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  • Dec 21, 2017:
    • Climate Change: Health - Motion to Take Note | Lords debates

      My Lords, I thank the Minister for her valiant defence of the Government's record. I will leave noble Lords to decide how many marks out of 10 it should get. I also thank all those who have spoken in this debate. It was a particular pleasure to hear the maiden speech of the noble and learned Lord, Lord Neuberger. Early in his speech, he mentioned that he had had to do a lot of risk assessments in his career. If I found that there was a 95% chance of something I was doing causing a negative effect, I would stop doing it. I am glad to see that the vast majority of the Members of your Lordships' House are on the side of the 95% rather than the 5%. I believe it is in fact 99% of scientists who believe that it is human activity that is causing climate change. Indeed, they also tell us that, even if we stopped this very day all the activities that cause climate change, global warming would continue. It is a bit like an ocean liner: you switch off the engine but it still carries on for several miles. So the sooner we stop doing those things the better.

      I was very struck by the comments of the right reverend Prelate the Bishop of Derby about how, as a community and a country, we need to take action, but also how we have individual responsibility. Some years ago, I made a new year's resolution that, the next year, I would live more lightly on the planet. My most recent effort in that respect has been to build a passive house-a highly insulated house-and it is very gratifying to see how many public housing projects are now being built to that gold standard; it is terrific. I recommend such a new year's resolution to all noble Lords. If we all take a step every year then we will be moving in the right direction.

      Finally, I wish all noble Lords a happy Christmas and a green and healthy new year. I beg to move.

      Motion agreed.

    • Climate Change: Health - Motion to Take Note | Lords debates

      My Lords,

      "Climate change isn't just hurting the planet-it's a public health emergency".

      That is the conclusion of Christiana Figueres, chair of the Lancet Countdown, a collaborative research project which published a report in October that has shone a light on the damaging impacts that climate change is having on our health.

      In 2009, the UCL-Lancet Commission published its first report on the relationship between climate change and health. It concluded, simply, that climate change represents the biggest threat to global health in the 21st century. Since that publication, the Lancet has continued to work on this topic, and instead of describing climate change as a threat, the most recent report concluded, optimistically, that climate change represents the biggest opportunity for global health in the 21st century. This change of tone reflects a growing recognition that action on climate change can bring about dividends for public health, a notion which empowers the health and climate community to capture these co-benefits. More recently, the Lancet has pioneered the concept of planetary health. The foundation of this concept is the growing body of evidence that the health of humanity is intrinsically linked to the health of the environment. But by its actions, humanity now threatens to destabilise the earth's key life-support systems, with significant implications for the political systems and economies that run the nations of the world.

      This year's Lancet Countdown is the latest report in this field from a cross-sectoral partnership of universities and organisations from across the world. It is an accountability mechanism, using 40 indicators to track progress annually on climate action and health, and to catalyse political and scientific discussion about its importance. Today's debate is proof that it has already succeeded in the second of those aims. The Lancet has committed to producing this annual state of the union report in order to try to sustain, in the interests of global health and stability, the momentum on climate change that was achieved with the negotiation of the Paris Agreement.

      The key conclusion from the report is that climate change is damaging health worldwide. The multiple threats to human health of climate change are unequivocal, interacting and potentially irreversible: from direct impacts such as heat waves and extreme weather events such as storms, forest fires, floods or drought, to indirect effects on ecosystems, such as agricultural losses and changing patterns of disease, and effects on economies and social structures, such as migration and conflict. These effects disproportionately impact the most vulnerable populations, but every community will be affected. The World Health Organization agrees that climate change negatively affects the basics of life: safe drinking water and access to food and shelter. Here in the UK, the latest climate change risk assessment under the Climate Change Act 2008 includes heat waves, flooding and drought as aspects that risk UK public health.

      According to Countdown, the critical issue at hand globally has been the delay in our response to climate change, which over the past two decades has jeopardised human life and livelihoods. However, the good news is that the past five years have seen an accelerated response, and in 2017, momentum is building across a number of sectors. The direction of travel is set, with clear and unprecedented opportunities for public health. That is why the tone of the latest report is more optimistic than before.

