When we were a member of the European Union, we benefited from sharing with other members measures to prevent plant and animal, as well as human, diseases. We shared intelligence of disease threats; common rules on phytosanitary standards, border security and animal health; world-leading scientific and pharmaceutical developments; and veterinary expertise. Since we left, we have had to invent our own system and develop partnerships where we can. Our developing border controls regime, some of which came into effect only this month, is very important in that respect. We have heard very important points from several noble Lords on that subject, including the noble Lords, Lord Taylor, Lord Lilley, Lord Krebs and Lord Davies of Brixton.
As a botanist, I will focus on diseases of plants, including those that we eat and those that we need for other purposes. Half of all emerging diseases of plants are spread due to the increasing globalisation of the trade in plants and plant materials, including soil, by both traders and individuals. Natural spread, assisted by weather events, is the second most important factor. Global warming can also enable the establishment of pests that would otherwise not survive a winter here in the UK. As we know, our country has just had the warmest year for decades, and that affects our economy and biodiversity.
As a former member of your Lordships’ recent special inquiry into the state of the UK horticulture business, I will mention some of our findings on plant diseases and the effect on our economy of poor control. Sandy Shepherd, managing director of Ball Colegrave, told us, as a witness from the industry, that biosecurity is
“the fundamental thing that we worry about in our business”.
All our witnesses were particularly concerned that bringing infected plants from abroad could infect UK stock. The UK Plant Health Risk Register contains 1,423 pests and pathogens that have been assessed for the threat they pose to the UK, of which 998 have been spread via live plant movement. Although I agree with the noble Earl, Lord Kinnoull, on grey squirrels, they do not fall within that category.
Fruit trees and bushes and forest trees are particular issues. The Woodland Trust tells us that we import about 19 million forest trees every year and that 20 serious diseases of trees have been identified through imported trees since 1990. That has accelerated the loss of tens of millions of trees. Given the Government’s ambition to plant millions of trees for carbon capture and biodiversity reasons, it is vital that we minimise the risks to the survival of those trees from imported diseases. The Woodland Trust told the committee:
“The single most effective biosecurity safeguard is to reduce the need for imported plants and source all trees for planting in the UK, from stock that has been grown its entire lifespan in GB”.
It suggested to us that an improved labelling system for UK-grown trees would enable consumer confidence that the product they are buying is biosecure and UK-grown for the whole of its lifespan, not imported and just grown on in the UK for a couple of weeks.
For imported plants I know that the Government are working with the Plant Health Alliance on a voluntary certification scheme but, as the noble Lord, Lord Carrington, said, the committee recommended that this be compulsory. However, we felt that more support for compliance would be needed for SMEs in the industry. Both the RHS and the National Trust support the Plant Healthy scheme, but Martin Hillier from Hillier Nurseries told us that the accreditation scheme was a good start but should be compulsory and set at a higher standard.
The Woodland Trust tells us that the overall ambition to reduce reliance on tree imports will be realised only if we invest in the UK nursery sector to equip nurseries with the skills, labour, funding and policies that enable the scaling up of production of UK-grown trees. This will also create green jobs to benefit the local and national economy. The committee agreed with that and called on the Government to improve recruitment of people into horticulture and increase the training opportunities for them, from T-levels in schools to apprenticeships and higher education, as well as careers advice. In addition, the timescales of many growers are long and require long-term planning, which is difficult without a clear UK strategy for horticulture, and preferably a Minister with responsibility for ornamental and environmental horticulture as well as the edibles part of the industry. Will the Minister take this back to the department? Without this support UK growers will struggle, and we will have to rely on imports with all the consequent biosecurity risks.
We also need a high-level quarantine scheme for high-risk hosts based on scientific research. For example, olive trees, which were mentioned by the noble Earl, Lord Cork and Orrery, when infected with Xylella—a serious pest for our native trees—can remain without symptoms for 12 months, so they should be quarantined for at least that length of time. We were promised that that would be explored in the GB plant health strategy, but it has not yet been done. Can the Minister say when it will happen?
