in the UK, and at current rates of decline we will miss the Smokefree 2030 deadline by five years nationally and by 17 years in the most deprived communities. So, further measures are necessary if we are to reduce health inequalities and increase healthy life expectancy, both of which are government manifesto commitments.

The detail of what is required is set out in the latest report from the All-Party Parliamentary Group on Smoking and Health, of which I am a member. I am pleased that the Government have committed to considering its recommendations for the forthcoming tobacco control plan. However, as the Minister told us on Friday that publication of the plan has been delayed from July 2021 to some time in 2022, amendments to this Bill are needed to accelerate progress in reducing smoking prevalence and to deliver the Government’s Smokefree 2030 ambition.

The Minister will not be surprised to hear that I and others will table amendments to this Bill to consult on the introduction of a “polluter pays” levy on tobacco manufacturers, to fund lifesaving measures to help smokers quit and prevent youth uptake, to close loopholes in existing regulations and to ratchet up regulation of tobacco through measures such as the proposal from the noble Lord, Lord Young, to put health warnings on cigarettes themselves.

In all debates about health and social care, we spend a great deal of time discussing the costs of the increasing demands upon the system, but probably too little agreeing measures to curb the rising level of those demands. Better education and greater information about health issues is vital, but funding for public health issues has not been protected in recent years in the same way as the costs for treating the consequences of illnesses. Personally, I wish there had been much better education about diet and greater understanding of the importance of physical education in my youth. I should have learned more about issues connected with diabetes before I was diagnosed with the condition.

Across the UK, the number of people diagnosed with diabetes has doubled in the last 15 years and it is estimated that the costs associated with it account for 10% of NHS expenditure. We need to support the provisions in the Bill on restricting the advertising of less healthy food and drink and recognise the importance of these measures in reducing the significant harms that can come from diabetes. People struggling with obesity and diabetic control, children especially, are not helped by the advertising of foods that are high in fat, sugar or salt. We need to strengthen nutrition labelling requirements.

For people with diabetes who need insulin, which includes all type 1 diabetics, we need to address the short-termism that denies many of them access to continuous glucose monitoring systems and technology such as insulin pumps that can help them to maintain good diabetic control. Complications from poor diabetic control can include heart attacks, strokes and amputations, as well as kidney damage, loss of eyesight and mental health problems.

In 2017, the report produced by the Medical Technology Group showed that

“80% of the cost of Type 1 diabetes is spent on treating complications—many of which are avoidable.”

We all know that the NHS is under many great pressures, but we can reduce those pressures by reducing the number of people in hospital and by looking to increase investment in technologies that help people with diabetes to improve their control.

Cigarette Stick Health Warnings Bill [HL]

Lord Rennard Excerpts

2nd reading
Friday 3rd December 2021 Lords Chamber

[Lord Rennard (LD)]

My Lords, almost exactly 20 years ago, I described in this place how 300 lives were being lost each day in this country because of smoking tobacco. I asked then what the scale of public outcry demanding action would be if a similar number of lives were lost as, say, the result of a plane crash occurring every single day. My speech was in support of my noble friend Lord Clement-Jones’s Tobacco Advertising and Promotion Bill, a Private Member’s Bill which he successfully steered through all its stages and which, when it became law, largely banned tobacco advertising.

Measures of tobacco control such as that have been shown to be effective and significantly reduced rates of smoking in this country. The facts have refuted the many self-interested and bogus claims made over many years by the proponents of the tobacco industry. However, further action is needed because smoking remains a leading cause of premature death, now killing around 250 people every day in the UK. To put that in perspective, 151 people died yesterday as a result of the Covid pandemic. People should be horrified to hear that smoking is likely to have killed more people last year than Covid-19.

We need this Bill to help reduce the appeal of cigarettes to children and young people and to encourage existing smokers to quit. Who could seriously disagree with those aims, given that half of all people who smoke will die because of the habit and most people who take up smoking do so when they are young?

