Accountability and Transparency in the NHS

Baroness Brown of Silvertown Excerpts

Thursday 14th March 2013 Commons Chamber

[Mr Deputy Speaker (Mr Lindsay Hoyle)]

Order. Before the hon. Lady responds—[Interruption.] I am sorry, but does the Opposition Whip have something to say?

[Lyn Brown (West Ham) (Lab)]

No.

[Mr Deputy Speaker]

Thank goodness for that.

We need short and concise interventions, because many Members wish to speak and I do not want to have to reduce the time limit further, but that is what will happen if we are not careful.

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[Kate Hoey (Vauxhall) (Lab)]

It is a pleasure to follow the right hon. Member for Charnwood (Mr Dorrell), who speaks with a breadth of experience and history in the national health service, and I congratulate the hon. Member for Bristol North West (Charlotte Leslie) on securing this long debate, providing an opportunity to all of us to say a few words.

I agree wholeheartedly with everything my hon. Friend the Member for West Lancashire (Rosie Cooper) said, particularly about what seems to me, too, to be a growing public body desire for secrecy. This is happening not in the national health service alone, but in many other bodies. Indeed, as my hon. Friend well knows, it is happening in this House. I am concerned about a number of issues—how staff are treated, getting rid of the telephone exchange and a whole number of other decisions taken up there somewhere. We, as Members who work here, have very little say.

It is important for us to remember the Nolan principles of public life to which every public body is meant to sign up—accountability, openness, honesty and leadership. I do not want to say much specifically about what happened in Mid Staffordshire, but it was appalling. As someone who has had a good and well-led hospital in my constituency for many years, I find it almost unbelievable that all that could have happened in the Mid Staffordshire hospital with so few people seeming to know what happened or to speak out about it. Then, when it was pointed out, no one listened. That provides a terrible warning about what can happen. We all think that we know what is happening in our constituencies, but we do not always, as this episode has shown.

Let me talk about my local hospital Guy’s and St Thomas’, King’s College hospital and SLAM—the South London and Maudsley hospital. What has been called the “King’s Health Partners” has sought to bring together the research work at King’s College medical school with others, and the body is now growing to be almost an entity in itself, making decisions, sending out publicity and getting further and further away from the foundation trust.

Looking back to when my right hon. Friend the Member for Holborn and St Pancras (Frank Dobson) was Secretary of State for Health, some of the decisions he made in the Health Act 1999 were more about accountability than anything that has been done since by any Government. For example, he instructed NHS chairmen to hold their board meetings in public, while non-executive directors were required to live in the area served by the trust—a crucial step that fundamentally changed St Thomas’ hospital when we had a local chairman who knew the area, was involved in the hospital and cared about it. She spent all her time as chairman wandering around the hospital trying to find out about everything that was going on: she was accountable to everyone. That was crucial to the public, too, as they knew that they had people on the board who knew what was happening in the locality.

I believe that one of the first responsibilities of non-executive directors—they are not part of the management —is to visit the wards, to talk to patients, to collate local concerns and to talk to MPs, local councillors and the local authority. That was always happening. We had a very good system. There were concerns about the treatment of the elderly at one stage in one of the wards for elderly people at St Thomas’, but they got dealt with very quickly because we had a responsive chairman and a responsive board. A lot of that happened when my right hon. Friend the Member for Holborn and St Pancras was the Secretary of State. The Health Act 1999 also gave the chief executive officer absolute personal responsibility for clinical governance standards—another important reform—in addition to the responsibility to be the accountable officer.

Later we had foundation trusts, although I have to say that I did not vote for them. I have had a well-led foundation trust up to now, but I did not feel that this was the right way ahead for the national health service at the time. We have got them, however, and some foundation trusts saw fit to erode the principles as financial considerations took precedence over clinical standards on many board agendas. The foundation trusts still remain the chief executive officer’s responsibility.

One thing the King’s Health Partners are doing in the name of foundation trusts is steamrolling ahead to bring about a merger of Guy’s and St Thomas’ hospital, which is a huge trust, King’s College hospital, which is another huge trust, and the South London and Maudsley trust. It is believed that the merger will somehow lead to a “world-class”—I do not know how many times Members have heard the term—hospital.

I am furious and angry—as are, I think, all five of the MPs representing the area at how this merger has been handled. The lack of openness has been appalling and there has been no public board meetings or disclosure of information about the proposed changes. The proposals have been either badly put forward or not put forward at all. The board at St Guy’s and St Thomas’ has an occasional surreal meeting as a showcase for public involvement, but it never discusses the real issues. It opens meetings for the public only when it suits the board.

[Lyn Brown]

Does my hon. Friend agree that the plans for reorganisation of the trusts south of the river need to be put on hold?

[Kate Hoey]

That is precisely what the five Members of Parliament have asked for. Recently, on 28 February, we heard from the chairman of Guy’s and St Thomas’, who was previously a permanent secretary at the Department of Health. That takes me back to one of my earlier points about people moving around within the health service. It is always somebody who has been someone else in somebody else’s patch that gets a job with another NHS trust. This chairman wrote to say that the project is forging ahead with a full business case. William McKee, who brought together trusts in Northern Ireland, has been appointed and we are told that he is going to spend at least £5 million to bring about the business case to show why this will be such a wonderful idea. The right hon. Member for Bermondsey and Old Southwark (Simon Hughes) and I have written back asking who is actively responsible, how the money from the different bodies is being allocated, what the precise budget will be and how it will be spent by whom. The whole accountability thing is there in a nutshell. Who is actually accountable? Does the Secretary of State have any say whatsoever? No. Apparently he is only interested if the move will clearly not be good for patients in clinical terms.

I know that the establishment of such a large trust will be totally against the interests of people. Trusts cannot operate on such a large scale. One chief nurse cannot be responsible for all those hospitals.

NHS Funding

Baroness Brown of Silvertown Excerpts

Wednesday 12th December 2012 Commons Chamber

[Mr Hunt]

I will make a little progress before giving way.

[Lyn Brown (West Ham) (Lab)]

rose—

[Mr Hunt]

I said that I would make a little progress, if that is all right.

