Taylor Review of Modern Working Practices

Debate between Lord Prior of Brampton and Lord Brooke of Alverthorpe

Tuesday 11th July 2017 Lords Chamber

[Lord Prior of Brampton]

My Lords, the noble Baroness is clearly right about the lower tax take. Clearly, if earnings are higher, the tax take will be higher. It is rather shocking. These are the figures in America: in 1970 the average median salary among the lowest-paid 90% of people was $34,000; in 2013 it was $31,000—it has gone down. This is the problem that all western economies face: earnings are stagnant and falling. Our children’s generation may be facing a less prosperous future than we do. This is the huge dilemma that we all face. When she says there will be a lower tax base, she is absolutely right. The whole point of improving productivity is to improve earnings. It is in all our interests to improve earnings—to see wages grow.

The noble Baroness also talked about the confusion between the living wage and the national minimum wage. She has now confused me so I shall have to write to her. She went on to talk about the Low Pay Commission. When the previous Government brought in the living wage and the trajectory for it, that was a political decision; it was not made by the Low Pay Commission. One of the criticisms of the minimum wage is that politicians cannot resist the temptation to get involved in it. To some extent, the Low Pay Commission has been subverted by politics. I guess that was inevitable. Actually, the increase in the living wage was one of the great triumphs of the coalition Government.

[Lord Brooke of Alverthorpe (Lab)]

My Lords, I have not read the report yet, so I would be grateful if the Minister could put me right. Not all western countries are in the difficulties that the States and the Anglo-Saxon type economies are in. Sweden does not have the kinds of problems that we have. It has some, but not on the scale that we have. The major difference between Sweden and similar countries is that the difference in income between those at the top and those at the bottom has not widened in the way that it has in the UK and the States. To start to address this, we have to look at that as well—not just the quality of the work but the totality of the distribution of income in the workforce. Do the Government have any plans for doing that?

[Lord Prior of Brampton]

The noble Lord is right that the disparities in Sweden are smaller than in the US, the UK and other parts of the world. They are smaller but they are not non-existent. It is a big issue in the Scandinavian countries as well. We intend to address that through our industrial strategy. The second issue that the noble Lord touched on is that growth in productivity, in so far as there has been any, used to trickle down into the incomes of all people—everyone was brought up by improvements in productivity. That link seems to have been greatly weakened over the years, so that when there is growth, it goes to the top 10% and not to the 90%. The noble Lord is quite right that we need to look at that very carefully.

Industrial Strategy: Engagement

Debate between Lord Prior of Brampton and Lord Brooke of Alverthorpe

Monday 27th February 2017 Lords Chamber

[Lord Prior of Brampton]

The noble Lord may have seen the letter that BlackRock sent round to all FTSE 100 companies in which it talked very strongly about the need for long-term sustainable improvements when considering remuneration. I was pretty staggered to see that between 1998 and 2015 the average take-home pay of a FTSE 100 chief executive has gone up from £1 million to over £4 million. In 1998, that represented 47 times the average salary of an employee, now it is over 128 times. Remuneration is a very serious issue and if we want to live in a fair society, we need to address it.

[Lord Brooke of Alverthorpe (Lab)]

My Lords, will the Minister have a look at a Private Member’s Bill that was introduced here twice previously by the now deceased Lord Gavron, who was very prescient in seeing the difficulties arising from the growth in the salary gap between CEOs and their employees? That Bill was supported by noble Lords all around the House. It would be well worth the Minister’s while to look at it. He mentioned that he does not want the Government to interfere in the deals between employers and employees in the private sector. However, the Government have responsibility in a very substantial part of the country’s employment—namely, in the public service. What are the strategy and targets for improving productivity in the public service?

[Lord Prior of Brampton]

The noble Lord makes a very good point. Industrial relations, employee engagement—call it what you will—is much better by and large in the private sector than in the public sector. We are not good employers, if we are honest. Like me, a number of noble Lords in this House were staggered that the junior doctors, for example, were forced into taking strike action. These people are vocationally committed, yet somehow we created an environment in the public sector which is far from satisfactory.

Public Health England: Alcohol

Debate between Lord Prior of Brampton and Lord Brooke of Alverthorpe

Tuesday 5th July 2016 Lords Chamber

[Lord Brooke of Alverthorpe]

To ask Her Majesty’s Government when they expect Public Health England to publish its independent evidence-based report on alcohol.

[The Parliamentary Under-Secretary of State, Department of Health (Lord Prior of Brampton) (Con)]

My Lords, the evidence review is currently being peer reviewed and PHE will publish it later this year.

