Ultra-processed Foods
Baroness Young of Old Scone Excerpts(3 years, 10 months ago)
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Lord Bethell [V]
My Lords, the noble Baroness has made her point well. When the pandemic began, the national food strategy team were investigating the health risks associated with a diet heavy in ultra-processed foods. The team is in the process of restarting its work and will return to the question of ultra-processed foods in its final report, which it currently plans to publish over the winter.
Baroness Young of Old Scone (Lab) [V]
My Lords, the noble Baroness, Lady Bennett, has demonstrated that there is a bigger killer on the block than Covid, and that is ultra-processed foods. Covid has increased the focus on the need to reduce obesity and diabetes and to promote healthy eating, but we have run out of road on the kind of voluntary approaches that the Minister has just described. Will the Government now regulate for the rapid reformulations of ultra-processed foods? The responsible supermarkets want a regulated level playing field so that they can get on with helping us all avoid what is now the biggest cause of premature deaths: the consumption of ultra-processed foods.
Lord Bethell [V]
The noble Baroness is entirely right to say that Covid has focused our minds on obesity and the role of diet. However, voluntary approaches are necessary. We have to take people, industry and government with us. That is the core of our approach and it will remain our approach.
Covid-19: Track and Trace System
Baroness Young of Old Scone Excerpts(3 years, 10 months ago)
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Lord Bethell [V]
My Lords, the current low level of prevalence of the virus means that the pressure on automated tracing devices such as the app is less heavy than it would be under other circumstances. The biosecurity centre is already making a massive difference to co-ordinating our local response to the disease. We have made terrific progress so far and our management of lockdown measures will reflect that fact.
Baroness Young of Old Scone (Lab) [V]
Statistics on the first full week of operation show that less than 58% of the contacts of confirmed symptomatic cases are traced and say that they will self-isolate—it is difficult to know whether they do so. “Test and trace” tracks only contacts of symptomatic cases, and the ONS infection study shows that only one-third of total new infections are symptomatic. Will the Minister admit that “test and trace” is resulting in the isolation of an ineffectively small proportion of the contacts of all new cases and will not prevent a second wave of the disease?
Lord Bethell [V]
My Lords, last week’s figures suggest that 67% of people who tested positive for coronavirus were reached by our contact tracers. This figure is rising every week. The epidemiological logic is that a system such as “test and trace” will never be 100% ubiquitous or track everyone who carries the disease—asymptomatic infection is a part of this terrible disease. However, it can have a profound effect on its spread and break the chain of transmission. That is why we have invested in this infrastructure and why we appealed to the British people to comply with the isolation protocols.
Restaurants: Calorie Labelling
Baroness Young of Old Scone Excerpts(4 years, 10 months ago)
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Baroness Blackwood of North Oxford
The noble Lord has asked a most innovative question, to which I do not have an immediate answer in my notes. I hazard a guess that scooters offer some balance benefits, but I shall get back to him on that.
Baroness Young of Old Scone (Lab)
Are the Government losing their grip on this issue? We were promised the Public Health England sugar reduction data in April, when it did not appear, and then “in late summer 2019”. Can the Minister tell us how late summer will be this year?
Baroness Blackwood of North Oxford
Based on the weather, I cannot really answer that, but I absolutely reject the premise that the Government are losing their grip on this issue. We have seen some real successes since the publication of the 2016 plan. The soft drinks levy has resulted in the equivalent of 45 million kilograms of sugar being taken out of soft drinks, which is a genuine success. Some products in the sugar reduction programme have exceeded their first-year targets: a 6% reduction in sugar in yoghurts has been achieved. As I mentioned, significant investments are being made in schools to promote physical activity and healthy eating. We accept, however, given the obesity crisis, that much more needs to be done and the noble Baroness will be glad to hear that the Secretary of State has, as I said, commissioned the CMO to urgently review and drive this agenda forward, which is exactly what we intend to do.
Tobacco and Related Products Regulations 2016
Baroness Young of Old Scone Excerpts(7 years, 10 months ago)
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Baroness Walmsley
May I correct something that the noble Lord, Lord Forsyth, said? He suggested that there was an inconsistency in my remarks. I point out to him that my regret Motion regrets the advertising ban. If there were no advertising ban, it would be perfectly possible to have a public information campaign.
Baroness Young of Old Scone
My Lords, after the excursion by the noble Lord, Lord Forsyth, into Europe bashing, may I bring the House back to the subject in hand, which is these regulations?