I must confess to being both surprised and delighted at this afternoon’s motion, because I would have thought that the last thing the right hon. Member for Leigh (Andy Burnham) would want to do was remind the nation of his opposition to our increasing the NHS budget. The motion is about spending, but we can spend only what is in our budget. What did he say about budget and spend during his failed bid for the leadership of his own party? [Interruption.] I think that right hon. and hon. Members on the Opposition Benches should listen to what those on their Front Bench are saying. He said:

“It is irresponsible to increase NHS spending in real terms”.

So let me ask him to clarify this to the House: does he stand by his comment that it is irresponsible to increase NHS spending?

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[Lyn Brown]

Will the right hon. Gentleman confirm just how many nurses’ jobs have been cut on this Government’s watch?

[Mr Hunt]

I will confirm for the hon. Lady that the nurse-to-bed ratio has gone up so that nurses are spending—[Interruption.] Perhaps the Opposition will want to hear about issues of care. The average bed is getting two hours of nursing care per week more than under Labour.

Let me give the right hon. Member for Leigh another chance to clarify Labour policy on health spending. In Wales, Labour has announced plans to cut the NHS budget by 8% in real terms despite an overall settlement protected by Barnett. Given that the motion condemns an alleged cut in NHS spending, will he, once and for all, condemn the choice that Labour made in Wales? If he does not want to do that, let me tell him what the British Medical Association says is happening in Wales. It talks of a “slash and burn” situation and “panic” on the wards. Would he want that to be repeated in England? If not, he should not sit idly by but have the courage to condemn the choice that Labour has made in Wales.

While we are on the subject of Wales, the right hon. Gentleman will know that NHS patients there are five times less likely to get certain cancer drugs than English NHS patients, but the Labour Welsh Health Minister has said it would be “irresponsible”—the same word that the right hon. Gentleman used—to introduce a cancer drugs fund in Wales. Does the right hon. Member for Leigh support what Labour is doing with regard to cancer drugs in Wales—yes or no?

Mental Health

Baroness Brown of Silvertown Excerpts

Thursday 14th June 2012 Commons Chamber

[Lyn Brown (West Ham) (Lab)]

It is a pleasure to follow the thoughtful contribution of the hon. Member for Worthing West (Sir Peter Bottomley). I am very glad to be in the Chamber to speak alongside those who have made exceptional speeches today, including my hon. Friend the Member for North Durham (Mr Jones) and the hon. Member for Broxbourne (Mr Walker) to name just two.

I will highlight three things. The first is the key factors that are linked to mental well-being and the characteristics of my local borough of Newham. The second is what resources are available to my local health authorities and mental health services. The third is the need for those resources to be improved in the light of what we know works in improving mental health.

The need for a robust strategy to promote well-being is illustrated by the correlation between the determinants of mental ill health and some of the characteristics of the population of my borough. As my hon. Friend the Member for Vale of Clwyd (Chris Ruane), who is no longer in his place, attested so powerfully, one such determinant is age. The rates of mental illness vary across age ranges, but it is a sad fact that younger people are more likely than the elderly to experience mental ill health. A high proportion of mental health problems develop between the ages of 14 and 20. One in 10 children between the ages of five and 16 have a mental health problem, and such problems may well continue into adulthood.

The borough of Newham has one of the youngest populations in the country. The number of young people with mental health problems is therefore greater than elsewhere. Some 40% of the borough’s population is made up of people under the age of 25. As nearly 10% of people aged between five and 16 experience mental health problems, statistically we can expect 4,262 of the children and young people in Newham to experience such problems. That clearly has an impact on the needs of the population of Newham and on the type of service that it requires. It should be funded to cater for those needs.

We all know that there are other important determinants of the mental health of a community. One of those is deprivation. Common mental disorders such as depression, anxiety and obsessive compulsive disorder are more prevalent in deprived households. Again, Newham suffers from high levels of deprivation. It is ranked the third most deprived local authority in the country and 51.5% of its children live in poverty. The index of deprivation ranks the borough fourth in the country for the proportion of children aged between nought and 15 living in an income-deprived household. That is just one measure of deprivation, but I am sure hon. Members will agree that it is a worrying one.

In addition, the decline of owner-occupation and the increase in the private rented sector changes the very nature of local communities. Support networks that people rely on—their friends and family, and wider communities such as their Church and faith—are disintegrating as housing pressures force families to move home, leave their communities or remain in overcrowded, sometimes unhygienic and often poorly managed private rented housing, which is sadly a fast-growing sector of tenure in the London borough of Newham.

In my constituency, there is a high level of need for services that will enable the people of Newham to be self-sufficient and lead independent, successful lives. My concern is that the process used to allocate the resources needed to support those services is fundamentally flawed. It is skewed in a way that significantly disadvantages my community.

Since 2006, if not earlier, the population estimate for Newham has clearly been an underestimate by the Office for National Statistics. The under-count was estimated at about 60,000 people until, in November 2011, the ONS went some way towards recognising the historic underestimate by provisionally estimating the population at 272,000, an increase of 32,000. That significant increase of 13% is, by the way, the largest change in any London borough. However, the new figure still falls some 30,000 short of the population estimate made by an independently commissioned study. That is a shortfall in excess of 10%.

The real population of the borough stands at roughly 300,000. That is the figure that should drive resource allocation, because it relates to the real world and real need. However, the ONS mid-year estimates are used to determine how the national funding pot is allocated to local areas, even though they do not accurately reflect the true population of my area. Given the level of need in my constituency, to say that resources are not allocated on a level playing field is an understatement.

The effect of an inadequate allocation system is compounded by a reliance on historical spend to determine current needs. That means that my local primary care trust has consistently struggled to find resources to deal with persistent need. Figures in the House Library tell me that expenditure per head on mental health in Newham in 2010-11 was £208.93. That compares with £447.21 in Westminster and £331.81 in Kensington and Chelsea. I wish to hammer home the point that the spend for Newham is based on the ONS population estimate, so the real spend per head is even lower.

The shadow health and wellbeing board for the London borough of Newham has discussed the matter at length and agreed a robust strategy, with a clear focus on maintaining resilience within the community. It wants to support people by ensuring that they possess the skills and resources that will enable them to negotiate successfully the challenges that they experience.

