Health: Breast Cancer

Baroness Thornton Excerpts

Monday 3rd October 2011 Lords Chamber

[Earl Howe]

My noble friend makes an extremely important point. That is why we need a body such as NICE, the National Institute for Health and Clinical Excellence, to advise the health service on what treatments represent cost-effective value for money. The tendency of drugs to impose considerable cost on the NHS is very great, as he points out. It is important that clinicians focus on those drugs that really do the best for patients. I am aware that a number of drugs are currently being assessed by NICE with regard to breast cancer.

[Baroness Thornton]

My Lords, I apologise for my conference throat—it is all the cheering I did last week. The Government published a strategy for cancer in January 2011 and set a target of improving cancer survival rates, so that by 2014-15 an extra 5,000 lives will be saved each year. What progress has been made towards meeting the target that was expressed in Improving Outcomes: A Strategy for Cancer and saving those extra 5,000 lives a year?

[Earl Howe]

My Lords, there are broadly three ways in which we can attain that target. The main way is through early diagnosis—in particular, by making sure that women are aware of the signs and symptoms that could indicate breast cancer—but also by improving access to screening and to radiotherapy, which has already been covered in the question from the noble Baroness, Lady Morgan. To support the NHS to achieve earlier diagnosis of cancer, the strategy has been backed by over £450 million over the next four years. That is part of over £750 million additional funding for cancer over the spending review period.

NHS Future Forum

Baroness Thornton Excerpts

Thursday 15th September 2011 Lords Chamber

[Baroness Thornton]

My Lords, I am very pleased that my noble friend Lady Wheeler has put this Motion before the House today. The timing is perfect: we are within a few weeks of the long awaited Second Reading of the Health and Social Care Bill; and we are within a few days of the party conferences, at at least two of which, my own and that of the Liberal Democrats, the threats to and future of the NHS will be near the top of the agenda for our members. What happens at the Conservative Party conference is probably as much of a mystery to the Minister as to the rest of us. However, we do know from announcements made by the Prime Minister from one of his holidays this summer that he thinks that it is “job done” as a result of the work of the Future Forum, and that the Government's proposals now have widespread support from staff and patients. I could not help but wonder at what point the Prime Minister made this announcement and what particular beverage he might have been enjoying at the time.

However, as I said in your Lordships' House when the Future Forum was established, as well as when it reported, it is a political fix by the Prime Minister and his Liberal Democrat deputy. One of them had realised that his Secretary of State was not a safe pair of hands and had succeeded in uniting the whole medical profession—patients and patient groups—against his proposals; the other had just had a disastrous set of election results, lost a referendum and received a good kicking from his members at the Liberal Democrat spring conference in March. The noble Baroness, Lady Williams, described the reforms at that time as privatisation by stealth and said that they amounted to a plan to dismantle one of the most efficient public services of any in Europe.

Of course, I do not hold the Future Forum responsible for its genesis. I accept that all its members have acted in good faith and worked hard in the service of the public. I also accept that they did broadly a good job within their remit. However, it has to be said that the whole of this Bill is topsy-turvy. Instead of consultation, pre-legislative scrutiny and a draft Bill, and a legislative process followed by implementation, we have implementation speeding ahead and an initial consultation on a White Paper whose responses, it has to be said, were largely ignored by the Secretary of State when they did not accord with his plans. Indeed, that evidence included a large number of “buts” and raised many issues. Many organisations thought that the White Paper contained some very risky proposals.

Then a Bill arrived without the evidence base that the noble Earl has always said should be present before legislating. There has been no pre-legislative scrutiny. Frankly, if ever a Bill would have benefited from a Joint Committee of both Houses, this is it.

Then, halfway through its Commons stages, there was an unprecedented pause and a listening exercise, which should have taken place at the outset. We have the Future Forum. This body, which has made many recommendations about amendments to the Bill, has no authority other than being appointed by the Prime Minister. The people making recommendations and active in public life on a much smaller scale than this, with much less responsibility than the Future Forum, are subject, as are all of who have been governors of schools, to completing a register of interests. None of the Future Forum has done so. That is not a satisfactory or businesslike way to proceed with creating public policy and taking it forward into legislation.

