Privilege

Debate between Sarah Wollaston and Geraint Davies

Thursday 7th June 2018 Commons Chamber

[Dr Sarah Wollaston (Totnes) (Con)]

I put on record my thanks to all those who appear as witnesses before our Select Committees. Many of them do so knowing that they will face a considerable level of challenge, but they come prepared to put their case, on the public record. They do so because they know that to refuse to appear shows contempt not only for this House but, more importantly, for the public, because Select Committees carry out their work on the public’s behalf, and in almost every case the House delegates to us the ability to call for persons, papers and records. That is an extraordinarily important role that we have on behalf of the public.

I join my hon. Friend in condemning the action of Dominic Cummings and the way that he has behaved. It is a disgrace, frankly, and we should call it out. I also think that we need to reflect on what we now do when individuals refuse to appear. I agree with the right hon. Member for Leeds Central (Hilary Benn) that it is time now to take action. I speak in a personal capacity, because there is a difference of opinion over the pros and cons of taking this matter forward. I welcome the further inquiry of the Privileges Committee. There is a difference of opinion on the pitfalls of involving the courts, but, ultimately, the experience of other jurisdictions such as New Zealand and Australia, which have that final backstop, is that they have not had to use it. There is a case for saying that, where we do not have a final backstop, we will increasingly see examples of witnesses like Mr Cummings refusing to answer to the British people and to Parliament.

[Geraint Davies (Swansea West) (Lab/Co-op)]

Does the hon. Lady also agree that if witnesses feel that they are not obliged or compelled to appear before a Select Committee, they could be bribed or intimidated into not attending? Someone might have an interest in a witnesses not attending, and bribe them or intimidate them.

[Dr Wollaston]

There is a danger that people will increasingly come under pressure to make the judgment that, by not appearing at all, the reputational damage will be less, so the hon. Gentleman makes a very important point. However, we have now come to a point where having the final backstop of a penalty—

NHS and Social Care Commission

Debate between Sarah Wollaston and Geraint Davies

Thursday 28th January 2016 Commons Chamber

[Dr Wollaston]

I agree with my right hon. Friend. However, in parallel with the process of looking at long-term funding arrangements and settlements, we must get on—here and now—with changes that are needed in the short term. I want to touch on a few such areas.

The first area is prevention. I absolutely agree with the right hon. Member for North Norfolk that it is bad practice to cut money from public health, simply because of the challenges we face. If we look at the NHS budget, we can see that 70% of it goes on helping those living with long-term conditions. We know that many future problems are brewing here and now.

Let us just take childhood obesity, which we discussed at length last week. A quarter of the most disadvantaged children now leave primary school not just overweight, but actually obese. Given the problems that that is saving up, in the personal cost to those children and the wider costs to the NHS—nearly 10% of the entire NHS budget already goes towards treating type 2 diabetes—how can we not be grasping that nettle as a matter of urgent prevention to save money for the whole system?

[Geraint Davies]

Does the hon. Lady agree that there is an inter-relationship between child poverty and obesity, and indeed between child poverty and other health problems that generate costs, and is not part of the solution to the dilemma of how to meet the costs of health and social care to look again at such demographic drivers?

[Dr Wollaston]

Indeed. The data from Public Heath England are absolutely stark: from looking at the index of multiple deprivation and the incidence of childhood obesity, we can see that not only is there a large gap, but that that gap is widening. As part of the strategy, the Government must aim not only to lower overall levels of childhood obesity, but to narrow that gap, particularly by looking at measures that will help to do so. I thank the hon. Gentleman for making that point.

The right hon. Member for North Norfolk referred to the need for self-care, and we know that we need a much greater focus on how we can support people to improve their own health. If we are going to raise money for the whole health and care system, there are mechanisms to do so that will also help to prevent ill health in the future. One example is a sugary drinks tax, which could lever money into a very straitened public health budget to put in place measures that we know will help. We need the NHS to get on with prevention, and in my view we need more of the funding that is available to go into saving money for the future.

--- Later in debate ---

[Dr Wollaston]

If that were the case, it would be a problem. I think that the two things could happen in parallel. We could work towards a consensus about future funding at the same time as focusing relentlessly on what needs to be done in the here and now. However, I agree that if it were a distraction, it would be a problem.