[Lord Brooke of Alverthorpe (Lab)]

I am grateful to the Minister for that response and I look forward to the report. Is he aware that the latest statistics from the Health and Social Care Information Centre show that hospital admissions due to alcohol-related illnesses are continuing to rise and are now more than 1 million, that the number of deaths arising from alcohol continues to go up, and that the cost to the NHS of alcohol-related problems is more than £2.5 billion? Given the difficulties that the NHS faces in funding itself at the moment, given that the economy may slow down as a result of Brexit so that less funding is available and given that we heard today about the prospect of another doctors’ strike, are the Government prepared to review the plan for the NHS to which the noble Lord so frequently refers? It may need to be changed completely, so what is plan B?

[Lord Prior of Brampton]

My Lords, that goes slightly beyond the Question on the Order Paper. The Government are committed between now and 2020 to putting £10 billion of new money in real terms into the NHS and we have a plan to deliver on that. Clearly, if the economy changes to a great extent, we will have to keep that in mind.

Health: Alcohol

Debate between Lord Prior of Brampton and Lord Brooke of Alverthorpe

Thursday 12th May 2016 Lords Chamber

[Lord Brooke of Alverthorpe]

To ask Her Majesty’s Government what steps they are taking to alert the public to the dangers of alcohol and its causal links with hypertension, depression, Alzheimer’s and other forms of dementia.

[The Parliamentary Under-Secretary of State, Department of Health (Lord Prior of Brampton) (Con)]

My Lords, the new UK Chief Medical Officer’s advice on low-risk drinking helps people understand how they can reduce their risks from alcohol consumption. Public Health England has recently launched One You, a marketing programme providing personalised feedback on alcohol and other potentially harmful behaviours. In primary care, alcohol-risk assessments are offered to all patients registering with a new GP and 3.5 million people have had one as part of their NHS health check.

[Lord Brooke of Alverthorpe (Lab)]

I am grateful to the Minister for his Answer and for the efforts which I know he makes on this topic. Is he aware that we now have 9 million people suffering from hypertension, that the number of people with depression has doubled since 2005 and that the evidence now quite clearly shows that 62 illnesses are related to alcohol? Given the amount of money which the drinks industry spends on advertising seeking to persuade people to drink more, is it not time that the Government start to undertake some important work with a publicity campaign gently to persuade people to drink less and live a better, longer and happier life?

[Lord Prior of Brampton]

My Lords, the new guidelines published by the CMO are very clear about how much alcohol should be drunk and the implications it has for health. I do not know whether the noble Lord has been on to the One You website or has downloaded the drink tracker app. The information is out there. A campaign is being conducted by Public Health England, and we are making some progress.

Alcohol Strategy (EUC Report)

Debate between Lord Prior of Brampton and Lord Brooke of Alverthorpe

Wednesday 10th February 2016 Grand Committee

[Lord Brooke of Alverthorpe]

It is 50 milligrams to 100 millilitres of blood.

[Lord Prior of Brampton]

We will see what impact that has: if it is major, we should clearly take it into consideration.

Since April last year, the standard GMS contract has included delivery of an alcohol risk assessment to all patients registering with a new GP. This has the potential to raise awareness of alcohol as a risk factor with a large percentage of the population. The Government are also continuing to work with Public Health England, which is giving a high priority to alcohol issues by working with local authorities. However, we believe it is right that the primary responsibility for drug and alcohol issues should be with local authorities. PHE will support all local authorities and their partners to put in place high-quality interventions to prevent, mitigate and treat effectively alcohol-related health harm. As noble Lords will know, services include local licensing controls and specialist services to support recovery for dependent drinkers.

In 2014-15, the Department of Health commissioned PHE to review the evidence and provide advice on the public health impacts of alcohol. The review of evidence has been completed and is in the process of being written up as they complete a peer review process. It will be available in due course.

The new alcohol guidelines provided by the CMO are currently out for consultation. That will have an important impact on the debate as we go forward, so I hope that noble Lords in this House will contribute to that consultation. The department recognises that in the light of the new guidelines further work will need to be done on labelling and an appropriate transition period will be put in place to ensure industry can change its labelling in a cost-effective way.

The noble Lord, Lord Brooke, raised the issue of duties and the mixed messages that might come from reducing duties. All Governments face this issue. They have to get the balance right between what is good for people and what people want to do in a free and democratic country. It is a difficult balance to strike. I do not think that the Chancellor has been any more or less responsible in this matter than previous Chancellors. One of the joys of living in a democracy is that these issues are balanced for us. In a world that was less free, a ban might be put in place—prohibition or something—but I do not think that many of us would like to live in that kind of society. So this balance between what is good for you and what people like doing is something that we vote for in general elections.

We recognise the contribution that not just individuals but also businesses and our communities can make to help people better understand the risks associated with alcohol. I am sure that this is an issue to which we will return in due course. Change will not happen overnight. I take very much on board what the noble Lord, Lord Hunt, said about how we approach this issue, and that a nudge can sometimes create a barrier to change.

