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Grand Committee

Thursday, 27 June 2013.


Question for Short Debate

1 pm

Asked by Lord Harrison

To ask Her Majesty’s Government what is their assessment of the United Kingdom’s relationship with Morocco.

Lord Harrison: My Lords, Morocco is a country with which the UK can do business. I visited it in January 2011 with the all-party friendship group—a visit funded by our Moroccan friends—and I hope that I developed a better understanding of it than was evident elsewhere. It was of course at the time of the incipient Arab spring, and I remember Wyre Davies, the BBC commentator, saying that Morocco, along with the other countries in the Maghreb, was going to be subject to great upheaval. For many years, Morocco has been responding to the home-grown need to ensure that that does not happen.

There is a further dispute that everyone knows about in terms of the western and southern Sahara. I went to Laayoune, where I consulted with my colleagues—not only the NGOs—and met the Saharis but, most importantly, I met the UN peacekeepers at MINURSO. Speaking to their head and deputy head, I was quite convinced that Morocco had not played its cards right in ensuring an understanding about the November 2010 incident. This was where its own police had been mown down, but not as many civilians had been slaughtered by the police as had been claimed. The Moroccans have sometimes suffered from reporting in London. There was film evidence of that incident and it should have been conveyed better.

I want to ask the Minister, whom I am very pleased to see here today, what the Government are doing about encouraging fair reporting of Morocco, whether they are supporting the Moroccans’ autonomy initiative for the western or southern Sahara, and whether they support the United Nations’ demand for a census of the refugee camps in Algeria.

Uncertainty and insecurity are very important. We can do business with Morocco on the question of security, especially given its strategic importance in being a bulwark against sub-Saharan countries which perhaps have been influenced by al-Qaeda.

One who does understand Morocco is the UK ambassador, Clive Alderton. Speaking at the recent 800-year anniversary of England’s diplomatic ties with Morocco, he talked about the importance of seeing the bigger picture between our two countries. He, of course, worked with and served Prince Charles before he became our ambassador. What the two countries share is that we both have monarchies and are maritime trading nations. Each country is perched on the north-western edge of its continent and each boasts of being

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a regional hub: we with the United States, the European Union and the Commonwealth; Morocco with Africa, the Maghreb, the Americas, the Gulf and the European Union. Does the Minister envisage making an official visit to Morocco? I think that she of all people would be the appropriate person to visit on behalf of the United Kingdom, but perhaps she could give a report of recent visits by the United Kingdom Government.

Morocco also has a link with the European Union. It applied for membership as far back as 1987, showing the forward-looking view that it has taken in its relations with the European Union. It is now proposed that deeper and more comprehensive ties with the EU should develop. Again, I ask the Minister whether the UK will support that development and see an ally in Morocco in terms of our working with the European Union over the future.

I think that we can do business in the area of tourism. We have some 50,000 Moroccans here in the United Kingdom—some of them in the House of Lords—but half a million tourists go there every year, and the intention is that that should swell to 1 million by 2020. I know that an important role is played by the British Council in Morocco in spreading the use of English, which is so important for servicing tourists. Can the Minister report on what budget we have to promote the British Council’s work there? Tourism is a changing product: green tourism is an example, as well as the wonderful big cities in Morocco.

With the noble Baroness, Lady Andrews, who is head of English Heritage, I recently met the Tourism Minister from Morocco. There was a suggestion that the two countries might work together on the protection of historic monuments. During my visit in early 2011 I got the sense that UK business was not fully aware of the opportunities for business and trade. I am particularly pleased to see the noble Lord, Lord Sharman, who can perhaps correct me on that. However, the Moroccan economy is changing, generating more added value: where it was fresh fruit, now we are talking about food processing; where it was traditional dress that was sold, now we are talking about ready- to-wear clothing—pret-a-porter; and we are also talking about automotive parts. Are we sensitive to these changes and new opportunities? We recently had the first Morocco-British trade day. I believe it was a success but can the Minister tell us of any tangible results?