      I am glad to note that here in the UK the Climate Change Act 2008 is legally binding whether we are in or out of the EU, and we will also continue to be a signatory to the Paris Agreement although we will have to submit our own submission separately from the rest of the EU. But even if all the signatories to the Paris Agreement achieve their commitments, it is estimated that there will still be an increase in mean global surface temperature of 2.7 degrees by 2100, resulting in significant environmental change, so the Paris targets are not enough. However, if the targets are not achieved, and the attitude of the current US Administration makes it likely that they will not, over 4 degrees is possible, with profound damage to the planet and human health.

      So let us look in more detail at the impact of climate change on health. Annual weather-related disasters increased by 46% between 2000 and 2013, and scientists attribute this increase to climate change. These disasters have a monumental effect on the health of the affected communities. Droughts and flooding result in starvation and the mass movement of people, all of which are disastrous for health. Here in the UK, 1.8 million people are living in areas susceptible to flooding or coastal erosion. Although relatively few people die from drowning during UK floods, the psychological trauma and effects on mental health of having your home or business flooded are considerable. A UK study found that flood victims were more than six times more at risk of depression and anxiety and seven times more at risk of PTSD than the general population. So what are the Government doing to reduce the risk of flooding and protect vulnerable areas, and how are the planning regulations being used to discourage new building in areas susceptible to flooding?

      Massive storms destroy people's homes, and most of this damage worldwide is not insured. Again, these storms result in the displacement of people and major health issues, such as cholera, where populations are living close together in poor-quality temporary shelter. Accelerated efforts towards poverty reduction and sustainable development have helped to minimise harm to date. However, the Countdown report's authors believe that limits to adaptive capacity will soon be reached, so we must address the root cause of these disasters, which is climate change itself, and I shall come to that in a minute. In the meantime, what are the UK Government doing to help populations that are displaced by such disastrous weather events?

      Secondly, global warming has a direct effect on the livelihoods of vulnerable people exposed to heat-wave events. From 2000 to 2016, the global average temperature where people are actually living has risen by approximately 0.9 degrees Celsius, more than twice the global mean land temperature increase. Since 2000 the number of those vulnerable people exposed to heat-wave events has increased by around 125 million. This means more people dying from overheating and more people working on the land whose productivity is impacted. The report calculates that global physical labour capacity in populations exposed to severe temperature rises decreased by around 5.3% from 2000 to 2016. This reduces their income and has an effect on local and global food security. Of course, extreme cold weather also usually results in increased deaths, especially of older people through hypothermia, while the increase in the number of UK deaths due to overheating is projected to rise by a massive 250% by the 2050s, partly due to our ageing population, unless action is taken. Both these effects put major stress on the resources of our NHS.

      Then there is the effect of global warming on communicable diseases. The geographical scope of some of the vectors of communicable diseases has increased considerably, and this is very worrying for us in the UK. We are already seeing Culex modestus, a vector for the West Nile virus, being found in south-east England. Higher temperatures in future will also increase the suitability of the UK's climate for other invasive mosquito species. Plant diseases are already reaching us, with major effects on the countryside. For example, in the last few years many of our large and important trees have suffered from diseases that we did not see decades ago, and this has been linked to climate change as well as the increase in the cross-border sales of trees.

      So are we doing enough to adapt to the effects of climate change? The report concludes that we are not. However, there are great opportunities. Mitigating climate change benefits health in many ways, but there are some areas where the two are particularly closely linked-for example, air pollution, which is a global health crisis. Seventy-one per cent of the almost 3,000 cities in the World Health Organization's database do not satisfy WHO annual fine particulate matter exposure recommendations. That includes London and 43 other British cities. This poor air quality results in 40,000 premature deaths each year in the UK-and not just of those who suffer from lung problems.

      The UK Government have identified poor air quality as the largest environmental risk to public health, being linked to cancer, asthma, stroke and heart disease, diabetes, obesity and changes linked to dementia. In the case of fine particulates, we also know that they particularly affect young children, including the brain development of infants.

      It is the heating, transport, industry and energy sectors which are the source of man-made air pollution, producing most of the particulates, as well as carbon dioxide and other gases linked to global warming, so we need clean transport and clean energy production, but we have an economic system in which the full costs of climate change are not paid for by those responsible for the problem. Will the Government look at the real cost of the use of fossil fuels and consider carbon pricing as a means of getting the balance right? Will they take positive action to reduce the number of diesel vehicles on our roads? What action are they taking to encourage and enable people to insulate their homes properly?

