Health and Care Bill

Lord Young of Cookham Excerpts

Consideration of Commons amendments
Tuesday 5th April 2022 Lords Chamber

[Lord Young of Cookham (Con)]

My Lords, I rise briefly to support Amendment J1, so ably moved by the noble Lord, Lord Crisp. I also join him in thanking my noble friends Lord Howe and Lord Kamall, the two Ministers involved, for their engagement with movers of the amendment on Report and for the genuine attempt they made to seek agreement to narrow the small gap between the Government’s position and ours—an attempt which, I fear, was blocked by HM Treasury.

On this subject, on Report, my noble friend Lord Howe said:

“Our strong preference is to continue with high tobacco taxation and excise as the best means and the most efficient process through which to generate revenue that can be put back into public services.”


I wish I shared his optimism, given the current pressure on the public purse and the recent experience with the levelling-up White Paper, published in February. The Institute for Fiscal Studies said that

“the White Paper contains no new funding; instead, departments will be expected to deliver on these missions from within the cash budgets set out in last autumn’s Spending Review. Departments and public service leaders might reasonably ask whether those plans match up to the scale of the government’s newfound ambition—particularly in the face of higher inflation.”

The same is true for tobacco control. Even before the rise in inflation, budgets for tobacco control and smoking cessation had been cut by a third since 2015. Already by 2019, it was clear that the Treasury’s claim that the tax system would provide funding for tobacco control was misplaced. That is why, when the Government announced the smoke-free 2030 ambition in 2019, they also promised to consider a polluter pays approach to funding tobacco control and smoking cessation, which is the substance of the amendment before your Lordships this evening.

On Report, my noble friend Lord Howe said:

“The proposal may look simple on the surface but it is complex to implement. It may also take several years to materialise.”


Our proposals build on the pharmaceutical pricing scheme operated by the Department of Health, which is a far more complex industry with far more complex products. If the Department of Health can successfully run a scheme for pharmaceutical products—an industry and set of products that are complex and evolving—I fail to see why it cannot operate such a scheme for cigarettes. These are simple, commodity products produced by an oligopolistic industry, with four main manufacturers responsible for more than 95% of sales.

The noble Lord, Lord Stevens of Birmingham, who I am pleased to see in his place, said on Report that

“if it is deemed appropriate to have a form of price and profit regulation for the medicines industry, which delivers products that are essential and life-saving, it does not seem too far a stretch to think that an equivalent mechanism might be used for an industry whose products are discretionary and life-destroying.”—[Official Report, 16/3/22; cols. 294-98.]

I agree. However, I also accept that further investigation of our proposals would be needed, which is precisely why a consultation without commitment is the appropriate way forward, as the all-party parliamentary group’s amendment proposes.

I hope that, even at this late stage, my noble friend might demonstrate some flexibility in order to try to bridge the narrow gap between the Government’s position and that in the amendment.

[Lord Hunt of Kings Heath (Lab)]

My Lords, I, too, support the noble Lord, Lord Crisp, in his amendment. My noble friend Lord Faulkner would of course have been in his place to speak in favour, but he is unable to be here, so perhaps I may make a few remarks which I think he might have made.

Going back to Report, the Minister suggested that the tobacco industry is already required to make a significant contribution to public finances through tobacco duty, VAT and corporation tax. But I do not think that states the case as accurately as possible, because we know that tobacco manufacturers are skilled at minimising the amount they pay. For example, between 2009 and 2016, Imperial Brands, the British company that is market leader in the UK, received £35 million more in corporation tax refund credits than it paid in tax. The largest amount of tax collected by the Government comes from excise tax and VAT. This, of course, is not paid by the manufacturer; it is passed on to the consumer. That was a point HM Treasury made in 2015, when the Government consulted but, alas, decided not to put an additional tax on tobacco products to pay for tobacco control.

My understanding is that, in total, smokers spend nearly £11 billion on tax-paid tobacco products, more than three-quarters of which goes to the Government in taxes. We know that the majority of smokers are not well off; they often suffer multiple disadvantages. We must compare that huge tax take with the pitiful amount that is actually spent by the Government encouraging people to stop smoking. It is certainly not enough to make England smoke-free by 2030.

I listened carefully to the Minister’s introductory remarks. The noble Lord, Lord Kamall, objected to the terms of the amendment of the noble Lord, Lord Crisp, because, he said, the independent review had not yet reported and therefore we were seeking to pre-empt what the review will say. I thought the noble Lord, Lord Crisp, responded to that incredibly well. I do not think he is seeking to pre-empt the review; his amendment asks the Government to consult on recommendations in the review if the Secretary of State thinks that it is required. It is left entirely in the Secretary of State’s hands to act according to whether he or she considers that the recommendations should be consulted on.

This is a sensible amendment, it points us in the right direction, and I hope that, even at this late stage, Ministers may be sympathetic.

Mental Health Services for Rough Sleepers

Lord Young of Cookham Excerpts

Monday 21st March 2022 Lords Chamber

[Lord Kamall (Con)]

The noble Baroness makes the very important point that a number of people who are homeless suffer from alcoholism and alcohol abuse—and indeed drug abuse. For some of these people, the issues they are suffering from are often interrelated. Therefore, in the joined-up thinking we are looking at, charities, civil society organisations and the NHS are making sure that we treat the various symptoms in an integrated way.

