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  • May 21, 2018:
    • Education (Student Support) (Amendment) (No. 2) Regulations 2018 - Motion to Regret | Lords debates

      I would add that the Browne recommendations had no cap at all.

    • Education (Student Support) (Amendment) (No. 2) Regulations 2018 - Motion to Regret | Lords debates

      My Lords, like the noble Lord, Lord Hunt of Kings Heath, we, too, oppose the introduction of these regulations-and for very similar reasons. It always makes sense to make policy based on evidence and on the advice of experts. This is what the Government have failed to do in relation to the funding of student nurses. The removal of the bursaries for undergraduate nurses has already considerably reduced the number of applicants, and the number of those taking up a place was 705 lower last year than the year before. Given the 40,000 nurse vacancies that the noble Lord mentioned, this is a serious matter for patient safety, as pointed out by the Care Quality Commission. I accept that these are only one year's figures, but I believe that, before upsetting the apple cart even further, the Government should postpone removing bursaries from postgraduate nurse trainees and other important groups until we have clear evidence of the effect on the number of undergraduate student nurses.

      If we want to increase the number of registered nurses quickly, which we need to do, it makes more sense to support the two-year postgraduate route, not put it at risk by removing those bursaries, too-because this is the quickest way to get more nurses. Most suppliers of the two-year courses indicate that capacity could be increased by 50% given the right financial support, yet the Government are planning to deter applicants by removing the bursary. This does not make sense. Instead, the Government are focusing on the two four-year routes into nursing, yet the apprenticeship route is not providing the expected 1,000 extra nurses per year. The most recent data tells us that there are only 30 apprentice nurses-hardly a success. Will the Government look into the barriers that are preventing NHS employers taking on apprentices? It could be the 60% cut in funding for further professional development, which has affected the number of those who would like to become training assessors and mentors for student nurses and apprentices.

      Nursing associates have a role both as assistants to registered nurses and as users of an alternative four-year route into nursing-but, again, it takes a long time and these associates, as the noble Lord, Lord Hunt, said, should not while training ever be seen as substitutes for fully qualified nurses. So why are the Government planning to deter applicants for the rapid postgraduate route, where 64% are over 25, where they are predominantly women and where they are more diverse than the general student population? In a career such as nursing it would be advantageous to attract people with a little more life experience than the average 18 year-old.

      Also, we know that older women and ethnic minority students are more debt-averse, as well as already having a student debt of up to £50,000 from their first degree. Therefore, it is vital to look at how this fast route into nursing could be supported. The RCN tells us that, if the fees were paid and a modest bursary towards living costs provided, the total would be less than the average annual premium paid by trusts over a single year for a full-time agency nurse. This is short-termism of the worst kind.

      While the Government carry out their review of post-18 education, they might benefit from looking at the measures introduced in Wales by Kirsty Williams AM, the Liberal Democrat Minister in the Welsh Government responsible for medical education. Her conversations with students revealed that the main concern and deterrent was not fees but living costs. Therefore, she has introduced the equivalent of the minimum wage for students during their course. This method of student funding should be carefully considered by the Government while carrying out their review, particularly for nursing students, who have more contact time than other students because of their clinical placement and therefore less time to get a part-time job to support themselves. Will the Government please consider this sensible idea?

      The House of Commons Select Committee on Health and Social Care stated that the nursing workforce should be expanded at scale and pace to avoid dangerous levels of vacancies. It should be based on need and demand rather than affordability. It is up to the Government to say how the money will be raised, but from these Benches we recommend some sort of hypothecated taxation or a reformed national insurance scheme which is truly progressive and demonstrates intergenerational fairness. The Liberal Democrats are also in favour of restoring the bursaries for undergraduate student nurses and we are against these new regulations, which would remove the bursary from postgraduate nursing students and other important health professional courses.

  • May 16, 2018:
    • Social Workers - Question for Short Debate | Lords debates

      My Lords, when we come to the end of this short debate and we all go home for our piece of toast because all the cafés here are closed, I hope that the noble Lord, Lord Parekh, will feel that we may not have had quantity but we certainly had quality. We have certainly had that so far from him and from the noble Lord, Lord Kennedy.

      The job of a social worker is always difficult. They have to make finely balanced judgments every day, based on a large number of factors. Every case requires them to use their professional judgment and experience and very often they are themselves judged by those who know little about it. When it comes to decisions about taking children into care, they are often damned if they do and damned if they don't-but I thank them for what they do.

      As vice-chair of the All-Party Parliamentary Group for Children, I will focus on children and family social workers, because last year our group carried out a very revealing inquiry in this area called No Good Options. We are currently part way through a piece of follow-up work. Many of the issues we revealed are applicable to all social workers.

      The big issues are heavy case loads and stress; staff turnover and stability of the workforce; and the opportunity to undertake further professional development, with pathways to progress in the profession. Staff were also concerned about the status of the profession. I hope that the new regulator, Social Work England, under the able leadership of the noble Lord, Lord Patel of Bradford, will be able to contribute positively to that status and quality with the right kind of regulation. Social workers want their professional views to be respected and to bring about the best outcomes for the children in their care. I think I can say that anyone who becomes a social worker really cares about the people they serve, and we should value the work they do for society.

