Obesity Strategy 2020

Caroline Johnson Excerpts

Thursday 27th May 2021 Commons Chamber

[Dr Caroline Johnson (Sleaford and North Hykeham) (Con)]

Helping people to achieve and maintain a healthy weight is one of the most important things we can do to improve our nation’s health. As a consultant paediatrician, I have seen at first hand a worrying rise in obesity among our children and the health complications that come with it. I remember in my practice seeing a nine-year-old heavier than I was at seven months pregnant. I saw a young teenager weighing more than 120 kg—that is more than 19 stone. I saw many children with significant obesity-related health problems.

As other Members have said, the trend is increasing. One in three children leaving primary school are already overweight and one in five are leaving with obesity. This trend is further exacerbated in the most deprived areas of this country, where children are twice as likely to be obese as their peers in the richest areas. This is tragically setting up far too many young people for a lifetime of health complications, from diabetes to mental health, as well as reinforcing health inequalities.

In my experience as a doctor, the patients I see want to maintain a healthy weight but find it challenging to do so—and it is challenging, perhaps not surprisingly given the food environment in which we live. In particular, eating out has gone from an occasional treat to a regular feature of our social lives, but we have very little information on how many calories are in the food offered. This is important because on average meals out contain more than twice as many calories as those prepared at home. Accordingly, I welcome the Government’s proposal to introduce calorie labelling on menus, because it will empower people and give them the chance to make the healthy choices that they want to make. Nutritional information is already available on the food and drinks that we buy in supermarkets; expanding the practice to larger restaurants and cafés will help customers to make more informed decisions when they eat out. The evidence shows that calorie labelling on menus can reduce the number of calories consumed by about 8% and, indeed, that it leads to the development of healthier menus.

Although I welcome the push for reformulation to reduce the sugar and calorie content of food, I am worried that in their efforts to reduce the calories on menus, food producers and establishments may make greater use of artificial sweeteners. Research has shown that the mismatch between the sweet taste and few calories provided by artificial sweeteners can confuse the body’s systems and lead to hunger cravings that result in the consumption of an even greater number of calories overall. We need to be careful to ensure that our efforts to reduce calories do not unintentionally create the opposite effect with artificial sweeteners.

Finally, I wish to discuss an area that needs greater emphasis in the Government’s strategy to tackle obesity: education. As other Members have mentioned, education is really important in tackling obesity. Today’s greater prevalence of eating out is partly because of an increase in disposable income and convenience. We also know that cooking skills at home are just not what they once were. Education has a significant part to play by instilling healthy habits in young people and showing them not just what is healthy but how to make it, so that by the time they leave school they have good kitchen-safety skills and can cook simple, healthy and nutritious meals. I hope that when she responds to the debate the Minister will have time to elaborate further on the Government’s intentions in regard to education in this policy area.

Covid-19 Update

Caroline Johnson Excerpts

Thursday 15th October 2020 Commons Chamber

[Matt Hancock]

Yes, I do think more action is needed, and that is why we are taking it today.

[Dr Caroline Johnson (Sleaford and North Hykeham) (Con)]

The Prime Minister has been very clear on the risk of obesity for those who get coronavirus, in that people who are obese have a more severe disease course than those who are slimmer. In tier 3 areas, however, many gyms are being closed and many sporting activities are being restricted. What are the Secretary of State and the Department doing to ensure that we can encourage activity among people in those areas? Perhaps we could have a work out to help out scheme, with free online activities targeted to each age group and each physical ability.

[Matt Hancock]

I love the idea of work out to help out. It is undoubtedly true, from the science that I have seen, that obesity contributes to a worse impact for those who catch coronavirus. This is something the Prime Minister has spoken about with great passion, and it is something we want to tackle, so I will absolutely look into that idea. I would also say that we have changed the proposals for people who are shielding, even in the highest risk, tier 3 areas, who should always be clear that outdoor exercise is a good thing.

Oral Answers to Questions

Caroline Johnson Excerpts

Tuesday 6th October 2020 Commons Chamber

[Matt Hancock]

Yes, absolutely. I think we agree right across the House on the importance of this agenda. The first and most important part of it is to bear down on the long waits, because the longer that people wait, the more dangerous cancer can become. That is happening, and we also have to make sure we bring the referrals forward, because we do not want to have fewer people referred for the diagnostics. At the same time, we are expanding the diagnostics that are available, both in hospitals and increasingly in community hubs, which are safer from a covid point of view and, for the long term, will mean that diagnostic centres for things such as cancer can perhaps be on a high street or in the places where people live, so that they do not necessarily have to go to a big, acute hospital to get the diagnostics part of the pathway done.