The noble Lord, Lord Rennard, hit the nail on the head. Why are the major tobacco companies all piling into these products and their manufacture, distribution and promotion globally? It is not because, in a spirit of public protection, they want to see smokers take up these products rather than the main part of their activities, which will continue to be the pushing of tobacco globally.
We have to ask ourselves why there is a need for regulation in this area. The reality is that electronic cigarettes are effective in reducing, in the case of smokers, their reliance on tobacco, but this needs to be associated with a wider tobacco control strategy and some good, targeted, mass promotion—not of individual products in the vaping field but with the concept that, if you are a smoker, vaping may be one of the things, among others, that can help you. That must include psychological support as well as simply a change of product. I hope, too, that the Government will ponder on further increases in the price of tobacco; at the end of the day, that is the most effective way of reducing demand. Perhaps we can hear from the Minister what the Government are planning to do to ensure that there is public promotion of vaping as an alternative for smokers, access to good-quality, evidence-based stop smoking services and changes in costs.
We should not delude ourselves that tobacco manufacturers are getting into vaping products simply to allow people who are smoking currently to reduce their risk. They are getting into it because that, in their view, is the double whammy: an alternative product that can run alongside their very damaging products, which will continue, and a little bit of what in the environment movement used to be called “greenwashing”—I do not know what one would call it in the public health movement—in order to make their image more acceptable publicly. Therefore, I would not support the amendment of the noble Lord, Lord Callanan.
Health: Diabetes and Obesity
Baroness Young of Old Scone Excerpts(7 years, 10 months ago)
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Lord Prior of Brampton
Of course they should be giving that advice, and indeed they are. There is also clear advice on the Public Health England website as to what is the right diet. Confusing messages have been given over the past couple of months. Therefore, I think it would do no harm to repeat in the obesity strategy what is the right diet.
Baroness Young of Old Scone (Lab)
My Lords, is the Minister aware of recent emerging research that confirms the view that has been held for some time that if people with type 2 diabetes—and there are 3.5 million of them in this country—reduce their weight by 10% and take modest regular exercise, in a significant number of cases the effects and complications of their diabetes can be put into long-term remission with consequent reductions of pressure on NHS resources and capacity? Despite that, less than 10% of people with diabetes get any such help in reducing their weight and increasing their exercise, and therefore having the option and opportunity of turning off their diabetes. This issue has been raised significantly over the past five years. What urgent steps can the Minister outline, rather than simply relying on local action that is clearly not working?
Lord Prior of Brampton
The noble Baroness is clearly right that weight reduction can reverse diabetes. My father, for example, has lost weight and his diabetes has, effectively, been put into remission. There is no question that it works. However, it is very difficult to lose weight once you are overweight. The figure is that only one in 210 people with a BMI of over 30 can reduce it to a normal level; hence the emphasis that the Government are putting on explaining this to children and young people before they get fat. That is the critical place to aim. However, I entirely agree that greater access to structured education programmes is very important.
NHS: Diabetes
Baroness Young of Old Scone Excerpts(7 years, 11 months ago)
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Lord Prior of Brampton
My Lords, I am not sure that that question has much to do with the original Question on the Order Paper. However, without the levels of immigration that we have had in the past, the NHS simply could not operate.
Baroness Young of Old Scone (Lab)
Is the Minister aware that one of the most cost-effective interventions in the care of people with diabetes is to educate them in how to manage their own condition in order to avoid progressing to the costly complications which constitute 90% of the costs to the NHS? Is he also aware that we are still bumping along with less than 10% of people with diabetes receiving any education whatever in how to self-manage their condition daily? What plans do the Government have to increase that figure stratospherically, to a point where all people with diabetes are not only offered education but are encouraged to take it up and use it?
Lord Prior of Brampton
The noble Baroness will know a lot about the diabetes prevention strategy that is being launched with the support of PHE and Diabetes UK, and about the DESMOND and DAFNE structured education programmes. The plan is to roll out the prevention strategy across the whole country by 2020, at which time we expect that at least 100,000 people will have personalised support, which will include structured education.
Health: Diabetes
Baroness Young of Old Scone Excerpts(8 years, 10 months ago)
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Baroness Young of Old Scone (Lab)
My Lords, I thank my noble friend Lord Harrison for prompting this debate and for so eloquently telling the House about how hard a job it is for people with diabetes to manage their condition on a day-to-day basis. I also thank the noble Baroness, Lady Masham, for continuing with that theme. It is not an easy condition. I should declare an interest as chairman of Diabetes UK.