      We found evidence of rising demand, rising thresholds for intervention, and increasing case complexity-at a time when resources are falling. Schools are now taking on tasks that used to be carried out by children's social workers. As a result of this, one of our recommendations was that the Department for Education and the then Department for Communities and Local Government should carry out a review of the resourcing of children's social services and provide the resources needed to enable local authorities to adhere to the LGA guidance on case loads. One problem reported to us was that local authorities cannot afford the early, low-level interventions that can prevent a case escalating into a more complex and serious matter that costs more to treat. All our witnesses were committed to this preventive work, but many found it impossible to afford because they can afford only the mandatory services.

      This upward cost and case-load spiral puts a very heavy burden on staff and supervisors. All this leads to high staff turnover, which hinders the development of stable relationships with service users. When social workers leave a stable job and go to work for an agency, they often have more work flexibility, a more manageable workload and sometimes higher pay, so you cannot really blame them. But this is not the ideal way to serve vulnerable children who suffer when their social worker keeps changing.

      Some local authorities have managed to reduce the use of locum staff, but some still have very high levels. Whereas the average was 16%, five authorities had 40% and one had 100% locum staff. In response to this, many authorities have grouped together to sign a memorandum of understanding to keep the cost of locums down and reduce churn. This has worked well and we believe that 80% of children's services now work in this way-but will the Government please look into whether there could be a national memorandum on the payment of locum staff, as the costs are crippling some hard-pressed local authorities?

      Case loads vary tremendously. A number of our witnesses recommended 12 families per social worker as the optimum case load. In Essex, where average case loads have decreased in recent years, from between 25 and 40 per social worker down to 12, the inquiry heard that staff turnover had markedly decreased and morale had improved. The LGA advises that all employers should use a workload management system that sets clear targets for safe workloads in each service and regularly assess each social worker's case load, taking into account complexity, capacity and the need for supervision. We recommended that the Department for Education should develop a strategy to reduce churn in the children's social work system. Will the Government seriously consider the need to do this?

      Cafcass is one of the country's largest employers of children and family social workers, because of their role in making assessments and advising the courts. Under the recently ended chairmanship of my noble friend Lady Tyler of Enfield, who cannot be in her place today because of other commitments, Cafcass has been turned around from what some in past years regarded as a failing organisation to one that recently received an outstanding inspection report from Ofsted. My noble friend, her chief executive and every single Cafcass staff member are to be congratulated on this achievement.

      Although, as with most organisations, some still criticise aspects of Cafcass's service, it might be instructive to look at how it made such impressive improvements. The answer, of course, is complex-and a lot of hard work. However, two paragraphs of the Ofsted report stand out in relation to our debate today. Ofsted stated:

      "Successful workforce planning and innovations in Cafcass's recruitment processes (plus additional investment secured by the chief executive) have resulted in a higher number of frontline practitioners with more capacity to sustain a high-quality service. Senior leaders are not complacent. They are committed to maintaining average caseloads for staff at manageable levels to safeguard employee well-being and productivity. In our survey of Cafcass staff, 97% agreed or strongly agreed that Cafcass, as a national organisation, continually strives to improve".

      This comment is a great credit to the management and governance of the organisation, but I did notice that very important phrase,

      "plus additional investment secured by the chief executive".

      I suspect that all employers of social workers would want to be able to say that.

      Attention at Cafcass was also paid to staff well-being, continued professional development and promotion opportunities. Ofsted stated:

      "Staff report that they are well supported, feel valued and have good access to a wide range of training and development opportunities. Many staff have benefited from in-house development schemes and have been promoted to more senior positions within the area. Staff turnover is low and caseloads are manageable across all areas of practice. Managers are readily available and guide and advise the skilled workforce effectively. The performance and learning review (PLR) process works well and includes a good balance of staff development and well-being, self-assessment, reflection and case discussion".

      This has clearly been a blueprint for success that others could follow.

      The fact that careful case planning allows the majority of Cafcass staff to consistently provide excellent, timely services for children, their families and the family courts contributes to staff morale and a high level of staff retention. I know that a big effort was also made to ensure that staff produce strong, evidence-based and succinct reports that minimise the need for additional experts, and reduce delay and the need for further appointments, which can only be helpful to service users. The voice of the child is very powerful and often quoted verbatim in reports.

      Social work is a people business and those who find ways to invest in their staff reap the rewards, as has been demonstrated. What plans do the Government have to invest in the quality and status of social work, for the sake of the workers themselves and that of their clients?

  • May 14, 2018:
    • Animal Products: Labelling and Packaging - Question | Lords debates

      My Lords, does the Minister believe that the Food Standards Agency's plan to privatise the inspection of food producers will give consumers confidence in the safety of their food? Does he agree that the plan for producers to choose and pay for their own inspector and agree the remit and frequency of their inspection is rather like letting them mark their own homework? How will that encourage the rest of the EU to continue to import British food after Brexit?