Another effect of climate change which impacts UK growers, especially in the south-east, is shortage of water. If the UK horticulture industry is not supported to transition to sustainable water management practices, it will jeopardise our ability to grow our own trees and be self-sufficient. The Plan for Water is welcome but water management in the horticulture sector requires more effort, such as looking at the planning barriers for small reservoirs on growers’ and farmers’ own land.
Horizon-scanning for new and emerging threats, research and risk assessment are essential if we are to keep track of incoming diseases and those that are becoming more prevalent. Here the International Plant Sentinel Network, co-ordinated by the Botanic Gardens Conservation International and supported by Defra, plays a key role. I must declare an interest here as I was the honorary chair of the board of BGCI for 10 years and retain an interest in its work. The IPSN uses plant species held in botanic gardens’ collections outside their natural range as sentinels to gather evidence on new and emerging pests and diseases and novel host-disease interactions that can affect UK biosecurity. It provides an early warning system for emerging pest and pathogen risks and is a pivotal partner in the UK biosecurity strategy, which has been mentioned by many noble Lords.
Tools developed include digital plant health checkers to enable non-specialists to monitor plant health issues. For example, the emerald ash boring beetle, which was mentioned by the noble and right reverend Lord, Lord Chartres, and the noble Earl, Lord Cork and Orrery, is a great danger to our ash trees, and is common in eastern Ukraine and western Russia but fortunately not in the UK—so far. The tool helps people to recognise it to enable early warning in case it comes in on imported plants. Another initiative involved citizen scientists in identifying the sap-sucking insects that can transmit Xylella.
Botanic gardens also use alien plants in their collections to monitor for dangerous pathogens. Related to this work, may I ask the Minister whether there is any consideration of the inclusion of invasive alien plant species in the biosecurity strategy, due to their potential to host key pests and pathogens?
So much of this work depends on data and IT systems. I was therefore concerned when I read that Gareth Davies, chief executive of the National Audit Office, in his annual statement yesterday, said that three-quarters of the Defra IT budget is spent on maintenance of out-of-date IT systems. Given what we know can go wrong when IT systems go wrong, is the Minister confident of the robustness of the department’s disease surveillance system?
Finally, I have one more question, about surveillance of risk. Due to complex and expensive biosecurity regulations related to the movement of plant material nationally and internationally, it is becoming near impossible for scientific institutions to exchange material to support research into pests and diseases. Would the Government consider exemptions for bona fide research institutions contributing to the management and control of plant pests and pathogens?
]]>With my interests in health and education, I have always been concerned about fire safety in schools, colleges and hospitals Like all noble Lords who have spoken, I am concerned that regulations about the installation of sprinklers have been weakened. We know they can extinguish, or minimise, fires early and enable evacuation and access for the fire services. The London Fire Brigade’s briefing for this debate recommends that all new schools and hospitals, and any new extensions to old ones, as well as care homes, are fitted with sprinklers. The noble Lord, Lord Hendy, has said how cost-effective retrofit is as well. This strikes me as common sense and cost-effective, given the major danger to pupils, staff and patients when there are major fires, in addition to the disruption to pupils’ education, to parents and to local communities. I agree with my noble friends Lord Goddard and Baroness Brinton in asking the Minister to assure us that all new schools and the so-called 40 new hospitals will all have sprinklers.
The other school safety issue is combustible cladding. In December 2018, the Government banned the use of combustible insulation and cladding on the facades of certain high-rise buildings, but many other types of high-rise buildings remain outside the scope of the ban, including non-residential school buildings. As a result, over 100 school building projects have used combustible facade insulation since December 2018. I am told that, in the past 10 years, 1,003 education building projects will have used combustible facade materials. Will the Government extend the scope of the ban to educational establishments?
Much of the briefing we have received reflects the difficulty for local fire and rescue services in keeping up with the increasing demands of current legislation on their professional advice, monitoring and inspection. Fire safety assessments of schools are done by school staff not trained to do so, with no requirement to provide evidence. FR services believe they should check this assessment but accept that this would put greater pressure on their resources. However, it should be done, and appropriately resourced.