Previous speakers have highlighted how diabetes of all types is a very serious and expensive condition, affecting 3.9 million people and their families in the UK—a figure that continues to rise. Diabetes impacts not only on people but on the NHS: it now accounts for 10% of the NHS budget, and 80% of that is spent on the complications associated with diabetes. That is a pretty staggering sum—80% of £10 billion—and it is heartbreaking that some 80% of the complications are avoidable. So we are talking about big money being spent on complications such as blindness, stroke, heart disease, kidney failure and, ultimately, premature death, many of which are avoidable. Fundamental to this is that people with diabetes need to be supported and educated about their condition, so that they are engaged and encouraged to manage it effectively and reduce the risk of complications, for both their own good and that of the NHS.
Managing your condition on a day-to-day basis is a hard task, and there is remarkably little help in some cases. There are 8,760 hours in a year, and for only three of those are you in front of a healthcare professional. The remaining 8,757 hours are up to the person with diabetes. It is a very technical condition, which needs hour-by-hour management of diet, medication and physical activity to make sure that the magic blood glucose level is kept healthy and steady. It requires knowledge, engagement and skills, yet less than 16% of newly diagnosed people with diabetes—both types 1 and 2—are offered any formal education or learning programme at all. Less than 3.4% of newly diagnosed people take up programmes. Does the Minister agree that that is unsatisfactory and lamentably low, when so much is at stake in terms of both the individual and the pressure on the NHS?
Why is education for self-management not offered to more than 16% of people? First, there is a lot of mythology about the costs. A programme for a person with type 1 diabetes costs about £308; for type 2 diabetes it is somewhere between £65 and £75. It is not an insignificant cost bearing in mind the numbers of people we are talking about, but education for self-management is hugely effective. Department of Health research shows that an education programme for type 1 diabetes could save the NHS £48 million a year. Other evidence shows that the savings from an education programme for type 2 diabetes could be as much as £367 million per year. Yet we see that the up-front cost of the programmes is a disincentive to commission sufficient education, and there are just not enough programmes around. Commissioners are concerned about short-term costs rather than seeing the longer-term savings that would result.
Offering programmes is only one issue; take-up is the other. When programmes are offered, why are they not taken up by more than 3.4% of people? First, people with diabetes are not always told when they are diagnosed just how serious their condition is. We still get stories from people with diabetes who describe their moment of diagnosis, mostly in general practice, as being told that they have “a touch of diabetes”. That is like being “a touch pregnant”—it simply does not exist. If you have diabetes and are not given proper care, support and education to help you manage your condition, you run the risk of developing the serious complications we have talked about.
Education is also not taken up because sometimes it is provided in a rather traditional, inflexible way—perhaps at the wrong time, at the wrong place, in too long a period that results in people having to take time off work, in the wrong language, or in the wrong culture. We have to press the commissioners and the providers to look at new ways of providing that vital education, using new technology, online opportunities, peer learning groups, lay educators, flexible times and flexible locations. We have provided programmes based in Starbucks and in village halls. We need to find ways that are as attractive as possible to that huge range of people now developing diabetes, and offer easy-access programmes—tiered education, where people get taster courses that might encourage them to go on to better and more substantial education programmes. Particularly, we need to learn from some of the countries that the noble Baroness, Lady Manzoor, talked about—lower-income countries which have had to find more cost-effective ways of meeting mass markets for diabetes education. We hear of text-based systems and, particularly, group-based lay educator-led programmes.
We need follow-up, too, if people do not attend their educational programmes; we should not just take no for an answer, so we need electronic registers and follow-up systems. Most of all, we need good marketing: we need to use the best available modern marketing techniques, which are currently used in the commercial sector, to encourage people to take up these programmes. It can be done: 40 people went through Bexley’s education programmes in 2009; by 2010 the figure had gone up to 1,000. There is evidence that education works to reduce blood glucose; to improve people’s confidence in managing their condition, and to improve their psychological state as a result; and to improve their real health outcomes. I will quote one example, of Allan, who did not get any such education until he had lived with type 1 diabetes for over 30 years. He said:
“Before the course I was being scraped up literally by paramedics due to hypos at least once a week. One week three times in a week. Since the course I have not needed outside assistance once. Four years now since the course”.