The UK is only the seventh trading partner of Morocco, way behind France and Spain, according to the journalist Jonathan Fryer. Let us think about some of those other opportunities coming along. These include the new cities being created for Morocco, and Tangier with its free port on the Mediterranean, which is going to be home to Renault and Nissan’s new production facility, with 170,000 vehicles planned, swelling to 400,000 in time. Although the UK is Morocco’s fourth largest investor, are we doing enough to take advantage of those opportunities?

Can we do business in the financial services sector? When I went there in January 2011 I did not see many British banks. However, Casablanca has recently become the new financial centre not just for Morocco but for north Africa. A new agreement was reached between the Moroccan Financial Board and City UK, which I

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recently received as chair of your Lordships’ European Union economic and finance committee. All these opportunities are well documented in the excellent brief I received from Tanya Warburg’s Freedom for All organisation.

We are talking about opportunities for small businesses, for agricultural development and fisheries development—there is a link between the Laayoune fisheries and the Canary Islands for instance—as well as the phosphates and ammonia found in Algeria. If we could bring together Morocco and Algeria, currently enemies, there would be enormous business opportunities. Then there is renewable energy, where the Moroccans are doing so much, and water management, telecoms, aeronautics, and transport infrastructure. We drove down excellent motorways; I understand that 150 kilometres a year are added to the railways in Morocco. That warms my heart, coming from Chester, birthplace of Thomas Brassey, the great builder of world railways in the 19thcentury.

There are some notes in a minor key when discussing Morocco. Others will elaborate on human rights and on youth unemployment, which we share as a common cause in the European Union. The World Bank’s interesting report criticises the quality and access to education. The European Council for Foreign Relations has issued strictures on Morocco’s slow drive to democracy. However, so much has been done by the Moroccans in trying to drive forward a modern country. King Mohammed VI seems to be a man of the people and Prime Minister Benkirane’s Islamist Government, who have not fought to curtail the rights of women, are tackling the troublesome levels of corruption and repairing some past difficulties with abuse in the truth commission. I conclude by saying that Morocco is a friend with whom Britain should be proud of doing business.

1.10 pm

Lord Sheikh: My Lords, at the outset I thank the noble Lord, Lord Harrison, for arranging this debate. The United Kingdom and Morocco enjoy a long and happy history—a heritage of which I believe we should be proud. Earlier this month, the British Embassy in Rabat celebrated the 800th anniversary of diplomatic relations between our two countries, a point made earlier by the noble Lord, Lord Harrison. In April this year the Moroccan Minister of Foreign Affairs made his first official ministerial visit to London. An estimated half a million British tourists travel to Morocco every year to take advantage of its outstanding natural beauty and renowned hospitality. This tourism helps maintain our relationship, and Morocco is economically dependent on it.

I believe that the recent social revolutions across north Africa and the Middle East, coupled with the economic turmoil across much of the western world, present an opportunity to look again at our priorities. It is a chance to refocus where we should be looking to build stronger bridges for the future and dedicating more of our efforts. I firmly believe that Morocco should be one of the countries we should focus on, and with good reason. Like some other countries in

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the Arab world, Morocco is engaging in fundamental democratic reforms. While it remains essentially a kingdom, a new constitution was adopted in July 2011 establishing a more democratic system of governance. A key political change is that the majority party in Parliament, rather than the King, now has the right to nominate the Prime Minister. Strong human rights provisions were also included in the reforms, although I appreciate they have had mixed results.

Last September, the United Nations special rapporteur on torture, Juan Mendez, reported his findings following a visit to Morocco. He was concerned at the continued use of cruel treatment by some security forces on the ground and in prisons. However, he also noted that the general situation regarding the practice of torture has improved and that a culture of human rights, with a genuine political will, is slowly emerging. Morocco has implemented a National Human Rights Council and announced that it will ratify the optional protocol of the UN convention against torture later this year. In recent years, further rights have been granted to women and the King has also stated that tackling unemployment and poverty are two of his main priorities. Unemployment has shrunk significantly over the past decade and spending on social programmes and subsidies have increased substantially.