Yesterday, I wrote to the noble Earl about Future Forum mark 2 and what influence its deliberations might have on the progress of the Health and Social Care Bill in your Lordships' House. I look forward to an answer to that. I have asked whether we will have a pause and whether we will be seeing amendments resulting from the Future Forum's deliberations.

I now turn to what the Future Forum has already said and I will use the Liberal Democrat’s aspirations for the Future Forum and what it should bring into the Bill as my guide. We know that the Prime Minister thinks that the Future Forum has done the trick, but what of his deputy, Mr Clegg? Mr Clegg had 13 red lines. On this side of the House, we believe that seven of those have failed and six have fallen short, as my noble friend Lady Wheeler has said. I think that his score card stands at C plus, but my noble friends behind me think that that is probably too generous.

I am grateful to my noble friend Lady Wheeler for reminding the House that our duty in this House is to the NHS and the nation. It is our duty not to suspend our critical faculties when we look at the Bill. We believed that this was a deeply flawed Bill from the outset, but at least it was coherent. We now think that it is immensely more complex and bureaucratic. Ultimately, it will be more expensive for the taxpayer. That was mentioned by my noble friends in different ways.

Much has been said already about the Secretary of State’s powers in the Bill. I suspect that that issue will test the House’s powers of understanding and literacy, as my noble friend said. I also suspect that some of our lawyers will probably engage with it as well, so I will not refer to that in my remarks today. I want to look at some of the other issues that the Future Forum has tackled.

On more democratically accountable commissioning, we have to say that that has failed. The relevant clauses of the Bill do not yet contain elected members or councillors on commissioning consortia, while health and well-being boards are able only to give their opinions to consortia. Consortia are under no obligation to abide by that opinion. The call for a much greater degree of coterminosity between local authorities and commissioning areas was mentioned by my noble friend Lady Pitkeathley. Practice lists do not bear any relation to local authority boundaries, by and large, so they are not a reliable solution to this problem.

A call for no decision about the spending of NHS funds to be made in private and without proper consultation, as can take place by the proposed consortia, has failed. As my noble friends have said, consortia will not be as transparent as PCTs currently are because they do not have to abide by the Nolan principles on public life and the public meetings legislation. It is left up to them to decide what business to conduct in private and not in public. That is unsatisfactory and we are talking about billions of pounds of public spending. We have failed there.

Then there was the call for the complete ruling out of any competition based on price to prevent loss-leading corporate providers undercutting NHS tariffs and to ensure that healthcare providers compete on the quality of care. There is no doubt that something has been achieved here. However, there will continue to be a number of NHS services not covered by the tariff with greater competition from private providers. That means that price competition for those services has not been ruled out. So that has failed.

We need to turn to cherry picking, which could destabilise and undermine existing NHS services relied on for emergencies and complex cases. We have failed completely on that point. The Government’s amendments addressing cherry picking require only that a provider be transparent in how it chooses its patients. It says nothing about preventing providers picking the easiest and most profitable patients. Furthermore, picking patents is only one part of cherry picking. Private providers will also be able to pick the easiest and most profitable types of treatment to provide—elective surgery, for example—while leaving the NHS to do the expensive loss-making treatments such as emergency inpatient care. Nothing in the government amendments prevents that and therefore risks destabilising those NHS services.

There was a call for government commissioning to be in full compliance with the Human Rights Act and freedom of information laws. The Liberal Democrats were particularly concerned that freedom of information should be extended throughout the Bill. That has not happened. It is an important priority for our discussions when we look at the Bill. Billions of pounds’ worth of public money and millions of people's treatment are at stake.

We also had a call for ensuring that health and well-being boards are a strong voice for accountable local people in setting the strategic direction for co-ordinating the provision of health and social care services. There is a failure there. Consortia are under absolutely no obligation to abide by the views of health and well-being boards. So we go on. I will leave the failure regime, which was introduced at such a late stage, for our attention in a few weeks’ time.