  • May 10, 2018:
    • Children: Obesity - Question | Lords debates

      My Lords, does the Minister agree that when you cook your meals from scratch, you know what is in them and are more likely to stay healthy? Can he assure me that children learn to cook in schools, not just the theory of nutrition? Will he also join me in encouraging the BBC to produce a cookery programme aimed at children?

    • Children's Services: Funding - Question | Lords debates

      My Lords, is the Minister aware that the All-Party Group for Children is doing a report on children's social services? It has become very clear to us that thresholds for intervention are rising, leading to the situation that the noble Lord, Lord Laming, just mentioned. The Children's Commissioner published a report yesterday that indicated that the general public's expectations of intervention for children in need are much higher than what they actually receive. Is the Minister aware of that, and is he going to do anything about it?

  • Apr 26, 2018:
    • The Long-term Sustainability of the NHS and Adult Social Care - Motion to Take Note (Continued) | Lords debates

      My Lords, as the brilliant Select Committee report makes clear, sustainability of health and social care is mainly achieved by a match between demand and available resources. Whatever funding solution the Government eventually propose, there is always likely to be pressure on money, so two approaches are necessary-to reduce demand and to work more cost-effectively. As my noble friend Lord Willis said, healthcare costs cannot be considered in isolation. Social care and the wider determinants of health, from public health, prevention, education and housing must be factored in. So the issue is much wider than the NHS, although its role in helping to reduce demand by prevention of ill health and developing new models of care is crucial.

      The committee was quite right in its recommendation 19: it is essential that social care and health are properly integrated from top to bottom as they are interdependent -and Salford has proved that that works. Social care thresholds are rising but the need remains and is often displaced to the more expensive NHS. That is not clever. As the population ages, and as technology and infrastructure develop and appreciate, funding levels need to be adjusted accordingly. However, it is vital that we get a grip on rising demand, which is not caused just by our ageing population but by our failure to prevent preventable diseases. An eight year-old child wrote to me the other day about the link between child obesity and junk food; he said that we were not preventing preventable diseases, that it was not hard to prevent them and yet we were not doing so, and it was very sad. Well, indeed, it is very sad. The Select Committee was forced to write:

      "We are of the firm opinion that continued cuts to the public health budget are not only short-sighted but counter-productive".

      Hear, hear. I strongly support its recommendation 30 that these funds should be restored.

      Unless we put more effort into prevention of ill health, the burden of disease and demand for services will continue to rise. The committee pointed out that 89% of deaths in the UK are caused by cardiovascular disease, cancer, respiratory disease and diabetes. Many of these diseases are caused by lifestyle choices, such as poor diet and sedentary lifestyles, alcohol abuse and smoking. In recommendation 29, the committee proposes a nationwide campaign to highlight the problems caused by obesity, particularly among children. I hope that my speech on child obesity last week indicated how much I support that. I welcome the fact that the chef, Hugh Fearnley-Whittingstall, has already started that nationwide campaign with one city, Newcastle-upon-Tyne, as the noble Lord, Lord Rea, pointed out.

      Many diseases are also caused by the social determinants of health, poverty, poor housing and poor air quality, which can shorten life in poor areas by as much as seven years, according to Professor Michael Marmot. This shocking health inequality is not social justice and must be addressed.

      The five-year forward view called for a radical upgrade in prevention and public health and yet, in recent years, as many have said, we have seen a 30% cut in spending on these areas. Hard-pressed local authorities cannot subsidise public health. The Select Committee makes it very clear that this must change. What are the Government going to do about it?

      People must take some responsibility for their own lifestyle choices, but we must not continue to rely on the NHS to fix it when we make the wrong choices. To make the right choices, we need information and help from public services that have now gone. However, people are not responsible for finding themselves in poverty or for living in areas with terrible air quality and poor access to healthy foods, as Hugh Fearnley-Whittingstall discovered.

      The Government cannot rely on food retailers to take responsibility for this, but they do have a role to play. I welcome the recent initiative by Waitrose to introduce healthy eating specialist advisers in some stores-although it must be pointed out that Waitrose stores are not usually to be found in the poorest areas of the country. I congratulate those food manufacturers which have already reformulated their products to reduce sugar, salt and saturated fat and to reduce portion sizes but, as the noble Lord, Lord Rea, said, there is still a very long way to go. What plans do the Government have to learn from the response of sugary drink manufacturers to the threat of the mandatory sugar tax?

      There is also enormous potential for technology and innovative treatments. The committee's recommendations 24 to 28 encourage this, which I support. Where I live in Wales, we do not have access to some of the new tests and treatments available to noble Lords who live elsewhere in the country. It is a postcode lottery, which is the responsibility of the Welsh Labour Government. I say to the noble Baroness, Lady Meacher, that we are also about to lose the only GP practice in our large village of 4,000 people. Although I have often had to dial 50 times before getting through to make an appointment, I will miss it. I hope that my husband and I will not find ourselves sitting for over four hours in the A&E department of our local hospital as a result of the withdrawal of our valued primary care, so I agree with the committee's recommendation for a review of the business model of primary care.