      Progress on coal phase-out has tangible benefits for air quality globally, and it is good to see that in 2016-17, the amount of additional coal capacity planned for construction halved. In addition, traffic emissions make a major contribution to the quality of the air we breathe, especially in cities. Sustainable travel uptake, such as walking and cycling, can mitigate climate change while at the same time encouraging healthier lifestyles and improving air quality.

      In these ways, mitigation tackles climate change and reduces the harm to health from air pollution. When will the Government spend on sustainable travel reach £10 per head annually, as they have committed to do, and why are they planning to reduce the "active travel" investment from £287 million per year now to £147 million per year by 2020? As physical inactivity and obesity cost the NHS more than £1 billion a year, this seems a very unwise reduction.

      I also draw the Minister's attention to the need for a comprehensive carbon capture and storage strategy, as recommended in the report of the advisory group on CCS, ably led by the noble Lord, Lord Oxburgh. Clean energy production is essential, but as we grow our ability to produce electricity by sustainable means, we expect to have to depend on fossil fuels for many years. In the light of that, it was very disappointing that the Government cancelled the carbon capture and storage competition. The noble Lord's report is unequivocal that CCS is an essential component in delivering the lowest-cost decarbonisation across the whole economy, and there is no justification for delay in getting a national strategy up and running. His six recommendations provide a blueprint for how this needs to be done, yet the Government have not responded to the report. I hope that the noble Baroness can tell us why that is and when a government response will be provided.

      Food and agriculture is also a sizeable contributor to climate change. The average dietary CO2 emissions per person in the UK are 5.6 kilograms per day, but if we ate according to the WHO's nutritional guidelines, they would fall by 17%. The dietary changes would also save almost 7 million life years over a 30-year period, mainly due to a reduction in coronary heart disease equivalent to an average increase in life expectancy of just over six months. Here is another opportunity to improve health and address climate change by focusing on the links between the two.

      What are the Government doing to promote healthy eating in line with the WHO nutritional guidelines, so that the health of the population can benefit while also reducing greenhouse gases? Are they putting into practice lessons learned from the success of the campaigns to reduce smoking and drink-driving and applying them to healthy eating? There is some good news from right inside the NHS itself. The NHS Sustainable Development Unit has had considerable success in reducing the health sector's greenhouse gas emissions.

      If noble Lords agree that our environment has a major effect on public health, they have to be worried about the life sciences part of the industrial strategy. In his evidence to your Lordships' Science and Technology Committee, Sir Paul Nurse recently said that the strategy should really be called the health science strategy, because it completely leaves out the environmental and other life sciences, in which the UK has considerable strength. Do the Government plan to publish a separate strategy for life sciences that are not directly linked to health? The reason I ask is that environmental sciences are very much connected with health and there is a danger that they will be ignored. Unlike many other departments, however, the Department of Health has a very large research budget, which should be used in this area. Sir Paul also observed that a great deal of money is being spent on genome sequencing, but that there has been very little work on how the environment affects the expression of the genome on the health of our people.

      In conclusion, I very much welcome the noble and learned Lord, Lord Neuberger of Abbotsbury, to your Lordships' House and look forward to his maiden speech; I am very honoured that he has chosen to use this debate for it. I also pay tribute to all the scientists and publishers who worked on the Lancet Countdown report, which has inspired this debate. I beg to move.

  • Dec 13, 2017:
  • Dec 12, 2017:
    • NHS: EEA Doctors - Question | Lords debates

      My Lords, according to the BMA, almost half of EEA doctors are considering leaving the UK and one in five has already made plans to do so. Given that it takes 13 years to train a consultant, what is the Minister doing to fill these gaps in the short term? Is he aware that there are numerous doctors from around the world already resident in the UK but whose qualifications fall short of what is required by the NHS? They would dearly love to be able to upgrade their qualifications and help us to fill the gap that is going to be left by the Tory Brexit, but there is no organisation that will advise and support them to improve their qualifications. What will the Minister do about that?

