Health and Care Bill

Richard Fuller Excerpts

Report stage
Monday 22nd November 2021 Commons Chamber

[Alex Norris]

Yes, I agree. I look with real sadness at the loss of exercise-on-prescription schemes that were part of the public health grant but have gone over the last decade. Similarly, on swimming, the decisions in the Budget relating to local authorities will lead to councils, which are setting their budgets as we speak, closing more leisure centres and swimming pools. We should mourn those losses, which come as a result of a weak bit of public policy.

In the Bill, the proposed watershed with regard to high fat, sugar and salt products is broadly a good thing. With that in mind, we do not oppose Government amendments 31 to 39, which are relatively modest tweaks, but we should not lose sight of the fact that we are talking about a significant proposal; I know that colleagues have interest in this. Beyond a watershed on traditional broadcast media, we will also see a complete online ban of high fat, sugar and salt advertising. This is a blunt tool in pursuit of an important goal.

New clause 14 in the name of the hon. Member for North East Bedfordshire would implement a more nuanced system, as proposed by the advertising industry itself. This is mirrored in amendments 106 to 109 in the name of the hon. Member for Buckingham. We probed this point in Committee. I was surprised then, and remain surprised, that there seems to be little interest from Ministers or the Department in even having that conversation and exploring creative alternatives. The desired benefits are non-negotiables. If there are other ways to achieve those benefits, they ought to be approached with an open mind.

[Richard Fuller (North East Bedfordshire) (Con)]

I am grateful to the hon. Gentleman for mentioning my new clause. We have a number of issues potentially to put to a vote later. Given what he has said and given that the Minister was a bit hazy about this issue in Committee, would he be minded to support my new clause if it were put to a vote and the Minister did not come forward with something more robust?

[Alex Norris]

The hon. Gentleman tempts me, but my problem is that I want to know that the conversations have taken place and that the proposal has been considered as an option. I would not say today that I think it is the best option, but I am surprised that that conversation has not taken place, which is why I have highlighted it. There is still time for the Minister to reconsider, and he should.

I was less persuaded by amendments 3 to 5 in the name of the hon. Member for North East Bedfordshire, which seek to permit brand advertising as long as it does not refer to an HFSS product. In many cases, the brand and product are so inexorably intertwined that it might undermine the goals and aims of the whole intervention. I do, however, support amendments 6 to 8, which refer to the nutrient profiling model—the model that is used to determine what is and is not considered to be a high fat, sugar and salt product. It is important that there is certainty and that it does not move around more than the science would say that it ought to.

We talked about this issue at length in Committee. If we are asking the industry to reformulate and change, companies ought to be able to base product decisions on the certainty that the Government will not arbitrarily change the criteria. Such companies may have made significant time, financial or infrastructure investments in a certain product and then could see the criteria change overnight. In Committee, we extracted a commitment from the Minister to a Government amendment on this matter. That was reiterated in a letter on 13 November, when the Minister wrote to Committee members and committed to

“introducing a Government amendment at Commons Report Stage to include a duty to consult before changing the NPM technical guidance.”

I am surprised not to see that at this point. I hope that we will get clarity from the Minister, or indeed that he is minded to accept these amendments, because this is an important development. We also want the level playing field suggested by amendments 110 to 113, so we will be listening with great interest to his reply.

This is the wrong Bill at the wrong time. It does nothing to address the real causes of ill-health in this country today. In this part of the proceedings, colleagues have given the Minister a chance to change that and I hope he is minded to take it.

[Richard Fuller]

It is a great pleasure to follow the hon. Member for Nottingham North (Alex Norris). I will speak to new clause 14 and the other amendments in my name. I am grateful for the Opposition’s support for amendments 6, 7 and 8 and for an industry-led alternative—in spirit, if not necessarily in voting. I think the hon. Gentleman, as well as many of my hon. Friends, will be wanting to hear something from the Minister to show that he has been listening to concerns that have been raised across the House.

I was surprised and delighted to see on some of my amendments the name of the hon. Member for Central Ayrshire (Dr Whitford), but she advised me that that was an error, so I am sorry that the potential amity between me and those on the Scottish National party Benches will have to wait for another day.