  • Apr 17, 2018:
    • Children and Young People: Obesity - Question for Short Debate | Lords debates

      My Lords, we have a childhood obesity epidemic in this country, with disadvantaged children significantly more likely to be affected. Nearly one in four children is overweight or obese in their first year of primary school, rising to more than one in three by the time they leave. Overweight children are more likely to become overweight adults, leading to heart disease, cancer, diabetes and stroke. Issues related to diabetes are a strain on the economy and on the NHS, so we need to address this at the earliest possible opportunity, while people are young-hence this debate.

      Out of the mouths of babes and sucklings come truth and wisdom, so I thought that perhaps we should hear from the children themselves. It so happens that I recently received 30 letters from children at St Joseph's Catholic Primary School in Burnham-on-Sea. These eight and nine year-olds are very aware of the dangers of obesity, such as heart disease and diabetes-although they did not mention cancer, even though 5% of cancers are thought to have a dietary link. They are not alone, since 85% of the population is also unaware of that link.

      The children have been looking into the advertising of junk food on TV and wrote to ask me to do something about it. They said that 23 children out of their class of 30 had seen more junk food adverts than healthy food adverts. Here is what William had to say:

      "As everyone knows fat is bad for you and surely our kids are being poisoned by too much. Firstly we should get good foods on our plates. Secondly we need to get bad foods off our plates. Thirdly fatty foods can block your arteries. I would draw your attention to the fact that 28 out of 30 children said adverts make us want to buy garbage. Therefore we must not let unwholesome adverts on TV every day, just on Mondays and Saturdays and moreover we must show more Fit4Life adverts. My evidence to support this is only 10 out of 30 kids have seen Fit4Life adverts which is not good. In summary we must stop this advertising problem. My final point is that you are responsible".

      George agreed, but he let out a little secret:

      "Isn't it the case that people like the taste of fat and if you keep eating junk you will get heart disease? Some eat a midnight snack under the bed, not often but it is probably junk food".

      Jared was concerned about the NHS. He said:

      "Surely we can help the NHS. They are having too many customers".

      He must have read the 2016 report from the Food Foundation, which claimed that the current diet-driven crisis is crippling the NHS. The report said that NHS costs associated with being overweight or obese are £6.1 billion every year and £27 billion for the wider economy.

      Ryan thinks you should have a balanced diet. He said:

      "My view is balance. Get rid of some junk food but not all junk food because some people like it, including me".

      The new soft drinks industry levy, commonly known as the sugar tax, came into force recently, and that is a very good thing-although the children are not fooled. They have noticed that it is limited to sugary drinks. For example, Brac said:

      "I would draw your attention to hidden sugars which are found in cereal, yoghurt, bread, smoothies and pizza".

      No fool, Brac.

      So, on the children's behalf, can I ask the Minister whether the Government plan to do anything about all the other hidden sugars in our food? I must say it is very heartening to hear that so many popular drinks have been reformulated, although I am sure they would not have done it without the levy. So it is important to monitor the effects of the sugar tax, and I hope the Minister will say how they intend to do that. Will he also tell us where the money is to be spent and whether local authorities, which now have the responsibility for public health, will have a say in the matter?

      The Advertising Standards Authority's Committee of Advertising Practice is about to carry out a review of whether the rules on advertising junk food during children's TV programmes and on non-broadcast media are right. The children and I think the rules need changing, so I hope the reviewers will take notice of their opinion. For example, Emma said:

      "In my opinion adverts about junk food are taking over and I can't help noticing that they mostly do it when children are around. Clearly people are falling for things like, if you eat these delicious golden chicken nuggets it will make you happy and if you drink this Cola, you and your brother will get along forever".

      But Lillia was not taken in. She said:

      "Bad food makes you fat and ill and in the end you just die".

      Manley agreed. He said:

      "Don't eat junk. It could give you a very bad tummy ache".

      Joshua had a solution. He said:

      "Isn't it clear preventable diseases aren't being prevented? It's not hard to prevent them yet we don't. It's quite sad don't you think?".

      He wants cheaper fruit and vegetables. The Food Foundation agrees. It recommends:

      "Subsidies that favour healthy food over unhealthy food".

      The ASA said in its briefing to us at half past two this afternoon:

      "Currently, the evidence shows that advertising has only a modest effect on children's food preferences and that there are multiple and complex factors, beyond advertising, that are instrumental in childhood obesity."

      The causes are indeed complex but the children of St Joseph's and many other experts do not agree that advertising has only a modest effect on children's food preferences. Their letters refer to the large number of junk food adverts on TV programmes-in "family time", not just children's programmes-but they do agree that there are other factors. Holly says:

      "Surely the Government can make a law saying there should be a limit of junk food adverts".

      But she realises that it is not just about what you eat; keeping fit is also part of the solution, and it is fun. Tommy agreed. He wants more PE lessons.

      Finbar described children's sedentary lifestyles. He said:

      "It seems to me that people are starting to get more lazier by the day. As I see it people finish school or work, go home then walk to their TV or games console. And might even have their dinner there".