[Lord Young of Cookham (Con)]

My Lords, given the success of the Everyone In campaign, through which 15,000 rough sleepers were given accommodation to protect them from Covid, does my noble friend agree that that progress must be maintained? Given that many rough sleepers have mental health issues, can my noble friend say whether the specialist funding for mental health services for rough sleepers will be extended beyond the next two years?

[Lord Kamall (Con)]

I thank my noble friend for raising that important point. The new rough sleeping strategy from the Department for Levelling Up, Housing and Communities will set out how departments will work together to end rough sleeping. This will build on the recent success to which my noble friend refers to ensure that rough sleeping is prevented in the first instance and responded to when it occurs. We are going to work closely with the Department for Levelling Up, Housing and Communities and other departments, as well the voluntary and social enterprise sector and others, to make sure that we are all joined up.

Cigarette Stick Health Warnings Bill [HL]

Lord Young of Cookham Excerpts

3rd reading
Friday 18th March 2022 Lords Chamber

Moved by

[Lord Young of Cookham]

That the Bill do now pass.

[Lord Young of Cookham (Con)]

My Lords, this Bill extends the logic of health warnings on cigarette packs to the cigarettes themselves. If implemented, it would require both cigarettes and cigarette papers to display health warnings such as “Smoking kills”. This is likely to be particularly effective for dissuading children, who tend to start smoking with individual cigarettes rather than packs.

While England is undoubtedly among the most successful nations in the world at tackling the tobacco epidemic, we have tended to follow rather than lead when it comes to the implementation of bold policies to address this deadly addiction. The Bill gives us the opportunity to be the first, helping to cement our place as a world leader in tobacco control.

We know that only one-third of the 280 children who take up smoking every day in England will successfully quit, and another third will go on to die from smoking-related diseases. These cigarette warnings were one of the recommendations by the APPG on Smoking and Health for the forthcoming tobacco plan, which we discussed at a recent meeting with Javed Khan, the chair of the Government’s independent review into smoking. We were encouraged by his interest in all our recommendations, including this one, and we look forward to seeing his report, which is due to be published on 22 April.

While we could be the first to implement cigarette warnings, this is not a novel policy. I first proposed cigarette warnings as a Health Minister in Margaret Thatcher’s Government in the late 1970s. By 2024, I will have been in Parliament for 50 years. I hope I will not have to wait that long before this policy is introduced. I beg to move.

[Baroness Merron (Lab)]

My Lords, I pay tribute to the noble Lord, Lord Young of Cookham, for his tireless efforts and creativity—over many decades, as we have heard—in tackling the negative effects of smoking on the health of individuals and communities. This is a considered and sensible Bill, and we are happy to support it today.

Additional health warnings at the point where people are about to smoke, on cigarettes and cigarette papers, is not a measure for its own sake; it is a further step towards helping to drive down smoking rates and indeed discourage people—especially the young, as the noble Lord referred to—from starting to smoke in the first place. By our doing this, people will have the chance to live longer and have healthier lives, and health inequalities between the richest and the poorest stand a chance of being reduced. For every smoker who dies, there are another 30 who are suffering from serious smoking-related diseases.

Just this week, on Report on the Health and Care Bill, your Lordships’ House voted in favour of a consultation to explore whether the “polluter pays” principle might be effective in the case of tobacco. This Bill seems to chime well with the mood about the direction that smoking legislation in the UK needs to go in. I wish the Bill every success and once again congratulate the noble Lord, Lord Young of Cookham.

Health and Care Bill

Lord Young of Cookham Excerpts

Lords Hansard - Part 1 & Committee stage
Monday 31st January 2022 Lords Chamber

[Baroness Hollins (CB)]

My Lords, it is a pleasure to follow the noble Baroness, Lady Pitkeathley, and her powerful speech. I support the amendments in this group and will speak to my Amendment 225. First, I declare an interest as an unpaid carer myself, who has had to take on considerable additional caring responsibilities as a result of the pandemic. I enjoyed the description of the noble Lord, Lord Howarth, of the use of poetry, because it is certainly a new hobby of mine, which I found very helpful during those long months of caring.

Mencap’s survey from the first wave of the pandemic in 2020 found that four in five carers of people with learning disabilities were taking on much more care of such people in their families because of the loss of paid support and daily activities for their family members. For many, it will take many months, even years, to return to pre-Covid levels of paid support to support those carers.

During the pandemic, care and carers were often spoken about as synonymous with care homes. I found it very discouraging as an unpaid carer myself to think that it was so little understood in government communications about the pandemic. I tabled this amendment to ensure clarity regarding to whom the Bill refers when it uses the term “carers”. As the noble Baroness, Lady Pitkeathley, explained, it does this by providing existing definitions of carers that are present in related legislation. I too thank Carers UK for its helpful briefing and support.

The amendment is necessary because there is so much confusion about the term “carers”. It is used to describe paid care workers, who I prefer to describe as support workers, or perhaps carer support workers, but that is not the same as caring for a family member and caring about a family member, which is a central part of the role.

The amendment is necessary for another reason: the inclusion of parent carers and young carers more systematically, where appropriate, in the Bill’s consultation and involvement provisions. This should drive better practice and outcomes for all concerned as well as providing clarity.