As well as continuing to have a relentless focus on tackling variation, we need to follow the evidence in healthcare. When money is stretched, we must be sure not only that we spend it in a way that follows the evidence, but that we do not waste money in the system. I caution the Minister on the issue of seven-day services, which we have discussed at the Health Committee. If there is evidence that GP surgeries are empty on a Sunday afternoon because there is no demand, and in parallel with that we are being told that out-of-hours services are in danger of collapse because, in a financially stretched system, there are not the resources or manpower to offer both, we must be led by the evidence and be prepared to change what we are doing.

When money is tight, we owe it to our patients to focus on the things that really will improve their care. There must be no delay in making changes when we know that something that has been put in place with the best possible intentions may be having unintended consequences. We must be clear that we will follow the evidence on best practice and value for money, so that patients get the best outcomes in a financially stretched system.

[Geraint Davies]

The Government have decided to make Saturday a working day in a regime where a couple who are both doctors can be sent, without a choice, to different parts of the country to practise in hospitals and only have family time together at weekends. Now that Saturday will be a working day, their situation will be virtually impossible. Does the hon. Lady agree that that needs to be considered in case it causes a further leakage of doctors and, therefore, less efficiency in the system?

[Dr Wollaston]

I have to declare a personal interest here, because one reason why my daughter, who is a junior doctor, has spent a year in Australia is that there are sometimes difficulties with married couples—or, indeed, people in any relationship—being able to work in the same part of the country. There is far more that could be done to help junior doctors, in addition to the contract negotiation about money. However, as I have a personal interest, it is probably best if I do not comment further on that.

I want to draw attention to the role of the voluntary sector, which the right hon. Member for North Norfolk referred to. I pay tribute to the voluntary sector partners in my constituency—bodies such as Dartmouth Caring and Brixham Does Care. Across the constituency, a number of organisations are making a real difference to people’s lives, yet very many voluntary sector organisations are coming under extreme pressure. I could give examples of voluntary sector partners that have had to close, sometimes for the want of very small amounts of money, even though they have delivered enormous value. These are locally-facing organisations.

It was welcome that Simon Stevens gave a commitment to look at making the arrangements for commissioning voluntary sector partners easier. Even though those commissioning arrangements may have been made easier, often the resources are not there to fund such organisations. We need to look again at how we can deliver best value for patients by supporting voluntary sector partners across all our constituencies.

Those are the areas that I want the Minister to focus on in the here and now, but I agree that in the long term, we must look at funding. One challenge in this country—and I think it is a wonderful thing—is that almost all the funding for the health service comes directly from taxation or national insurance. We are almost unique in that. Only two other countries exceed us in that regard. Government funding for the NHS accounts for 7.3% of GDP and only an additional 1.5% is levered in from the private sector.

The choice before us is whether to expand the amount that we raise through charging and top-ups. Personally, I do not support that. The Barker commission did not support it either. Top-ups and charging do not raise as much as people imagine by the time the bureaucracy involved in collecting the money and the unintended consequences that are often found, such as widening health inequalities, are accounted for. I hope that we do not choose to go down that route. The most equitable funding mechanism is taxation.

There is an issue of intergenerational fairness here, as the right hon. Member for North Norfolk said, and we need to consider it. These are hard political choices, which can no longer be ducked. Given the demographic challenge and the challenge of complexity that we face, the alternatives are appalling. The alternatives are to abandon our older people. The pressures that our hospitals face from those who cannot be discharged into the community and those in the community who cannot get into hospital are mounting. We can ignore them no longer.

I call on the Government to consider very carefully working with our Opposition partners at scale and at pace to bring forward an agreement on how we will bring more money into the system as a whole, and in the meantime, to make sure that the money we do spend is spent in the best interests of patients.

Childhood Obesity Strategy

Debate between Sarah Wollaston and Geraint Davies

Thursday 21st January 2016 Commons Chamber

[Dr Sarah Wollaston (Totnes) (Con)]

I beg to move,

That this House calls on the Government to bring forward a bold and effective strategy to tackle childhood obesity.

I want to thank the Backbench Business Committee for granting time for this debate. I also want to thank all my colleagues from across the House who are members of the Health Select Committee—and the staff of the Committee, particularly Laura Daniels—for their work on the report on childhood obesity that was published recently. Outside this House, there are also many organisations and individuals who have campaigned tirelessly to improve children’s health.