Diabetes UK got rather excited when the NHS Five Year Forward View was published; in fact, we got rather frisky, for two reasons. I will briefly thank the Minister for the commitment and the implementation of the diabetes prevention programme that is currently under way; that is an important move. However, there were also commitments in the NHS Five Year Forward View to empowering patients. It said that the NHS,
“will do more to support people to manage their own health … managing conditions and avoiding complications. With the help of voluntary sector partners, we will invest significantly in evidence-based approaches such as group-based education for people with specific conditions and self management educational courses, as well as encouraging independent peer-to-peer communities to emerge”.
That is great stuff. We were, therefore, pretty excited, but perhaps a bit overexcited. When the joint implementation statement from NHS England and others, Five Year Forward View: Time to Deliver, was published, there was absolutely no mention of how that element of empowerment would happen. I understand that there must be priorities, so I am hoping that the next version for next year’s NHS plan will focus on that area. Perhaps we can encourage the Minister to say today what will be done to make that five-year forward view commitment on patient empowerment real for people with diabetes, and when.
I hope that the Minister will be able to tell us how people with diabetes will be enabled to become confident, informed experts in their own condition. Can the Minister tell us what the Government will do to engage and educate those 3.9 million people with diabetes to ensure that they live long and healthy lives and that the avoidable complications of diabetes do not sink the National Health Service?
Viscount Falkland (CB)
My Lords, I thank the noble Lord, Lord Harrison, for again giving us the opportunity to discuss diabetes, and I congratulate him on the very comprehensive way in which he introduced the debate. I do not think anybody reading his opening remarks in Hansard to find out what this is all about could get anything better online.
Education, which is part of the title of this debate, is so important, and this debate is important because so many people have stressed the importance of education. I suppose that I was rather complacent, because I did not have a doctor when I was diagnosed with diabetes. I was 64 years old, in this House, and I did not think that there was anything wrong with me. I knew that I was having a little difficulty making speeches in your Lordships’ House—I used to dry and feel a little nervous. When we were talking about it, a friend in the House said, “I think you’ve got diabetes”. That was just before Easter in 1999. He said, “I think you ought to have it looked at straightaway. I’ll ring up my doctor”—a private doctor. I said, “I have no doctor, so thank you very much”. The doctor was very efficient and certainly did not say what the noble Baroness, Lady Young, said; I did not have a “touch of diabetes”. My sugar levels were almost catastrophic—no wonder I was feeling odd when talking to the House.
Noble Lords probably know that for a person whose metabolism and pancreas are working properly, the blood sugar levels will be around 5.5 or 6.0. Mine were 29. I was very fortunate in that the doctor acted quickly. He got me the last appointment before Easter—or I would not have been seen until the following week—with a diabetes specialist in a clinic the following day. The professor said, “This is a very sad situation, isn’t it?”. I said, “Yes. It sounds as though it really is”. He gave me an hour of education about my condition. He said some important things apart from explaining what the condition is—the malfunction of the beta cells of the pancreas and the whole business of metabolism. He said, “One thing that I must tell you is don’t be worried about this condition. What we’re going to do for you, and what we’re going to provide by way of education and advice, will make you able to control not just your diabetes but your life. You will be eating better and taking more exercise”. That is exactly what happened.
I have been on a learning curve since then. In eight of those intervening years I was on ordinary medication and then, because I ran out of my own insulin, I was put on synthetic insulin, which noble Lords will be familiar with. There are two lots, one of which carries me through the night. As all diabetics know, when you are asleep your liver produces sugar. I also have the insulin which I take before every meal. Every day I check myself on a wonderful machine. The technology that is available to enable one to supervise one’s condition is excellent.
I found myself an NHS doctor. I have nothing but praise for the NHS but it just does not have the time to provide the necessary education. I was approached by a member of staff of this House who knew that I had spoken previously about diabetes. He said, “My doctor has told me this week that I’ve got diabetes”. I asked what the doctor had said and was told, “He didn’t say very much and that’s why I’m asking you what it’s all about”. I replied, “You need some information. It means that you really have to alter your life”. I ran across to the nurse in the House of Commons and she was horrified to hear of the doctor’s reaction. She said, “Send him here and I’ll give him some of the leaflets that we have here, so at least he’ll know the basics”. I imagine that that experience of a member of staff here is replicated all over the country.
Baroness Young of Old Scone
I hope that the noble Viscount referred him to Diabetes UK as well.
Viscount Falkland
Diabetes UK is an excellent organisation and I congratulate the noble Baroness. The last time we had a debate on this, I think she was only just starting in her role. Having heard her excellent speech today, I would say that she has obviously been on a very successful learning curve. I was very interested in everything that she said.