The warnings on cigarette packs have helped to inform smokers of the serious dangers associated with the habit and helped some of them to quit, but evidence shows that the effectiveness of pack warnings wanes over time, and new measures are needed to grab the attention of those who continue to smoke.

It is a terrible thing, as the noble Lord, Lord Young of Cookham, referred to, that many children have access to individual cigarettes. This means that a health warning on individual cigarettes is necessary to help prevent young people taking up the habit. Warnings on cigarette sticks are a logical next step, following the successful introduction of warnings on cigarette packs.

Reducing the number of children and young people who take up smoking is vital if we are to reduce health inequalities. Half of the difference in life expectancy between those in the poorest communities and those in the most affluent in this country is accounted for by smoking tobacco. Tackling this issue is a must if levelling up is ever to be a meaningful and not meaningless slogan. Around two-thirds of adult smokers take up smoking as children. Currently, 280 children take up smoking every day in England. Only a third of these children will presently succeed in quitting during their lifetime, and another third will die of a smoking-related disease.

The Bill’s proposal should not be seen in isolation, but as part of a comprehensive strategy for delivering the smoke-free by 2030 ambition, which is government policy and to which we all subscribe. The detail of all that is required was set out in the latest report from the All-Party Group on Smoking and Health, of which I am proud to be a member. I am pleased that the Government have committed to considering its recommendations for the forthcoming tobacco control plan, but we are still waiting to hear when we will see the details of that plan, publication of which is not yet in sight.

We cannot afford to wait before acting. The Health and Care Bill presents a perfect opportunity to enact measures to reduce the prevalence of tobacco smoking and, in particular, to reduce the number of children and young people who become addicted to it. The Government’s Bill could provide for the introduction of dissuasive cigarettes, as suggested in this Bill. Further amendments could provide for a complementary package of proposals to address the loopholes in existing legislation, strengthen tobacco regulation still further and provide the funding for tobacco control measures, which are desperately needed if the Government’s stated ambition of being smoke-free by 2030 is to be achieved.

In the meantime, we should signal strong support for this Bill, as we did 20 years ago for my noble friend Lord Clement-Jones’s Tobacco Advertising and Promotion Bill. As I said then:

“There are many terrible things in this world: natural disasters and those made by man. Sadly, there is nothing we can do about many of them. But smoking-related deaths and illnesses are terrible things about which we can do something, by supporting the Bill.”—[Official Report, 2/11/01; col. 1685.]

Smoking Cessation: Prescription of E-cigarettes

Lord Rennard Excerpts

Tuesday 2nd November 2021 Lords Chamber

[Lord Rennard (LD)]

My Lords, e-cigarettes are undoubtedly part of the way forward to achieving a smoke-free Britain. But why has it taken so long to get to this point and to begin fulfilling what was in the 2017 tobacco control plan and to adopt the recommendations of the 2018 Select Committee, chaired by Sir Norman Lamb, which highlighted the significant benefits of having medicinally licensed e-cigarettes which could be prescribed? How do we know that licensing will now proceed in a timely manner?

[Lord Kamall (Con)]

The MHRA has been quite clear that it wants to be in a position to license a product as soon as possible—it says 18 to 24 months. Noble Lords may well want to push the MHRA on that, and that is part of your Lordships’ role. But it is important that we make sure that, when we license a product, both consumers and public health experts can have faith in it.

COVID-19: Type 2 Diabetes

Lord Rennard Excerpts

Thursday 21st October 2021 Lords Chamber

[Lord Kamall (Con)]

I am beginning to wish I had eaten a full breakfast. With any strategy or programme, we always have to be careful about unintended consequences. As we focus more on obesity and make more people aware of healthy living and healthy eating, it is important to have the right balance and to be aware of the impact this can have, so that we are not creating more problems, concerns and anxieties for those who suffer from eating disorders.