The provisions in the Bill relating to carers to which this amendment refers do not mean that all groups of carers defined here must be consulted or involved for all services, but only where appropriate. It does, however, provide clarity. The Health and Social Care Act 2012, on which the legislation builds, did not define carers either, which in hindsight it probably should have. This is therefore an opportunity to refine the legislation based on this experience.

Carers UK’s view is that this amendment would improve the clarity and delivery of policy and practice. Family and friends who provide care often put their needs at the back of the queue, and yet the NHS would collapse without them. As already set out, young carers face particular health inequalities and challenges in caring. Evidence from the Children’s Society shows that one in three young carers has a mental health issue and 80% of young carers felt more isolated during the pandemic.

The amendment has the broad support of a variety of different organisations that deliver services and support to carers, and which would welcome this clarity. As well as Carers UK, this includes the Patients Association, MS Society and many local carers’ organisations. As they are the organisations which will be implementing the legislation, supporting and informing carers and providing clarity is essential.

When this issue was raised in Committee in the House of Commons, the Minister said that “carer” should be defined in its everyday sense as unpaid carer. However, we already have sound legislation, which can be referred to, that defines carers. We need to ensure that the muddle of terms created during the pandemic is undone. I ask the Minister to define carers clearly in the Bill by accepting this amendment and to recognise the hugely invaluable role that carers play in our society.

[Lord Young of Cookham (Con)]

My Lords, it is a pleasure to follow my new room-mate, the noble Baroness, Lady Hollins, and I agree with every word that she has just said. I also agree with the other speeches that we have heard in favour of the various amendments. I pay particular tribute to the noble Baroness, Lady Pitkeathley, for her tireless campaign over 40 years on behalf of carers.

I have added my name to Amendment 219 but I will focus on my Amendment 269, which focuses on young carers. I am grateful to the three noble Baronesses who have added their names. Might I be allowed a word on one line in Clause 80, whose future I thought we were debating in this group but which has now been incorporated into the Bill? The line is:

“The Community Care (Delayed Discharges etc) Act 2003 is repealed”.


Noble Lords with long memories may remember that Bill. At the time, I said it was the worst I had seen in 30 years. Instead of doing what this Bill seeks to do —to bring together health and social care to facilitate closer co-operation—it established an antagonistic relationship between the NHS on the one hand and social services on the other by enabling one part of the public sector unilaterally to fine another part. It was a friendless piece of legislation, heavily criticised in your Lordships’ House, as the noble Lord, Lord Hunt of Kings Heath, who had the misfortune to pilot it through, will doubtless confirm.

At the end, my noble friend Lord Howe said, nearly 20 years ago:

“On a more philosophical level, we need to ask ourselves whether this system of financially driven imperatives is what we want to see pervading the fabric of our public services wherever the NHS and social services interact. I am clear that it should not”.—[Official Report, 17/2/03; col. 929.]


How appropriate that, 20 years later, my noble friend helps to put the final nail in the coffin of that Bill. However, it had one redeeming feature: the obligation to assess prior to discharging a patient from hospital. However, as drafted, as other noble Lords have said, the proposals could have the unintended consequence of weakening protections for children who look after adult relatives.

My amendment is about young carers and is shaped by my experience when in another place of working with Andover Young Carers. Children barely in their teens were combining education with caring for disabled parents. The organisation was based in a small bungalow on a local authority estate, and it did heroic work, forging closer links with schools and children’s services. Some of the children spent more than 30 hours each week looking after parents and elderly relatives—almost the equivalent of a full-time job—as well as often having caring responsibilities for younger siblings. They cooked, did the housework, shopped, collected prescriptions, leaving little or no time to enjoy their childhood. The noble Lord, Lord Howarth of Newport, spoke movingly about the work of young carers in Kingston.

According to research from 2018, as the noble Baroness, Lady Wheeler, told us, there are more than 800,000 young carers in the UK. Recent figures show that 180,000 children in England who care for an ill or disabled relative are missing out on support, simply because they are not known to their local authority. Hence the need for this amendment which ensures that young carers are identified before adults are sent home from hospital to be looked after by them. If contact with adult carers is necessary, as we have heard, it is doubly necessary for young carers.

This is because we have clear evidence from Barnardo’s—I am grateful for its briefing—which shows that adults are being discharged from hospital into the care of children, without first making sure that these children are aware of their new responsibilities and that they have the support necessary to enable them to discharge them. I fear this is set to only get worse, placing more caring responsibilities on small shoulders, unless the Bill as currently drafted is amended.

The Care Act 2014 gave a young carer under the age of 18 the right to a needs assessment and placed a duty on local authorities to take reasonable steps to identify young carers in their area who may need support. Yet, in its report Still Hidden, Still Ignored, Barnardo’s found that young carers were still slipping through the net. Its finding is reinforced by the latest CQC survey, which found that 21% of people did not have their family or home situation taken into account when staff prepared them for discharge, a point referred to in the excellent paper which many noble Lords received today from Dr Moore at the University of Manchester.

This amendment places an obligation on the NHS to ascertain whether a patient will be cared for primarily by a young carer and, if so, to contact the local authority concerned for an assessment and the necessary support. This will not delay discharge but would ensure that hospital staff ask if a child under 18 will be the primary carer. If the answer is yes, the hospital should contact the relevant local authority which will ensure that a needs assessment is carried out.