The noble Baroness, Lady Prashar, has made a very important contribution to this debate and we take that very seriously. Any responsible Government would take this very seriously. How we get the right balance in this debate is very important. Part of getting that balance involves the kind of debate we have had this afternoon.

Health and Social Care: State Pension

Debate between Lord Prior of Brampton and Lord Brooke of Alverthorpe

Thursday 21st January 2016 Lords Chamber

[Lord Prior of Brampton]

My Lords, as my noble friend knows, the Government accepted the findings of the Dilnot review but felt that now was not the right time to introduce them, given the financial pressures on local government. We are committed to introducing the Dilnot reforms by the end of this Parliament.

[Lord Brooke of Alverthorpe (Lab)]

Is not the plan inadequate? Many noble Lords come with requests for quite justifiable changes to health services and the Minister very generously and kindly kicks them back because of inadequate resources to meet those demands. Surely it is the case that in looking at the plan we need to look at the longer term and not just the short term in five years.

[Lord Prior of Brampton]

The NHS plan is for the whole five-year period—the lifetime of this Parliament. It was signed up to by all the arm’s-length bodies within the NHS. The Government support that plan and are front-loading the financing to support the plan as well, so we believe that the plan is achievable.

Sugar Tax

Debate between Lord Prior of Brampton and Lord Brooke of Alverthorpe

Wednesday 13th January 2016 Lords Chamber

[Lord Prior of Brampton]

My Lords, as I said earlier, the Prime Minister and the Secretary of State for Health are thinking long and hard about what should be part of the obesity strategy. I am not sure that the noble Lord is right when he says that a modest tax would have much of an impact; it would have to be a significant tax to have a major impact on the consumption of sugary drinks.

[Lord Brooke of Alverthorpe (Lab)]

My Lords, does the Minister agree that the campaign against tobacco and cigarettes has been particularly effective? It has been applied across all sectors of the economy with no differentiation between any particular sectors. He mentions that, this time round, we have to be concerned about how sugar might impact on particular parts of the community but, surely, we should make our approach similar to what we did with cigarettes and tobacco and we should apply it right across the board so that we all gain from the change.

[Lord Prior of Brampton]

My Lords, I think that the noble Lord is right; indeed, the Prime Minister has called this the new smoking. Obesity is as important to public health as smoking has been in the past. We have to build a much stronger case among the public at large before we can start to introduce the full range of tax and other measures that we have had for cigarettes and alcohol.

Alcohol

Debate between Lord Prior of Brampton and Lord Brooke of Alverthorpe

Wednesday 9th December 2015 Lords Chamber

[Lord Brooke of Alverthorpe]

To ask Her Majesty’s Government whether they will review the responsibility deal for alcohol in the light of the Institute of Alcohol Studies’ report Dead on Arrival? Evaluating the Public Health Responsibility Deal for Alcohol.

[The Parliamentary Under-Secretary of State, Department of Health (Lord Prior of Brampton) (Con)]

My Lords, we are currently reviewing all aspects of the responsibility deal, including for alcohol. Partnership working continues to play an important role and the Government remain committed to its principles. We will continue to engage with the alcohol industry to encourage it to take action to reduce some of the harms caused by alcohol.

[Lord Brooke of Alverthorpe (Lab)]

My Lords, I am grateful to hear that the Government have decided to review the responsibility deal after its operation for the past five years. During that time, we have seen obesity grow; we have seen no increase in the activity undertaken by individuals; and we have seen more people presenting in hospital with alcohol problems. Will the Minister tell us whether he is sticking to the principles that guided the previous partnership, which was not, in fact, supported by the health industry? What will be the changes in the future to ensure that there is some real pace and real change taking place and that the mechanism of a voluntary approach is not used to delay?

[Lord Prior of Brampton]

My Lords, we have asked the London School of Hygiene and Tropical Medicine to review the impact of the responsibility deal, which it will do later in 2016. There have been, however, some benefits from it on alcohol, to which the noble Lord referred particularly. The number of units not sold as a result of it is 1.3 billion and the package labelling on alcohol products has improved substantially.

Health: Post-polio Syndrome

Debate between Lord Prior of Brampton and Lord Brooke of Alverthorpe

Tuesday 20th October 2015 Lords Chamber

[Lord Prior of Brampton]

NHS England’s approach to most people who are suffering from long-term conditions is best summed up through its House of Care programme, which is very much based around the individual and their carers and so is personalised. Of course, personal health budgets can have a big role to play for people with long-term, complex, chronic conditions.

[Lord Brooke of Alverthorpe (Lab)]

Is the Minister entirely content with the change that has taken place whereby we do not develop single-disease strategies? I speak as a patron of the British Liver Trust. We have long argued that there should be a strategy on liver disease, but this has been resisted. We find an increasing number of people dying from liver cancers, yet no strategy exists because of the decision that the Minister explained to us.