[Lord Rennard (LD)]

My Lords, one in three deaths during the first period of the pandemic were among people with diabetes. Obesity accounts for most of the risk of developing type 2 diabetes and, even without the problems of the pandemic, a type 2 diabetic, such as me, at my age, is expected to put on one or two kilos every year. Will the Minister now look to reverse what the King’s Fund says is, in real terms, a £1 billion cut in local authority public health budgets since 2015, and at providing even more support for programmes such as GP referral to fitness classes, which can help people manage their diabetes more effectively?

[Lord Kamall (Con)]

As well as looking at the important role that funding can play, it is important to do better with the money available. There are many things we can do to make sure that the programmes we have are more effective, but I repeat that we have to make sure that they work and we have to look at the evidence. When discussing the evidence internally in the department, I have been told that many of these programmes will be reviewed after five years to make sure that they are effective and do not lead to unintended consequences.

Folic Acid

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Monday 26th April 2021 Lords Chamber

[Lord Bethell (Con)]

I hear the frustration loud and clear and reassure the noble Baroness that we are working on this at pace.

[Lord Rennard (LD)]

My Lords, in response to numerous questions and debates on this subject over the years, no Minister has ever produced a satisfactory explanation of why we do not add folic acid to flour. Would it have made any difference if the folic acid suppliers had had the Prime Minister’s mobile phone number?

[Lord Bethell (Con)]

No.

Alcohol Harm Commission: Report 2020

Lord Rennard Excerpts

Thursday 22nd April 2021 Grand Committee

[Lord Rennard (LD)]

My Lords, introducing minimum unit pricing for England was a key recommendation of the commission. A strong evidence base for this was provided by a wide range of organisations, including the Children’s Society, the Association of Directors of Public Health, Cancer Research UK, the British Medical Association and several local authorities. A 50p minimum unit price in England has been estimated to lead to almost 22,000 fewer hospital admissions and 525 fewer deaths per year when in full effect. This would save the NHS £1.3 billion annually. As hospitals deal with the consequences of Covid-19, freeing up capacity is essential. People who live in poverty are more vulnerable to the effects of alcohol abuse. It is estimated that nine in 10 lives saved by minimum unit pricing would be from low-income groups. Yet the spokespeople for some business groups and right-wing organisations oppose minimum unit pricing, citing their previously rarely expressed concerns about poverty, when their real concerns are simply about profits. We need to remember that alcohol has a major impact on the public’s health.

Alcohol can cause over 200 conditions including cancer, heart disease, liver disease, stroke and mental health problems. When I asked a Question about this issue three years ago, the noble Lord, Lord O’Shaughnessy, then the Health Minister, cited evidence that

“in 10 years, minimum unit pricing could on an annual basis reduce alcohol-related deaths by 356, alcohol-related hospital admissions by 28,515, and crime by 34,931 crimes.”—[Official Report, 28/2/18; col. 654.]

But we were told to wait for more evidence from Scotland and elsewhere. We now have that evidence. The policy is working in Scotland; it is being introduced in Wales. We should not have to wait any longer in England.

ONS: UK Life Expectancy

Lord Rennard Excerpts

Thursday 17th December 2020 Lords Chamber

[Lord Bethell (Con)]

My Lords, I cannot give an answer in the round and explain every element, but we have to face up as a nation to the fact that some of our habits are unhealthy. In some communities smoking rates are extremely high, and the difference between different communities is profound—1.6% in west London, compared to 25.7% in Blackpool. Our obesity, BMI and consumption of high-calorie food is just too high. This is not the sole explanation, but as a nation we have to face up to some of our behaviours.

[Lord Rennard (LD)]

My Lords, half the considerable difference in life expectancy between the richest and poorest in our country is entirely accounted for by smoking. At present, the Government are spending considerable amounts of money on advertising campaigns which tell people how to keep safe during the Covid pandemic. In the future, will the Government reinstate advertising aimed at promoting smoking cessation, to meet their own target of making Britain a smoke-free country and helping to improve the health and life expectancy of the poorest in our society?