I know the Government have made positive steps to ensure that the needs of young carers are recognised in the guidance which will accompany this Bill, and for that I am grateful. However, without a clear duty on hospitals to establish whether a patient is being discharged into the care of a child, the current situation is likely to continue. Guidance is worthy, but sadly not definitive. Therefore, the pathway for young carers to get the local authority assessment they are entitled to needs to be strengthened and here the health service is the key missing link. I speak to this amendment today because young people who care carry huge responsibilities and we must, as a society, do more to ensure they can live the flourishing lives they deserve.

[Lord Warner (CB)]

My Lords, I strongly support all the amendments in this group. The noble Lord, Lord Young, has been so persuasive and I endorse what he said about young carers. As someone who has been involved with carers for almost as long as the noble Baroness, Lady Pitkeathley—I now regard her as my general in these matters—I want to focus on Amendment 221, to which I have added my name.

It is worth remembering that this Bill is being considered in the context of adult social care funding having been starved, in my view, by three successive Governments. Even when huge sums of money are being raised for health and care through a national insurance levy, social care has to wait its turn. A bit like Oliver Twist, it is at the end of the queue—hopefully there will be some money left in the coffers after the NHS has removed a substantial part of it. That context is very important.

In that context, I find it surprising that somebody somewhere in the Department of Health and Social Care thinks it is a good idea, as the noble Baroness, Lady Pitkeathley, said, to weaken the protections for carers. It is worth bearing in mind that one in five carers now waits over six months for an assessment. In a survey from last November, only 24% of carers had received a carers’ assessment or reassessment in the past year. This is the context in which officialdom and Ministers have thought it a good idea to weaken the protections provided in the 2003 Act. There may have been some weaknesses in that Act, but this was not one of them, as it provided for the NHS to undertake these assessments before people were withdrawn. The noble Lord, Lord Hunt of Kings Heath, is not in his place, but he was the person who took that Bill through and achieved support for that protection for carers.

Health and Care Bill

Lord Young of Cookham Excerpts

Lords Hansard - Part 2 & Committee stage
Monday 31st January 2022 Lords Chamber

So this is about not mass medicating without consent. It is about trust, decision-making and being democratic. This is one more area in the Bill where the Government should think again.

[Lord Young of Cookham (Con)]

My Lords, I shall respond to the injunction from the Front Bench and speak for less than two minutes. I had not planned to intervene in this debate, but I was provoked by my noble friend Lord Reay, with whom I find myself in respectful disagreement, and further provoked by the noble Baroness, Lady Bennett.

Listening to my noble friend’s speech took me back 42 years. It was like Groundhog Day, because in March 1980 I had to sit through a speech lasting more than one hour by Ivan Lawrence on fluoridation. I was lucky because in 1985 he set a new record by speaking from 5.12 am until 9.35 am. I was refreshing my memory about what I said in response to the debate 42 years ago in just two paragraphs—I should explain that I was the Minister responsible at the time, when I said:

“I think I should first explain that fluoride occurs naturally in most water supplies, sometimes at a satisfactory level for the prevention of dental decay. Fluoridation consists merely of the adjustment to the optimum level for dental protection—one part per million in temperate climes—of the fluoride content of those water supplies that are deficient in it naturally. When water containing the optimum level of fluoride is consumed during the years of tooth formation, the protection conferred in childhood continues during adult life.”—[Official Report, Commons, 6/3/1980; col. 792.]


I wound up:

“Finally, as my right hon. Friend indicated last January”—


that was January 1980—

“it remains the Government's view—like that of their predecessors for many years—that extensive trials throughout the world have shown that fluoridation safely and effectively reduces the prevalence of dental caries—one of the commonest diseases and one which has lifetime consequences for general and dental health.”—[Official Report, Commons, 6/3/1980; col. 799.]

Since that time, government policy has not been delivered, as the noble Lord, Lord Hunt, explained. Initially it was the area health authorities that did not do it, and now it is local authorities. It is now imperative that government policy is delivered, and that is why I wholeheartedly support these clauses in the Bill.

[Lord Storey (LD)]

My Lords, I shall speak briefly on Amendments 224 and 261 and share my views on fluoridisation. I agree with the noble Lord, Lord Reay, that it is a pity we did not have a proper full debate on this matter.

There is a real problem among young children, particularly those in deprived communities, who have increasing levels of bad teeth—dental decay. You would think that as a result of that situation we would be trying to do something more practical about it, yet we see dental inspections in schools decreasing. When I was first a head teacher, the dental services would come in twice a year to inspect children’s teeth and would give a little note to the parents so they could go to their dentist. The second problem we face is that, as we heard from the noble Lord, Lord Hunt, you cannot find an NHS dentist, particularly in a deprived area, for love nor money. That is a problem for families that cannot afford to use a private dentist, even if one was available.

When I was leader of the council in Liverpool, all political parties together—I have to tell my colleagues—decided against fluoridation, so we took the view that perhaps there was a different way of doing it. We were setting up the network of children’s centres in the early 2000s. We therefore made dental health in the nought to five age group one of the highest priorities in the city council’s strategic plan. We also issued additional guidance to our primary schools, asking them to make encouraging better dental health a higher priority. As a result, 10 years later in 2013, the British Dental Association’s 10-yearly survey showed that a reduction of 28% in caries had been achieved in Liverpool’s schools. The targeted approach achieved an outcome double that identified in the York review as the average caries reduction from fluoridation. We will also have helped many children to develop lifelong good personal dental hygiene habits, which is a crucial part of the strategy.