      Ukactive, chaired by our noble friend Lady Grey-Thompson, promotes physical activity for children. It told me that half of all seven year-olds are failing to achieve the recommended 60 minutes of physical activity per day. NHS research in 2015 found that one in five children did no sport or physical activity at school. It would help schools to plan if the Government were clearer about their long-term plans for the primary PE and sport premium. This might be the responsibility of the Department for Education, but could the Minister from the health department enlighten us? As Finbar said, physical inactivity is a major cause of childhood obesity.

      The children want to know what we are going to do about it. Cancer Research UK proposes a 9 pm watershed on TV advertising of junk food. This does not require legislation; Ofcom could be instructed to act. Will the Minister comment on that? It is a decade since Ofcom's restrictions came into effect, and in that time viewing habits have drastically changed. Evening and family programmes, shown between 7 pm and 9 pm, are now most frequently watched by children and young people, yet they are not covered by existing regulations unless the advertisement is directly aimed at children. It seems that current rules are no longer fit for purpose. The Obesity Health Alliance found that more than half of food and drink adverts shown during family viewing would be banned on children's TV under current rules.

      Your Lordships might wonder whether there is any evidence that restricting the marketing of junk food could help in the fight against childhood obesity. Well, I have good news. There is evidence from Quebec that a ban on advertising junk food to children can work. Its strict rules since 1980 have resulted in a much lower level of child obesity there than in any other part of Canada. Will the Minister look at this evidence and act on it? Given that Public Health England advised the Government to include further advertising restrictions in the 2016 child obesity plan, perhaps the Minister will explain why the Government did not take its advice. Could he now tell the House whether they have seen the error of their ways? If so, I will be delighted to tell the children of St Joseph's.

    • Children and Young People: Obesity - Question for Short Debate | Lords debates

      To ask Her Majesty's Government what steps they are taking to address obesity among children and young people.

  • Mar 29, 2018:
    • Surgery: Waiting Lists | Department of Health and Social Care | Written Answers

      To ask Her Majesty's Government what assessment they have made of the impact of minimum waiting times on patients awaiting surgical procedures in (1) the South West Lincolnshire CCG area, and (2) England.

    • Brexit: Health and Welfare - Motion to Take Note | Lords debates

      My Lords, this has been a very well-informed debate, led by my noble friend Lady Brinton with her excellent and wide-ranging speech, on which I congratulate her heartily. There have been some excellent and moving speeches from across the House. I hope others will forgive me if I say how much I support the passionate and robust comments of the noble Lord, Lord Balfe.

      As ever in your Lordships' House, we have covered the ground very thoroughly. My noble friend Lady Brinton started us off by expressing her concerns about procurement and the need to protect our NHS from United States predation. We heard worries about the levels of staffing in both health and social care, and particularly the effects on some of our most vulnerable citizens of the loss of care workers from the EU. We heard about the loss of the EMA and its consequences for medicines regulation and for the access of UK patients to cutting-edge medicines. We heard concerns about clinical trials and the availability of clinical isotopes if we leave Euratom. We heard concerns about the recognition of qualifications; about research; about medical treatment across the Irish border; about data sharing; about health inequality; about reciprocal parking for disabled drivers; and about mental health. Lastly, from my noble friend Lady Tyler we heard a welcome, which I endorse, for the Prime Minister's recognition at last that we need a long-term funding settlement for the NHS.

      For myself, I would like to mention two issues that have been mentioned but not dwelt upon. The first is my concern that, if we leave the EU, we will no longer be part of the European Centre for Disease Prevention and Control, the ECDC, and have a seat at its table, currently occupied by Professor Dame Sally Davies, the Chief Medical Officer. The ECDC is an EU agency aimed at strengthening Europe's defences against infectious diseases. It works in partnership with national health protection bodies across Europe to strengthen and develop continent-wide disease surveillance and early-warning systems. The ECDC pools Europe's health knowledge to develop authoritative scientific opinion about the risks posed by current and emerging infectious diseases. It provides the NHS with evidence for effective decision-making, helps to strengthen our public health system and supports our response to public health threats. It does so through surveillance, epidemic intelligence, scientific advice, microbiology, preparedness, public health training, international relations and health communication. Its programmes cover a number of important issues that have been debated in your Lordships' House over the past couple of years, including: antimicrobial resistance and healthcare-associated infections; emerging and vector-borne diseases; HIV; influenza; TB; and vaccine-preventable diseases. All in all, the ECDC monitors 52 communicable diseases.

      If we no longer have access to these services after Brexit, we will suffer when, for example, there is a flu epidemic or pandemic and vaccines or other specific treatment need to be rationed across the EU. This is almost inevitable, as it is not possible with current technology for vaccine production to be scaled up fast enough since we need to know the specific flu mutation that we are dealing with before we can start manufacture. The ECDC will be driving who gets what, as it will be the conduit to the World Health Organization for the EU; the UK will be a single nation at the back of the queue, as we will be with new medicines licensing and access. What action have the UK Government has taken to ensure that UK patients do not suffer because of our exit from the ECDC?