I am so pleased that there are Members in both Houses of all parties and across this House who are turning their attention to the actuality of the Bill and its applicability. I highly commend the noble Baroness, Lady Williams, and other Liberal Democrat Members—noble, honourable and plain activist—who have not swallowed the line that now all is well with the Health and Social Care Bill. I know how difficult it can be to find yourself at odds with your leadership, your party and your own Government. I have been there many times over the past 30 years. But in this case, our first duty is to the NHS, its patients and those who work in the NHS. We must proceed by not looking at theoretical structures and esoteric arguments. We must look outside the Chamber and hear the clinicians and patient groups and let them be the guide to what happens to the NHS in the future.

NHS: Cost-effectiveness

Baroness Thornton Excerpts

Monday 12th September 2011 Lords Chamber

Asked By

[Baroness Thornton]

To ask Her Majesty’s Government whether the Department of Health will draw attention to the recent report in the Journal of the Royal Society of Medicine on the cost-effectiveness of the National Health Service.

[The Parliamentary Under-Secretary of State, Department of Health (Earl Howe)]

My Lords, the department welcomes the report to which the noble Baroness refers, and recognises the significant gains in health achieved by the National Health Service since 1979. However, its evidence is limited and does not support broad generalisations on NHS cost-effectiveness. The NHS can still make major improvements to the health of the nation and must continue to respond to pressures from an ageing population, new technology and rising patient expectations.

[Baroness Thornton]

My Lords, I thank the Minister for that Answer. The Government seek to justify the hugely risky reforms of the NHS by saying that our NHS is not fit for purpose in a variety of ways, including not being cost-effective. We all know that improvements can be made—there is no doubt about that at all—but how does the Minister reconcile that with yet another authoritative report in the Royal Society of Medicine journal which says, among other things, that in terms of cost-effectiveness—that is, economic input versus clinical output—the UK NHS is one of the most cost-effective in the world, particularly in reducing mortality rates, and that among other systems, the US healthcare system is one of the least cost-effective?

[Earl Howe]

My Lords, I must point out one thing about this report: it does not make any claims for how cost-effective our health system was at any given point in time. What it does is measure the improvement in mortality over a period and then assess the cost-effectiveness of that improvement, which is a very different thing. Yes, the NHS has made great strides in improving mortality rates, but that is the only metric that the report deals with. It completely ignores other measures of quality. It is also completely silent about anything that happened after 2005, so recent years are not covered.

Smoking

Baroness Thornton Excerpts

Thursday 8th September 2011 Lords Chamber

[Earl Howe]

The noble Baroness is right. We believe that the Government’s commitment around the introduction of tobacco display legislation strikes the right balance. We have amended the implementation dates. Displays will come to an end in large shops on 6 April next year, and in small shops on 6 April 2015.

[Baroness Thornton]

My Lords, my Government and this Government should be proud that today there are more than 2.5 million fewer smokers in England than there were in 1998. The noble Lord, Lord Ribeiro, points to the challenge of how to make certain behaviours unacceptable. Does the Minister believe that the Government’s nudge policy will work here? Will the Government invest in a public information campaign aimed at substantially and permanently changing public behaviour in this respect?

[Earl Howe]

My Lords, we are going to publish a tobacco marketing plan later this year which will lay out precisely what we propose to do at a local level. It is our intention to support local efforts to raise awareness and use the insights that we know about from behavioural science to influence positive changes in behaviour, including around the social norms of not smoking when children are present. Voluntary local initiatives are already working. There is a very good example of that in Lincolnshire at the moment. We want to roll out more programmes like that.

NHS: Hospitals

Baroness Thornton Excerpts

Thursday 8th September 2011 Lords Chamber

[Earl Howe]

The noble Baroness is right to pull me up. If I implied that the NHS was across the board providing a lower standard of care than the private sector, I apologise because that is certainly not the case. There are some shining examples of care delivered by the NHS. However, as she will know, not all hospital trusts are as good as hers. Some give us cause for concern in a clinical sense, and they need to be challenged sometimes on the way they look at quality. That is going on at the moment with the quality, innovation, productivity and prevention programme that she will know very well.

[Baroness Thornton]

My Lords, let us get this Question back to transparency. Over a year ago, David Cameron, the Prime Minister, said:

“Greater transparency across Government is at the heart of our shared commitment to enable the public to hold politicians and public bodies to account”.