Whether we have fluoridation or not, we need to be absolutely sure that the journey we are going on is correct. In the meantime, we should look at other ways. We should also look at what our colleagues in Scotland have been doing with their Childsmile project, which has been shown to be safer, less wasteful and more effective, and better value for money. I hope that at some stage we will revisit this issue and have a much longer and more considered debate.

Health and Care Bill

Lord Young of Cookham Excerpts

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

The Government so far have argued that addressing inequalities is already implicit in the first aspect of the triple aim—the requirement to consider the effects of decisions on the health and well-being of the population. It has clearly not been obvious to many experts and charities scrutinising the Bill. However, if it is the Government’s intention to ensure that the reduction of inequalities is prioritised, they should make this explicit in the Bill.

[Lord Young of Cookham (Con)]

My Lords, this is my first contribution to the debate on the Bill and, listening to earlier exchanges, it struck me how many were being made by those who had either run the NHS as administrators or, indeed, as Ministers. I can join that happy band. I was a Health Minister in 1979 and put on the statute book the Health Services Act 1980, abolishing area health authorities. Nostalgia has overcome me, as phrases I used 40 years ago about streamlining the structure and making it more efficient have been recycled in debates on this Bill.

My first piece of health legislation followed the appointment of commissioners to run the Lambeth, Southwark and Lewisham Area Health Authority which was breaking its cash limits and behaving illegally. Unfortunately, our suspension was also illegal, and I had to pilot through the other place the National Health Service (Invalid Direction) Bill, with much hilarity at my expense from the Opposition. So, more than 40 years later, it is good to join in another debate about NHS reorganisation. Today’s debate about inequality was actually raised 40 years ago: noble Lords may remember the Black report on inequalities in health. I was rereading it last night and it struck me how many of the 37 recommendations made 40 years ago are still relevant today.

Mine is the lead name on four amendments, but I plan to say very little on Amendment 66 and leave it to the noble Lords, Lord Rennard and Lord Faulkner, to make the case for a specific reference to smoking as a key factor in reducing health inequalities.

As we have heard, the Bill gives integrated care boards a responsibility to reduce inequalities in access to health services and in health service outcomes. The biggest cause of inequalities are factors such as smoking, obesity and alcohol, particularly smoking, which is responsible for half the difference in life expectancy between the richest and poorest in society—an issue that was raised an hour ago during Oral Questions. Others will say more about the imperatives of tackling these hazards to health.

I will focus instead on Amendment 152 in my name and will also speak briefly to Amendments 156 and 157. These amendments are supported by the noble Lord, Lord Shipley, who will focus on housing and why legislation is necessary, and by the noble Baronesses, Lady Neuberger and Lady Watkins. I am grateful to Crisis, the homeless charity, for its briefing.

I commend the Government’s welcome commitment to tackle health inequalities and hope the forthcoming White Paper on levelling up will have a strong section on this, following the recent report of the Public Services Select Committee, chaired by the noble Baroness, Lady Armstrong. I hope that will put flesh on the bone of what risks becoming more of a slogan rather than a policy, meaning different things to different people. I hope the levelling up White Paper will directly address inequalities in health.

As the Secretary of State for Health has said recently, we must tackle the “disease of disparity”, and these amendments highlight the experiences of those groups who are undoubtedly at the worst end of that disease. In current NHS policy and documents, these groups are referred to as “inclusion health populations”—a term used to highlight the need for health services to overcome the social exclusion and marginalisation that many people face, resulting in dire consequences for their health. That group includes rough sleepers, Gypsy, Roma and Traveller communities, vulnerable non-UK nationals and people with substance misuse issues.

These people develop health conditions usually seen in people in their 70s and 80s up to 40 years earlier, and often die from them. Tragically, the average age of death among people experiencing homelessness is 46 for men and 42 for women. Clearly, these are not health outcomes we should accept for anyone. The solutions exist, and chime very well with what the Health and Care Bill seeks to do. However, it currently does not go far enough.

The Bill places a welcome emphasis on integrated services. To tackle the health injustices for people who are socially excluded, we need holistic, integrated health services to meet their needs, and we need them everywhere. They do exist in some places; they are also referred to as “inclusion health services” and they have a significantly positive impact. For example, Pathway, the leading health charity for inclusion health, has helped 11 hospitals in the UK create multidisciplinary teams of doctors, nurses, social care professionals and housing workers. These teams support over 4,000 patients every year who are homeless, with very positive outcomes. An audit of Pathway’s services in 2017 showed a 37% reduction in A&E attendances, a 66% reduction in hospital admissions and an 11% reduction in bed days. However, despite these successful services, inclusion health services are not currently commissioned at the scale required, and access to them is a postcode lottery. King’s College London found that 56.5% of homelessness projects in England do not have a specialist GP inclusion health service in their area—hence the amendments on best practice.