In all, it seems as if this new constitution is laying the groundwork for introducing laws that will build greater levels of engagement with and transparency towards the general public. It is important we recognise how the conviction that fuels such reforms can spread across borders, calm tensions and set examples for others. These measures are a beacon of hope in an ever insecure region. Can the Minister highlight the role that Morocco has taken in promoting or contributing to regional stability?

Our Foreign Secretary recently reaffirmed his support for the progress that Morocco has been making towards implementing the new constitution, particularly through the Arab partnership, with efforts to tackle corruption and encourage political participation. I very much share this sentiment and, on that note, I would be grateful if the Minister could also provide details of any programmes that we are supporting in Morocco through civil society.

Our relations with Morocco can be enhanced further by undertaking more trade. As I have stated many times before in your Lordships’ House, one of the keys to building and advancing successful relationships between countries is by having increased levels of trade. Such trade allows for increased diversity and consistency of goods and services, leading to the widening and opening up of markets. This in turn nurtures cultural and technological exchange and helps bring countries closer together, benefiting economies on both sides. Indeed, 2012 was a landmark year, as the bilateral trade between our two countries passed £1 billion for the first time. Despite suffering a setback, Morocco’s GDP growth rate in 2012 was 2.9%, which is a respectable figure within the context of the global downturn and higher than that of many western countries. It is also projected to accelerate to an average of 4.8% over the next few years.

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Morocco boasts a number of economic achievements that have, unfortunately, gone unnoticed and to which we should be paying much closer attention. Last year, it built the largest port in the Mediterranean, Tanger-Med—again, this is a point made by the noble Lord, Lord Harrisonas a strategic way of capitalising on its geographical position as a primary gateway between Europe and Africa. It is also establishing itself as a hub for international investors looking to get into Africa, with the creation of Casablanca Finance City. Morocco also enjoys free trade access to 55 different countries, representing more than 1 billion consumers and 60% of the world’s GDP. Bearing all these points in mind, it is no surprise that Ernst & Young recently ranked Morocco as the second most attractive African country for foreign investors.

I spoke last month in the Queen’s Speech debate on the importance of the UK investing in Africa. We must act now, before other countries beat us to it.

1.18 pm

Lord Sharman: My Lords, I, too, thank the noble Lord, Lord Harrison, for introducing this debate and for giving me the opportunity to make a few remarks about trade and business with Morocco. As your Lordships will know, I was appointed the Prime Minister’s trade envoy to Morocco at the end of last year, so in this debate it is appropriate that I restrict my remarks to matters of trade. I will leave the other aspects of the relationship to those who are much better qualified to deal with them.

From the point of view of many parts of British business, the first thing they say when you talk to them about Morocco is that it is too French and too risky, both of which are fundamentally untrue. That is not the case; Morocco is important to us as a market, as the previous speakers have said. It is a market that we must be concerned with, and UKTI has reflected that. It is one of only 14 markets in Africa where UKTI has a permanent presence.

In my judgment, it is particularly important because if you accept the proposition that Africa is likely to be the next great area for generating global growth then, looked at from the perspective of Great Britain Ltd, we have penetrated that area quite successfully in anglophone Africa, largely through the southern states. However, the phrase that I use is to say to people, “When you look at China, you would not go into half of China”, and we have practically ignored francophone West Africa. What Morocco gives us, particularly with the structures in place there through Casablanca Finance City, is the opportunity to use that as a hub and penetrate francophone West Africa through it. Interestingly, I was visiting a vegetable-growing operation down there a few weeks ago which, your Lordships might be surprised to know, farms 8,000 acres of vegetables in Senegal but it is done via Morocco.

I hope I have made the point that it is strategically important for business. I would like to talk a little bit about the Morocco/British Business Council which has rather fallen into abeyance but I am working on it. It has not met for some time and, when I was in Morocco in March, I met Mostafa Terrab, the Chief Executive of OCP, the large phosphates business. He

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and I will co-chair a new initiative in that area, probably with a different title. It will be much more restrictive in its ambitions but these will be readily achievable. I am working on that at the moment and hope we can launch it in September or October this year.