That is the point of my noble friend’s Question. I would like an assurance from the Minister that minutes and discussions are available at local and national level on the public record of meetings with private and independent healthcare providers.

[Earl Howe]

My Lords, the origin of this Question was, I believe, a freedom of information request that was replied to by my department. The background is that we have a small handful of hospitals that will struggle to achieve foundation trust status in their own right. I suggest that civil servants have to be allowed to have potentially helpful conversations with those who have experience of turning around financially challenged organisations. That is the background. We are perfectly transparent about that situation, as were the Government of which the noble Baroness was a member.

NHS: Medical Records

Baroness Thornton Excerpts

Wednesday 7th September 2011 Lords Chamber

[Earl Howe]

The noble Countess is of course correct that good patient care is about humane and sensitive treatment by the staff who serve in the National Health Service. At the same time, I think we are all clear that technology has a role to play in enhancing patient safety and improving the quality of care that the good staff of the NHS can deliver.

[Baroness Thornton]

My Lords, can I entice the Minister into being slightly more definite about when the House might see the new IT strategy which the Government keep telling us that they are about to publish? As a former Minister, I know that the answer “soon” is one that the House always looks at with some wry smiles. If we could have a more definite date, that might be helpful.

[Earl Howe]

My Lords, we plan to make an announcement towards the latter part of the autumn about the way forward for informatics, which will mean—we are clear about this—that we continue to gain more value for money from taxpayers’ investment and ensure that informatics support is fit for purpose in the modern NHS.

Southern Cross Care Homes

Baroness Thornton Excerpts

Tuesday 12th July 2011 Lords Chamber

[Baroness Thornton]

My Lords, I thank the Minister for repeating the Statement. Although we had a discussion about Southern Cross two weeks ago, it is an ongoing sorry tale which seems to get worse by the day for the residents, their families and the staff of Southern Cross. I think the Minister will accept that Southern Cross’s announcement yesterday that the responsibility for managing the 752 homes will pass back to the 80 landlords who own them will almost certainly cause a vacuum that is bound to be the source of great uncertainty and anxiety among residents and their families.

I am reassured that the Government are very active on the matter, but there are questions that we need to have answered. Southern Cross is not being informative and there are things that we need to know about the situation. My questions concern what happens next and how the Government will manage this difficult situation. Can the Government publish a list of all 80 landlords? I have read in the media rumours that some landlords still have to be identified. Yesterday, it was further announced that control of 250 of the homes would be handed back to their landlords immediately. What does immediately mean? Does it mean tomorrow? What will happen? What is the process?

The House needs to know which homes those are and who is running them. Is a list available? It is certainly not available on the Southern Cross website. It is also likely that many of the landlords will have little or no experience of running care homes. For example, does the Minister have any information on the intentions of property-owning companies such as London & Regional, which owns 90 Southern Cross homes, or Prestbury, which owns 21? In the previous Statement in the House, the Minister assured the House, as he has again, that the Association of Directors of Adult Social Services is trying to support its members, who will have a key role in ensuring that the new operating companies are able to provide good quality care and that they know how to perform financial stress tests to ensure that their business models are sound. What support and assistance are the Government providing to ADASS?

I read from my press cuts that Downing Street has said that public money will be used to ensure that those in the homes can stay. Is that true and how would it be achieved? Would money be made available through local authorities? If the Government intend to provide additional resources, they will need to do so to hard-pressed local authorities if they are expected to help. What advice are the Government giving to local authorities if the property company or landlord for any of the home-owning companies is offshore?

I am reassured that new operators taking control of the homes will need to be registered with the Care Quality Commission and that plans are in place to ensure that that happens, but given the pressure on the CQC, I wonder how it will be able to achieve that within the timescales that we seem to be facing. Will the Government make more resources available to the CQC to deal with that worsening situation?

What can the Minister tell the House about the terms and conditions of the 44,000 employees of Southern Cross? Does the Minister know how many homes are likely to close? What is the timetable for such closures likely to be? What will happen to those residents? We know that, for the very old and very vulnerable, a move such as that can result in their death or hospitalisation. That is an extremely distressing matter.