[Dr Caroline Johnson (Sleaford and North Hykeham) (Con)]

What steps he is taking to ensure that patients with illnesses other than covid-19 can access the treatments and procedures that their diagnosis requires.

[The Minister for Health (Edward Argar)]

It is vital that non-covid treatments are restored as quickly and safely as possible. That is what the NHS is doing. It is working to have them restored, by October, to around 90% of last year’s levels.

[Dr Johnson]

Thankfully, children are relatively robust in the face of coronavirus. However, children’s services, like other hospital services, were understandably reduced during the pandemic. What is my hon. Friend doing to ensure that paediatric services are now 100% up and running and will not be affected by a future wave of the pandemic? What is he doing to support NHS trusts in dealing with the backlog of appointments delayed by the coronavirus?

[Edward Argar]

I pay tribute to my hon. Friend for her service to her constituents both as their MP and as a paediatric clinician. She is right to raise this important issue. Restoration guidance has already been published by NHS England and NHS Improvement, setting out a framework to fully restore services in this area, which I agree is vital. I would be very happy to meet her to discuss this further.

--- Later in debate ---

[Matt Hancock]

I pay tribute to the group that the hon. Lady mentions. I have put a huge amount of effort into supporting social prescribing, including with funding, and I encourage her CCG to engage with such bodies to make sure that we can get funding to support them on the frontline.

[Dr Caroline Johnson (Sleaford and North Hykeham) (Con)]

  At the start of this pandemic, in the first lockdown, abortion services were relaxed to allow women to enable them to access the service from home, but I am particularly worried about the effect that has had on those women who are particularly vulnerable, subject to abuse or in coercive relationships. Now that we know that the risk to women of childbearing age from attending a face-to-face appointment is extremely low, what assessment has my right hon. Friend made of the ongoing need to continue in this way?

[Matt Hancock]

The Under-Secretary of State for Health and Social Care, my hon. Friend the Member for Bury St Edmunds (Jo Churchill) has committed to consult on the subject to make sure we get to the right outcome.

Coronavirus

Caroline Johnson Excerpts

Monday 9th March 2020 Commons Chamber

[Matt Hancock]

We have ongoing discussions with the Welsh Government. For instance, the Welsh Government joined the Cobra meeting this morning—in fact, they have been present at all the Cobra meetings—and we have had very good engagement on the Bill. I will look into the two specific points that the right hon. Lady has raised and will talk to my Welsh colleagues about them.

[Dr Caroline Johnson (Sleaford and North Hykeham) (Con)]

May I thank the Health Secretary for the way he is managing this crisis, and for how frequently he has come to the House to answer questions? Pregnancy is a time of great joy, but in the context of coronavirus it can also be a time of great worry. Is there any specific advice from the chief medical officer for ladies who are expecting or who are considering starting a family?

[Matt Hancock]

I am glad to say that the evidence so far indicates that there is not a particularly raised concern. Nevertheless, I entirely understand the level of worry that getting coronavirus might cause somebody who is pregnant, so we are researching this very carefully.

Coronavirus

Caroline Johnson Excerpts

Tuesday 3rd March 2020 Commons Chamber

[Matt Hancock]

We have increased the number by 500 already, and there are plans for more to come, as and when that becomes necessary.

[Dr Caroline Johnson (Sleaford and North Hykeham) (Con)]

An increasing number of people are self-isolating, but they still require routine care. Are GPs providing that routine care, and what advice is being given to GPs on whether they should wear masks, and whether they should visit a patient at home or get them to come to the surgery and so on?

[Matt Hancock]

We do not want people who suspect they have coronavirus to go to their GP; we want them to do this via NHS 111. Further to my earlier point about being able to self-validate for sick pay for seven days, they can of course then do that by phone and get an email confirmation, should they need to, to extend that to the full 14 days. Of course, as well as tackling coronavirus, the NHS must do business as usual. We are increasing the amount that people can do over the phone, Skype and other forms of telemedicine. That could be increasingly important if there is widespread concern about communicable diseases.