Fire safety is, of course, not all that the fire brigades deal with. They rescue people from all kinds of situations, including the increased flooding events caused by climate change. It is very concerning therefore that they are finding difficulty in recruiting enough officers. Services are calling for more flexibility in the fire uplift grant, which pays for prevention services. In addition, in order to adequately meet fire safety requirements, all FRSs need greater council tax flexibility, a three-year government settlement and an allocation of the protection grant that reflects local circumstances. Can the Minister comment on this?
While many colleagues have focused on building safety, I would like to focus the main thrust of my remarks on issues of the fire standards for furnishings. According to UKRI research, the UK is one of the highest users of chemical flame retardants—the chemicals that extend the time it takes for a material to catch fire. This is partly because of our open-flame ignition test. However, there are both health and environmental concerns about these substances. The researchers also found that a significant proportion of fire deaths are caused by inhalation of toxic fumes from these chemicals, as was mentioned by my noble friend Lady Brinton, including cyanide gas and carbon monoxide. That is not all: even before fires occur there are risks to health, including increasing diabetes, obesity and cancer risks, as well as effects on hormones, DNA, and heart and kidney function. Particular concerns have been raised about potential effects on babies and young children, who may be more susceptible to health impacts while they are developing and are likely to frequently put their hands in their mouths. This is because flame retardants migrate out of the products through wear, abrasion and disposal or recycling. They collect and persist, staying in the body, air, food and drinking water, as well as on surfaces; they also enter rivers and lakes.
What is being done? Not enough. In 2014 and 2016, the Government consulted on ways and means of reducing the use of flame retardants because of these concerns, but nothing was done then. In 2019, the House of Commons Environmental Audit Committee report, Toxic Chemicals in Everyday Life, identified concerns regarding the use of flame retardants, including emphasising the potential health impacts for babies and children. It pointed out that the furniture and furnishings regulations have been under review by BEIS, as it was then, and by its predecessor department for 10 years.
In 2021, at last, the Office for Product Safety and Standards ran a call for evidence on a UK product safety review. It published research on fire risks of upholstered products this year. The Government now propose new fire safety regulations for upholstered products. The consultation ended in October. One of the intentions of the draft regulations is to:
“Enable and encourage a reduction in the use of chemical flame retardants.”
However, the draft regulations fall short of what is needed and would, for example, exclude from scope items such as small cushions and baby products, including playpens and carrycots. I hope that I can correctly assume that mattresses used in hospitals are included. Given that the smallest of items can cause a fire, can the Minister tell me why baby products are excluded from scope? There are also measures about better enforcement and compliance, all of which would require additional personnel and funding. Can the Minister tell me whether these measures would be adequately funded, given the concerns I expressed earlier about resources for the FRS?
I am not the only person expressing these concerns. In March 2023, scientists in the journal Environment International asked that
“a very high level of certainty about the human and environmental safety of flame retardants is demonstrated before they are approved for use”,
and to ensure that there are “monitoring systems” to rapidly flag issues and replace flame retardants. Dr Paul Whaley, from Lancaster University, said that
“there has to be a proper balancing of the harms and benefits of flame retardants, that includes a comprehensive evaluation of the effectiveness of flame retardants as a fire safety measure”.
The House of Commons Environmental Audit Committee followed up its earlier report this month, complaining that
“many of the Government’s proposals stop short of what the Committee had previously recommended”.
Like me, it wanted to know why baby products are being excluded from scope, whether best practice from other countries is being considered, and what measures the Government are considering that would give more information to consumers on the chemical flame retardants used in their furniture.
The Fire Brigades Union considers that the proposals are deregulatory and put profits before firefighter and public safety. The Chartered Trading Standards Institute also felt that more products should be in scope, including products labelled for use outdoors—because they are often stored indoors.