Turning to the care home sector more generally, it would seem that although Southern Cross is definitely the most urgent, it is not alone in the sector in its struggles. The UK’s second largest care home provider, Four Seasons Healthcare, has amassed debts of £730 million that have to be repaid by September 2012. What will happen to the Lloyds properties, as this landlord is in administration? NHP, which owns 250 homes, is at a standstill with its bondholder. Indeed, my honourable friend John Speller MP, in his question in another place to the Secretary of State for Business, Innovation and Skills, pointed out that it is not just old people we are talking about here. For example, Craegmoor provides residential care services for adults with mental health problems or learning disabilities. It has 3,300 places, 174 care homes and a debt of £37.8 million. Care Principles provides similar services. It has 450 places in 17 care homes and secure hospitals; its debt is £45.77 million. Care UK runs care homes and services for the elderly. It has 3,100 places in 57 homes and a debt of £127 million.

Clearly these problems have to be addressed. I do not expect the Minister to answer questions about those homes. However, I am asking the Minister whether there is a plan and, if so, what is it? It seems to me that Southern Cross is actually the beginning of this process and solving its problems may not be sufficient.

Tobacco Advertising and Promotion (Display and Specialist Tobacconists) (England) (Amendment) Regulations 2011

Baroness Thornton Excerpts

Monday 11th July 2011 Lords Chamber

Moved by

[Baroness Thornton]

That this House regrets that the timetable for implementation of the Tobacco Advertising and Promotion (Display and Specialist Tobacconists) (England) (Amendment) Regulations 2011 (SI 2011/1256) may result in up to 4,000 more young people taking up smoking than if the original implementation date had been kept to; further regrets that the Government have not explained how they will mitigate burdens on business “while maintaining the expected public health gains”; and calls on the Government to make the health needs of young people the priority by keeping to the original timetable for implementation.

Relevant documents: 32nd Report from the Merits Committee

Baroness Thornton: My Lords, many noble Lords will be familiar with the part of the Health and Social Care Act 2009 which set in motion the regulations previously in place to enact the implementation of the display legislation to start on 1 October 2011, less than three months from today, to be in force in all shops by October 2013. The same regulations provided that small shops had an additional two years, therefore, to prepare. These regulations will not begin to come into force until April 2012 and will not be completely enforced until April 2015. This is a total delay of four years. The reason for this Motion of regret is to give the House an opportunity to discuss the reasons for such a delay and to ask what bearing the persistent lobbying by tobacco industry-funded organisations may have had on the decision that the Government have taken in this regard.

In its 32nd report, the Merits Committee raised some important points. It suggested that the House might want to seek explanation from the Minister about how the regulations could achieve the Government’s policy objectives. It pointed to the inconsistencies of the growth review, which seeks to reduce the regulatory burden on small enterprises. This might account for the delay in implementation for small shops—although I would question this anyway, and will in a moment—but it does not explain why the implementation date for larger shops is being put back. However, I accept that from today, because of the government delays, three months may not be sufficient time for large shops to prepare for this, although they have had quite a lot of notice. The Minister will need to explain the reasoning behind this decision.

The Merits Committee also called attention to the Written Statement on tobacco control issued by the Government on 9 March, in which the Government state that the take-up of smoking by young people is a particular concern. Smoking is an addiction largely taken up in childhood and adolescence and it is crucial to reduce the number of young people taking up smoking in the first place. The report went on to say that nicotine is highly addictive and that each year an estimated 320,000 young people under 16 will try tobacco for the first time and 200,000 of them will become addicted.

We are all aware of the troubling statistics which surround this issue. The Merits Committee went on to say that, taking the Government’s own baseline statistics, the 18-month delay being proposed as a result of the amended regulations may result in 4,000 young people and children becoming addicted to tobacco, with the consequent long-term health effects. I should therefore be grateful if the Minister would explain whether the Government think that this is a price worth paying for the delay in implementation.

It is worth noting that in March 2009 Norway passed a similar law, which it implemented from January 2010, allowing retailers only nine months to comply and protecting Norwegian children from tobacco marketing five years earlier than the proposals before your Lordships’ House. There is no objective evidence that the Norwegian retail trade has suffered unduly.