[Lord Prior of Brampton]

I agreed that I would meet with the noble Lord opposite to talk about post-polio syndrome, but perhaps this raises wider issues, including about liver disease and other disease categories, which we can cover at the same time.

NHS: Reform

Debate between Lord Prior of Brampton and Lord Brooke of Alverthorpe

Thursday 16th July 2015 Lords Chamber

[Lord Prior of Brampton]

Interestingly, the number of consultants has increased very significantly over the past 15 years across not all but most specialities. The noble Lord refers to dreadful weekends, and how he dreaded them, particularly bank holidays. That is really why we are here today, so that in future patients like him do not dread them.

If I indicated earlier on that I blame the 2003 contract for the difference between five days’ and seven days’ working, and if that was the implication of what I said, I withdraw it. What I meant to say was that I felt that that contract to some extent de-professionalised the profession.

[Lord Brooke of Alverthorpe (Lab)]

My Lords, most people will welcome much of what is in the Statement.

I would like to come back to the issue of seven-day working that in principle this side supports and accepts. Some of the problems that we have at the moment in the NHS are the top issues with patients. We keep talking about patients being “top of the tree” and being in charge. Can the Minister tell the House what issue about NHS performance at the moment disturbs patients most of all? We have a list of issues where we are doing well: tell us what is worst.

The worst is the inability to access a GP, on a timely basis, five days a week, not seven days a week. This is not new. The position was bad in 2010, when Labour, my party, was in power, but it deteriorated while the Lib Dems and the Conservatives were in the coalition. I can point to Questions in Hansard raised in 2012, when we were promised by the noble Earl, Lord Howe, that discussions were taking place in the profession about trying to improve access to GPs, particularly where there were problems in London. I speak as a patient with a GP in London, who asks how he is to provide a seven-day week service when he cannot get the GPs and does not have the money to do it.

My noble friend Lord Hunt asked a basic question which is of prime concern to people, particularly in London. Will spreading this over seven days until such time as you can provide the 5,000 trained GPs who were promised, which will be seven years down the road, lead to a further deterioration in the ability to access a GP during the week?

[Lord Prior of Brampton]

There is no doubt that, looking forward over the next five years, the resource to be put into primary care will be greater, relatively, than it has been in the past. We wish to deliver more care outside hospital. That is why we are committed to training and having in place 5,000 more doctors in general practice by the end of this Parliament—not just GPs, but others who will support GPs.

The model of primary care will change significantly over the next five years, and it is fundamental to the five-year forward view that we reduce the number of people going into acute hospitals and that we discharge people at the other end of their journey through an acute hospital much quicker.

NHS: GP Clinics

Debate between Lord Prior of Brampton and Lord Brooke of Alverthorpe

Thursday 25th June 2015 Lords Chamber

[Lord Brooke of Alverthorpe]

To ask Her Majesty’s Government whether they will provide an annual report to Parliament regarding the operation of seven-day opening of general practitioner clinics.

[The Parliamentary Under-Secretary of State, Department of Health (Lord Prior of Brampton) (Con)]

My Lords, we are committed to seven-day GP access. We have already invested £175 million in 57 schemes covering 2,500 practices, offering improved access including evening and weekend appointments. The 2016-17 mandate to NHS England, to be published later this year, is expected to reflect Government commitments, including on access. The Government hold NHS England to account for progress against these objectives and publish an annual assessment of NHS England, including progress in delivering the mandate.

[Lord Brooke of Alverthorpe (Lab)]

My Lords, I am grateful to the Minister for the information he has just given. Will he recall that earlier in the week, in reply to a Question about the number of GPs in practices, he said that the general practice model “is largely broken”? His second statement was that it “is probably broken”. In the light of that expression of his concerns about what was happening in GP practices, I presume that he was associating himself with those millions of NHS patients who increasingly find it difficult to see a GP within the time they want, or to see a GP of their choice. If so, can he say whether moving from what is broadly a five and a half-day weekly GP practice to seven days for all will improve matters for those patients or make matters worse, especially as it is being done on a broken model, to use his own words? In those circumstances—

[Lord Brooke of Alverthorpe]

In those circumstances will he say what the new model will be, spell it out to the public and say how many GP practices will have to close?

[Lord Prior of Brampton]

The noble Lord makes a number of interesting points. One of the leaders of the BMA talked yesterday about the need for a renaissance in general practice, which was about the only thing in that speech that I agreed with. We need a renaissance and a complete transformation in general practice because the structure of primary care is largely unchanged since being set up in 1947, and the population’s requirements have changed fundamentally. So over the next five years, I expect primary care to go through a renaissance and be transformed from the bottom up.