Perhaps we can start by looking at the example of Team GB and their success in the Olympics. On the morning of their track cycling victory, the architect of the team’s success, Sir David Brailsford, put their success down to the principle of marginal gains and their relentless pursuit of identifying every efficiency in the rider, the bike, the environment around them and their training regime. All those marginal gains were added together to win gold for Team GB in the Olympics. I think we need to adopt the same principle when it comes to tackling childhood obesity.

Too often, I hear people saying that it is all about education, or about getting children to move more in PE at school, but I would say that there is no single measure. We all know that this is an extremely complex problem that requires action at every level. I therefore call on the Minister to look at every single aspect of tackling childhood obesity. If we were running a cycling team hoping to win the Olympics, we would realise that we could not achieve success if we left any of the factors out, so let us apply that principle here.

Let me set the scene by telling the House why this subject matters so much. We know from the child measurement programme in our schools that around one in five of our children who enter reception class are either obese or overweight. However, by the time they leave in year 6, a third of our children are either obese or overweight. Perhaps even more worrying are the stark data on the health inequality of obesity. A quarter of the children from the most disadvantaged groups in our society are leaving school not just overweight but obese, which is now more than twice the rate among children from the most advantaged families. My first question for the Minister is this: will the childhood obesity strategy not only tackle the overall levels of obesity but seek to narrow that yawning and growing gap in our society between the least and most advantaged children? Any strategy that fails to narrow that gap will have failed our children.

[Geraint Davies (Swansea West) (Lab/Co-op)]

Does the hon. Lady agree that some of the overall problem can be explained by the fact that people do not know how much sugar is in their food? She will know that women are supposed to have no more than six spoonfuls a day, and men no more than nine. Only today, when I was in Portcullis House, I bought three items: a Snickers bar, which has five spoonfuls of sugar; a yoghurt with seven spoonfuls; and a Coke with nine. She will be glad to hear that I did not eat any of them; perhaps I was just removing them from other people. Does she agree that an awareness of how much sugar we are eating is very important if we are to manage our diets?

[Dr Wollaston]

Indeed. I completely agree with the hon. Gentleman, and I shall come on to that subject later. I am relieved to hear that he is not on a sugar high for the debate.

I want to set out not only the scale of the problem but its consequences. It has consequences for the whole lifetime of our children, in relation to their physical and emotional health. They also suffer the impact of bullying at school, as they are too often stigmatised in the classroom because of their weight. There is increasing evidence that obesity is a factor in causing many preventable cancers, and it also has an impact on conditions such as diabetes and heart disease. This has a cost not only to individuals but to wider society and to the NHS.

The Minister will know how essential it is that, as part of the “Five Year Forward View”, we tackle the issue of prevention. We cannot do that without tackling obesity, particularly among children, given the lifetime impact and consequences of the condition. She will know that 9p in every £1 we spend in the NHS is spent on diabetes. We estimate from the evidence that the Health Committee took during our hearings that the overall cost of obesity to the NHS is now £5.1 billion a year, and the wider costs to society have been estimated to be as high as £27 billion, although the estimates vary. We simply cannot afford to take no action.

Physical activity is of course extraordinarily important and I am confident that it will feature strongly in the Government’s strategy, but it is no good focusing solely on that. Physical activity is good for children, whatever their weight. Indeed, it is good for all of us, whatever our age. However, any strategy that assumes that we can tackle childhood obesity solely through physical activity will simply be ignoring the overwhelming evidence that most of the gain will be in reducing calories. That is not just about sugar, however. It is easy to be accused of demonising sugar. The fact is that children have more than three times the recommended amount of sugar in their diet, but that is perhaps the easiest aspect of the problem to tackle. The Minister will recognise the fact that we are talking about overall calories, which also include fats.

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[Dr Wollaston]

I thank my hon. Friend and fellow member of the Health Committee for her intervention. At a time of shrinking public health budgets, there is a huge additional benefit from having this kind of levy, in that many of the other measures that the Minister will want to see in the strategy—on exercise in schools, teaching in cookery lessons and health education—could be funded in part through a sugary drinks tax. I hope she will look carefully at this idea and consider introducing it.