I now find myself at the age of 80, which is around the age that the doctor predicted I would live to if I looked after myself, and I still feel pretty well. I still ride a motorcycle and so on. I hasten to say that I check myself with my machine before I go anywhere near a vehicle, because it is very dangerous to have diabetes and to drive a vehicle. I hope that most people who have the condition report it to the DVLA, because not to do so would be very serious.
With this complaint, education never stops. We are constantly developing treatments, machines and monitors, and we have different kinds of medication, so we have to adjust to changes the whole time. It is ongoing. I absolutely agree with the noble Baroness, Lady Young, on what we could save in the National Health Service if we got education right—she produced the figures; I could not find them. It is short-term thinking because, as she said, the upfront cost is very high. But the cost if people have heart disease, amputations or all the other dreadful things that can happen, as she outlined in her speech, is astronomical compared with what one would spend on education. Unless they have education, people will not look after their condition. I hope that the Minister can reassure us that there is movement in the right direction on this because it is a growing threat.
I am very glad that the noble Baroness, Lady Manzoor, drew our attention to what happens in the third world, or the developing world as we now call it, and how awful it is for people who do not have our fortune in having a National Health Service that gives us important parts of what we need to treat our conditions. In those countries, a high proportion of their income is spent on this disease. The worry and stress that that must cause is absolutely appalling. The noble Baroness made a very interesting contribution on that.
It is going to get more expensive. One noble Baroness—I cannot remember which one—mentioned the replica pancreas that is now being developed in the United States. That will all become very expensive. People who come here from Saudi Arabia with diabetes can, I suppose, afford it, but people here will not be able to. Important developments are going on, which is good news, but the rising cost beyond the high levels that we already have in the NHS really does mean that organised education is the only way. This is the argument I am making and I hope that the Minister will also make it. And it should not just be short-term education—people really need a course.
The nurses in my NHS practice are absolutely excellent. When they go on a course, they are marvellous. Most of them are immigrants, I might add, so noble Lords will understand that I have no sympathy with UKIP. In the National Health Service, they are marvellous. They love what they learn and they pass it on; they are an important part of the future. I hope that this debate, which I knew would be good but has been better than I expected, will result in an improvement in the NHS service and for patients.
Children and Families Bill
Baroness Young of Old Scone Excerpts(10 years, 5 months ago)
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Baroness Young of Old Scone (Non-Afl)
My Lords, I hope I am not the only person who is going to speak at this point. I would find it really awesome to be the only one who caused this rather rare event of an amendment being carried over between two sessions of business.
I support Amendments 264, 265 and 266 on standardised packaging. I do not want to make too many of the points that have already been made—at breakneck speed, may I say; it showed that we can speed up if we put our minds to it—but will bring in a few others. There really is quite a consensus stacking up that there is a pressing case for standardised packaging.
The World Health Organisation says that standardised packaging would produce,
“the maximum reduction in the marketing effect of tobacco packaging”.
Australia has adopted it, as everybody knows, and the early evidence is that the standardised packs there are making smoking less appealing and have not caused any problems for retailers, which was one of the predictions. Scotland and Ireland have committed to it in principle, and I have it on very good authority that the Health Minister in Wales is convinced of the evidence. New Zealand, Canada, France, Norway and India are all considering this way forward.
We have huge support here from the medical colleges, including the Royal College of Paediatrics and Child Health, from the BMA, and from charities such as my own charity, Diabetes UK—I declare an interest as chief executive—as well as Cancer Research UK and the British Heart Foundation. They all believe that there is an increasing body of hard evidence. Of course, the public support standardised packs, with 64% polling in favour.
Standardised packs are really important because packaging is the last advertising route left to manufacturers and tobacco companies are spending a huge amount on pack design, and they do not do that for no reason. They recognise the truism that kids and young people are attached to brands. If you have ever tried to persuade your child to buy a pair of supermarket trainers you will know exactly how attached to brands they are.
When I was a kid and all my friends were starting to smoke, there was a league table of cachet. I am really old so Navy Cut was considered a bit more gentlemanly than Wills Woodbines. Embassy and Regal were the great working man’s fags and of course Silk Cut was for the ladies. Then the 1980s came and people took up Camels or Gauloises or, the height of cool, Lucky Strike. I was terribly tempted, I must say, by Balkan Sobranie, which were wonderfully coloured little cigarettes with gold filters. I had a friend, Brian, who smoked them and I used to sit there with one unlit, toying with this beautiful, chic sophistication while he puffed away. Alas, he died at 51 of lung cancer.