    • NHS: EEA Doctors - Question | Lords debates

      To ask Her Majesty's Government what assessment they have made of the number of doctors from European Economic Area states working in the United Kingdom who may be planning to leave the NHS after the United Kingdom's withdrawal from the European Union.

  • Nov 30, 2017:
    • NHS: Staff - Motion to Take Note | Lords debates

      My Lords, I thank the noble Lord, Lord Clark of Windermere, for bringing forward the debate today. It is high time that we debated the fiscal issues in relation to health.

      Although it is always nice to see the noble Lord, Lord O'Shaughnessy, answering a debate, I fear he is the wrong Minister for this one. Indeed, I think there should be a whole row of Ministers sitting on the Government Front Bench today, led by a Minister from the Treasury. Here is the reason. Noble Lords who know me will recall that my favourite word in health debates is "prevention". Without prevention of a great deal of the country's ill health, of which we are perfectly capable, the cost burden of preventable diseases will bring the NHS to its knees. Our hard-pressed health and care workers will never be able to work hard enough. My party's policy, for the moment, is to add one penny in the pound on income tax for health and social care, while continuing to take lower-paid people out of tax altogether by raising the personal allowance. However, while this would provide the NHS and social care with what they need for the moment, in the long term, this will not be enough if we carry on the way we are going.

      I am a great believer in evidence-based policy and also a great admirer of Professor Sir Michael Marmot and his rigorous work on health inequalities and the social determinants of health. That is why I said what I did about the Minister being the wrong person to answer this debate. If you want to lead a healthy life, all the evidence shows that you need to be conceived and born to a family that is comfortably off. The Marmot indicators show very clearly that poverty and deprivation are the clearest indicators pointing to poor health. So what are the factors that contribute to this-those things known as the social determinants of health? Of course, they are low income; poor housing; low educational attainment, leading to lack of well-paid work; poor air quality; poor access to the cultural activities that contribute to our well-being and mental health; and poor access to the healthy food, help and advice that help us make the right choices for our own health.

      So until we get a truly progressive tax system that taxes poor people less than rich people, until we stop subsidising the fossil fuels that pollute our air and warm our planet, until we train a highly skilled workforce and until we start building affordable well-insulated homes for poor people, we will never iron out the major health problems that keep our doctors and nurses far too busy. That is why we should have a Treasury Minister leading a team of Ministers from transport, housing, education, DWP, DCMS, DCLG, BEIS, Defra and all the other acronyms. Until we get a whole-government approach to the health of the nation, we will never solve the problems of health and social care. So as the noble Lord, Lord Clark, has rightly identified, fiscal policy is a powerful tool in this battle. I would like to hear the Minister say that the Prime Minister will show a bit of leadership on this and set up a powerful Cabinet sub-committee with teeth, which will be able to hold all the other departments to account on their contribution to the health of the nation. Until I hear about some mechanism of that sort, I fear that the Marmot indicators will never shift.

      In addition to that, we politicians need to put our heads together. I fear that the Government's failure to heed the calls of my right honourable friend Norman Lamb MP and others to put together a cross-party commission on a sustainable health and care service is very wrongheaded. Good-quality health and social care are things that people care about and vote about, and they depend very much on the welfare of staff. So I would have thought that any sensible Government would prefer to bring in all points of view to find the answers to a problem that has been growing for years, as the noble Lord, Lord Clark, just said. And no, the Government do not have all the answers. This House's Select Committee, led by the noble Lord, Lord Patel, had many of the answers, but they nearly all involved money, yet what did we get in the recent Budget for an NHS that needed more than £4 billion extra and a care system that needed £2.6 billion? We got £1.6 billion for the NHS and nothing at all for social care. But of course, we got £3 billion put aside for Brexit. How many doctors and nurses could we get for that?

      It is clear that the overwork, stress and effective pay cuts suffered by our doctors, nurses and other health professionals will continue. These are contributing to their low morale and the fact that many of them want to leave, cut their hours or retire early. The public service pay cap imposed by the Chancellor for many years has not been lifted, despite a comment to the contrary by Jeremy Hunt. The small easing of the pay restraint announced by the Chancellor last week is conditional on the money being saved elsewhere by the removal of year-on-year increments of other health workers. It is all about saving money, not patient safety, yet patient safety is a big issue when you have demoralised staff working longer than they should in a team with vacancies. The Royal College of Physicians told us that 69% of doctors work on a rota with vacancies and that 74% of them are worried about the ability of their service to deliver safe care. Half of those polled by the RCP believe that patient safety has deteriorated over the past 12 months. What are the Government doing to ensure patient care?