During my time as a Housing Minister, I saw the impact of social exclusion on people, including how not having a stable home to live in is devastating for people’s physical and mental health. Therefore, working closely with expert organisations across these sectors including Crisis, Pathway, St Mungo’s and many others, we want to amend the Bill to ensure a strategic focus in the new systems being set up to help the most socially excluded in our society.

The amendments introduce two important and necessary changes. The first would place a duty on integrated care partnerships to have due regard to the need to improve health outcomes for inclusion health populations when they create their healthcare strategies. Placing a duty on partnerships will make it clear that inclusion health is a strategic focus, and that should follow through and be reflected in the resourcing and commissioning decisions of integrated care boards. I do not regard the requirement to “have regard to” as an onerous imposition.

The second change would make clear the importance on health outcomes of having a stable home. It would mean that, in addition to the partnership having to consider health and social care in its strategic integration arrangements, it would also need to consider housing. This possible change would make clear that housing is on a par with health and social care services. The noble Lord, Lord Shipley, will say more about this.

With the advent of the Everyone In scheme in March last year, which sought to provide safe accommodation for those who without it would have continued to sleep rough, we saw how critical it is for people to have a place of their own. We need to build on that success and prevent rough sleepers drifting back on to our streets. My amendment legislates to ensure that health, social care and housing services continue to work more closely together to consistently support people who too often fall through the gaps between these services.

These amendments are firmly within the scope of the Bill. They will complement and strengthen its welcome aims to integrate health services across the whole system and tackle health inequalities. The amendments are neither overly prescriptive nor bureaucratic; their aims are simple. I look forward to my noble friend the Minister’s reply.

Care Workers: Professional Register

Lord Young of Cookham Excerpts

Monday 10th January 2022 Lords Chamber

Asked by

[Lord Young of Cookham]

To ask Her Majesty’s Government what plans they have to introduce a professional register for care workers.

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

We will invest at least £500 million in the social care workforce over the next three years. The major investment includes the introduction of a digital care workforce hub. This hub will help identify people working in social care and provide them with access to resources to help them in their careers. It will also include a skills passport to provide staff with a permanent record of their training and development over their career.

[Lord Young of Cookham (Con)]

My Lords, I am grateful for that reply. In his letter to us today on NHS resilience, the Secretary of State says:

“Social care is vital for our success in managing Covid-19, working as part of a single system with the NHS.”


We all agree that we need to integrate the NHS and social care and provide a high-quality, seamless service to users, but as long as those in the social care profession are seen as the undervalued poor relations of those in the health sector, such integration is going to be very difficult. Scotland, Wales and Northern Ireland have already introduced a registration scheme, offering professional skills and better working conditions for those in social care and making it a more attractive career profession. When will England do the same?

[Lord Kamall (Con)]

As my noble friend rightly points out, the devolved Administrations have registers in place in Scotland, Wales and Northern Ireland and they have taken a phased approach over the years to registers of staff working in a variety of roles across social care, because of the complexity of the sector. This is why our first priority is to embed a knowledge and skills framework to clearly understand the current layout of the workforce and the skills required in their roles and to look at potential pathways before we consider mandatory regulation.

Cigarette Stick Health Warnings Bill [HL]

Lord Young of Cookham Excerpts

2nd reading
Friday 3rd December 2021 Lords Chamber

Moved by

[Lord Young of Cookham]

That the Bill be now read a second time.

[Lord Young of Cookham (Con)]

My Lords, I hope that we will now move to calmer waters.

I am sanguine about the prospects for this Bill reaching the statute book at this late stage of the Session. However, that is not fatal as its provisions could be implemented by a simple amendment to the Tobacco and Related Products Regulations 2016—easily done now that we have left the European Union. I have chosen this subject to keep up the pressure on the Government on public health and to help shape the agenda for the forthcoming tobacco plan; perhaps my noble friend the Minister can say when we might expect it. I do so also because the campaign against the harm done by tobacco has been one of my preoccupations since entering Parliament in 1974.

This Bill extends the logic of health warnings on cigarette packs to the cigarettes themselves. If implemented, it would require both cigarettes and cigarette papers to display health warnings such as “Smoking Kills” or “Smoking Causes Cancer”. I first proposed this measure as a Health Minister in 1979 in Margaret Thatcher’s Government. I was told by representatives from the tobacco industry that we could not add health warnings to cigarettes because the ink used to print the warnings could be hazardous to health. Thankfully, the debate around tobacco control has progressed significantly since then, and I am confident that noble Lords will see the compelling case for dissuasive cigarettes. From being an initiative that, I believe, I was one of the first to suggest, it now commands broad support from the Royal College of Physicians, Cancer Research UK, the Health Foundation and the Association of Directors of Public Health—in all, some 71 organisations concerned with reducing the harm done by tobacco.

Smoking remains a leading cause of premature death. The Chief Medical Officer, Chris Whitty, has said that it is likely to have killed more people last year than Covid-19. However, smoking kills on the same scale every year and will go on doing so for years without robust action. In 2019, one in seven of the UK population were smokers. In England alone, around 280 children under 16 start smoking for the first time every day. Smoking is highly addictive: only one in three smokers will be able to quit before they die.

There is evidence that, over time, the responsiveness of smokers to existing warnings declines. New techniques are therefore needed to refresh their interest. Cigarettes are cancer sticks and consumers should be warned on the product, not just on its packaging. There is a growing body of research evidence from around the world supporting the effectiveness of what are known as “dissuasive cigarettes”, particularly in making cigarettes less attractive to younger adolescents and those who have never smoked.