Let us face it: we know from evidence what works. The health and wellbeing board has indicated that it wants to focus its activity on parenting skills and pre-school education to set up an early family environment that supports children’s emotional and behavioural development. It wants to support lifelong learning, with health promotion in schools and continuing education, as schools are a really important resource, particularly for children facing difficulties at home.

The board also wants to find a way of improving working lives in the borough, as one in six people in the work force are affected by mental health problems, and a way of supporting a good and healthy lifestyle by encouraging exercise and good diet. It wants to encourage the learning of new skills and the taking-up of creative pursuits—social participation that promotes mental well-being across the piece. The board is also supporting communities through environmental improvements. Environmental predictors of poor mental health include neighbourhood noise, overcrowding, fear of crime, poor housing and so on. Finding out what to do is frustrating, but it is also frustrating that resources are being rather unfairly allocated. Newham is poorly served in that regard.

I thank the Backbench Business Committee for creating this opportunity to discuss an issue that is often invisible, and on which there is not enough focus and debate. Poor mental health has an extraordinarily detrimental impact on huge numbers of people in our communities. We could and should be dealing with the problem in a plethora of holistic ways in our local communities.

Newham is severely under-resourced in the face of significant pressures on mental health provision. I am glad to see the Minister of State, Department of Health, the right hon. Member for Chelmsford (Mr Burns), in the Chamber. I know he has listened to me and, given that he is a former Whip, that he is a very honourable man. I shall write to him to push the case for greater funding for Newham as we continue to fight for the resources that my communities desperately need to access better life chances, which includes better mental health.

Health and Social Care Bill

Baroness Brown of Silvertown Excerpts

Tuesday 13th March 2012 Commons Chamber

[Jonathan Reynolds]

No, sit down and listen for once.

It is clear that the majority of non-biased, objective opinion is against the Bill proceeding. Never in the field of public policy have so many opposed so much and been listened to so little.

Should the Government not be asking themselves this: if the Health Secretary cannot convince the people who he wants to devolve power to, and if the Deputy Prime Minister cannot convince his own party members to support the Bill, maybe—just maybe—there is not that much going for it? The Health Secretary cannot even visit an NHS hospital, so low has his reputation sunk.

As has been said, the people who oppose the Bill, whether the royal colleges or Opposition Members, do not oppose all reform. Of course, NHS services will have to change over time, particularly in the provision of specialist services. The Labour Government introduced reforms, which used the private sector to the advantage of the NHS. The Bill does the opposite and uses the NHS for the benefit of the private sector. The problem is not reform, but these reforms. To say that anyone who opposes the Bill is against all reform is crass and simplistic.

Let us please put an end to the nonsense that the reforms are just an evolutionary approach following what has happened in the past. If that were the case, would there be an unprecedented groundswell of opinion against them? Once the Bill is passed, the primary care trusts and the strategic health authorities will be gone, and clinical commissioning consortia will be responsible for the whole NHS budget. Local authorities will take public health, and Monitor and the NHS Commissioning Board, not the Department of Health, will be responsible for the health system. That is a fundamental, top-down restructuring of the NHS, and no one wants it.

To justify that revolution, the Government started by rubbishing the success of the NHS. It began with the cancer survival rates and carried on from there, and every time the Government’s case has been knocked down. The King’s Fund, the respected health think-tank, in its review of NHS performance since 1997, clearly showed dramatic falls in waiting times; lower infant mortality; increased life expectancy across every social group; cancer deaths steadily declining; infection rates down, and in mental health services, access to specialist help, which is considered among the best in Europe. Again, I put it to the Government that they have no justification for the revolution that the Bill brings about.

The Government’s other justification has been that the NHS has too many managers, yet their reforms create a structure so confusing that, when an organogram of the new structure was published, it became a viral hit on the internet because it looked so ludicrous. What do the experts in the King’s Fund say about this? The myths section about the Bill on its website says:

“If anything, our analysis seems to suggest that the NHS, particularly given the complexity of health care, is under-rather than over-managed”.

[Lyn Brown (West Ham) (Lab)]

During the Bill’s passage, it has struck me just how vulnerable my constituents will be to doctors who are not as good as many of those who currently serve them well. One of our opportunities in Newham with a decent PCT was to deal with doctors who did not provide the right care. Is my hon. Friend , like me, concerned about the vulnerability of many of our constituents if the Bill is passed?

[Jonathan Reynolds]

I agree with my hon. Friend. If the Bill is passed, perhaps one of the biggest changes will be to the relationship between doctor and patient. Every time a patient is not referred for some sort of specialist treatment, they will wonder whether that is on clinical grounds or because their GP has one eye on the budget. Whatever the basis for those fears, GPs will be in a difficult position, and because NICE guidance will no longer be compulsory, the problem will be compounded when people compare their experience with that of others, using the internet or other means.

However, the most worrying aspect derives from the stories that we hear from parts of the country where individual GPs might have a financial interest in the services that they now commission. Such a relationship would not only destroy the trust at the heart of the system, but provide perverse incentives for how it might develop in future.

NHS (Private Sector)

Baroness Brown of Silvertown Excerpts

Monday 16th January 2012 Commons Chamber

[Andy Burnham]

The point that I am making is about how to manage the system, how to ensure proper regulation and how to ensure that NHS providers and the system work in the interests of NHS patients. If the right hon. Gentleman is arguing that there would be the same control managing the system through a series of fragmented commercial contracts, I would be interested to have that debate with him. Frankly, I do not believe that he is being serious, if that is his point.

[Lyn Brown (West Ham) (Lab)]

I have been contacted by constituents who access their cancer and cardiac care from Barts and from the London hospital. They fear that as a result of the Bill their health needs will be deprioritised in favour of private patients who can afford to pay. What would my right hon. Friend say to my constituents about their fears?