Helena Rubinstein used to say:
“In the factory we make cosmetics but in the store we sell hope”.
But of course we are not talking about selling hope; we are talking about selling addiction, cancer, heart disease, poor quality of life and early death for our children and young people.
Noble Lords have already shown that more than 200,000 kids aged between 11 and 15 start smoking each year. We really should take the step. Why do the Government continue to delay? I am sure the Minister will tell us. If they are waiting for the emerging impact of the Australian policy, they should not. The conclusive evidence could take two or three more years with another 500,000 kids addicted to a killer habit. We know that HMRC believes that there is no evidence that standardised packaging would increase the illicit trade that is one of the concerns, so there is no case for waiting for the Australian evidence. Why does the Minister believe there is a case for further delay? Will he please simply give in and get the Government to support Amendments 264, 265 and 266? I particularly commend Amendments 265 and 266, which strengthen the amendment further.
Baroness Thornton (Lab)
My Lords, the noble Earl and I have been discussing the regulation of tobacco products since 2008. At that time he was often sceptical about the efficacy of our proposals for the retail marketing of tobacco products. I particularly welcome these amendments because it is important that we keep this issue alive. Since 2010, my noble friend Lord Hunt and I, as well as others, have asked a series of questions about the enactment of the legislation concerning the display of tobacco products. I congratulate the noble Earl on making that happen successfully. It has been a success: it is now normal to walk into your corner shop and not see tobacco products side by side with comics and chocolates, which used to normalise tobacco for our young people.
It is important to be clear in what we are talking about. There are all the statistics in the world that people can talk about in terms of cancer, addiction and all those other things. However, we are talking about whether we are prepared to allow the over-powerful and wealthy tobacco companies to gain their next market for the profits they need to make from tobacco products. That is what this amendment is about. They can exist only if they continue to recruit young people to tobacco addiction so that they have their next generation of smokers, and that is what this is about. It is about reducing the number of young people who, by becoming addicted to tobacco and tobacco products, provide tobacco companies with their next generation of smokers. We know how hard it is to stop smoking once you have started, and I speak as an ex-smoker.
I hope that, over the years when the noble Earl has distinguished himself as the Minister in his job at the Department of Health, he has had access to all the information and research, and now has at his disposal all the facts about tobacco addiction and all the terrible diseases that this brings to everybody, so that he will be convinced that we need to take this forward. I hope he will tell the Committee either that the Government will support these amendments, or that they are not necessary because the Government intend to take plain packaging forward as quickly as possible.
Baroness Young of Old Scone
My understanding of this is that, because the Government would not come forward with a more general provision, this amendment has been hitched on to the Bill in desperation because it seemed to be a sensible place to try to get it into. The convolutions that the Minister is rightly pointing out would be solved at a stroke if there were to be a ban on differentiated packaging across the board and standardised packaging were introduced for all cigarettes.
Earl Howe
That indeed is my understanding. Noble Lords have taken the opportunity of this Bill to raise the dangers of smoking, particularly of passive smoking for children, and I have no issue with that. I merely point out that there are problems with the amendment as drafted. I am not saying that it would not be possible to draft another amendment which noble Lords might care to consider between now and Report. Being able to enforce these provisions as drafted is also a significant aspect. For example, it may be hard to judge whether a product could reasonably be expected to attract children, as the amendment would require, or to determine what might be aimed at or would attract 18 year-olds but not, let us say, 17 year-olds or 13 year-olds.
I am grateful to noble Lords for raising this important issue and for keeping this debate at the front of our minds. It is a debate that we need to continue. As I have said, the Government have yet to make a decision on this policy, but if we were to bring in such a measure, we would not want it to be circumscribed in the way that is proposed. We would not want to set up a situation in which both branded and standardised packs could be sold legally depending on where they were sold and what other products were sold alongside them. I therefore urge noble Lords not to press their amendments and respectfully suggest that they consider other avenues for bringing this matter before the House on Report.