      What about nurses? The Royal College of Nursing has reminded us that, since 2011, nurses' pay has dropped in real terms because their tiny pay awards have nowhere near kept up with inflation. No wonder trusts are having difficulty recruiting and retaining enough nurses and we now have 40,000 vacancies. So trusts are having to turn to expensive agency nurses-and things will get worse if Brexit ever happens. Indeed, it is happening already as some nurses from other EU countries go home and the number of applications to come here has fallen by 96% in the last year. UK applicants, too, are being deterred from training by the withdrawal of the student nurse bursaries.

      Another fiscal measure that is demoralising nurses is the serial cuts to the budget for continuing professional development. This has gone from £205 million to £104 million, and now £83.49 million, over two years, so the opportunities for nurses to increase their income by undertaking specialist training are diminishing. Will the Government restore that funding for CPD and also look again at the bursaries for student nurses?

      We are very dependent on doctors from abroad, including from the EU countries. We are not training enough of our own doctors. Despite the increase in medical training places by up to 1,500 per year by 2020, this simply will not do while we have rising demand and some doctors going back to their home country. It takes 13 years to train a consultant, so what are we to do in the meantime? Further funding for specialist training for home-grown doctors will be required, as well as an assurance to those who come to us from abroad that they are welcome here.

      I have a particular concern about the cancer workforce. I have been involved in an inquiry by the All-Party Group on Cancer about where we are at this point, half way through the timeframe of the cancer strategy in England. Are we on track to deliver all the objectives or not? Although the report will not be published until next week, I think I can whet your Lordships appetites by revealing that all the evidence points to the fact that we are not. In particular, my colleagues and I were very concerned about the evidence of workforce shortages. We are still expecting the strategic review of the cancer workforce from Health Education England, which was promised a year ago. We were told it would come in December 2017, which starts tomorrow. I look forward to it. However, its delay has meant that the shortages which are apparent all across the NHS workforce are even more severe in cancer services because of the specialist staff needed to achieve the strategy. We heard that the lack of the staffing review, delays in releasing funding from NHS England and the last-minute changes in the criteria for transformation funding have meant that cancer alliances have not been able to plan properly and have certainly not been able to commit to funding staff posts until they are sure that they have the money available.

      The cancer workforce is just one sector where, because of the clear objectives in the cancer strategy, it has been possible to measure progress against aspiration. However, we heard from several sources that workforce is the greatest challenge to delivering the strategy. I believe that fiscal measures could improve the situation here and right across the NHS, if only the Government were willing to put them into place.

  • Nov 16, 2017:
    • Young Women: Self-Harm - Question | Lords debates

      My Lords, I thank the Minister for acknowledging the shocking 68% increase in the number of young girls being admitted to hospital for self-harm over the last decade. Does he agree that school counsellors can be a very valuable resource in helping to tackle this terrible epidemic of emotional distress among young people, because they are non-stigmatising and easily accessible? However, I visited an area yesterday where I was told that all the school counsellors have had to be sacked because the schools cannot afford to pay them. Will the Minister work with the Department for Education to ensure that by the end of this Parliament every secondary state school in this country has a school counsellor, so that we can tackle the welfare requirements of young people as well as their academic requirements?

    • Young Women: Self-Harm - Question | Lords debates

      My Lords, on behalf of my noble friend Lord Storey, and at his request, I beg leave to ask the Question standing in his name on the Order Paper.

  • Nov 2, 2017:
    • A Manifesto to Strengthen Families - Motion to Take Note | Lords debates

      My Lords, I start by welcoming the Minister to the House of Lords and congratulate him on his meteoric rise to the Government Front Bench. I also thank the noble Lord, Lord Farmer, for a very interesting debate and extremely important manifesto. There are so many policy areas that could be improved in order to redress the magnitude of family breakdown in this country that it is hard to know where to start. However, I plan to mention adoptive families, the benefits of family hubs, what can be done to keep offenders in touch with their families to reduce reoffending and the importance of teaching children about relationships in school.