[Dr Whitford]

I am grateful to the hon. Gentleman because that has saved me from having to put a disclaimer at the start of my speech, as I was rather shocked to find my name on his amendments. I just reiterate the point made by the hon. Member for Nottingham North (Alex Norris). It is a concern that the names of companies, as we saw in F1 racing and other things, simply promote certain types of food and drink and you cannot separate the brand from the product.

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[Richard Fuller]

I am grateful to the hon. Lady for making her point clear.

As the hon. Lady and other hon. Members know, my amendments relate to the ways in which the Government are seeking to restrict advertising for foods that are high in fat, sugar and salt as part of their obesity strategy. Those measures essentially ban such advertising on TV before the 9 pm watershed and ban all paid-for HFSS advertising online at any time of the day or night. My hon. Friend the Member for Buckingham (Greg Smith) has already done a very good job in drawing out some concerns about that.

What are the concerns about what the Government are doing? First, I should mention that I have a number of important food businesses based in my constituency, including Unilever and the cereal company Jordans Dorset Ryvita, and I think everyone would be surprised to hear that products such as porridge, muesli and granola are going to be subject to these bans. All these products have ingredients such as naturally occurring oils and sugars, as well as fibre, vitamins and minerals, and because of those natural ingredients they will be caught by the Government’s definition of “HFSS”.

It is also worth considering—I was not on the Committee and I do not know if it was considered at length—the impact on food services such as takeaways and home-delivered foods. Papa John’s, which is located near me in Milton Keynes, supports hundreds of entrepreneurs and small businesses through its franchise model, and it writes to warn me:

“These would restrict our ability to invest in our businesses and our people, at a time of significant economic uncertainty for the UK economy, and would also place our franchisees, many of whom are single owner small businesses, on an unsustainable financial footing.”

I think the Government have to do a few more hard yards in support of our small businesses, and this is not a very good way of showing any support for them.

[Jim Shannon]

The number of diabetics, both type 1 and type 2, across the United Kingdom and the number of children with obesity is rising. Does the hon. Gentleman feel that new clause 14 cannot address the issue of those rising numbers? If it cannot, what more needs to be done?

[Richard Fuller]

I absolutely do not agree. The reason why the Opposition Front-Bench team are probing on this is that we are not harnessing all the talents to come up with the solution. As the hon. Member for Nottingham North said, he does not have, or want, any objection to the objective—he just feels that there may be better ways to do it. That is what my amendments are trying to create. They would introduce a better way, working with established principles and with the industry—let us face it, it has the experts in this—rather than undermining issues to do with how the Advertising Standards Authority has managed how products are advertised and rather than bulldozing through the industry, which is the current process that the Government, or this Department anyway, are proposing.

Let us just remember that this pressure on our food and drink manufacturers is part of a wider effort of social responsibility that we are putting on them. The proposal does not sit alone, but with other things, in particular around environmental protection. The Food and Drink Federation has calculated that the cost of the UK Government’s proposed environmental health policies is at least £8 billion. That is equivalent to £160 a year on household food bills that we are asking the industry to take on.

It is estimated that the introduction of this policy will cost £833 million, but the Government’s own impact assessment estimates that the benefits are likely to be in the order of only £118 million. That is a real dead loss that we will be putting, let us face it, on food bills, primarily of those in lower income brackets. Members on all sides should take a moment to consider whether this is the right time and the right process for doing that. As the Government’s own assessment shows, the actual effect on diet for those who are targeted is estimated to be 1.7 calories a day, so it is a lot of effort and cost, but not very much impact.

New clause 14 proposes an alternative that would require the regulator to implement an alternative set of increased restrictions for online, but developed through the industry by the Committee of Advertising Practice. The new clause would legislate for a three-step filtering process drawn up by the industry to appropriately manage the targeting of online ad campaigns.

Another of my amendments would introduce brand exemptions. I take a different view from the hon. Member for Central Ayrshire, who said that brands are intrinsically tied to their product. The truth of the matter is that Coca Cola is made by Coke and Coke Zero is made by Coke. Coke Zero is advertised with the word “Coke” on it. This issue is not necessarily covered by the legislation, but Coke is not tied to one thing. Brands are extraordinarily flexible in how they can assist progress in achieving some social means. The Minister should consider looking again at this area.

Finally, on the nutritional profile, the issue is consultation. I can see that the Secretary of State has tabled some amendments on that, and perhaps the Minister can talk about that. They do not seem to make the changes I would like to see, but I would be interested to hear what he has to say.