National Health Service (Procurement, Patient Choice and Competition) (No. 2) Regulations 2013
Baroness Young of Old Scone Excerpts(11 years ago)
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Lord Warner
It is not a separate issue because there is considerable overlap between those who are providing adult social care from outside the public sector and those who operate in the NHS market. They are very often the same providers. It is that market in social care that in this country has built and run a whole nursing home sector because the NHS turned its back on nursing home provision more than 30 years ago. It turned its back on providing a pattern of services that might have been relevant to today’s needs. Alongside the NHS we have a market-driven service—and very soon we shall probably be discussing something called the care and support Bill, which I and a number of noble Lords have been considering on the Joint Committee. The bad news for some is that within that legislation are some provisions for market-making, and that is the term that was being used in adult social care. Even as we speak, the Local Government Association and the Department of Health are enhancing the skills of local government in market-making in this area. However, the NHS does not seem to want to play in that game. It does not seem to want to pursue—
Baroness Young of Old Scone
I am afraid I cannot resist interrupting. Does the noble Lord’s pride in the social care market extend to the number of fairly large companies that have either almost gone bust or indeed have gone bust in the social care market in the past 12 months, or indeed to the failure of a considerable proportion of the social care market to deliver standards that are acceptable to the Care Quality Commission? I wonder if the social care competitive market is actually delivering what he wants it to deliver.
Lord Warner
I do not think anybody in the private nursing home and residential care market has achieved the dizzy heights of Mid Staffordshire trust in the way they looked after patients.
Baroness Cumberlege
My Lords, we could have a whole debate on profit. Every person who sells their talents and does work has to profit. You cannot live without a profit unless you are receiving social care. Profit, of course, funds all our pensions, and a whole lot of other things—but I do not want to go into all that, because I think it is irrelevant to this debate.
I think that we should just look at what the private, independent sector does at the moment. South London, a very stressed area, has had a lot of problems with hospitals not having enough capacity. The Labour Government introduced urgent care centres, and they were introduced into south London. It is interesting to see that the regulator, the Care Quality Commission, recently described the service as first class; it is open seven days a week, from eight until eight. Better still, it was described by one of its users as the,
“best NHS experience I have ever had in my life”.
I am sure that that person was not only right about the experience but right that, whoever provides the service, it is the NHS—for it is the NHS that has paid for it through a contract. So privatisation is not about the provider; it is about reaching into your wallet to pay for the service for which the state should pay. That is the fundamental ethic of the NHS.
In southern England, an independent provider has ensured that 99% of target patients are screened for breast cancer, which compares with the national average of 77%. The provider also invested £4 million in new technology for outreach services. My third example—and I could go through lots—is in the north-east, where an independent provider of sexual health services has been able to screen 35% of 15-24 year-olds for chlamydia, which is significantly higher than the national average of 24%. It also saved commissioners money by reducing duplication across services.
Baroness Young of Old Scone
I am sorry to interrupt at this time of night, but I am conscious of the fact that the noble Baroness is citing lots of examples of where private sector provision and competition has produced good results. Is she equally aware that the Care Quality Commission had to remove two licences from urgent care providers for an inadequate service that could not be allowed to be sustained for even a few days longer after it was detected? They are not all success stories, by any means.
Baroness Cumberlege
My Lords, of course I accept that. We accept that in the NHS, do we not? You have only to look at the recent inquiries to know that the NHS is not perfect. What I am trying to put over is that by using a wider range of providers you can improve services for the NHS, but of course you need regulation and somebody ensuring that the quality is high. It is not perfect in all cases—of course I accept that—but it is not perfect in the NHS either. I do not think that any of your Lordships would not rejoice in better services that enhance patient care being provided. That is what we are all about. My view is that competition involves not a yes/no ideological choice but a pragmatic and nuanced judgment about how, or whether, to make use of it.
That is what brings me on to these regulations. There is much in them that will strengthen the NHS. I do not want to see them annulled or to see another delay. The NHS has been in something of a difficulty with all the changes that are being made, and it is now time to settle down and get on with it. So I do not want to see further delay. On the detail of the regulations, first and foremost I think that Regulation 2 of Part 2, which sets out the procurement objectives, is very good. It says—and I paraphrase a little—that NHS England and CCGs, when procuring healthcare services, must consider the needs of the people who use the services. So it is not about the staff but about the needs of the people who use the services.
There is a lot of rhetoric, as there has been for years, about putting patients first. However, we know that that rhetoric is not always put into practice. Again, I refer to some of the recent inquiries that we have had. In fact, we should be very concerned, as is the King’s Fund, that the UK has the second highest rate of mortality amenable to healthcare of 16 high-income countries. We should be deeply worried that we have the second highest death rate among those comparable countries. The NHS does need to change and improve. The think tanks and the people who think endlessly about the NHS all agree that it needs change. The Labour Party agrees that it needs change. The debate is about how to do it.