      I start with adoptive families-not mentioned by anybody except the right reverend Prelate the Bishop of Oxford-since I have a particular interest in them. I was recently contacted by a couple who are both psychologists and are adoptive parents. I took very seriously the points they were making, which were about burnout of adoptive parents and the lack of support for them. They reminded me that adoptive parents take on some of the most needy and challenging children in our society-traumatised children whose mental and physical health has been damaged by their life experiences. The people who take on these children are heroes and their attempts to give them a stable and loving family in which to recover from their previous trauma should be applauded and supported. However, these adoptive parents often have to deal with violence directed at them or other siblings, self-harm, incontinence, inappropriate or dangerous sexual behaviour, anger, school refusal and many sorts of mental health problems. Adoptive parents cannot take sick leave, resign or ask for a transfer to another department. Unlike foster parents, they do not get much help. Indeed, if they adopt after fostering, whatever help they had before often just stops.

      Adoption UK thinks that as many as a quarter of all adoptive parents are in crisis and in need of professional help to keep the family together. But local authority post-adoption services vary tremendously; despite the fact that adopters save local authorities a massive amount of money, some are less than helpful when asked for help. Can the Minister say what is being done to ensure that an appropriate level of support for adoptive families is offered everywhere? If we do not do this, the NHS will be saddled with the cost of the mental health issues of the parents as well as their children.

      Mental health has been mentioned by several noble Lords-the noble Lords, Lord Farmer, Lord Shinkwin and Lord Alton, among others. This brings me to the subject of teaching relationship and sex education in schools and the ability of schools to identify and signpost mental health problems. The best way to deal with mental health is of course to prevent the problems arising in the first place-the noble Lord, Lord Bird, mentioned prevention. Many of the issues that children face arise from family break-up or from violence or poor relationships in the family. Many children do not have a good model of healthy and respectful relationships at home. It is therefore often the job of the school to pick up the pieces and help build up children's resilience. There is a major role for relationship and sex education in this, so I welcomed the Children and Social Work Act earlier this year, which should ensure that all children get it in an age-appropriate manner as part of their PSHE curriculum.

      I have become aware, however, that the regulations to mandate schools to prepare and publish their RSE policy have not yet been made. Can the Minister say why this is and when it will be done? I welcomed the Prime Minister's initiative on mental health first aid training in schools and wonder if the Minister can update us on how that is progressing. Such work can help children to ride out the worst effects of family unhappiness or even breakdown.

      We live in a very unequal country, and an interesting statistic in the briefings we have received caught my eye. It showed that poor families break up more frequently than more affluent ones. As the noble Lord, Lord Parekh, said, almost half of five year-olds in poorer families are in broken families, compared with 16% in wealthier ones. This did not surprise me. It is widely known that a high percentage of parents are worried about money, and that money is frequently the cause of family arguments, so what is being done to improve the finances of families with children? I am afraid that the marriage tax allowance, which the noble Lord, Lord Morrow, mentioned, brings in less than £5 a week, even if the family applies for it, so that is not going to make much difference. By the way, I am not suggesting that it be improved, as I do not approve of it in the first place. I do not think it is the role of the state to support particular kinds of families.

      Benefit cuts and the six-week wait for universal credit have sent far too many families into debt, and to food banks. If the Government are really concerned to keep families together, which, of course, is a laudable aim, they need to do everything possible to ensure that parents can feed their children and pay the bills. We hear about the record number of people in work, but the fact is that many jobs are very low paid and a high percentage of poor people are in work and eligible for benefits, which makes a nonsense of the Government's constant claim that the best way out of poverty is through work. I would say it depends what sort of work, and how well it is paid. Can the Minister say what plans the Government have to make what they choose to call the living wage into something people can actually live on?

      Many families need a range of services to help them survive, stay together and bring up their children successfully, and it is desirable that these services be easily accessible and linked together. That is why I, like the noble Lord, Lord Farmer, and others, support the idea of family hubs, which can be based on children's centres or Sure Start centres. I hope they will not become what the noble Lord, Lord Mawson, called the shiny new thing that disappears before long, as they would offer a wide range of services for parents as well as children. This is not a new idea. Several years ago, I visited the Coram Centre, where all kinds of services such as debt advice, immigration advice, English lessons and help to find a job and a home were offered to the parents of children in the nursery. It was a great example of what can be done in response to the particular needs of the families in the locality. Therefore, can the Minister say whether the Government support family hubs and whether extra funding will be made available, given the savings to many other services that they could provide in the future?