I have decided to concentrate most of my efforts as trade envoy on a limited number of industrial sectors. This is because one cannot do everything and I would sooner try to do a number of things well than a lot of things badly. The first sector I am concentrating on is financial services, to which other noble Lords have already referred. The CFC project in Casablanca is very interesting and impressive. Noble Lords will not know that I was financial adviser to the London Docklands Development Corporation when Canary Wharf came into being. I was also the financial adviser to the Irish Government in the creation of the International Financial Services Centre in Dublin. I would describe CFC as a combination of the two. It has a very attractive package of incentives on offer and a huge, fantastic site. When it gets going it will be a key place in north Africa through which to access the rest of francophone Africa. The stock exchanges in London and Casablanca are talking to each other about a project to work together. We are also looking to see if we can get an insurance centre established there, linking in to the London insurance market.

The second sector, which may sound a bit surprising, is higher education. I acknowledge the work of the British Council in Morocco in this area and, in particular, the work done by Martin Rose, its director there. There are a large number of co-operative agreements between British universities and Moroccan universities being developed. These have moved in recent years away from the old focus on the humanities and more towards science and technology. We are in the preliminary stages of discussions on the establishment of a campus of a British university in Morocco and also a British-based business school which will, I hope, be within Casablanca Finance City.

Reflecting what has been said earlier, the thirst for English language skills is prevalent wherever you go in Morocco today. The thirst for English-based secondary school education is there as well and there are ongoing discussions about the establishment of a leading, independent British secondary school in Morocco. This is important because it fuels the relationship that then builds trade.

The third area I am looking at is energy, but only in the sense that Morocco, like many other north African countries, does not have a lot of hydrocarbons knocking around the place. It is not self-sufficient in energy and is looking at importing liquefied natural gas. The areas of renewables, particularly energy from waste such as tapping methane from groundfill or anaerobic digesters based on vegetable and food waste, are ones where Britain has the technology to participate, and we will be having discussions on them. The second area of renewables, which is at an early stage but has great potential, is wave power.

Let me say a quick word about agribusiness. It is not that I do not think it is important but it is taking care of itself quite well at the moment. However, we can put focus on that. On tourism, developments need

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to look further than only tourism and should include event management, conferences and so on. Were the facilities there, it would be an attractive proposition.

From my point of view, the prospects for furthering our trading relationship with Morocco are good. I have been able to enjoy cordial relationships and, as has been said, it is an open country. It is very easy to do business with Morocco and we should be doing so.

1.26 pm

Lord Anderson of Swansea: My Lords, my noble friend and I are both members of the Friendship Group with Morocco in our Parliament and therefore I warmly congratulate him on his initiative and, indeed, on his impeccable timing on the 800th anniversary of our diplomatic relations. I take the opportunity also to salute the excellent work here by Her Excellency the Ambassador of the Kingdom of Morocco, Her Highness Princess Lalla of Joumala Alaoui.

Like my noble friend and the noble Lords, Lord Sheikh and Lord Sharman, I shall refer to some of the key elements of our bilateral relationship, particularly in relation to the agriculture side. I invite the Minister to comment on the extent to which Moroccan agricultural exports to the UK and the European Union are constrained by the protectionism within the common agricultural policy. I shall later say a few words on the basis of what the noble Lord, Lord Sharman, has said about our cultural relationships.

No one doubts that, like other countries in the Arab world, Morocco faces huge challenges—massive illiteracy, at 44%, and fast-growing youth and graduate unemployment. I pose the intriguing question: given this background, why has there been no Arab spring or Arab uprising in Morocco? Why is Morocco apparently largely exempt from the turbulence of most of the other Arab countries? I observe that, broadly, the monarchies have largely avoided such troubles. His Majesty King Mohammed VI is a force for stability and has had the political wisdom to ensure political evolution in the direction of a constitutional monarchy and an intent to ensure that moderate Islamic forces are kept within the tent. It helps, of course, that he is a direct descendant of the Prophet.