[Andy Burnham]

I wish I could allay the fears of those people, but when there is a proposal placed at the heart of the NHS for hospitals to devote half their facilities—their beds, their appointments—to private patients, how is it possible to give that guarantee to those patients, particularly when the Government are relaxing the waiting time standards that we did so much to establish in the NHS, with the two-week wait for cancer referrals and 18 weeks for elective operations, and a four-hour wait in A and E? How can we have that confidence when, effectively, the Government are taking those safeguards off the public and giving the green light for a massive expansion of private sector treatment in NHS hospitals?

National Health Service

Baroness Brown of Silvertown Excerpts

Wednesday 26th October 2011 Commons Chamber

[The Secretary of State for Health (Mr Andrew Lansley)]

I ask the House to reject the motion. I am sorry about the tone of much of what the right hon. Member for Leigh (Andy Burnham) said. This was his first opportunity to make a speech about the NHS and I thought that he might take the trouble to thank NHS staff for what they have achieved over the past year, rather than disparage and denigrate everything they have been doing. I also thought that he might take the opportunity to approach the issues facing the NHS from the standpoint of patients, rather than simply playing politics with the service, but he did not. Insulting me was the least of the problems in his speech. It seemed like the Burnham memorial speech—clearly no hard feelings about losing the election, then. Having spent 13 years in the House in opposition, I shall—at the risk of patronising him—give him a few words of advice: do not keep fighting the election that you lost. It is not the way to win any future election, and it will carry absolutely no credibility in the NHS.

Equally, the right hon. Gentleman will carry no credibility by wandering around telling people that he was not planning to cut the NHS budget, given that he made it absolutely clear in The Guardian last year that that was exactly what he intended to do and that he told us, in the run-up to the spending review, that it would be irresponsible to increase the NHS budget in real terms. I searched the Labour manifesto for any commitment to funding the NHS in real terms, but there is none. In March 2010, he might have said that he knew all these things, but he did not tell the public about any of it—[Interruption.] Well, it is here in his manifesto. The only reference to any kind of investment in the NHS is a plan to

“refocus capital investment on primary and community services”.

[Lyn Brown (West Ham) (Lab)]

Will the Secretary of State give way?

[Mr Lansley]

In a moment.

We know what that meant, because when we opened the books on arriving in the Department we saw that Labour was planning to slash by more than half the capital budget of the NHS. Every Member of Parliament who has a major hospital building programme in their constituency would have been affected by that. That might include my hon. Friend the Member for Harrow East (Bob Blackman), who has the Royal National Orthopaedic hospital in his constituency, or Members from Liverpool, who have the rebuild of the Royal Liverpool and Broadgreen hospitals and, all being well, the rebuilding of Alder Hey. That might also include the hon. Member for Copeland (Mr Reed). The last Labour Government, before the election, cut the capital budget, and his project—the West Cumberland hospital at Whitehaven—could have been at risk as a consequence of that. [Interruption.]

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[Mr Lansley]

Thank you, Mr Deputy Speaker. I will now give way to the hon. Member for West Ham (Lyn Brown).

[Lyn Brown]

I am grateful to the Secretary of State for giving way. Will he now admit that this is the first time that the NHS budget has seen a real-terms fall since 1996, the last year of the Tory Government?

Health and Social Care (Re-committed) Bill

Baroness Brown of Silvertown Excerpts

Wednesday 7th September 2011 Commons Chamber

Another piece of misinformation that has been put about is the idea that the amendment would prevent or delay the abortion process. Again, that is incredibly untrue. Counselling would be delivered within 24 to 48 hours, and the abortion process would take seven to 14 days to arrange. This amendment, this offer of counselling, is not for women who have made up their mind and—fantastic for them—want to go straight to the abortion clinic; it is for women who may be in distress. The counselling would be delivered within 24 to 48 hours, so there would be no delay whatever to the abortion process. In fact, many women who accepted the offer of counselling and proceeded to an abortion would proceed empowered, because they would have had the opportunity to talk through their situation with someone totally impartial—

[Lyn Brown (West Ham) (Lab)]

rose—

[Kate Green (Stretford and Urmston) (Lab)]

rose—

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[Nadine Dorries]

No, I have given way to the hon. Lady once. I will give way to the hon. Lady who also acts as a Whip.

[Lyn Brown]

I am listening with interest to the hon. Lady. How can she guarantee that the counselling that she proposes will not delay the abortion process?

[Nadine Dorries]

I have spoken to organisations that provide counselling and have 80,000 registered counsellors throughout the UK. [Hon. Members: “Who?”] The British Association for Counselling and Psychotherapy. I asked, “If somebody required counselling, was at a GP’s practice and a telephone call was made, how long would it take to get a counsellor to a particular woman?” The answer was that counselling could be delivered in the GP’s practice, at another venue or in the woman’s home, and that it could be anything from immediate to within 48 hours.

Registered counsellors, who have e-mailed me regularly since the amendment was tabled, say that they would love to work—counselling is a growing industry—and to have the opportunity to work with women in that situation. Unfortunately, however, counselling is available on the NHS only via the abortion provider or via the hospital.

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[Lyn Brown (West Ham) (Lab)]

One of my biggest worries about the Bill is that it will stop me intervening in the health service to encourage outcomes for my constituents who come to me for help and advice. Does my hon. Friend agree that it will diminish my ability to represent them, rather than enable me to do so?

[Joan Walley]

My hon. Friend is right. Constituents go to Members of Parliament as a last resort to try to ensure fairness in how the system deals with everything. I have just had a high-profile case in my constituency relating to the postcode lottery, which my hon. Friend the Member for Pontypridd (Owen Smith) referred to.

Health and Social Care (Re-committed) Bill

Baroness Brown of Silvertown Excerpts

Tuesday 6th September 2011 Commons Chamber

[Lyn Brown (West Ham) (Lab)]

Bearing in mind the lack of popularity of the proposals among our constituents, is my right hon. Friend as worried as I and my constituents are about the £850 million that is being spent on redundancies and the projected £2 billion of primary care trusts’ budgets that is being held back from patient care to cover the risks and costs associated with the reorganisation?

[Frank Dobson]

I entirely agree. Nobody could possibly claim that redundancy payments constitute money being spent on improving services for our constituents. That is just money down the drain as far as patient care is concerned.