[Lord Bethell (Con)]

The noble Lord makes his point extremely well: smoking rates in this country are far too high. The huge amount of Covid advertising at the moment has squeezed out a lot of our public health messages, and I reassure him that we will return to them—including the smoking campaign—when normal business resumes.

Cancer Task Force

Lord Rennard Excerpts

Tuesday 20th October 2020 Lords Chamber

Asked by

[Lord Rennard]

To ask Her Majesty's Government how the new cancer taskforce will operate; and what funding that taskforce will be able to direct towards reducing any backlog in identifying and treating cancer patients.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Bethell) (Con)]

My Lords, the Cancer Recovery Taskforce’s role is advisory, to oversee the development of a national cancer delivery plan due to be published later this autumn. The task force is chaired by Professor Peter Johnson, the national clinical director for cancer. It met for the first time in September and is due to meet again on Thursday. Membership is drawn from across the cancer community, and I thank all of those involved. NHS Improvement has recently confirmed annual funding allocations of £153 million for 2021 to the cancer alliances in England.

[Lord Rennard (LD) [V]]

My Lords, I refer to my interests as in the register. Cancer Research UK and Macmillan have reported that 2.4 million people are now waiting for screening, tests and treatments for cancer services. The Commons Health Select Committee has reported that the number of MRI and CT scans to diagnose the disease has plummeted by 75%. Given that the Government spend on average half as much on capital in healthcare compared to similar countries, what is the scale of the investment over the next year that will be specifically allocated for the latest technologies and additional staff to deal with the backlog of cancer diagnosis and treatment?

[Lord Bethell (Con)]

My Lords, the situation raised by Cancer Research UK and others causes concern, but I reassure the noble Lord that we are doing more than a million routine cancer appointments and operations per week to catch up with the backlog. Urgent two-week waits for GP referrals are back to almost 85% of pre-epidemic levels and we have a massive plan to address this, which includes the creation of Covid-secure environments, switching to new drugs for those who cannot make it to hospital, the judicious use of radiography, targeted messaging to those who may suffer from the symptoms of cancer, the use of rapid health diagnostics, an alliance with charities, a cancer recovery plan and enhanced monitoring on a single version of truth basis of our progress on this important issue.

Health Protection (Coronavirus, Local COVID-19 Alert Level) (Very High) (England) Regulations 2020

Lord Rennard Excerpts

Wednesday 14th October 2020 Lords Chamber

[Lord Rennard (LD)]

My Lords, there is possibly nowhere else in the country more lacking in confidence and trust in Boris Johnson’s Government than Liverpool. Previous Conservative Governments spoke about “managing Liverpool’s decline”—but Liverpool fought back, and what the city needs now is a managed recovery from the Covid pandemic. Almost everyone in Liverpool recognises that, with intensive care units at 95% capacity in the main hospitals, saving lives is paramount. The question is how best to do this, and people know that saving livelihoods is vital for the long term, too. As the Echo said yesterday:

“Many of us will feel frightened, isolated and lost amidst the tangle of seemingly contradictory rules and support packages—barely providing a sticking plaster to cover the deep wounds to our region’s economy.”


The problem is that there is simply no confidence that Boris Johnson’s policies are soundly based on science or that there is a proper plan for making sure that lockdown measures do more than just postpone the spread of the virus and ensure that people’s livelihoods are protected. The Government expect to be trusted but they have not trusted local authority leaders or local public health services, which could have done a much better job with test and trace.

People see Boris Johnson’s Government as incompetent and uncaring. They sense a whiff of corruption as contracts are inexplicably awarded to friends of those in government without normal transparency rules. They hear from journalists about briefings from a “senior government source” and assume that this must mean the man who goes to Barnard Castle for an eye test. There should be an end to such anonymous briefings.

People in Liverpool feel singled out. They feel that they are being told to walk alone, but the people in Liverpool never will.