Coronavirus

Caroline Johnson Excerpts

Wednesday 26th February 2020 Commons Chamber

[Matt Hancock]

It is my job to worry about all those things. The answer is that that sequence of events confirms to me the importance of quarantining people. I know that there were some concerns about quarantine, but I think it showed that we were dead right to quarantine people because it turned out that they tested positive during the quarantine. Mr Speaker, I just want to put on the record my thanks to the hon. Lady, and everyone in her constituency and the Wirral more broadly, who have risen to this challenge.

[Dr Caroline Johnson (Sleaford and North Hykeham) (Con)]

Constituents have been writing to me with regard to travel advice. They are planning holidays to countries that are currently affected and for which the travel advice is to isolate on return if symptomatic. Some do not want to go on those holidays because, understandably, they are genuinely frightened, but they cannot reclaim the money because the travel advice is not saying that they cannot go. If they do go, they then have to isolate when they come back, which effectively lengthens their holidays and creates significant difficulties in relation to their responsibilities. Will the Secretary of State advise my constituents on what they should do in that circumstance and what discussions have taken place with the Foreign Office on this matter?

[Matt Hancock]

Decisions on precise travel advice for each country is of course a matter for the Foreign Office, but I can tell my hon. Friend that all those considerations are taken into account. We have to base decisions on the best possible science and clinical advice.

Social Care

Caroline Johnson Excerpts

Tuesday 25th February 2020 Commons Chamber

[Matt Hancock]

No, I do not recognise those figures because they are not the accurate representation of what is actually happening. There are many within that figure who are judged under legislation to need to pay for their own care, and they do. We have to start from a basis of fact and, frankly, until Labour Members start working on this from a basis of fact, it is very difficult to take their contributions seriously.

The critical thing is that, as life expectancy is increasing, more people are looking forward to ageing in comfort and dignity, and that is good news. Opposition Members may not like it. It is odd; they do not seem to want to think that life expectancy is going up. We have a duty to ensure that our social care system is equal to the task. There are many things we should be proud of in our social care system, although we would not have gathered that from the speech by the hon. Member for Worsley and Eccles South. Some 84% of providers of social care are rated as good or outstanding, and 90% of people who receive care are satisfied with its standard. The proportion of adults with learning disabilities living in their own home or with their family has increased every year since 2014-15. That is good news, which we should welcome.

[Dr Caroline Johnson (Sleaford and North Hykeham) (Con)]

Is my right hon. Friend not right to say that life expectancy is continuing to go up? We would expect it to slow down, because we are not all going to live forever. The key thing is not just how long we live for; it is how long we live a high-quality, healthy life for.

[Matt Hancock]

My hon. Friend is absolutely right, and that is the sort of analysis on which we can make decent policy progress, because it based on the facts, rather than on making things up.

--- Later in debate ---

[Jackie Doyle-Price]

The issue is that local authorities are commissioning care from local care providers and paying the rate that the individual resident is incurring. It is about what they are prepared to pay for that bill and not the local authorities paying living wages directly to employees. However, that is pushing the risk on to care providers, and we need to acknowledge that there will be workforce challenges for those providers. They will be competing more and more for people. While there is that downward pressure from local authorities on what they are prepared to pay and the upward pressure on wages, the risk is being borne by providers.

Part of the solution is also not just about who pays. We need to be a lot more imaginative about this. We all know that we will live longer—beyond 70—and that we will have more years in life in retirement. Just as we make plans for our pensions, we need to make provision for our homes and how we are going to live in old age. The simple fact is that our housing requirements when we are in our 40s and are raising a family are rather different from what we might require in our 90s. We know that falls are one of the biggest burdens on the NHS, so the fact that we are not encouraging people to make sensible lifestyle decisions about their homes is causing additional cost to the NHS, as well as, potentially, the need for more long-term residential care. One reason why we have that issue is that we have allowed, collectively over decades, so much wealth to be stored in our housing stock that we have encouraged people to behave in a way that makes them want to cling to it. I would like us to look more imaginatively at incentives through the tax system to encourage people to downsize and look at different ways of living. We want to use the planning system to encourage the development of retirement villages where people can purchase extra care.

[Dr Caroline Johnson]

Some people like to care for relatives at home, and it is not uncommon to create a small annexe within or adjacent to the property for an older relative to be cared for, but currently, the council tax system means that if that relative passes on, after that—within two years—people will be charged double the council tax for that part of their dwelling. Does my hon. Friend think that that is something that we can improve on and change to encourage people who wish to look after their relatives in their properties to do so?