I understand—but I am sceptical—that the reason given for such an extended delay for small shops has clearly been the concern that the legislation might adversely affect their businesses. I am afraid I have to question this. I believe that the cynical campaign that has been mounted to delay implementation can be shown to be more for the benefit of tobacco manufacturers than for small retailers. It has become increasingly clear that what purported to be a cry of pain from thousands of small retailers was really a covert and dishonest campaign by the tobacco industry.

Members of both Houses of Parliament have been contacted by three groups, each purporting to represent tobacco retailers: the Tobacco Retailers Alliance, the Association of Convenience Stores and the National Federation of Retail Newsagents. We know that the Tobacco Retailers Alliance is, in effect, a wholly owned subsidiary of the Tobacco Manufacturers’ Association. It is the most obvious kind of front group; it does not even have its own offices but operates from the Tobacco Manufacturers’ Association headquarters. At least that is clear and transparent.

The Association of Convenience Stores can claim a little more independence, and yet it, too, is beholden to manufacturers for subscriptions, sponsorship and advertising. When asked by Stephen Williams MP, the chair of the All Party Parliamentary Group on Smoking and Health, it confirmed that it receives around £100,000 a year from tobacco manufacturers. I would, however, point out that the Association of Convenience Stores has claimed that the cost of compliance would be between £2,000 and £5,000, and yet its own survey of small shops in Ireland found that the average cost of compliance was only £300.

I regret to say that the National Federation of Retail Newsagents has been much less forthcoming, seeking to conceal tobacco industry funding of its far reaching campaign against the display legislation. It recently procured, without any cost to itself, the services of a lobby firm called Hume Brophy, which telephoned and e-mailed the offices of Conservative and Liberal Democrat MPs on its behalf in the weeks before the Government were due to announce their decision on the display ban seeking their support for the repealing of the legislation. The Government are to be congratulated on resisting these blandishments.

It was discovered that Hume Brophy also acted for British American Tobacco and the company was asked whether it was funding the campaign. At first BAT denied this but, following questions at its AGM from Kevin Barron MP, it had to admit that not only had it funded the NFRN campaign against the display legislation but that it had also had meetings with Hume Brophy and the NFRN to discuss how it should be taken forward.

Once this was revealed, Hume Brophy wrote to Stephen Williams on 7 June to apologise for its involvement in such covert lobbying—it needs to be congratulated on so doing—and said that the NFRN agreed that it should write to Members of Parliament to explain. John Hume, of Hume Brophy, wrote:

“I understand that a letter to MPs will be forthcoming from the NFRN in the next couple of days”.

So far we are not aware of a single MP having received such a letter from the NFRN. In fact, it has refused to send one.

However, instead of accounting to MPs and Peers for its dubious lobbying techniques, the NFRN has attacked the Public Health Minister for attending the All-Party Parliamentary Group on Smoking and Health celebration of the 40th birthday party of Action on Smoking and Health and for presenting ASH with an award from the World Health Organisation for its work. We know of the right honourable Lady’s commitment to this issue and she is again to be congratulated on her continuing support. Frankly, rather than attacking the Public Health Minister for her commitment to reducing the harm caused by tobacco, the NFRN should do the decent thing and apologise to MPs for covertly doing the tobacco manufacturers’ dirty work.

I believe that the tobacco manufacturers have repeatedly sought to deceive parliamentarians by concealing their central role in the campaign against the display legislation. I would like the Minister’s view of this matter. Does he agree with me that this is unacceptable and does he think that it may have undermined in some way the UK’s publicly stated commitment to live up to its obligations as a party to the World Health Organisation’s Framework Convention on Tobacco Control? Indeed, the Prime Minister is on the record committing this Government to putting an end to what he has called the scandal of secret industry lobbying.

The Tobacco Control Plan for England published in March clearly states:

“The Government takes very seriously its obligation as a Party to the World Health Organisation Framework Convention on Tobacco Control”.