      My second issue is that of food safety. I am sure that all noble Lords agree that the safety of our food is an important element in enabling our citizens to be healthy. In order to ensure safe food, our food producers need to practise the highest possible standards of hygiene, which most of them do, and our consumers need the best possible information. It is because of this that scandals such as 2 Sisters, Muscle Foods, DB Foods and Fairfax Meadow are relatively rare. It is also because of this that British food producers are currently able to sell their goods in large quantities across Europe and the rest of the world. Indeed, one claim the Government make about the potential benefits of Brexit is that British food producers will be able to sell more, thus benefiting our economy. We shall see.

      There does not seem to be much emphasis on food and health in current government thinking. The agriculture Command Paper Health and Harmony, which came from the Environment Secretary, makes little reference to food apart from the issue of pesticide residues. The fisheries paper focuses on maximum sustainable yields-again, nothing about health. The focus seems to be more on cheap food than on food standards. But the British people want decent, affordable, sustainable healthy food, not a race to the bottom. I am concerned that this is not the direction in which we are going. I certainly do not think we should be opening our doors to a lot of foods from the United States, where its need to export large amounts of corn syrup means that sugars are found in the most surprising foods. For example, breast milk substitute in the United States can contain any kind of sugar in any amounts. We do not want that here.

      Let us look at how our food industry standards are currently maintained. Currently, they must be up to the standards of the European Food Safety Authority, controlled by the European Commission. In the UK, the regulator is the Food Standards Agency, but it relies heavily on local authority environmental health officers and trading standards officers. I expect that the Government will say that the UK food supply is safe and that we are currently aligned with EU standards and that that will continue, so what is the problem? The problem is this. Between 2012 and 2017, the FSA's budget was cut by 23% and the number of samples taken for testing by EHOs fell by 22%, so resources, including local authority funding of EHOs, are already stretched.

      On top of that, Ministers have insisted that the FSA makes even greater savings, as a result of which last year it obligingly published a document entitled Regulating Our Future: Why Food Regulation Needs to Change and How We Are Going to Do It. I have just read a critique of this document by a collaboration of academics from the University of Sussex and City, University of London. I have scarcely ever read such a scathing academic study. The authors have the grace to support the proposal for mandatory registration of food business operators. They also support demands by environmental health officers that they should have the power to refuse registration to,

      "FBOs that cannot demonstrate they can produce food that is safe and honestly labelled".

      However, the rest of the report is strongly critical, in particular of the proposal that inspection of FBOs should in future be outsourced-and not just outsourced. The proposal is that the food producer itself should contract a third party to inspect it on a basis it thinks is right at an agreed frequency and decide whether the inspection is notified-talk about marking your own homework. The fear is that the food producer will go for the cheapest option, which is unlikely to be the most rigorous, and our food safety will be affected. The other worry is about access to information-and the list goes on.

      I do not think that this proposal from the FSA will give confidence to the European Commission or the European Food Standards Agency, in which case UK FBOs will have great difficulty selling their produce to either the EU or other countries, given that all over the world countries are moving to EU standards so that they have only one set to deal with. Add to all that the fact that the majority of vets contracted to supervise abattoirs and meat-cutting plants were recruited by the FSA's outsourcing contractor from non-UK EU countries and you have a recipe for disaster in UK food safety.

      This is one of the issues that the Government need to take extremely seriously when they are negotiating our exit from the EU. We need some confidence that the safety of our food, which has such a big effect on our health, will be taken into account by the Government.

    • Brexit: British Citizens - Question | Lords debates

      My Lords, is it not true that polling shows that if we were talking about a vote on the deal, seven out of 10 people would like to have it? On this day, a year before the Government have chosen to take us out of the EU at whatever cost, will the Government tell the young people of this country exactly what opportunities they propose to take away from them?

  • Mar 20, 2018:
    • Free School Lunches and Milk, and School and Early Years Finance (Amendments Relating to Universal Credit) (England) Regulations 2018 - Motion to Regret | Lords debates

      My Lords, I too echo the concerns of the noble Lord, Lord Bassam, about the Government's proposals to introduce an earnings threshold for eligibility for free school meals and milk. This is very unfair, because it takes no account of the number of children who the parents have to feed. It is a cumbersome way of doing things which will make it very difficult for families to plan their budgets and, as we have heard, will cause a poverty trap for many. This comes on top of recent cuts in benefits which have already made many working families worse off and the food banks busier.

      Let me say first why free school meals are so important. There is plenty of research showing that nutrition levels in school meals are vastly better than those in either the average packed lunch, only 1.6% of which reach the same nutritional standard, or certainly those in a cheap bag of chips and a fizzy drink from the shop on the corner. One of the best services we have for school-age children is the provision of a nourishing meal at lunchtime. For some children in poverty, this is the only decent meal they will get all day, and it is essential that it is provided for them if their parents cannot afford to pay. Many teachers will tell you that they have children in their class who come to school without any breakfast. One local authority has taken this so much on board that it has decided to offer free meals for poor children every day of the year. That is because teachers notice evidence of malnutrition in some children when they come back to school after the holidays.