Regulation 2(b) refers to,
“improving the quality of the services”,
as the purpose of the legislation. Surely that is what we all want. Poor care is very expensive. It involves returning to hospital to put right what has gone wrong in the first place, litigation, poor staff morale and misery for users, families and friends. Regulation 2(c) is about efficiency. We all have a duty to ensure that money is not wasted and services are efficient. The noble Baroness, Lady Hollins, has just talked about that and what we need to do to ensure that we have commissioners of the highest order. Surely that is what we are trying to achieve.
Health and Social Care Bill
Baroness Young of Old Scone Excerpts(12 years, 1 month ago)
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Baroness Young of Old Scone
My Lords, I support the amendment of the noble Baroness, Lady Emerton, from two perspectives. One is as the chief executive of Diabetes UK, where we increasingly hear stories from patients about the care that they receive in hospitals. One in 15 of all patients in hospitals at the moment has diabetes. They may not be there as a result of their diabetes but they have it—it is, of course, a serious condition. There is strong evidence that poor care in hospitals exacerbates that condition rather than improves it. I shall just mention two issues: people lose control of their own insulin and glucose management and they develop pressure problems—particularly foot and leg problems, which can dramatically escalate and lead to amputation.
Patients increasingly tell us that one of the major problems that they face in receiving care as an in-patient is that readings, checks and procedures are undertaken by healthcare support workers who are insufficiently trained and knowledgeable to alert qualified staff to take action. Just yesterday, the All-Party Parliamentary Group on Diabetes heard the distressing story of a gentleman who had been admitted to hospital and who went into a hypo through insufficient management of his glucose levels as he lay in a hospital bed. The healthcare support worker said, “I thought you were a bit strange when I gave you your lunch”. If people with diabetes “go a bit strange”, any qualified nurse will know instinctively that this is serious and needs to be dealt with. It is unforgivable that patients in a healthcare establishment have worse control over their diabetes than when they are in their own homes. I am not laying that at the feet of healthcare support workers entirely but, increasingly, the care given to people in beds, day in and day out, is given by people who need to be accredited and qualified.
The second perspective from which I want to speak is as the ill-fated chairman of the Care Quality Commission who set up the regulator for health and social care. I confess that one of my great regrets, when I resigned from that post, was not to be able to take forward work that I saw as absolutely vital. It had become abundantly clear to me, from the regulatory work in healthcare, that the key to quality was very dependent on the quality of nursing care. It is absolutely central to quality as a whole for people in healthcare. What has also become clear to me—and the evidence is borne out in many cases of poor care—is that it is not published standards or agreed levels of care that are important but the knowledge, education and skill of the nurses and healthcare support workers who are providing that care. It is about how they feel about the job and about their commitment to the job—not just seeing it as another job but seeing that improving things for patients is at the centre of what they do.
Had I stayed as chairman of the Care Quality Commission, I was intending—and I had already begun discussions with the Royal College of Nursing and others —to mount a major campaign to ensure that the nursing process, and with it, at its heart, the healthcare support worker, was improved and that formal registration and regulation of healthcare support workers was introduced. The Minister may well say that these improvements can be tackled through a voluntary register but, from my experience, I do not believe that this is the case. This is so important that a formal statutory register is absolutely required.
Baroness Hollins
My Lords, I support the amendment. I note that one of the reasons given for not considering statutory regulation for this group is that there is a very high turnover of staff in this grade. This seems to me to be a symptom of an unsatisfactory situation and perhaps points to the poor job satisfaction and lack of prospects for healthcare workers. My noble friend has pointed to the problems with skill mix. I think that she was really talking about skill mix across the whole range of mental and physical healthcare settings and not just physical healthcare. Within that, she would have included people with learning disabilities.
It seems to me that there must be some minimum requirements for training and supervision. I know that the Government suggest that it is the responsibility of the employer, and perhaps also of the commissioner, to ensure that the service which is provided reaches minimum standards. Perhaps that requires that, in order for commissioners to contract with an employer, a service has to have been appropriately accredited. A service which has been accredited has of course been accredited for the whole service, not just for the work of individual staff, who are subject to their own regulatory authority.
This morning, I revisited the Royal College of Psychiatrists’ accreditation standards for adult in-patient wards for people with learning disabilities—I should remind noble Lords that I am a past president of the Royal College of Psychiatrists and a psychiatrist myself. The college’s general standards very helpfully include attending to recruitment and retention of staff, training, supervision, management of complaints and so on. It is helpful to think about the relationship between the necessary accreditation of services and the need to attend to the training and aspirations of all those staff who work in such services: retention and job satisfaction are key to this.