[Geraint Davies]

rose—

[Geraint Davies]

The debate is often between reformulation and tax. I agree with the tax on fizzy drinks, but if we had a tax on overall sugar input—for the sake of argument, let us suppose that sugar makes up half a Hobnob and the tax is at 10%—that would give an incentive to the manufacturers to reformulate without the price going up and we could get the sugar content down.

[Dr Wollaston]

I thank the hon. Gentleman for that, which brings me on to reformulation. It should also form a core part of the strategy. Our view was that we should have a centrally led programme of reformulation across foods and drinks, and that what manufacturers want is a level playing field. The trouble with reformulation is that it takes time; there has been an effective programme on salt, but that has happened very gradually, over a 10-year period. There is no reason why these things should be mutually exclusive; I come back to that point about marginal gains and say let us do all of the above. I know that the Minister is looking closely at reformulation and understands how powerful it will be. The evidence we heard was that it could take 6% of the sugar out of children’s diets. Reformulation, alongside other programmes, will play a part, but it will not work on its own and, unfortunately, it will take longer.

We also need to examine the pervasive effect of marketing and promotion. Do I want to have a kilogram of chocolate for almost nothing when I buy my newspaper? Of course I do, but please do not offer it to me. Please do not make me walk past the chicanes of sugar at the checkout or when I am queuing to pay for petrol. We know that 37% of all the confectionary we buy is bought on impulse. It does not matter how much we are intending not to buy it, if it is presented to us on impulse, we buy it, as impulse is an extraordinarily powerful driver. I therefore hope that any strategy will tackle that part of consumption, along with portion sizing. The supersizing of our society is in part down to the supersizing of portions and offers. All of this needs to be included in our approach, as does dealing with advertising. This advertising is pervasive and it is hitting our children everywhere they go, on television, online and through the influence of “advergames”. We know that this is very powerful in driving choices for children, so I hope the Minister will look carefully at that. She will have seen our recommendation of a watershed of 9 pm.

Time is running short, so I shall close my remarks, as I know other Members will want to cover many other aspects, such as exercise, the effect of what local authorities do, how much more powerful they could be in their roles if we gave them greater planning powers, and so on. Early intervention, research, education, teaspoon labelling—please do it all. We need a bold, brave and effective strategy, and we need to learn from British cycling and the law of marginal gains.

Sugary Drinks Tax

Debate between Sarah Wollaston and Geraint Davies

Monday 30th November 2015 Westminster Hall

[Dr Wollaston]

Yes. As I pointed out, we could end up inadvertently widening health inequalities. The hon. Lady is absolutely right that a tax would send a clear message—right in front of people, on the shelf—that certain products are cheaper because they are not as harmful. That is the clear beauty of it.

I ask Members to consider what could be achieved with such a levy. If it might raise between £300 million and even £1 billion a year, the possibilities are extraordinary in terms of what we could do to improve the health and wellbeing of the nation’s children. We should not miss that opportunity. I hope that the Government will accept all the points and concerns raised by hon. Members and reconsider their policy, giving serious consideration to how much could be achieved for the benefit of our nation’s children and their health.

[Geraint Davies]

I support a sugar tax. In Mexico, the average person has half a litre of Coke every day. Did the hon. Lady consider the possibility of a tax on sugar as an input into other products? After all, if I was making Hobnobs and the tax was at 10%, and 50% of a Hobnob was sugar, I would only have to make a slight change to the price, the formulation, or the number of biscuits. Would it not be better instead to have a tax on all sugar inputs, to give the right incentives to both consumers and producers?

[Dr Wollaston]

I thank the hon. Gentleman for his intervention, but the point is that we wanted to respond to the issue about whether a sugar tax is regressive. It is much more challenging to use a direct replacement for the sugar, which would mean zero sugar for those kinds of products. That was partly why we took that view.

However, the approach that we recommend for the kind of products that the hon. Gentleman has mentioned is one of reformulation. During the last decade, there has been a successful programme of reformulating salt within our processed foods, but such a change takes time, because we have to adjust the nation’s palate gradually. Yes, we can make bigger step changes if we replace part of the sugar in one go, but there is sometimes something about the chemistry of sugar within cookery that means a sugar substitute does not do the same job. We wanted a tax where a sugar substitute did the same job as sugar, in effect.