What does the Minister have to say to all that criticism of the proposals? We need materials in our homes which deter fire risk but do not damage our health. I would like to know what research the Government are funding to identify such products and disseminate their use.
]]>When considering how to go about helping and protecting children as they find their way through life, I always go back to the UN Convention on the Rights of the Child and, of course, the “best interests of the child” principle, enshrined in UK law thanks to the noble Baroness, Lady Bottomley of Nettlestone.
I am quite surprised that I am the first person in this debate to mention the convention. Relevant to this debate is recommendation number 25 in the concluding observations published in June this year by the UN Committee on the Rights of the Child in its latest report on the UK’s compliance with the convention to which we are signed up:
“Noting the decision taken by the State party to prevent the implementation of the Gender Recognition Reform (Scotland) Bill, the Committee recommends that the State party recognize the right to identity of lesbian, gay, bisexual, transgender and intersex children and put in place measures to ensure that all adolescents can enjoy their freedom of expression and respect for their physical and psychological integrity, gender identity and emerging autonomy. In this context, the State party should ensure that any decisions regarding systems of gender recognition for children are taken in close consultation with transgender children and in line with children’s rights, including the right to be heard and the right to identity, in accordance with their evolving capacities, with free and informed consent and appropriate safeguards.”
In the light of our long-standing commitment to the UN Convention on the Rights of the Child, under which the committee evaluates our compliance every five years, will the UK Government take notice of that recommendation? It is relevant to how schools respond when children express any kind of gender distress, uncertainty or lack of conformity with others. It means that schools must listen to children, consult them about how they wish to live and, as far as possible, ensure they are treated in the way that makes them feel most comfortable. When this is done, it helps avoid distress and mental health problems in the future.
The committee further recommended that we urgently address the long waiting times faced by transgender and gender-questioning children in accessing specialist healthcare services, including for mental health, to improve the quality of such services and ensure that the views of such children are taken into account in all decisions affecting their treatment.
I will now use the opportunity of this debate to turn to a fundamental safeguarding concern of mine, which is to ensure that sexual abuse of children is never ignored or brushed under the carpet. That can happen only when there is a legal duty to report what is known or suspected—a deterrent from allowing fears of reputational damage to make a person keep silent. When a child has the courage to disclose sexual abuse, he or she just wants it to stop. If that does not happen, the child, as well as continuing to be abused, loses all trust in those in whom they have confided.
In respect of this, I had great hopes of the Independent Inquiry into Child Sexual Abuse, IICSA, and it has not disappointed. However, when I look at the Government’s response, I do not believe they have responded appropriately. IICSA’s recommendation 13, “Mandatory reporting”, says:
“The Inquiry recommends that the UK government and Welsh Government introduce legislation which places certain individuals—‘mandated reporters’—under a statutory duty to report child sexual abuse where they: receive a disclosure of child sexual abuse from a child or perpetrator; or witness a child being sexually abused; or observe recognised indicators of child sexual abuse.
The following persons should be designated ‘mandated reporters’: any person working in regulated activity in relation to children (under the Safeguarding and Vulnerable Groups Act 2006, as amended); any person working in a position of trust (as defined by the Sexual Offences Act 2003, as amended); and police officers.
For the purposes of mandatory reporting, ‘child sexual abuse’ should be interpreted as any act that would be an offence under the Sexual Offences Act 2003 where the alleged victim is a child under the age of 18”.
There follow exceptions, which I will not go into.
IICSA then says:
“Where the child is under the age of 13, a report must always be made. Reports should be made to either local authority children’s social care or the police as soon as is practicable”.
Here is the crucial bit:
“It should be a criminal offence for mandated reporters to fail to report child sexual abuse where they: are in receipt of a disclosure of child sexual abuse from a child or perpetrator; or witness a child being sexually abused”.
That is what I was hoping for.
Initially, the government response sounded hopeful. It said:
“We accept the need for mandatory reporting; the government has agreed to implement a mandatory reporting regime for child sexual abuse which will be informed by a full public consultation”.