The fundamental problem behind the proposals is that the Government are, in effect, proposing a further major fragmentation of the national health service. In the past, up to the point at which the previous Tory Government introduced an internal market, the spending on administration in the NHS amounted to 4% of the total. That was largely because great big slugs of money were transferred round the system, and I am prepared to accept that there might be some disadvantages in that arrangement. Since then, however, under that Government and the Labour Government, the system has changed to one in which the money follows the patient. That has led to the creation of all sorts of exceptionally expensive systems to bring about individualised transactions, which has resulted in the cost of administering the national health service rising to 12% of the total—an increase of 8%. The NHS is spending about £100 billion a year at the moment, so an extra £8 billion that should have been spent on patient services is now being spent on the administration of the semi-fragmented system. What is now being proposed will involve yet further fragmentation, and I shall explain why I believe we will end up spending yet more money, but not on patients.

NHS Future Forum

Baroness Brown of Silvertown Excerpts

Tuesday 14th June 2011 Commons Chamber

[Mr Lansley]

Yes, I can give my right hon. Friend that assurance. He will know that in our response to the Future Forum we will strengthen the role of health and wellbeing boards, deliver more integrated care and ensure that the local health and wellbeing strategy is a central document in determining the shape of commissioning in the NHS, social care and public health. The powers, including those for service reconfiguration in an area, will be maintained so that they must continue to meet the four tests I set out last year. The public voice will therefore be at the forefront of the response to any changes in the local service.

[Lyn Brown (West Ham) (Lab)]

Given that the Secretary of State is about to waste £2 billion on this reorganisation—money that would be better spent on patient care—will he give us an assessment of how many A and E departments will close over the next two years?

Childhood Obesity

Baroness Brown of Silvertown Excerpts

Tuesday 3rd May 2011 Westminster Hall

[Mary Macleod (Brentford and Isleworth) (Con)]

Thank you, Mr Gale, for the opportunity to introduce this debate on childhood obesity, which is, unfortunately, an issue that I understand far too well. Childhood obesity is a significant issue in my constituency of Brentford and Isleworth, which is part of the Hounslow borough—13.9% of children in reception are at risk of being obese, with the figure rising to 24.6% by year 6, or age 10—so I have a personal interest in finding out as much as I can about the issue and what we can do to address it.

I believe that there are two strong reasons why childhood obesity requires Government focus. First, the issue concerns children, who may not, therefore, be directly responsible for the situation in which they find themselves. We must, therefore, do all that we can to support and help them. Secondly, the potential long-term implications on the health of these children is serious, as is the cost to the state of their medical care, so it is our duty to do all that we can to address the issue.

This debate is timely, because there have been several recent developments on the issue. When I switched on the news this morning, there was a story about overweight people in middle age having a greater chance of dementia. On the children’s side, the Greater London authority has commissioned a report on childhood obesity in London, which looks in detail at the causes of childhood obesity and the effectiveness of intervention programmes. The London assembly has published a report on childhood obesity in London, “Tipping the scales”, which considers the role that the Mayor of London could play and puts the cost of treating childhood obesity in the capital at £7.1 million per annum. The current generation of obese children will cost the London economy £110.8 million a year if they grow up to be overweight adults. The Government recently launched their responsibility deal as part of the strategy for public health in England. They are also working on the paper on obesity, which will be published later this year. It would be good to hear from the Minister about any progress on that.

In today’s debate, I want to review the scale of the issue, talk about some of the possible causes of childhood obesity and look to the future to discuss what actions we can take. First, how significant is childhood obesity in the UK? The headline figures on childhood obesity in this country are alarming—29.8% of children aged two to 15 are either overweight or obese, which is almost one in three children. On current trends, two thirds of children will be overweight or obese by 2050. Breaking down the figures on childhood obesity throughout the UK shows that there is a particular problem in urban areas, especially London. Data for 2009-10 show that in London 11.6% of children aged four to five, and 21.8% of children aged 10 to 11, are at risk of being obese. I have already mentioned the figures for my area in London.

The figures are a significant worry for the future health of our nation as a whole, because evidence suggests that overweight adolescents have a 70% chance of becoming overweight or obese adults. Obesity is a disease with, potentially, very serious health implications, including, in the short term, breathlessness, feeling tired, and back and joint pains, and, in the longer term, hypertension, cardiovascular disease—mainly heart disease and stroke—type 2 diabetes, musculoskeletal disorders, especially osteoarthritis, and some cancers, including breast cancer and colon cancer. There are also psychological issues of low self-esteem, lack of confidence, depression and feeling isolated, which restrict a person’s potential ability to earn. Obesity is also associated with a higher chance of premature death and disability in adulthood. The long-term costs for the UK of this level of childhood obesity are vast. The 2007 Foresight report on obesity predicted that the NHS costs associated with overweight people and obesity will double to £10 billion per year by 2050, and that the wider costs to society and business will reach £50 billion per year by 2050.

Secondly, why is there an issue? Before we can decide how best to tackle childhood obesity, we need to understand more about what causes it. As one doctor once put to me, at its most basic level the formula behind obesity is simple—we put on weight when we take in more calories than we burn off through day-to-day living and physical exercise. However, we need to dig deeper than that to find out what is causing the problem, because, clearly, a number of factors are at play.

We are talking about children, so perhaps the biggest single factor is parental influence. Weight Concern reports that children with two overweight parents are 70% more likely to be overweight themselves. GPs to whom I have spoken in my area are often the first point of contact for parents on the issue, and they feel that, often, parents do not accept that their children are overweight. Given that perhaps more than a quarter of other children in the class are also overweight, they may feel that their child is normal. They may also feel that the suggestion that their child is overweight is a direct criticism of their parenting skills, and they are reluctant to accept that.

I am not a parent myself, but I have discussed this issue with friends and constituents who are. There is no doubt in my mind that there is a lack of knowledge and information that is easy to understand. Often, parents simply do not realise the number of calories that they are feeding to their children. For example, I am pretty sure that no parent would allow their child to sit and eat five spoonfuls of sugar, but some think nothing of giving them fizzy drinks containing the same quantity. Ask a parent how many calories there are in a bowl of chocolate-flavoured cereal and what percentage of a child’s recommended intake of sugar that represents, and I would wager that most would probably not know the answer.