A full chapter is devoted to protecting public health policy from the vested interests of the tobacco industry. Is the proposed delay not a concession to exactly those vested interests and the result of a campaign by those who sell cigarettes on behalf of those who make them? Specifically, the Government have affirmed that the tobacco industry had no hand in the development of the tobacco plan, that they would publish details of any policy-related meetings with the industry by any part of government, and that they would require those engaging with the Department of Health on tobacco control to declare any links with or funding from the industry and encourage local authorities to follow that lead. In doing so, the Government are reflecting the mood across the House when during the passage of the Health Bill 2009 the noble Baroness, Lady Northover, moved an amendment to require the publishing of written guidelines on engaging with the tobacco industry. That amendment was withdrawn as the Government undertook that the Secretary of State would write to all Cabinet members reminding them of their duties under the World Health Organisation convention.

This is a Motion of regret. I do not seek to overturn the revised regulations, but I would like the Minister to confirm the commitment of the Government to live up to their obligation under Article 5.3 of the World Health Organisation convention to protect their public health policy from all commercial and vested interests of the tobacco industry, and to publish without any further delay details of all policy-related meetings with the tobacco industry and its front groups by any part of Government. I beg to move.

[Lord Borrie]

My Lords, three years ago the Chief Medical Officer, Sir Liam Donaldson, said that the ban on smoking in enclosed public spaces, which began in 2007, had been a great success in terms of both compliance and improved health. There had been a considerable drop in the number of smokers. I believe that the enclosed spaces ban has indeed been a great success, and for our social environment—a benefit to the whole population.

But in the Health Act 2009 the Labour Government sought to go further and ban the display of cigarettes in shops in order particularly to give even further discouragement to underage smokers. I thought the case for such a ban on display was a thin one. It ignored the fact that in recent years the display has had to be festooned with off-putting words such as “Smoking kills”, plus hard hitting pictorial warnings. Moreover, evidence from the likes of Iceland and the Canadian provinces where displays are banned was somewhat speculative as to the effect on smoking among the young.

In the UK we seem to have given up trying to keep a balance between the rights of individuals to do something which is legal—to sell and consume tobacco and cigarettes—and society’s desire to help people give up smoking and stop children purchasing cigarettes. The Labour Government ruled that a display ban should come into effect in 2011 for large outlets, but to protect small and medium-sized enterprises to some extent from the costs of the new regulations they should be subject to a ban only from 2013. I leave aside the arguments that this distorts competition between one group of retailers and another, and it may have been justified. Now, because of the recession, the present coalition Government seek to delay the imposition of the ban a further six months for large retailers, and a further 18 months for small retailers. My noble friend Lady Thornton from the opposition Front Bench regrets these delays. I regret I cannot join her in grumbling about the modest delays that have been proposed. There are more restrictions in the offing: from campaigning groups, particularly ASH; a ban on open-air smoking—in parks and beaches, such as applies in parts of Australia—bans on smoking in cars, which would be very difficult to enforce; and, of course, banning the use of brand names, which cropped up during the discussions on the Health Act a few years ago.

There is one country in the world to which I draw the attention of the Government: Bhutan, known perhaps to many walkers on the lower levels of the Himalayas as an interesting country somewhere between India and China. I mention Bhutan because all smoking is banned there, as are all displays of cigarettes and tobacco. How far do the Government want to go in their efforts to discourage the young from smoking? It is a splendid objective, but one which sometimes ignores the other aim of allowing people their own individual choices.

--- Later in debate ---

[Baroness Thornton]

My Lords, I thank the Minister for his usual detailed and very thorough explanation. I will resist the temptation to open up the arguments we went through in detail in 2009, notwithstanding the fact that my noble friend Lord Borrie, the noble Lords, Lord Stoddart, Lord Naseby and Lord Palmer, expressed their consistent views about this matter. The noble Baroness, Lady Tyler, was right to say that the Government should take credit for the tobacco plan, and certainly Members on these Benches will support further work on tobacco control.