This measure is popular. In a poll conducted by YouGov for Action on Smoking and Health, 70% of those surveyed supported health warnings on cigarettes, two-thirds of them strongly. Only 8% opposed the proposal. This includes majority support from voters from every main political party, including 70% of those who voted for my party in 2019. Adding health warnings to cigarettes and cigarette papers is a simple measure with minimal cost that would help deliver the Government’s Smokefree 2030 ambition. Tobacco manufacturers already print on cigarette papers, so this would be cheap and easy to implement.

This measure was one of several tobacco amendments to the Health and Care Bill tabled in the other place by officers of the APPG on Smoking and Health, of which I am a vice-chairman. As it stands, the Bill fails to include a single mention of smoking or tobacco and represents a significant missed opportunity to introduce key policies for achieving Smokefree 2030. Disappointingly, the Government refused to adopt the recommendations in the Commons, saying that they needed to

“conduct some further research and build a more robust evidence base in support of such additional measures before introducing them.”—[Official Report, Commons, 28/10/21; col. 812.]

However, these warnings are already under consideration in Canada, Australia and Scotland. Here is an opportunity for the UK to be ahead of the curve instead of waiting for others to lead. The robust evidence will be available only if someone does it.

Health warnings such as “Smoking kills” have been shown to be effective on billboards and tobacco packs, so why would they not also be effective on cigarettes? Adding warnings to cigarettes is important, because young people in particular are likely to start with individual cigarettes rather than packs. In addition to all the existing research on the effectiveness of health warnings, there have been at least eight peer-reviewed academic studies published since 2015 which specifically looked at warnings on cigarettes and found them to be effective, particularly in making cigarettes less attractive to younger adolescents and never-smokers.

This is a simple measure with minimal cost that would help deliver the Government’s ambition to make England smoke-free by 2030. This worthy ambition was announced in 2019, yet we are still waiting to hear what steps the Government will take to make it a reality. At the current rate of decline in smoking prevalence, Cancer Research UK has estimated we will miss that ambition by seven years, and double that for the poorest in society.

We will achieve a smoke-free 2030 only by motivating more smokers to make a quit attempt, using the most effective quitting aids, while reducing the number of children and young adults who start smoking each year. Dissuasive cigarettes will contribute to both objectives and reinforce the impact of other measures which require significant investment, such as behaviour change campaigns and stop smoking services.

This measure, along with the other tobacco amendments proposed in the Commons, will be retabled in the Lords after Second Reading next week by myself and colleagues from the All-Party Group on Smoking and Health, some of whom I welcome in today’s debate. I am confident these amendments will have strong cross-party support.

I end by quoting my honourable friend Bob Blackman MP, chairman of the all-party group, speaking during a recent debate on the Health and Care Bill in the other place:

“if we look back over the years, the measures on smoking in public places, on smoking in vehicles, on smoking when children are present and on standardised packaging of tobacco products were all led from the Back Benches. Governments of all persuasions resisted them, for various reasons … but we on the Back Benches who are determined to improve the health of this country will continue to press on with them, and we will win eventually. It may not be tonight, but those measures will come soon.”—[Official Report, Commons, 22/11/21; col. 74.]

I can assure the Government that, when the Bill comes to the Lords, we in this Chamber will take up the challenge. I beg to move.

--- Later in debate ---

[Lord Young of Cookham (Con)]

My Lords, I thank everyone who has taken part in this debate, starting with the noble Lord, Lord Rennard, whose long-standing commitment to the campaign to reduce the harm done by smoking is well known; he also underlined the all-party commitment. He trailed the broader package of a suite of measures as part of the APPG manifesto published earlier this year, of which this is one component. We look forward to taking that agenda forward on the forthcoming Bill.

My noble friend Lord Naseby and I have been on opposite sides of this debate ever since we both joined the House of Commons on the same day in 1974. I was reading last night a contribution that he made in May 1980, much of which he repeated today, showing consistency. I say to my noble friend that much of his speech was not about the Bill but about raising the age limit, the licensing regime, a potential levy and a tax on profits. I understand that. He described the promoters of the Bill as misguided. I wonder whether he would like to reflect on that, given the wide range of health organisations that I mentioned—for example, the Royal College of Physicians and Cancer Research UK—and whether he also believes that they are misguided in supporting the Bill.

[Lord Naseby (Con)]

The misguided bit is that the promoters of the Bill have not taken any advice on communication. It is quite clear to me, as one who has been a professional in that world, that to place a communication, as my noble friend suggested, on a narrow cigarette that is burning away, in red on a white background, is not good communication.

[Lord Young of Cookham (Con)]

I will come to that specific point, but he described the promoters of the Bill as misguided and I was making the point that he includes among those misguided people a very wide range of serious health opinion. As I said, I will come to his point.

The noble Baroness, Lady Uddin, put the Bill in personal terms. I am grateful for her contribution. She made the point that we need to move on from the health information on packs, which is now taken for granted, to a new means. On my noble friend’s point, he raised the question of whether it would be easy to read. A cigarette is right under your nose so it is probably easier to read what is on the cigarette than what is on the pack. Also, the pack is not seen by other people, whereas, if you put a message on the cigarette, those in the company of the smokers will also see it. I see that as an added advantage of this move.