It is worrying that the Government have undermined the Advertising Standards Authority with their approach. One of the other things is targeted advertising. I am sure it has struck hon. Members here as it has me that the tech revolution of the dotcom era was 20 years ago, and two decades of technical expertise in understanding how adverts are targeted is being swept away or ignored by the Department of Health and Social Care, which would much rather have “nanny knows what’s best”. The truth of the matter is that, by harnessing technology, the Government could get a better outcome than this official ban. As my hon. Friend the Member for Buckingham said, there are plenty of other ways to do it that would be hard for advertisers to get around.

I say to the Minister that I am trying to be helpful, as always, and, to be serious, as are the Opposition. The Government have made a slight misstep by adopting a top-down, state-driven model. I say to the Minister that the path of good intentions is littered with unintended consequences. The essence of conservatism is not to use the state to bully or, as perhaps the advisers in the various Departments say in modern parlance, to nudge. It amounts to one and the same thing. The Department’s attempt to censor products such as these is profoundly un-Conservative. Our party believes in individual responsibility and that families are the foundation of society where choices and power in society most naturally lie. Nowhere is that more important than in health matters, yet these proposals extend the role of the state and undermine parental responsibilities.

The measures make the Department of Health and Social Care look like a new outpost of cancel culture that denies free speech and has a predisposition that individuals should conform to what the state determines, rather than enabling informed free choice. It is desperately sad to see them being pushed through by a Conservative Administration. I say to my colleagues on the Back Benches: when will we wake up and realise that we need a Government who support free enterprise and individual responsibility, and who understand that the way to create growth in the economy is through enabling people to make free choices, rather than expecting the state to be the answer to every problem? With that question, I will wait to listen to what the Minister has to say.

[Dr Whitford]

I thank the hon. Member for North East Bedfordshire (Richard Fuller) for clarifying that I had not voluntarily added my name to his amendment.

Whenever we talk about such subjects, we hear a lot about the nanny state. As a surgeon working in A&E in general surgery, however, the difference when seatbelts, airbags and speed limits came in was night and day in how much time I spent dealing with people in operating theatres who had been involved in car crashes. Sometimes the state has to take action to protect people’s health and wellbeing.

The Bill focuses largely on reversing some of the most egregious aspects of the Health and Social Care Act 2012, which I welcome, but these measures focus on improving public health. There is no question that obesity, type 2 diabetes and other diseases associated with obesity pose not just a real threat to individual health but a threat that will overwhelm national health services in future. When I looked at the original Bill, however, I was surprised that, apart from the measures around obesity, there was little in the way of public health policy to improve and promote health, and there is also little enough about care.

It is not the national health service that delivers health. I have often said that it would be more appropriate to call it the national illness service, but who would want to work somewhere called that? The NHS spends most of its time catching people when they fall. Health comes from a decent start in life, a warm dry home, enough to eat and a decent education. Those are the things that deliver health, but there is nothing like them in the Bill.

Particularly, and surprisingly, there is nothing in the Bill on reducing harm from tobacco products and alcohol, which is why I rise to speak in support of new clauses 2 to 4, which seek to strengthen the health warnings on all tobacco products; new clauses 7 to 10, which seek to allow regulation of tobacco pricing; and particularly new clause 6, because the use of sweet flavourings to entice children and young people to take up smoking is indefensible.

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[Edward Argar]

I wondered what I was about to have bowled at me there, but my hon. Friend is absolutely right. I entirely agree that a huge amount of progress has been made; we believe that we need to go further with our proposals, but he is right to highlight that progress. He is also right to highlight the relevance of the central role of personal responsibility and the decisions that we and our families all take.

To meet the ambition of halving childhood obesity by 2030, it is imperative that we reduce children’s exposure to less healthy food and drink product advertising on TV and online. We want to ensure that the media our children engage with the most promote a healthy diet. The Bill therefore contains provisions to restrict the advertising of less healthy food and drink products on TV, in on-demand programme services and online.

[Richard Fuller]

The Minister has just mentioned seatbelts, and earlier he talked about alcohol and cigarette smoking, but this is about porridge and muesli. There is a sense that there is no end to what the Department of Health and Social Care feels is its responsibility to legislate on for what people should be able to do for themselves and their family. My point is that this is overreach by the state, as well as perhaps being the incorrect process for achieving the Government’s aims.