      I will say a few words about prisoners and their families. There is an important role for families to keep in touch with offenders while they are in prison in the interests of their relationships with their spouses and children, and of reducing reoffending. However, in many cases, the prison system does not make it easy for families to visit. There is some very good practice, such as Skype conversations, but in some cases it is hard to see the logic of where offenders are placed. For example, there is a large, brand new prison in Wrexham, near where I live in north Wales. I recently learned that only 10% of the inmates come from Wales and that many come from a very long way away in England. In addition, the prison is located on an industrial estate miles from the nearest railway station. It cannot be easy for families without their own car to visit in those circumstances, so what is being done to ensure that families who want to keep up their relationship with the offender are helped to do so?

      Finally, from experience, I issue a warning about impact assessments. During the coalition Government, my then honourable friend Sarah Teather said that policies would have a child rights impact assessment. I am not aware that that is being done. Therefore, if we are to have a family impact assessment, I hope that it really happens.

  • Oct 30, 2017:
    • Child and Adolescent Mental Health Services - Question | Lords debates

      My Lords, does the Minister agree that early intervention is essential to prevent escalation into crisis and lifelong problems? Is he aware that the number of CAMHS psychiatrists fell by 6.6% between 2013 and this year, while demand for their services rose? The number of qualified doctors who go into psychiatry is 2.6%, the lowest of any specialism, and some universities do not send any. Will he consult Health Education England to find out what it is doing about this, because the pipeline is drying up?

    • Child and Adolescent Mental Health Services - Question | Lords debates

      To ask Her Majesty's Government what action they are taking to ensure that children and young people can obtain timely access to Child and Adolescent Mental Health Services.

  • Oct 26, 2017:
    • Air and Water Pollution: Impact - Motion to Take Note | Lords debates

      My Lords, I thank my noble friend Lady Miller for her inspiring introductory speech. As an asthmatic person who has to come to London every week from the beautiful clean air of my home village in North Wales, I have a personal interest in this topic. As I stand by the roadside outside this building, I can smell the pollution, and it certainly affects my breathing. Unfortunately, I know that this is not a short-term effect, because the Royal College of Physicians tells us that the effects are lifelong and can make us more susceptible to infections and cancer. Indeed, I have noticed that too.

      However, I am an adult, and developed as a child in an environment with much cleaner air. On the other hand, the children of today, especially those who live and go to school in deprived urban areas, are growing up and developing in air that is toxic. One in five of London's primary and secondary schools is in an area of high air pollution, and 85% of those are in areas of greater than average deprivation. There are 950 schools and 1,000 nurseries across Britain close to an illegally polluted road.

      However, we should not be concerned just about areas of high pollution. A recent study in the Harvard New England Journal of Medicine concluded that there is no safe level of air pollution and that disadvantaged people have the greatest adverse health effects, so, for reasons of health quality, we need to tackle it urgently.

      The lungs are obviously the most susceptible organ. A study in southern California showed a clear link between the risk of developing early school-age asthma and air pollution associated with traffic. Apart from the obvious lung impairment and consequent increased stress on the heart, it is not widely known that air pollution, particularly the microparticulates in diesel fumes, can cross the placental barrier and affect the developing organs, including the foetal brain. This can have a very serious effect on all aspects of brain development, including cognition, and can also affect older people. We are reducing babies' life chances before they are even born.

      Infants are also particularly susceptible because they have a higher metabolic rate than adults and breathe a greater volume of air compared to their size. It is a double whammy: they breathe in more air and are more susceptible to its harmful effects. On top of that, they are often pushed around in buggies which put them exactly at the level of car exhausts. That is why it is particularly important for us to monitor the level of pollution around schools and nurseries and reduce it where necessary. We need to know what the problem is before we can address it.