I thank my noble friend Lord Judd for his support. Even if he is what one might call an ultra leftist, if not an outright Trotskyite on these matters, he knows that I am in sympathy with his views. My former noble friend Lady Morgan as always had wise and considered words on this. I wish her well in her new and very important position. The noble Lord, Lord Rennard, rightly reminded us that across the House we have been working on tobacco control issues for many years, and many noble Lords have made significant contributions to that progress. My noble friend Lord Faulkner is a great friend and campaigner on these issues, and I thank him for his hard work. I agree with him that the Government should be congratulated on their plan and their commitment to tobacco control. I also thank my noble friend Lady Gale for her support. She sat behind me and supported me when I was a Minister throughout the days when we discussed these issues at length.

The Minister has offered reassurance on a number of fronts, particularly concerning the tobacco lobby. I am pleased that the coalition Government are building on the policies established by the last Government, and I do not underestimate the battles that the noble Earl, his ministerial team and his honourable friends will be fighting across Government to extend tobacco regulation. The Minister should know that he has support across the House for the battles that he and his noble and honourable friends are fighting. I welcome the banning of tobacco sales from vending machines and the review of access to tobacco, and I look forward to hearing the results of the other initiatives outlined by the noble Earl. I also welcome the promised transparency, in particular on asking about funding from the tobacco industry. The noble Earl has given us an assurance that details of the meetings will be published. Finally, I welcome his emphatic rejection of the reasons for the delay.

I thank all noble Lords for their contributions to the debate and I beg leave to withdraw the Motion.

Motion withdrawn.

NHS: University Health Centres

Baroness Thornton Excerpts

Monday 4th July 2011 Lords Chamber

[Earl Howe]

My Lords, naturally, before preparing myself for this Question, I looked carefully into the way in which university practices are funded. The advice I received is that there is no reason to be concerned on that front. Many university GP practices are funded quite generously. Where they can lose out is over the quality and outcomes framework, which is targeted mainly at elderly patients with long-term chronic conditions, so it is not surprising that university campus practices do not earn the extra money that they could. Nevertheless, we believe that there is no case for making an exception for university practices in the way that they are funded.

[Baroness Thornton]

My Lords, I congratulate the noble Baroness on getting her head around the system of weighting for payments to GPs for their patients. It contains such gems as,

“An overall weighted listsize for the PCO is generated as the sum of Practice Weighted Listsizes for all Practices in the PCO, and this PCO Weighted Listsize is used together with the PCO Weighted Population”.

I will not go on, but I congratulate the noble Baroness. Given the mental health problems that students often face, is the Minister confident that the system of weighting takes proper account of that medical issue, which is certainly more prevalent than the chronic conditions that he mentioned in a community general practice?

[Earl Howe]

My Lords, the characteristics of each GP practice will naturally vary according to the patient population. Although a practice situated on a university campus may have higher numbers of patients who require mental health advice and support, there may well be fewer patients in need of other services. I am not aware that there is a particular issue of underfunding of university practices in relation to the mental health burden. As the noble Baroness will know, the QOF was adjusted in 2008 with a two-year time delay, so university practices have had a chance to adjust and prepare for the change.

Health: Stroke Care

Baroness Thornton Excerpts

Monday 4th July 2011 Lords Chamber

[Earl Howe]

My Lords, the noble Lord is quite right in all that he says. I would just point out that the official statistics are rather historic and it is important that we take stock when the revised figures are before us in some months’ time. As regards how best practice will be driven when the health service reforms are in place, I would repeat my earlier comments about the ability of the NHS commissioning board to drive forward higher quality, informed by the new quality standard produced by NICE. More particularly I think we can do a lot through the tariff. At the moment, best practice tariffs are starting to play a role in encouraging and driving best practice at hospital level.

[Baroness Thornton]

My Lords, tomorrow is the 63rd birthday of the NHS. Would the Government give the NHS the birthday present of eliminating local differences in stroke services by implementing the recommendations in the stroke strategy? In that way, when we all break into song next year when the NHS is 64 years old, we will actually have achieved something very important.

[Earl Howe]

It is very appropriate that the noble Baroness should remind the House of the NHS’s 63rd birthday. I can think of few better presents than that which the noble Baroness has outlined. I can say only that the efforts within my department, and indeed throughout the NHS, continue unabated to ensure that stroke patients are treated to the highest possible standards and that unacceptable variations are eliminated.