[Edward Argar]

I know my hon. Friend well and entirely understand the perspective that he brings, but I would argue as a counterpoint that the Bill strikes a proportionate balance, in the same vein as with seatbelts and other issues. Alongside personal choice and giving people the information to make choices, I believe that it is a proportionate and balanced approach—not the thin end of the wedge, as he might suggest, although perhaps I am characterising his words unfairly.

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[Edward Argar]

I am grateful for my hon. Friend’s confirmation that he does not intend to press his amendments to a Division, and I will ensure that his point will be heard not only in the Department of Health and Social Care but in DCMS as well.

I am grateful to my hon. Friend the Member for Carlisle (John Stevenson) for his amendments 111 to 113 and for bringing this debate before the House. I would like to reassure him that small and medium-sized enterprises—businesses with 249 employees or fewer—that pay to advertise less healthy food and drink products that they manufacture and/or sell will be exempt from the less healthy food and drink restrictions and can continue to advertise. The definition of SMEs will be provided in secondary legislation and not on the face of the Bill, which will enable Ministers to act promptly in future years if new or emerging evidence suggests that amendments are needed. We will conduct a short consultation as soon as possible on the SME definition to be included in the draft regulations. The Government want to ensure consistency with other definitions for size of business that have been used for other obesity policies, such as the out-of-home calorie labelling policy, to create a level playing field. Our preferred definition, therefore, is a standard definition used by Government across other policies.

[Richard Fuller]

On the point about an industry-led alternative, on which the Minister has kindly made some comments today, I think that this discussion will continue, particularly when the Bill is considered in the other place, so would he be prepared to meet me so that I can continue to make representations about certain improvements that could be made?

[Edward Argar]

I am certainly happy to commit that either I, as the Bill Minister, or the relevant policy Minister will meet my hon. Friend to discuss his views in this space.

Amendment 110 would ensure that advertisements placed on distributor or retailer websites are out of scope of the less healthy food and drink advertising restrictions. Again, I am grateful to my hon. Friend the Member for Carlisle for tabling the amendment, and I would seek to reassure him that the Government’s intention is to ensure that restrictions are proportionate to the scale of the problem. It is not our intention to prohibit the sale of less healthy food and drink products on the internet. Our aim is to reduce children’s exposure to advertisements of less healthy food and drink products, which is why the restrictions are being applied only to paid-for advertising online—namely, where an advertiser pays by monetary or other reciprocal means for the placement of adverts online.

We appreciate that there will be consumers who seek less healthy food and drink products, which is why this restriction applies only to paid-for advertising, and companies will be able to continue to use owned media in the same way as they do now. The restrictions will not apply to spaces online where full editorial control and ownership apply, such as a brand’s own blog, website or social media page. This means that retailers are able to continue promoting their own products on their own website, as this would not be covered by the restrictions.

I shall turn briefly to Government amendments 32, 35 and 37, tabled in the name of the Secretary of State for Health and Social Care. Amendments 32 and 35 will amend the definition of an advertisement placed on television and on-demand programme services to ensure that sponsorship credits around programmes and sponsorship announcements respectively are included for the purpose of this Bill. Members will be aware that sponsorship announcements and sponsorship credits are required so that viewers know which product is sponsoring any particular programme. Although these are not routinely considered to be advertisements in other contexts, the Government’s view is that they could reasonably be considered to be advertising less healthy food and drink products for the purposes of the Bill’s restrictions.

Amendments 32 and 35 will therefore clarify the status of those announcements, in effect to prohibit identifiable less healthy food and drink products from sponsoring programmes before the watershed, in line with the Government’s original policy aims. Amendment 37, meanwhile, will make it clear that UK businesses producing online advertisements intended to be accessed principally by audiences outside the UK fall in scope of the exemption and will not be in breach of the less healthy food and drink advertising restrictions set out in the Bill. This amendment is needed to ensure that the legislation aligns with the Government’s policy intention to exempt advertisements made to be viewed outside the UK. We are confident that the likely frontline regulator already has a clear remit and tests in place that should allow it to apply this exemption effectively.

Health and Care Bill

Richard Fuller Excerpts

Report stage
Tuesday 23rd November 2021 Commons Chamber

[Edward Argar]

My right hon. Friend is perspicacious in his prediction of where I was about to go. I was about to turn to amendment 10 tabled by my right hon. Friend the Member for South West Surrey and new clause 28 tabled by the shadow Minister, which go to the heart of what my right hon. Friend is talking about.