When I speak to parents about the issue, a common story emerges. Many start off with the best of intentions, breastfeeding their babies for weeks or months under the regular guidance of health visitors. Perhaps they then move on to religiously preparing pureed vegetables and home-cooked meals that they bag up and put in the freezer for their babies and toddlers. Gradually, however, as the years progress and as the influence of peers, TV and the media grows, as well as that of, critically, the children themselves, who become more demanding and fussy about what they eat, it is too easy to slip into bad habits from which it is very difficult to get them back.

I am not saying all this to give parents a hard time—far from it. What I am saying is that those who feed our children and organise their activities—typically parents and schools for the most part—are so critical to this issue and need to be supported in any way we can. Jamie Oliver and many others in the school environment have worked hard to make progress in improving the quality of the meals that are provided to children when they are at school, and they should be commended for that work.

As I mentioned earlier, there are many factors at play, and I want to touch on another key one. Deprivation has been shown to play a significant part in levels of obesity, with children from the poorest backgrounds being much more likely to be obese. When families are struggling financially, they are more likely to be attracted to cheap, high fat, energy dense and poor foods, many of which are marketed with “buy one, get one free” deals.

The 2007 Foresight report on obesity highlighted the full range of factors that it believed were behind the trend towards obesity and made the point that there are lots to consider. However, to summarise the causes, the issue is about parents who have been overweight themselves, those who live in an urban area and those who come from a lower-income household.

Thirdly, what can be done in the future? Given that so many different factors influence childhood obesity, this is clearly not just a health issue, although I am pleased that a Health Minister is responding to the debate. The issue is also affected by planning, housing, transport, education, business and other things. Therefore, although the model we are aiming for is spearheaded by the Department of Health, it must be integrated across all areas. The Government have already taken important steps. Public health funding has been ring-fenced to ensure that sufficient focus is given to the matter and, in March, the responsibility deal was launched.

In the White Paper, “Healthy lives, healthy people: our strategy for public health in England,” the Government stressed that localism is key. A partnership approach will be encouraged between the Government, local authorities, health representatives, education, business and the voluntary sector. In addition to putting in place the right environment for change with that partnership approach and by integrating policies across Departments, we need to tackle the problem head-on by making nationally recognised programmes available to address childhood obesity.

I am a fellow of MEND, which is a social enterprise that has evolved from a 20-year partnership between Great Ormond Street hospital and the University College London institute of child health. MEND is the child-weight management partner of more than 100 primary care trusts and 15 local authorities in England. MEND stands for Mind, Exercise, Nutrition, Do it, which sums up the approach that it takes to covering each of those important elements. At a recent parliamentary event for MEND, I met a young boy called Charlie and his mother, who had been through the MEND programme. Over 10 weeks, the whole family learned about portion sizes and how to read and understand food labels. They set goals as a family and took part in fun physical activities. Charlie told me that taking part in the MEND programme has not only helped him to lose weight, but given him new confidence. He now enjoys taking part in many school activities. The changes put in place have made a real difference to the whole family, including to Charlie’s sister. He now looks forward to going out shopping with her and her friends to buy new clothes, when previously he absolutely dreaded doing so.

Like many other programmes across the country, MEND builds in a number of best practices to ensure success. The programme is about working with the whole family to ensure that changes are made to the weekly shop and family activities. It focuses on nutrition and physical activity, and it aims to start young. One school in my constituency, Hounslow Manor, works with children from reception to achieve the greatest possible long-term impact. The programme also aims to deliver in a community-based way to reduce the stigma around the programme and build the real support networks that can make a difference.

In the GLA intelligence unit report published this month, MEND was evaluated as a cost-effective approach to obesity intervention. Other cost-effective programmes in the UK include the local exercise action pilots, which focus on increasing physical activity. Other such programmes include one to reduce television viewing in the US and the regulation of television advertising of high-fat, high-sugar products at certain times, which was introduced in Australia. I would like research to be directed at how we can extend the online elements of programmes that are provided to children. Children enjoy learning in an online, gaming-style environment, and it would be good to see how that could be used in obesity programmes to build up such an approach.

[Lyn Brown (West Ham) (Lab)]

I am thoroughly enjoying the hon. Lady’s contribution. I have stayed here from the previous debate just to listen to what she has to say and because I have a personal interest in the issue. Does she agree that getting children involved in cooking enables a child to explore foods that they might otherwise not try? That enables a family to experience better, more wholesome home-cooked food, rather than the processed rubbish that is thrust at them from television screens every day.

[Mary Macleod]

I thank the hon. Lady for her contribution and absolutely agree with her. The issue is about the whole family, including children, understanding what goes into food. If they understand more about that and participate and get involved in it, they will have a better understanding and knowledge of what it is all about.

How should we start to deal with the issue? I want to consider a couple of things that are happening and that might have an impact. The first is the move from a primary care trust-based model to GP commissioning consortia, and the other is the upcoming London Olympics. As we move towards GP commissioning, we need to consider the impact on the obesity service provision. Currently, providers such as MEND have suggested that decision makers in the new model will require clear information and guidance in the commissioning process for weight management programmes. They have also suggested that the commissioning process itself could be simplified and redesigned to ensure that it focuses on clear and consistent information and measured outcomes. The commissioning model will help in pulling together best practice. That is certainly the case in the Great West commissioning consortium, of which Hounslow is a part. It is already starting to focus on some of the public health issues that need to be addressed.

The 2012 London Olympics and Paralympics will soon be taking place. Those events provide us with a fantastic opportunity not only in London, but elsewhere around the country to build on the legacy that will be left. What better Olympic legacy could we have than a whole generation of children who appreciate the benefits and enjoyment that come from regular participation in sport? The Mayor of London is working hard to encourage schools in London to participate in his Get Set programme, which involves school children taking part in a host of sporting and cultural activities related to the games. A majority of my schools have signed up to that. We need to make sure that other such programmes are happening across the country and that the influence of the Olympics lasts well beyond the event itself.