It further says:
“We agree that implementing a new mandatory reporting duty could improve the protection and safeguarding of children, as well as holding to account those who fail in their responsibilities. A successful reporting regime will ensure that the individuals and organisations with a responsibility to safeguard children provide a robust and consistent response to abuse, putting the needs of children first”.
The consultation outcome was published in May and the Government published their guidance, Keeping Children Safe in Education, in September. Having read this guidance carefully, I would say that it is, on the whole, excellent—well-written, clear and comprehensive—but it lacks one thing and has one inconsistency, which is crucial. I will come to that in a minute.
The guidance says:
“If staff have any concerns about a child’s welfare, they should act on them immediately … follow their own organisation’s child protection policy and speak to the designated safeguarding lead (or deputy)”.
It then outlines the actions which can be taken, including making a referral to statutory services. It tells staff what to do if the DSL is not available, including
“speaking to a member of the senior leadership team and/or … local authority children’s social care … Staff should not assume a colleague, or another professional will take action and share information that might be critical in keeping children safe”.
It gives criteria for that.
It then goes on to describe what local authorities should do. I was pleased to read that it makes it clear that the Data Protection Act 2018 and UK general data protection regulations do not prevent the sharing of information for the purposes of keeping children safe and promoting their welfare. It says:
“Fears about sharing information must not be allowed to stand in the way of the need to safeguard and promote the welfare of children.”
So far so excellent. However, I noted the difference between all this advice and the section on female genital mutilation:
“Whilst all staff should speak to the designated safeguarding lead (or a deputy) with regard to any concerns about female genital mutilation (FGM), there is a specific legal duty on teachers. If a teacher, in the course of their work in the profession, discovers that an act of FGM appears to have been carried out on a girl under the age of 18, the teacher must report this to the police.”
In other words, it is against the law to fail to report that a child has been physically mutilated, but it is not against the law to fail to report or act on the knowledge or suspicion that a child has been sexually abused—and that is much more widespread. I wonder if the Minister can tell me: what is the difference?
]]>As we have heard, the instrument allows seeds treated with plant protection products, which have been authorised in at least one EEA member state before
The regulations also allow those who hold a valid parallel trade permit to apply for it to be continued for another two years. As we heard from the noble Baroness, Lady McIntosh of Pickering, the NFU tells us in its briefing that it needs five years rather than two to source equivalent products and that, without that, UK farmers will be at a disadvantage compared to EU farmers and will incur extra cost. Can the Minister say why the Government are allowing only two years? Defra says that the provisions will allow manufacturers sufficient time to apply for parallel product authorisation and PPP users to source alternative pest management solutions. I am still wondering what the hold-up is.
I always look forward to the arrival in my inbox of the Secondary Legislation Scrutiny Committee’s regular excellent reports. Its latest report shows that it shares my concerns that even further extensions may be needed on top of the ones we are discussing today if the sector does not get on with applying for authorisations or if the process of authorisation continues to be as tardy as it has been for the past three years. Have the manufacturers not bothered to make applications since 2020 or has the system failed to process them? Which is it?
In reply to the committee, Defra denied that there was a problem with the Health and Safety Executive’s capacity to process the documentation. However, it commented that
“the preparation, submission and assessment of new GB applications is a multi-year process”.
It went on:
“One application has already reached the assessment stage”.
One? After three years? These are important products to farmers. Defra has offered to consider streamlining the guidance to encourage industry applications. Perhaps there we have the answer to the mystery of why it has taken so long. Is this unclear guidance or gold-plating? Or has the whole thing fallen foul of the massive amount of work that the Civil Service and other organisations have had to do as a result of Brexit?
Defra’s reply to the committee emphasised the Government’s commitment to integrated pest management, which the Minister has repeated today. I applaud that approach, as do farmers who do not want to waste money on excessive spraying. However, I point out that the national action plan on pesticides, mentioned by the noble Baroness, Lady McIntosh of Pickering, was expected in spring 2022. How do I know this? It is on the Defra website; the consultation ended in February 2021. So, finally, can the Minister say when farmers and horticulturalists can expect this delayed national plan, because it will affect their ability to plan their cropping and land use, and the profitability of their businesses? I hope that the Minister can answer my questions.