      Schools are usually on main roads, often at intersections, where pollution is greatest because vehicles have to stop and idle. Of course, many parents drive their children to school, although a recent report on air pollution and London schools suggested that this is not a major contributor to air pollution. The same report emphasised the importance to children's health of physical activity and recommended active ways of getting to school, such as walking or cycling. It calculated that the benefits of the activity outweighed the risk of doing it in polluted air. However, it would obviously be better if the air was clean. I know a doctor who has carefully planned his children's walking route to school along those lines, making sure that they walk along the less traffic-ridden roads and experience cleaner air.

      I am sure that several speakers will recommend ways of reducing pollution in the first place, such as phasing out coal-fired power stations, supporting renewable energy sources, charging drivers of polluting vehicles for entering clean air zones, mandating reduced emissions standards for private cars, removing the dirtiest vehicles from the roads, encouraging electric cars and the charging infrastructure for them and, of course, improving access to public transport. I agree that those prevention measures are really important but, while we are waiting for all these measures to improve the air we breathe, we need to think about mitigation measures.

      Our greatest allies in that fight are trees and other green plants. London is one of the greenest major cities in the western world, with many large and wonderful parks and gardens and thousands of street trees. Not for nothing are our public parks called the lungs of London, and the same applies in other British cities. Private gardens play a very big role, too. A consequence of that is the proliferation of beekeepers in London, since the number and variety of forage plants is so great. It is probably this fact that prevents us having even dirtier air in London since, not only do trees absorb carbon dioxide from the air and give out oxygen, helping to mitigate global warming, but many of them are also very good at removing pollutants from the air before transpiring it out again.

      I am pleased to say that many big developers are quite aware of the benefits of trees and other greenery around their buildings and infrastructure, and build landscaping and planting into the plans from the start. A good example of that is the new American Embassy in Nine Elms Lane just opposite where I live. They are planting many mature trees, hedges and ornamental grasses around the new building, which will buffer the noise and pollution from the traffic and contribute to the well-being of users of the building and local residents. We need local authority planners to insist that all developers do this, and to plan sufficiently far in advance to allow British growers the time to grow the stock they need in the interests of British biosecurity. All noble Lords will have heard about the many plant diseases that we inadvertently import, so I am sure we would all want to support our own home-grown British industry. Do the Government intend to include the planting of trees and green areas in their plans to meet the legal limits for air pollution? I know there is a plan to plant 1 million trees, but many of them will be in rural areas, which have clean air anyway. They should be in urban areas.

      Of course, there are those who believe that our limits are too high anyway, so I urge the Government to keep going, even when current legal limits have been achieved. As members of the European Union, we have signed up to those legal limits, which we have still not achieved everywhere. I disagree with the noble Earl, Lord Caithness: it is not the standards that are wrong, it is the people who try to avoid them, such as VW. So, Brexit or no Brexit, will the Government introduce a new Clean Air Act so that we have new systems in place to achieve the standards to which we have signed up?

  • Oct 16, 2017:
  • Oct 12, 2017:
  • Oct 10, 2017:
    • Adult Social Care in England - Private Notice Question | Lords debates

      My Lords, the CQC report emphasised the need to co-ordinate care by stating that in future it will report not only on the quality of care in individual providers but on the quality of co-ordination between services. It quotes examples of services working together using technology and innovation to share data and improve care. How do the Government plan to encourage this approach? Will they look at funding models to make sure that they encourage co-ordination rather than deter people from co-ordinating?

    • National Health Service - Question | Lords debates

      I thank the Minister for his reply. Does he also agree with Professor Ted Baker's statement:

      "The model of care we have got is still the model we had in the 1960s",

      and that this "needs to change"? Can the Minister say how many of the new models of care are up and running and how many of the sustainability and transformation plans are in special measures? On World Mental Health Day, will he look into how many clinical commissioning groups are failing to commission good and timely mental health care, especially for young people?

    • National Health Service - Question | Lords debates

      To ask Her Majesty's Government what assessment they have made of remarks by the Chief Inspector of Hospitals that the NHS is not fit for the 21st century.

  • Sep 18, 2017:
  • Sep 12, 2017:
    • Gaming Machines - Question | Lords debates

      My Lords, younger gamblers, aged 18 to 24, have a greater propensity to develop problem gambling and mental health issues. They do it mostly online, which is very quick and easy. What will the Government do to reduce the volume of gambling advertising, particularly at sporting events? In many cases, the tone of this advertising is very clearly aimed at young people.