[Jackie Doyle-Price]

I completely agree. That is exactly the kind of incentive that we should encourage. The longer that we can encourage people to live independently, the better their quality of life and the better it is for the taxpayer, because there will not be those ongoing bills. The point is exactly that as we live longer, we will spend many years in a condition of frailty, and that needs to be properly managed through the system.

Every parent, with the best will in the world, will wish to hand on as much of their assets to their offspring as possible, but that could also encourage behaviours that are bad for their health. I want my parents to realise the value of their assets rather than protect their inheritance for me. I am sure that most people would think that about their parents, but there is a lot we can do on the tax system and incentives to encourage families to manage those issues collectively and in a way that is good for people’s welfare as they become elderly and enables them to do more for their children.

It is high time that we tackled this issue. We should also not look at this entirely in isolation from the issues regarding working-age adults, which are also a major challenge for local authorities as they manage their finances in this area. We must look at the issue of people with learning disabilities and autism being increasingly placed in areas of long-term care. The issue is that, although we have been broadly successful in moving out people with learning disabilities through the transforming care programme, sadly the pipeline afforded by those people moving out has been filled by people with autism. The Government have to give a much clearer challenge to commissioners. When faced with people with complex needs, the first instinct should not be to put them in residential care. Too often we have seen how those kinds of placements do harm. We need to challenge local CCGs and NHS England to put much better care upstream by providing early diagnoses for people with autism and giving them the tools to protect themselves.

Maternity Services: East Kent

Caroline Johnson Excerpts

Thursday 13th February 2020 Commons Chamber

[Ms Dorries]

I fear that you will shout at me again, Mr Speaker, if I try to answer my hon. Friend’s question fully, because I agree with everything that she has said. Maternal deaths absolutely must become a never event, and we must focus on making pre-eclampsia and post-partum haemorrhage, which lead to such deaths, never events. I went to the first meeting of the APPG on baby loss and, as my hon. Friend knows, I am always happy to go and hear anything that anyone has to say about this issue that will help our work in trying to improve maternity standards[Official Report, 2 March 2020, Vol. 672, c. 4MC.].

[Dr Caroline Johnson (Sleaford and North Hykeham) (Con)]

I should mention at the start of my question that I work as a consultant paediatrician, and that I look after babies and have attended a number of deliveries. I would like to thank the Minister for being so thorough, robust and dedicated in ensuring that this situation improves and that babies are safely delivered throughout the country. In my practice, I have noticed that all baby deaths and adverse outcomes are thoroughly investigated locally, but in my experience this tends to be done just locally. The lessons might be shared internally, but they are not being shared with other hospitals down the road, where the same mistake might be made. I welcome what she is doing, but can she reassure me that those lessons will be shared nationally, so that everyone can benefit from the lessons that are learned, and that such sharing will be widespread so that future tragedies are prevented? Can she also reassure me that, when she sets up the Healthcare Safety Investigation Branch process, its culture is such that doctors, nurses and midwives are able to give full and free answers, and that we get the balance between accountability and blame just right?

Wuhan Coronavirus

Caroline Johnson Excerpts

Tuesday 11th February 2020 Commons Chamber

[Matt Hancock]

The hon. Lady makes an important point, especially in relation to communicating through, for instance, the Department for Education and schools to make sure that schools get the reassurance that they need. I pay tribute to the way the hon. Lady has conducted herself, given the number of cases in her constituency, and the impact on local health services. We have taken action urgently where contact tracing has shown that it needs to be taken, and we will take that proportionate action. I am also very keen to be able to provide reassurances to people that we are taking the action that is needed and that the threat to the public remains moderate, even as we have seen the increase in numbers.

[Dr Caroline Johnson (Sleaford and North Hykeham) (Con)]

In my local hospital, staff are being provided with specially fitted masks to ensure their safety when treating patients who may or may not have the coronavirus. Will the Secretary of State confirm that that is part of a wider package of ongoing policies and procedures in the NHS to keep our staff safe when treating these patients?

[Matt Hancock]

Yes, of course. Making sure that we have the equipment to keep our staff safe is a very important consideration—keeping medics safe is very important not only for them but for the public, because they provide such an important service.