]]>As the NHS reaches its 75th year, it is a very different and much larger beast than when it started out. The challenges are not just greater but different. On the upside, to a great extent we have conquered infectious diseases through vaccination and sanitation. Because of the success of medical science, our population is ageing, leading to greater demand for healthcare. On the other hand, we have a high level of health inequality and poverty, and a food system that does not provide a healthy diet for many people. Preventable diseases are now the greatest cause of illness and death. In 1948, people walked everywhere; many did manual labour, so obesity was rare; they ate seasonally and cooked their meals at home, and ultra-processed foods did not exist. But the air was not necessarily cleaner, because we burned coal to heat our homes. Today, we lead a very different life.
So, post-Covid, the NHS has five major challenges. There is the state of social care, causing too many people to enter hospital and stay there for too long. Linked to that, there is a crisis in ambulance service response times and A&E waiting times, causing excess deaths and harm. Many diseases, including cancer, are being diagnosed far later than they could be, leading to poor outcomes. Long waiting lists for urgent and elective care are leading to damage to the economy as people cannot work while they wait. There is too little preventive work to help people lead healthier lives.
The Government’s response is a focus on increasing the front-line workforce while ignoring the poor communication and system planning in the service. While we certainly need to train and retain more health professionals, especially in deprived areas, they are not the only people the workforce plan should be focusing on. We need system planners and communications experts. The money available for the NHS to tackle these problems is not infinite, which means we need greater productivity.
Nobel laureate Paul Krugman said:
“Productivity isn’t everything, but in the long run, it is almost everything”.
A crude definition of productivity is the ratio of inputs to outputs. Some think this is all about individuals working harder, but NHS staff are all already working extremely hard. It is not about working harder but working smarter. It is about improving outcomes. It is also not just about national initiatives. There is bound to be poor buy-in for national initiatives when staff on the ground often have a better idea of what could be done better. That is not to say there is no room for national initiatives, but they do not need to be designed by McKinsey.
There are problems with measuring real productivity in the NHS: how to adjust for the mix and quality of outputs and recognising the difference between outputs and outcomes. The NHS produces a wide variety of outputs. GP appointments are not the same as hip replacements, but the service has quite sophisticated statistical ways of dealing with this. It is harder to adjust for quality. Doing two knee replacements rather than one looks productive, but not if the second was needed only because the first was botched; and especially, as in the case of a lady I know, if the patient has to see the consultant three times before he will accept that there is something wrong. Then we must ask, is the outcome better as a result of the NHS having done something? The lesson here is that it is productive to listen to patients. Unfortunately, the NHS has cut back on patient-reported outcome measures, which are a valuable way to assess outcomes. My first question to the Minister is: are there plans to reinstate or replace PROMs?
A recent internal paper about productivity said that NHSE is
“very good at generating ideas”
for efficiency initiatives but does not have clear processes to evaluate them. It added:
“The overall volume of initiatives means it is very likely that the system is overwhelmed, which means that initiatives are not as effective as they could be. Moreover, a lot of the initiatives we are taking forward lack the buy-in from front-line staff that is needed to make changes stick”.
The system and infrastructures that support waiting list management include IT and tools for proactive patient tracking, as well as the processes that staff follow to efficiently and accurately co-ordinate pathways for patients on waiting lists. Millions of hours of clinicians’ time are wasted due to inadequate IT systems. A recent BMA report found that four in five doctors believe that improving IT infrastructure and digital technology would help to tackle backlogs. Can the Minister therefore say whether systems analysts and IT and AI specialists are included in the workforce plan, as well as medical professionals? We did not just win the Battle of Britain using pilots.