I hope the shadow Minister will agree that amendment 10 and new clause 28 are, essentially, broadly unified in their intention and therefore I hope that he will allow me to take them both together. They require the Government to publish independently verified assessments of current and future workforce numbers for the needs of the health, social care and public health services in England.

There has rightly been much discussion on workforce planning for the NHS and adult social care. That reflects the deep debt of gratitude that the country owes the staff and also, as I said, their absolute indispensability in delivering on all our aspirations for healthcare and social care in this country and for our constituents’ care.

As part of our commitment to improving workforce planning, my Department is already doing substantial work to ensure that we recover from the pandemic and support care. We have already committed to publishing, in the coming weeks, a plan for elective recovery and to introducing further reforms to improve recruitment and support for our social care workforce, with further detail set out in an upcoming social care White Paper. We are also developing a comprehensive national plan for supporting and enabling integration between health, social care and other services, which support people’s health and wellbeing.

Let me turn to that framework, to which my right hon. Friend the Member for Epsom and Ewell (Chris Grayling) was alluding, for a longer-term perspective. The Department has already commissioned Health Education England to work with partners to develop a robust, long-term 15-year strategic framework for the health and social care workforce, which, for the first time, will include regulated professionals in adult social care. That work was commissioned in July by my hon. Friend the Member for Faversham and Mid Kent (Helen Whately) when she was in post in the Department. That work will look at the key drivers of workforce demand and supply over the longer term and will set out how they impact on the required shape and numbers of the future workforce to help identify those main strategic choices, and we anticipate publication in spring of next year.

It is vital that the workforce planning is closely integrated to the wider planning across health and social care and, as such, Health Education England, which has established relationships with the health and care system at a local, regional and national level, is best placed to develop such a strategy. Crucially, following the announcement yesterday of HEE merging with NHS England in improvement, we will, for the first time, bring together those responsible for planning services, for delivering services on the ground, and for delivering on the workforce needs of those services so that we can have a more integrated approach to delivering on that framework.

[Richard Fuller (North East Bedfordshire) (Con)]

I am grateful to the Minister for giving way. There is much to commend in the amendment of my right hon. Friend the Member for South West Surrey (Jeremy Hunt) and in what the Minister is saying. One thing that is not obvious in either, though, is the focus on labour costs and productivity. For example, how is technology going to reduce labour costs in the delivery of the same quality or higher quality of service? What is the possibility of creating new care pathways, which require less qualified staff to deliver as good or better service? What is going on in terms of reducing the proportion of non-clinical staff by the adoption of technology and other means in healthcare? Perhaps the Minister could address that. I am sure that my right hon. Friend will be doing so later, too.

[Edward Argar]

My hon. Friend is absolutely right. We see huge opportunities, almost every day, from new technology and new ways of using that technology to deliver more efficient and shorter turnaround times—for tests and diagnostics, for example. He is also right to talk about the need constantly to examine care pathways, and, where opportunities exist, to use highly qualified healthcare professionals but to look carefully at the most appropriate level at which a treatment or test can be carried out; historically, we may have used healthcare professionals for particular tasks for which they were almost over-qualified. It is right that care pathways are informed by clinical and scientific expertise and judgment, but that we continue to review how new technology, new ways of working and new care pathways can improve the productivity of our amazing workforce.

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[Justin Madders]

My hon. Friend is correct; we could not have anticipated what has happened in the past 12 to 18 months, but we can see what it means moving forward. Regular reviews of demand are critical, and we know that training these highly qualified and skilled staff takes time, which is why a longer-term view and approach are required.

[Richard Fuller]

I want to pick up on the increasing demand for mental health services. Does the hon. Gentleman accept that in general, it is utterly impossible to meet the expectation of increasing demand for health services without vast improvements in the efficiency with which people working in the health and care sector deliver that service? Is it not a shortcoming of both the Government and the Opposition that there is not an intense focus on solving that problem of labour cost productivity? Without that, we will not be able to meet current needs and we certainly will not meet future needs.

[Justin Madders]

We are always looking at ways to improve productivity, but we know that on the current figures there are 100,000 staff vacancies in the NHS. No amount of productivity gains will cover for that.