Externally, Morocco is conscious of its role as a bridge between the north and the south of the Mediterranean. One speaks of l’exception Marocaine, which arises from its geography and history and a self-confident view of its own role—the positive role it has played in Syria and the moderating role it has played in Israel/Palestine. As to the Barcelona process of 1995, the Union for the Mediterranean, Morocco has tried to build a regional impetus but this has been hampered by the west Sahrawi question. I have visited both the Laayoune and Tindouf and seen the position at first hand. In my judgment, ultimately the Moroccan offer of a substantial autonomy will be the end. That will allow a much greater regional link between the north and south of the Mediterranean.

Morocco is the pioneer of linking with western European organisations, NATO and the Council of Europe—I am a member of the assembly—which concentrates on strengthening democratic institutions

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and the rule of law. Of course, there are problems: the need to reform the judiciary and fight corruption; money laundering; media freedom; the position of women; and child labour. However, by and large Morocco has played a very positive role. In 2009 the Council of Europe Assembly created a new status of Partner for Democracy, and Morocco was the first country to enjoy that status of all the neighbours of the Council of Europe.

In March I was in Rabat as part of a monitoring process, and this week the Assembly will debate the two-year monitoring process of that new status. The school report, which is being debated this week, is mainly positive, describing what the rapporteur calls a “promising start”. The Venice Commission has recognised the quality of the new constitution. The king called on the winning party in the general election to form the Government, and Morocco has acceded to many Council of Europe conventions. There is indeed a new dynamic.

Finally, I would like to say a word about our bilateral cultural relations, which have largely been covered by the noble Lord, Lord Sharman. We have tried to identify areas of mutual interest. The tradition is of course francophone, but Morocco recognises that English is the language of employability and of research. Euromonitor found there to be a 12% wage premium for anglophone Moroccans. The British Council does remarkable work on the language side, with two language schools in Morocco and a flourishing examination bureau. Programmes include youth employability.

There has been an emphasis on English teaching, both at school level and at higher education level. In passing, let me say that I hope that the Moroccan diaspora in the UK—including graduates, many of whom wish to keep links with Morocco—may be used by our country for English language teaching, both in schools and as assistants in Moroccan universities. The emphasis has been on language, governance and link-building. There are research agreements and, as the noble Lord said, bilateral university agreements, and an excellent arts programme in design, digital arts, music and film.

Overall, there are very constructive links in this field. Of course, French predominates because of the country’s history. Our overall aim is not in any way to replace French—that would be impossible in any event—but to respond to the Moroccan wish to diversify, and to encourage and support the wish to diversify in a collaborative way. Thus the wide education, commercial, scientific and cultural opportunities offered by the globalised anglophone sphere will be made available to Morocco. It is an ambitious programme for a very special and friendly country. I congratulate my noble friend on procuring this opportunity to discuss our bilateral relations.

1.33 pm

Lord Chidgey: My Lords, of course we have to congratulate the noble Lord, Lord Harrison, on securing this debate at a very timely moment, coming as it does in the year in which we celebrate 800 years of diplomatic relations with Morocco. I have had the good fortune to visit Morocco on a number of occasions, including as one of the 500,000 tourists that people refer to. I

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once crossed the Strait of Gibraltar into the historic free port of Tangier and spent time in the ancient diplomatic quarter, which is traditionally engaged in all sorts of goings-on that I shall just call “trade” and “politics”. As a key point of entry into Africa from Europe, it is a hugely important route.

I had the pleasure of staying in the riads in Marrakesh, close to Jemaa el-Fna, the huge square at the heart of the city. It is bursting with all sorts of activities that you will not find anywhere else in the world, even down to the guy selling second-hand sets of false teeth, displayed in neat rows on a huge tray in the middle of the square. It is an amazing sight. Of course, by contrast down on the coast there is Essaouira, a perfect example of an 18th-century fortified town, complete with the original cannons still in place on the ramparts. The town is characterised by strong, persistent winds coming off the Atlantic, making its miles of beaches the world capital for kite surfing and wind surfing, as well as the site of an internationally acclaimed music festival. The amount of different cultural activities within Morocco is quite amazing. Given the opportunity, Morocco is a must-see place for noble Lords to experience for themselves.