Sadly, there are too many examples of the skills of our health professionals being wasted because of inefficient systems planning and poor communications. A recent example concerns former BBC journalist Rory Cellan-Jones, who suffered a broken elbow and facial bruising following a fall. He spent two unnecessary days in hospital and calculated that 90% of the staff time spent on his case could have been avoided with better planning and communications. It was eight days after his accident before he received appropriate treatment. It was not just a question of communication between staff, but communication with him. He says in his blog:
“Getting information about one’s treatment seems like an obstacle race where the system is always one step ahead. … But communication between medical staff within and between hospitals also appears hopelessly inadequate, with the gulf between doctors and nurses particularly acute. I also sense that, in some cases, new computer systems are slowing not speeding information through the system. On Saturday morning, as we waited in the surgical assessment unit, four nurses gathered around a computer screen while a fifth explained … all the steps needed to check-in a patient and get them into a bed. It took about 20 minutes and appeared to be akin to mastering some complex video game”.
It also took four hours to get the paperwork for his discharge.
My Lords, I have experienced a similar situation and it grieves me to see our skilled professionals not being used in the most cost-effective way. What are the Government planning to do about this?
]]>There are pluses and minuses in the Government’s thin programme for their last year in office. Like many other Lords, I regret that, despite all the work done on proposals for revising the Mental Health Act, including a White Paper, the Government have still not fulfilled the revision promised in successive manifestos, nor their promise to implement the recommendations of the Infected Blood Inquiry. Instead, despite that inquiry’s strong interim recommendations that compensation be paid now, the Government still insist on waiting until the final report.
There is, however, one measure in the gracious Speech of which I approve: the proposal to raise every year the age at which retailers can legally sell tobacco products to young people by one year. This does not ban smoking as such, but it should deter more people from starting. We know that most smokers start young and that tobacco is unique in that it either kills or shortens the lives of two-thirds of those who use it for any length of time. I have always supported measures to reduce smoking because it is different from all other ways in which people freely choose to damage their own health. It is addictive, harmful when used as recommended, can harm other people and costs us and the NHS millions every year. That is why there is overwhelming public support for, for example, the ban on smoking in enclosed public spaces.
There will also be consultation on measures to tackle the widespread illegal sale of disposable vapes to children. Vapes have their place. They are of value to adult smokers who wish to quit, and are rightly sometimes provided free on prescription, but I believe that the vaping industry has cooked its own goose by the reckless and widespread promotion—and sometimes the free supply—of single-use vapes to children. That undoubtedly has to stop, because these things are addictive and not without danger. The massive environmental damage done by these brightly coloured gadgets, with their sickly-sweet flavours and colours obviously aimed at children, has been well-rehearsed elsewhere, so I do not need to elaborate. I hope that, after the consultation, the Government will clamp down firmly on this already illegal practice. Of course, public health budgets have also been cut and this has resulted in fewer smoking cessation services, which must also be addressed.
The Government have announced an NHS workforce plan. This is a step in the right direction, but many of us would have preferred the proposal of the noble Baroness, Lady Cumberlege, during the Health and Care Act 2022, supported by us. This provided for an independent review of current supply, an assessment of need of the right staff in the right places in the future, and a plan for how to fulfil that need over five and 10 years. The Prime Minister mentioned doctors, nurses and dentists, and of course we need more of those, especially in disadvantaged areas. However, current resources could be used better. Many of the care problems that patients experience are about systems, processes and communication. There is much efficient good practice, and I agree with the noble Baroness, Lady Donaghy, about the very cost-effective fracture liaison clinics, which save a lot of time and NHS bed days but are available in only half of trusts—that is the problem. Will the Minister ensure that the workforce plan includes staff skilled in designing and implementing efficient systems and processes which make the most of the resources we have?
Taking stock means looking to the future and focusing on the major challenges to the NHS. Three things are needed. The first, as has been said, is sorting out social care and integrating it with health services. Despite Boris Johnson’s promise of an oven-ready plan, which never materialised, social care is still suffering from lack of funding and enough properly paid staff with opportunities to develop their skills. If there ever was an oven-ready plan, it is well past its sell-by date and should be thrown in the bin. The recent Covid inquiry has exposed how very important this is, especially at times of extra stress on the system, but it did not feature in the gracious Speech.