As part of the obesity paper, the Government will also no doubt want to consider the approach they should take on the use of legislation in the food and drinks industry. In its recent report, “Stepping up to the plate—industry in action on public health”, the Food and Drink Federation offers its view on the progress the industry is making, particularly in the areas of reducing salt, fat and energy in popular products and in improving food labelling and marketing. There is more that the food and drink industry can do in that area—for example, having clearer labelling, so that people know exactly what they are eating.

In conclusion, nearly one in three children in the UK is overweight or obese, and much more can be done to give them a better quality of life. We need to protect the long-term health of children and avoid unnecessary short and long-term financial burdens on the NHS. There needs to be a broad integrated and co-ordinated approach across Departments. We need to raise awareness about planning permission for fast food outlets very near schools and to ensure that we share best practice and measure outcomes from all the obesity intervention programmes. We want to use the London 2012 Olympics as a starting block to encourage more young people into sport and to engage in physical activity as much as possible. We need to integrate ideas, such as encouraging schools to grow food, into the curriculum and to support and encourage parents to restrict television and do more things outdoors. We also need to encourage eateries to sell healthy options and have better labelling, so that people know what they are eating. In addition, we need to encourage more exercise. I have signed up for the Race for Life that will take place this month in Battersea, so I will be running my 5 km for charity as well as for my health.

I came into politics to help to make a difference to my constituency and the country as a whole. I feel very strongly that by improving health outcomes on childhood obesity we can definitely make a real difference to many people.

[Justin Tomlinson (North Swindon) (Con)]

I pay tribute to my hon. Friend the Member for Brentford and Isleworth (Mary Macleod) for her excellent speech. I would also like to echo the comments my hon. Friend made with regard to the MEND programme. I met a child from my constituency who had taken part in the programme and it had made a real difference. As Members of Parliament, we should be extremely supportive of the MEND programme.

I am interested in this debate for a variety of reasons. I am the vice-chair of the all-party parliamentary group on heart disease. Heart disease runs in my family and I have always had an eye on trying to be as active and as healthy as can be reasonably expected. I am also a vice-chair of the all-party parliamentary leisure group. I am a big, unashamed sports enthusiast, because sport can play an extremely important and positive role in encouraging an active and healthy lifestyle. My hon. Friend set out the picture, but I just want to concentrate on three areas that have a significant impact on child obesity levels: planning issues, food and organised sport.

On planning issues, prior to becoming the MP for North Swindon I was a councillor for 10 years. I represented a new build housing estate that had many good things and many poor things. One of the biggest challenges was the huge differences that hampered a child’s ability to run around: back gardens are now a third of the size they were in the 1960s; front gardens all too often simply do not exist, with cars literally driving right in front of the front door, and we then wonder why children do not have the opportunity to run around; and there is a lack of accessible, useable open space. I was for ever being told that the ward I represented had a huge amount of open space, but I could not see that. All I could see was concrete, and I wondered what was going on. I did a little bit of digging and it transpired that open spaces included hedges and heritage sites, neither of which are suitable for jumpers for goalposts. We do not need premier league-standard open spaces for kids to run around. When I was growing up, the bit of open space in the middle of my estate was almost vertical. That was handy, however, as some of my friends were more technically gifted than me and some of my other friends, so we had the advantage of kicking downhill all day long.

I was the lead member for leisure on Swindon borough council for four years and a lot of the focus in tackling child obesity was on organised sport through leisure centres. The most significant opportunity for children to be active, however, is through open spaces where they are unsupervised, can put down jumpers for goalposts and follow the latest TV trends. If Wimbledon is on TV, out come the tennis rackets; with the Tour de France, out come the bikes; with the Ashes, out come the cricket bats; and football, in my case, was played for the majority of the year. I welcome the fact that in my constituency the council invested £6 million, working in conjunction with the national lottery fund, in the Lydiard park facility, and that we have fantastic parks such as Coate Water and Mouldon Hill right on the doorstep. On a sunny day, and we have been blessed in the past month or so, one can see thousands of families coming out and kids being able to run around.

Another interesting observation was that on Friday, following the fantastic royal wedding, I went to visit a number of royal wedding parties where communities had reclaimed the streets as open spaces. While parents sat around toasting the happy occasion, the children ran around and were extremely active, and I was touched by that. That shows the importance of having those open, accessible community spaces.

I echo the comments my hon. Friend made about food labelling. It is essential that parents, and children themselves, can make informed decisions. I am not one of those food zealots who says that we should never eat junk food, or unhealthy food. It is all part of a balance. I charged around as a youngster and was then sometimes fuelled by food that was deemed to be not particularly healthy, but it is about striking a balance. We need to see clear, uniform food labelling. I am a big supporter of the traffic light system. We have it here in our parliamentary restaurants and that makes a difference to my choice of food. On this occasion, the EU is dragging its feet. I encourage the Government to continue to put pressure on to ensure that all retailers use a uniform and clear system. I know that they are doing so. I welcome the Government’s public health responsibility deal, which has seen retailers such as McDonald’s, Pizza Hut and KFC committed to reducing trans fats. That is the big secret killer and we need to do so much to remove trans fats, reduce salt and display calories—all coming together as part of the informed decisions.

Hon. Members have already talked about cookery skills. I am a big advocate of basic cookery skills. I would go as far as to say that it should be a compulsory element of the national curriculum. I am a big supporter of the Let’s Get Cooking campaign, which is in its fourth year of a five-year £20 million programme funded by the national lottery. It encourages schools to take up cookery. I visited Haydonleigh primary school, in my constituency, a few weeks ago. Not only were the children taking part in a cookery session, the parents and grandparents were also coming in and getting involved so that, when they went home, it was not just a one-off, two-hour cookery session, but something that would become part of their home life. Echoing the point about allotments that was raised earlier, the school had its own allotment, and was using the fruit and vegetables that were grown in the school. Wherever possible, schools should be allowed to do that full cycle. Basic cookery skills are essential for later life. It was not so long ago that I left university, where the idea of cookery for the vast majority of my colleagues involved the ping of the microwave and a three-minute wait. We certainly need to do something about that.