I am confident that reformulation will be part of the Government’s response, because there is clear evidence that it works. Having said that, we know that it works better when there is some teeth to it, so I urge the Minister to go further than the responsibility deal and have something with real teeth. Things worked better when we had the Food Standards Agency and a bit of a stick in the background to make such changes happen, and industry wants a level playing field.

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[Dr Wollaston]

I am sure that will be part of it, but as I have said, I am not here to beat industry over the head. I want to bring industry with us. I celebrate what it has done, but it needs to go further. What we heard on our Committee was that industry needs a level playing field, and that a bit of regulation helps, because then everybody goes together. For example, take the chicanes of sugar that we have at checkout aisles, and the fact that we are being flogged a kilogram of chocolate when we go to buy a newspaper. With those types of things, we need a level playing field, so that we do not have any industry going down that route.

My view is not that we should not have discount promotions; we need those discounts and promotions to happen for healthier foods. The argument is often made that we will hit people in their wallets if we take these promotions away, but what we want is for people to be able to afford healthier, quality food. I would love that type of food to be the focus of deep discounting and promotions.

We then come on to the issue of clearer labelling. Jamie Oliver, in his presentation to us, made a compelling case about labelling. Let us put the number of teaspoons of sugar on drinks. This morning, I was trying to look at drinks labels, and I found them confusing. We need clear information that says whether the product contains 12, 13, or six teaspoons of sugar. To answer the point that my right hon. Friend the Member for Cities of London and Westminster (Mark Field) made about industry, it helps industry if people can clearly see that companies have made an effort to make a lower-sugar product. Let us allow that within clear labelling.

Let me come on to improved education. I would love to see more education about food in school, including proper cookery lessons, and for schools to have the resources to be able to do so much more in that regard. That is where I see one of the benefits of this levy going; it could go to support those kinds of lessons, not only in schools but in the wider community, and school sport. All those things are important. If we are to have school food standards, they should apply to all schools. Do we not care about every child in school?

[Geraint Davies]

The hon. Lady will know that I put forward a sugar Bill supporting sugar being denominated in spoonfuls. Does she accept that if there were two pasta sauces that were clearly labelled—one with six teaspoonfuls and one with three—there would clearly be an incentive for consumers to pick the lower-sugar one and that manufacturers would compete to get sugar content down, rather than up, in order to get people to buy their products?

[Dr Wollaston]

I completely agree with the hon. Gentleman. We have seen that where companies want products to be marketed as “healthier”, there is an incentive for them to reformulate, although we need honesty about that; sometimes, products can be marketed as “healthy” because they are low-fat, when they are packed full of sugar. We need to be clear about that.

Also, look at advertising: some products are allowed to be marketed to children, including breakfast cereals whose contents are 22.5% sugar; that was the rather shocking evidence that we heard. We need clearer guidance as to what constitutes a “healthy” product.

On that point about advertising, we felt that there was a clear case to have the watershed of 9 pm apply, so that we do not see junk food being marketed to children when they are watching very popular programmes. We were also very concerned about the pervasive nature of advergames on the internet: children think they are playing a game but, in fact, the games are the product of marketing companies, and the children are being sold particular items.

We are absolutely clear that all these things are very important and, as I said at the beginning, there is no one single piece of the jigsaw that will complete the picture. Indeed, the more pieces of the jigsaw that are put in place, the more effective a strategy there will be around childhood obesity.

I return to the point I made at the start: this issue matters and we cannot continue as we are. Also, although we did not go into this in great depth in our report, I urge the Minister to consider what interventions can be put in place for those children who are already affected by obesity. We were very supportive of the child measurement programme, but we were told by local authorities that funds are tight. As for extending the programme to bring in children from earlier years and pick them up before they get to primary school and run into difficulties, authorities do not have the resources to both put in place another year of monitoring and do what we need to in order to help those children who are already affected by obesity. Resources matter. I again urge the Minister, when she discusses this issue with colleagues, to consider what we can achieve, because we should not take the view that that nothing can be done about childhood obesity. We can do extraordinary good for the health of our children, and I really hope that when the Government bring forward their obesity strategy, they will be bold and brave, and recognise the urgency of this health emergency.