NHS Funding Bill

Caroline Johnson Excerpts

2nd reading & 2nd reading: House of Commons
Monday 27th January 2020 Commons Chamber

[Anne Marie Morris (Newton Abbot) (Con)]

It seems to me that the NHS Funding Bill is really just the beginning. If the Government are serious about identifying specifically how much money they will commit to particular parts of the NHS budget, that is to be welcomed, and certainly any increase in any part of NHS spending is welcome. A 3.4% increase compared with what we have had during the very challenging period of the past three to four years is therefore very welcome. I believe that it actually is a floor, not a ceiling. I totally understand the interpretation, which I think is correct, of the money resolution, but that relates specifically to amendments to this Bill. My reading of the money resolution is that we can, in further Acts, expand and increase these amounts.

My real concern is trying to get to the bottom of how these figures have been arrived at. There has been an assumption that it is all about inflation and looking at comparative figures, but there are three pieces to this. What are the assumptions underlying the decisions that have come to these figures? What assumptions have been made about inflation, because Brexit has changed much since these figures were first arrived at? How are we looking at demand and need? Do the Government really understand what the unmet need is? Certainly, reports by the Public Accounts Committee indicate that the Government do not really have a grasp of that. That then leads me to question whether these are the right figures to do what everyone in this House wants, which is to meet the needs of all our citizens for good healthcare and, ultimately, good social care, which is not part of this Bill. I think the Government have missed a bit of an opportunity here. It would be helpful if they had set out how they will flex if the assumptions with regard to savings and efficiencies changed, if the inflation rate changed, or if demand changed. The bits missing from this Bill are a formula to calculate the increase and some honesty about the basis on which the Bill has been put together.

As we have heard, some specific promises have already been made in a five-year plan. We have said that mental health spending will go up by £2.3 billion, which is a 4.6% increase a year; that mental health spending for children and young people will grow faster as a part of that budget; and that there will be an increase in primary and community healthcare spend in the areas of highest health inequalities. But as yet we do not have any mechanism for an annual statement on exactly where we are on this spending. In addition to a formula that explains how we got to this magic figure, there should be an annual statement on these figures so that we can see how the 4.6% a year increase for mental health has actually been delivered and whether children and young people are actually getting the biggest chunk.

It has been said, quite rightly, that in this Bill we are looking at only part of our total health and care ecosystem. We must look at what we do about infrastructure—hospital—spending. The £2.8 billion hospital infrastructure promise in the spending review last year was very welcome, but, as the hon. Member for Central Ayrshire (Dr Whitford) pointed out, what about the repairs? With regard to the training budget, the spending review refers to a 3.4% increase. Is that really going to cover it? How are we going to measure whether it is actually spent? The hon. Lady referred to the 1% increase in public health grant. Can that really be enough? For me, what is really needed is an annual report on all health spending. The biggest challenges to getting this right—I am not the first and I will not be the last to say it in this Chamber—are stopping the slippage from revenue budgets to capital budgets and the slippage that will inevitably occur if social care is not properly funded. We absolutely have to fix the social care challenge, and this Bill is not enough, and cannot stand alone, in terms of solving these issues.

This Bill is welcome, but it is in many ways a missed opportunity. We need to see the total picture. We need to have proper accounting. We need to have proper visibility of the numbers so that we as a House can demonstrate clearly to the great British people that we are delivering on what we have promised and what they need.

[Dr Caroline Johnson (Sleaford and North Hykeham) (Con)]

Does my hon. Friend accept that the purpose of the Bill is not to set out the absolute detail of every single possible thing that could happen over the next few years, but simply to provide assurance to the NHS in England of the minimum funding that it could possibly receive, and the massive increase that we are giving it, so that it can continue to plan for the future?

[Anne Marie Morris]

My hon. Friend is absolutely right that we should provide a long-term plan and a long-term budget. However, if we are to be honest with the public and with ourselves, we need to measure what we are doing and be clear and accountable to the public that what we have said we will spend delivers the outcome we have promised.

This is about openness, transparency and accountability, and that is the missed opportunity. It may well be that this sum is right and that the savings that have been promised can be made to enable it to be adequate, but there is some serious doubt about that. Without openness, honesty and the figures being reported on each year, we cannot put our hand on our heart and say that we are doing what we promised the British people we would do. There is a saying that what gets measured gets done, so let us measure this. Let us get to the crux of this spending and prove to the British people either that we have got it right or, if not, that we have a formula to get it right so that we can do what is right. We need a plan to monitor the10-year plan, which is great in ambition but needs to be properly scrutinised and properly monitored so that not just the Government and the Conservative party can be held accountable, but all of us in this House can be held accountable, because it is for all of us to get this right. It is not just down to the Government: it is for all of us to ensure that we deliver what people, frankly, need and deserve, and what we have promised.