The second is the need for more prevention of ill health. Preventable diseases, as has been said, are now the major causes of death, since modern sanitation and vaccination have conquered many of the communicable diseases. If Wes Streeting focuses on this, he will get my support. The three main factors needed here are action on healthy diets, clean air and healthy homes. The Government are failing on healthy diets despite having legislated for, but not implemented, several important measures that would have helped people make good food choices. Everyone, especially children, should have access to good, affordable food, and the Government should be doing a lot more to ensure that.
We have had many debates on clean air, but the legal limit for particulates in our air in the UK is still much higher than in other developed countries. Dirty air kills people through respiratory and cardiac diseases and interferes with the development of children’s brains. More action is needed on this now, rather than using it as a wedge issue at by-elections. Unhealthy, damp, cold homes also lead to respiratory diseases. It is a national disgrace that too many lower-income families are living in homes with mould growing on the walls and cannot pay their heating bills, and I did not hear anything positive in the gracious Speech about this.
The last factor is earlier diagnosis and treatment, and here there has been some progress. I welcome the units going around the country to check for early liver cancer, heart valve disease, lung cancer, et cetera, but what is needed is widespread access to treatment. I want to mention minimally invasive cancer therapies. These were invented here and are highly cost-effective. Can the Minister let us know what progress there is in extending these right across the country, instead of in only about half of it?
]]>Whenever I raise the topic of ultra-processed foods with the Minister, he replies that the Government cannot take action because it is difficult to define them, since brown bread is an ultra-processed food. I would like to tackle that head on. Brown bread could be ultra-processed, but it does not have to be—it certainly is not in my kitchen. So let us look at definitions. You could say that UPF contains things you would not find in a normal kitchen. That is helpful, but not enough. More helpful is the NOVA system, which puts foods into four categories, only the fourth of which is ultra-processed. Brown bread is not always found in that group.
NOVA provides a framework for assessing the degree and purpose of processing, and the relation between dietary patterns and health outcomes. It should be seen as complementary to nutrient-based approaches. Some national Governments have already begun to introduce policies informed by NOVA.
Foods and diets are of course complex. Lots of HFSS foods—high in fat, salt and sugar—are UPF, which is often called junk food, and lots of UPF are HFSS, so it is important to untangle the two. One piece of research did that neatly. Two groups of people were given diets for a week that were comparable in fat, sugar, salt and quality and told they could eat as much as they liked. One diet was made of minimally processed foods and the other UPF. Those on UPF ate 500 calories more than the others and gained weight. When they swapped the two groups around, the same thing happened. Dozens more studies have controlled for fat, salt, sugar and diet quality and have still found ultra-processed diets to be strongly associated with poor health. Other research shows that UPF are designed to make people eat more. They are soft and easily digested, taste good, are energy dense and, as has been said, some people become addicted to them.
Not every UPF is bad; it is the quantity and the overarching dietary pattern that matter. Our priority should be rebalancing the diet as a whole, and that is where government dietary guidelines come in. In the UK, reformulation has long been the focus of policy but, given the overlap between UPF and HFSS, reformulation should be only a first step to addressing the health outcomes associated with ultra-processed dietary patterns.
Part of the issue is profit maximisation. The business model is this: you take cheap commodity ingredients, deconstruct them and put them together in a different way, bind them with cosmetic additives and then brand and market the product with the aim of increasing sales and normalising consumption. In a capitalist economy, financial resources flow to the sectors that are the most profitable, and UPF is hugely profitable.
So what to do? Research definitively demonstrates that existing guidelines are inadequate—there is not a word about UPF in government guidelines—so will the Government amend their guidelines to promote the consumption of minimally-processed foods, improve the food in schools and public settings, and implement the existing legislation on advertising junk food on TV and online and relating to “buy one, get one free”? Many people on lower incomes rely on cheap UPF, so policy should not place further burdens on them.
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