Finally, and probably what I am most passionate about, is organised sport. Not so many months ago, we had a debate on the school sport partnership and I was openly critical of the proposed changes. I am delighted that the Government changed their position, because where school sport partnerships work well, they can help maximise sporting opportunities. One frustration with the debate at the time was that, despite approximately £170 million a year being invested in SSP, we had not seen a massive increase in competitive sport activity. The reason for that is that children are sports-gifted, generally, because their parents have encouraged them at a young age and, by and large, whether a school is offering that sport or not, they will have joined a sports club and carried on. The SSP, however, was about the other children—those children who would otherwise just sit in front of the TV, not taking part. The advantage of the SSP was that it offered a menu of different sporting activities and there was always something for everybody to capture their imagination. I have spent many happy times touring schools and sporting groups to see what different sport captures them. A lot of people will no doubt bash television today, but television often inspires children, whether through traditional sport or through programmes such as “Pineapple Dance Studios”—suddenly, there will be huge swathes of children dancing around in a dance hall. Yes, it is not a competitive sport as such, but it is extremely active.

The SSP in my constituency saw the number of schools taking part in two hours a week rise from 33 to 68 —a fantastic result. The changes have allowed the SSPs nine months to secure continued funding from schools. Where there are good SSPs, they will be successful. Where some of the SSPs were not so good, those schools are now free to commission their own sports coaches. That is essential because there are a limited number of teachers with confidence, particularly in primary schools, to offer that wide range. A number of teachers said to me that they needed help. Another welcome Government measure that would indirectly improve the situation is fast-tracking the troops to teachers programme, because often troops are up for outdoor active lifestyles. They will be able to come in and get the kids engaged in something that is healthy and active.

I am also a fan of working with local sports groups. If children are given a taster session, they make sure that they then have an opportunity to continue. In my constituency, we set up a successful sports forum with the active involvement of about 60 different sports groups. They share best practice and help secure extra funding, but they also link in with programmes such as the SSP, going directly to the schools and saying, “Why don’t you try this and we can then get you involved?”

[Lyn Brown]

I have enjoyed the hon. Gentleman’s contribution very much. I was involved in the culture sector when I was in local government, and in the Local Government Association, and I recognise many of his arguments. Does he agree with me that the biggest problem we have, following on from our schools sports intervention, is that when children leave school there is no exit strategy for young people to enable them to continue in the sports that they played? I played badminton for my school up until the age of 16. By the age of 16 I stopped and there was no local club, or link with my school and a local club, for me to continue my activity. That is where we fall down.

[Justin Tomlinson]

I thank the hon. Lady for that useful contribution. She is right. A lot of what we are doing is putting in the building blocks for a long-term future to tackle health issues. Organisations, such as the sports forum, can talk to people of all ages and ask people to engage. Local authorities and sports groups have a role in that. One of the best things that I saw was Swindon borough council’s Challenge Swindon campaign, which brought together offices, pubs and sports groups and got them all involved in different sports. It aimed to get people to try something and then continue to do it.

We face a number of other challenges. The lack of volunteers is always a challenge, particularly in sport. A huge number of sports groups would like to be able to do something, but there are not sufficient parents with the time to be able to do that—a particular problem for organised sport.

Private finance initiative schools are another challenge: when I was a councillor, the majority of schools in my area were PFI schools. We had a high-density development and a wonderful piece of open space, but a fence and a set of high hire charges blocked children from utilising what was their school until 4 o’clock in the afternoon. Sports clubs came to me on a number of occasions saying that they simply could not afford to use the facilities, which could not be opened because there was not enough flexibility. It was a crying shame that they were left unused.

An issue that I have brought into other debates is the cost of insurance for transporting children. As we push things such as the school Olympics or outdoor active learning, insuring a teacher to take a minibus can cost more than £1,000. I have urged the Government to create a national insurance scheme for teachers and sports clubs using minibuses.

We must not forget the Olympics and the Olympics legacy, about which we had a debate in the main Chamber last week. It is all about the legacy. We will have an enjoyable Olympics, when we are bound to win some medals, but the key will be the lasting legacy. That is why I was so supportive of the principle of school sport partnerships. A big advert for a whole variety of sports that different children will have never thought of trying will be on the television, and the ones we do particularly well in will inspire children to go and re-create them. We must ensure that we do all that we can. Going back to the point about insurance, if we want the school Olympics to work, we need to be able to get children from one school to another in order to compete.

My slightly more radical proposal is to do with how leisure and youth services work in local authorities. In the old days, leisure was very much about competitive sport, with the traditional youth service organising youth activities. The two would never meet in the middle. Times have now changed massively.

I remember that on a Friday night the leisure centre would put on an ice-skating disco for the teenagers—again, not technically a sport, but 600 teenagers building up a head of steam and racing around chasing after the person they thought particularly attractive was a sporting activity. It was absolutely fantastic. Under my radical proposal, the youth service with its mobile buses would have been better off pitching up at that facility, to offer advice, advocacy and support to those who wanted it, and letting leisure be the attraction to bring people in. Likewise with the point made about the Pineapple dance studios and the street dance, often the biggest challenge is to get young girls active, but hundreds of children want to do dance and cheerleading.

Youth and leisure services should sit around the same table, pooling their funds and facilities—the leisure centres often have the better facilities—and working together. They would then be on hand. My hon. Friend mentioned the Get Set programme, and I have written to all the schools in my constituency, encouraging them to do as much as they can.

In conclusion, we need to learn three lessons. First, it is important to have balance in an active and healthy lifestyle. We can sometimes be a bit too zealous in saying, “You should not watch TV. You should not play computer games.” When I was growing up, as soon as the sun was shining, I was charging around outside. I would not have dreamed of watching TV or playing computer games. However, in the evening, that is what I did. That is a fine balance to have.

Secondly, we should allow people to make informed decisions through clear labelling and to do things for themselves. To do that, they need the skills, which is why I am such a fan of the cookery lessons.

Finally, everything should be fun. Children like fun things. Give them the open spaces—as I said, it does not matter if the open spaces are vertical, because children are creative and will come up with their own way of dealing with such things. However, let us at least give them the opportunity to have a better lifestyle.

Several hon. Members rose—