      A nourishing, balanced meal containing fruit and vegetables is important not just for the health of the child, providing the vitamins needed for healthy growth and helping to prevent obesity; it is important also for the child's behaviour and academic attainment. Pilot studies on the effect of universal provision of free school meals for key stage 1 children when they were introduced by the coalition Government showed a distinct improvement in behaviour, and attainment advanced by as much as two months. This was particularly so with children from disadvantaged backgrounds. So it is clear that free school meals are one of the major tools in our armoury for closing the attainment gap between the rich and the poor.

      The main objective of our education system must be to help all children attain their maximum potential, and good nutrition is one foundation of this. A hungry child is not a learning child. Anything that has the potential for reducing the number of poorer children who receive such meals should be rejected. Indeed, we should provide free meals for more children, not fewer, because a free meals regime increases uptake, decreases stigma and reduces the number of children bringing in sandwiches and biscuits or going to the chip shop. That in turn improves the attainment of all children.

      The Government have told us that 50,000 more children will receive free meals under the new regulations than under the old and promise that no child already on free school meals will lose their meals while at their current stage of education. The problem with that is that children grow up. They get to the end of primary school or secondary school and, suddenly, children who were formerly eligible for free meals will no longer get them. There needs not to have been any change in their parents' earnings for this to happen because there is now an earnings threshold which takes no account of the size of the family.

      Every mum and dad knows that it takes twice as much money to feed two children as one, and three times as much to feed three. That is £10 a week for lunches every week of term, or £20 or £30 for bigger families, which could easily be enough to make it not worth taking a few extra hours' work. Where then is the fundamental work incentive that is supposed to underpin universal credit? Where now is the mantra "making work pay"?

      I am not going to go through the case studies in the briefing, as the noble Baroness, Lady Sherlock, has already done so, but there is clear potential for making a lot of families worse off. The Government need to look at the disposable income of a family once the 63% withdrawal of universal credit for every extra pound earned has been taken account of and school meals paid for. If they do that, they may come up with a fairer system.

      School lunches are not a luxury; they are an essential of life for those families who find it hard to feed their children. Of course, we are talking not only about meals; many other passported benefits are linked to free school meals which help make bringing up children bearable. They currently include the early years pupil premium. I beg the Minister to decouple that at the very least, because, again, it is in the interests of closing the attainment gap.

      Universal credit was supposed to avoid the cliff edge and make it worth while going to work. By introducing a lower earnings threshold, the Government are creating a cliff edge at a very low earnings level where it will hurt most and undermine the whole point of universal credit. In doing so, they are putting at risk the health and academic attainment of the poorest children. Will the Minister please think again?

  • Mar 14, 2018:
    • Universal Credit: Free School Meals - Question | Lords debates

      My Lords, on what basis was it decided that the earnings threshold for eligibility in Northern Ireland would be double what it is in England? Is this because poor children in Northern Ireland are twice as malnourished as they are in England, or could it be political expediency?

  • Mar 12, 2018:
    • Cannabis - Question | Lords debates

      My Lords, I welcome the Minister's acceptance that perhaps it should be a Health Minister standing at the Dispatch Box. Even so, is he aware that doctors in the UK are allowed to prescribe heroin to addicts in certain circumstances? How does he square that with the fact that they are not permitted to prescribe most effective cannabis medicines to patients in pain, even though these are available legally in many other countries? Is it not time that we stopped criminalising patients?

  • Mar 7, 2018:
    • Nurses: Training - Question | Lords debates

      My Lords, is the Minister aware that the vacancy rate for nurses in social care settings has doubled over the last four years? Given the other pressures on nursing homes, will the Government take specific action-perhaps grants for placements-to relieve this problem, which the NAO has described as dangerous?

  • Feb 21, 2018:
    • Cannabis-based Medication - Question | Lords debates

      I am grateful to the Minister for her commitment to explore every option. Is she aware of the legal opinion from Landmark Chambers making it clear that there is an exception under Section 30 of the Misuse of Drugs Act 1971, which allows that a licence for possession of a controlled drug can be permitted for medical purposes? Will she make use of that exception to save this little boy's life?

  • Feb 20, 2018:
    • Nuclear Weapons - Question for Short Debate | Lords debates

      My Lords, I congratulate my noble friend Lady Miller on asking this very important question.

      I speak in a personal capacity about the greatest threat to mankind and the planet: nuclear war. I believe that there are no safe hands for these weapons of mass destruction-not even ours. Global warming is a very major threat, but the threat of any detonation of nuclear weapons is even greater. Yet, despite the lead the UK has shown on the issue of global warming, we are not showing the same leadership on getting rid of nuclear weapons. Of all weapons of mass destruction, only nuclear weapons will kill not just one generation, but kill and maim future generations, resulting in the starvation of 2 billion people, even when used on a small, regional basis, as my noble friend said. It has also been made clear by the Red Cross and the Red Crescent that no medical response to a nuclear detonation would be anywhere near adequate.