I listened with some disbelief to my noble friend Lord Moylan. He started off by saying that he was surprised that I had introduced this Bill in the middle of a pandemic, implying that I should wait until the pandemic is over before introducing what I think would be a very useful health measure. Astonishingly, he described the message that I want to put on the cigarettes—“Smoking kills”—as propaganda. Even the tobacco manufacturers now admit that smoking is bad for your health. I just wonder whether my noble friend has ever read the 1962 report of the Royal College of Physicians—the whole weight of evidence. The health warning that smoking kills, and damages your health, is not propaganda but accepted health fact. He should move on.

My noble friend then described the 2030 target for a smoke-free England as ASH’s target, but it is not; it is a government target to which the Government have committed—I look to my noble friend on the Front Bench. Finally, my noble friend Lord Moylan described what I am doing as patronising. There is the libertarian wing within my party, of which he is clearly a member. I have listened to these arguments about things being patronising for the last 30 or 40 years. When there was a proposal to introduce compulsory crash helmets for motorcyclists, that was described as patronising. Parliament legislated and I do not think there is any question of repealing that. I heard exactly the same argument about seatbelts for drivers and then passengers; people said that was patronising legislation. I heard it about banning sponsorship for sporting events and banning smoking on public transport and then in public places. I am sure I will hear it again during the passage of the Health and Care Bill, which has a provision for adding fluoride to water.

Every single one of those measures has been adopted by Parliament, and I do not think anybody would seriously suggest that any of them should be repealed. In due course, measures such as the one I am promoting today will be accepted as conventional wisdom. I hope that, in a few years’ time, my noble friend will accept that this is the direction in which public opinion is moving. As I pointed out, this is a popular measure; it is popular within my party. I am glad I have got that off my chest.

I am very grateful to the noble Baroness, Lady Merron, for her support and her predicted support for the other measures that I and other noble Lords will introduce as amendments to the Health and Care Bill, which gets its Second Reading on Tuesday. That is much appreciated, as is her own record as a Minister in the Labour Government.

Finally, I am grateful to my noble friend the Minister, whose personal commitment to reducing the damage done by smoking shone through his speech. He put the Bill in the slightly broader context of government policy and recognised the imperative to drive down smoking. He said he had strong support for measures to stop people smoking. I will pick up one or two points from his speech for which I am very grateful. He said that the tobacco control plan would be published next year. “Next year” spans several months, so I wonder whether he could at some point be a little more specific about the timing of this plan, for which we have been waiting for some time, rather than referring just to 2022. He made the point that everyone is waiting for robust evidence. If everybody waits for robust evidence, no one will provide it, so at some point a country has to go first. I was grateful that he said that while he was unable to support this measure at the moment, he would consider it as part of the suite of measures to be looked at as part of the tobacco control plan. I accept what he says. That about sums up everything.

Bill read a second time and committed to a Committee of the Whole House.

Public Health Grant to Local Authorities

Lord Young of Cookham Excerpts

Tuesday 2nd November 2021 Lords Chamber

[Lord Kamall (Con)]

As noble Lords will know, the Chancellor has confirmed additional spend for public health, and the public health grant will be maintained in real terms over the spending review period, enabling local authorities to invest in prevention and front-line services such as child health visits. There will also be continued funding of £100 million per year over the period to tackle obesity in adults and children, as well as investment in a new start for life offer for families, with an additional £66 million in 2024-25. We know and recognise the importance of public health. At the same time, the NHS is committed to rebalancing between public health, prevention and therapeutics.

[Lord Young of Cookham (Con)]

Has my noble friend seen analysis by the University of York showing that expenditure on public health is three to four times more effective in terms of health outcomes than investment in the NHS? Will he take steps to ensure that we now invest in the resilience of the public health network to ensure that we are better placed for any future pandemics?

[Lord Kamall (Con)]

I thank my noble friend for that very important question. We continually assess our preparedness plans for infectious disease outbreaks and pandemics to ensure that they remain as robust as possible. This assessment includes, as appropriate, incorporating lessons learned from exercises that test the readiness of our plans and from our experience in responding to pandemics, disease outbreaks and other types of incident in the UK. The UK Health Security Agency will be dedicated to ensuring that we are protected from all future threats, including pandemics.

Social Care

Lord Young of Cookham Excerpts

Wednesday 27th October 2021 Lords Chamber

[Lord Kamall (Con)]

I thank the right reverend Prelate for that question. I am not able to answer it directly now, but I will send an answer.

[Lord Young of Cookham (Con)]

My Lords, further to the question from the right reverend Prelate, I understand the concern that the proceeds from the ring-fenced levy may not be enough to relieve all the pressure on social care. So will the Minister encourage the NHS trusts, which are receiving the bulk of the extra funds, to use Section 75 of the National Health Service Act 2006 to commission social care, thereby taking some of the pressure off local authorities?

[Lord Kamall (Con)]

I thank my noble friend for that suggestion, and I will take it back. What we have to remember about the way social care is funded is that, in reality, it is mostly private providers that provide social care, and these are funded by private and state-funded patients. Quite often, we find it is private patients who cross-subsidise state-funded patients. I will take the question from my noble friend back and send an answer.