      It should hardly be necessary to restate that it is illegal to possess such weapons, let alone use them, but that is what the new UN ban treaty seeks to do. In my contribution, therefore, I urge the UK Government to demonstrate by their actions their commitment to a world free of nuclear weapons, which they frequently express to Parliament and at the United Nations. Although the UK is a signatory to the 1968 nuclear non-proliferation treaty, very little progress has been made for five decades on the incremental reduction of nuclear weapons to which the treaty commits us. It is time we did something about that. Indeed, it seems that weapons are proliferating rather than reducing. It saddens me, therefore, that the UK Government refused to sign the new Treaty on the Prohibition of Nuclear Weapons-negotiated by the UN last July-and still seem not to have made up their mind as to whether they will attend the UN high-level conference on nuclear disarmament in May. If not this way, which way?

      The new ban treaty lays out a process leading to multilateral disarmament. The conference to discuss urgent next steps will be held in a climate of increasing possibility of a nuclear exchange between North Korea and the United States, or India and Pakistan, or Russia and NATO. There is no better time for world leaders to come together to take nuclear war off the table. The principal aim of the conference is to make progress on effective measures for nuclear risk reduction and disarmament. Membership of the NPT already commits us to that, so we really must take part. If we do not, we will increasingly be seen as out of step with the international community and rejecting the opportunity for global leadership that it presents.

      The UK should not wait for other states to take action: surely we should make our own decisions about something as important as this. The non-nuclear countries have shown the way by agreeing the resolution last summer, and many have now signed and ratified it. But without the participation of the nine nuclear countries, the threat-not just of intentional detonation, but of accidental detonation too-remains acute. The presence of nuclear convoys on our roads brings the latter very close to home.

      The treaty calls for progress to be made on a global agreement, which would include the nuclear-armed states and provide a phased and verified process for prohibiting and eliminating nuclear weapons. Verification is an area where the UK has considerable expertise to offer, so we should take part in discussions about how this can be done. Such processes have been very successful in reducing the use of chemical and biological weapons, and it is essential that the global community learns from that success in relation to nuclear weapons too. Chemical and biological weapons were banned first and then eliminated, so making them illegal was the essential first step.

      Parliamentarians and civil society organisations have called on world leaders to commit to attending the conference at the highest possible level. The Organization for Security and Co-operation in Europe Parliamentary Assembly, which includes the Parliaments of France, Russia, the UK, the USA and 52 other members, adopted declarations in 2016 and 2017 calling on member Governments to reduce nuclear threats, adopt no-first-use policies and support UN negotiations, including on the nuclear ban treaty and at the 2018 UN high-level conference. Even though we might be leaving the European Union, we are being told that we will still be in Europe, so there is no reason why we cannot continue to play an active role in this organisation and to support its demands.

      Jonathan Granoff, president of the Global Security Institute and UN representative for the World Summit of Nobel Peace Laureates, said recently:

      "Nine nations continue to hold the world at risk of nuclear annihilation. Although 120 non-nuclear weapons states have negotiated a treaty to ban the weapons, the states with the weapons remain deadlocked in inertia. It is time for leaders to come together … to discuss measures to reduce nuclear threats".

      So will our Prime Minister attend? Frankly, I would not trust the Foreign Secretary to make a positive contribution, but the Prime Minister might. If not now, when?

      While millions starve, over $100 billion per year is spent globally on nuclear weapons, including many millions of pounds by the UK. Personally, I believe that this is a terrible waste because I do not believe that the deterrence principle makes us any safer. On the contrary, possession of these weapons makes us a potential target, as it clearly does for the United States. Certainly the people of Scotland think so, which is why they are overwhelmingly against the location of these weapons on their soil. The money could be better spent to create jobs, support renewable energy, protect the climate and clean air, maintain our conventional defence forces and implement the sustainable development goals.

      The ban treaty also has something important to say about the ongoing humanitarian legacy of past nuclear weapons use and testing, and obliges states to provide medical rehabilitation and socioeconomic assistance to those affected by nuclear weapons and to make affected environments clean and safe again. The UK has nuclear test veterans, so I ask the Minister: what are the UK Government doing for them and what contribution are they making to assist victims in other parts of the world? Taking the first steps to engage with the ban treaty by attending the conference is not only compatible with our membership of NATO, the NPT and the Comprehensive Nuclear Test-Ban Treaty, it is a vital step towards fulfilling our legal obligations in relation to nuclear disarmament.

      Given the aggressive stance of the current holder of the office of US President, it is time for us, one of the United States's oldest friends, to show that jaw-jaw is better than war-war by participating in the high-level conference, even as an observer. Even if the other nuclear states refuse to take part, the presence of the UK would prove what the Government have recently been claiming-that even after Brexit, the UK will remain an outward-facing country, engaged with the rest of the world and taking a leading role in efforts for peace. I challenge the Government to prove their claim by attending the conference.

    • Charities, Social Enterprises and Voluntary Organisations - Question | Lords debates

      My Lords, charities are affected not just by regulation but by policy developments. Will the Minister say whether there is a protocol across government to investigate how new policy developments impact on charities and their ability to do their work?

  • Jan 30, 2018:
    • Women: Events Industry - Question | Lords debates

      My Lords, does the Minister agree that if you want to influence the behaviour of men you should start when they are boys? That is why it is very important that the curriculum for PSHE lessons includes elements that ensure that young people leaving school understand that both genders should be properly respected.