However, we are celebrating the 800th anniversary of UK-Moroccan diplomatic relationships and recalling the dispatch by King John of England—we were not the UK at that stage—in 1213 of the first diplomatic mission to make contact with the court of Sultan Mohamed Ennassir. King John, we are told, sought support for our conflicts in Europe—there is nothing much new there by the sound of it. There are close and ancient ties between our two countries as monarchies. Here there is an intriguing historical aspect.

As we in this House know only too well, just two years after his approach to Sultan Mohamed Ennassir in Morocco, King John was forced by the Barons of England to sign the Magna Carta, or the Great Charter of the Liberties of England. As we know, Magna Carta made chequered progress over the ensuing years, being sometimes rescinded, sometimes reinstated, with bits deleted, added and altered. Nevertheless, it was an important part of an extensive historical process that led to the rule of constitutional law in the English-speaking world. It is generally considered part of the uncodified constitution of England. The late Lord Denning described it as,

“the greatest constitutional document of all times—the foundation of the freedom of the individual against arbitrary authority”.

In 2005, the noble and learned Lord, Lord Woolf, called it,

“the first of a series of instruments that now are recognised as having a special constitutional status”.

Others include the Habeas Corpus Act 1679 and the 1689 Bill of Rights. Magna Carta was reconfirmed by successive sovereigns over the centuries and it was not until 1829 that a single clause of the charter was changed or repealed. However, by 1969, just three clauses remained in force.

The relevance of the progress of Magna Carta is, of course, that it took some 750 years for its constitutional powers to become redundant in our law. In the excellent brief provided by the House of Commons Library, there is a critical analysis of the 2011 Moroccan

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constitution by the International Institute for Democracy and Electoral Assistance. The Arab spring elsewhere seems to have created an opportunity to fast-track constitutional reform in a country where the monarchy has reigned for three centuries. The monarchy acknowledged the need for a social charter and later constitutional reform.

The new Moroccan constitution includes many human rights not previously recognised, which is clearly a major step forward. However, constitutional experts point out that several rights are unclear, such as the right to life not being accompanied by a clear abolition of the death penalty and contradictions in the establishment of equality between women and men. The recommendations include that any new constitutional reforms should be based on: fundamental rights and freedoms as recognised by the constitution in accordance with the Declaration of Human Rights, the origins of which are of course attached to Magna Carta; strengthening the independence of Parliament and the judiciary vis-à-vis the Executive; and recognising gender equality without the restrictions currently in place.

In April, our ambassador published an excellent op-ed in Le Matin on the relationship between Morocco and the UK, pointing out that Morocco played a vital role as a fellow member in the Security Council’s deliberations on threats to peace and stability emanating from the Sahel. As the noble Lord, Lord Harrison, pointed out, our ambassador knows the importance of the bigger picture, saying that,

“Morocco needs no lessons from the UK in pursuing the reforms which have been underway for more than a decade … Along with Britain”,

Morocco is,

“one of the oldest countries in the World and”,


“neither wisdom nor courage. But, where we have experience and expertise that may be useful”,

we are,

“proud to share them … as a partner and friend”.

Let the last word go to His Excellency Taieb Fassi Fihri, the Moroccan Minister for Foreign Affairs. He said in a speech at Chatham House in March 2011:

“Historical reform, important reform, ownership reform, open reform, audacious but serene reform—I hope that all Moroccans will be happy to live under the umbrella of the next constitution in Morocco”.

1.39 pm

Baroness Royall of Blaisdon: My Lords, I am grateful to my noble friend Lord Harrison for this timely debate, which has been a great learning process for me. It has been very good to learn about all the positive things that are happening in the relationship between our two countries. I am especially glad that the noble Lord, Lord Sharman, is here, as the Prime Minister’s trade envoy. It is good to know that UKTI is focusing on Morocco. We would all welcome the rebirth of the Moroccan-British Business Council.

I know that in April the Foreign Secretary hosted a high-level lunch for a Moroccan delegation. It is good that, at that level, we are making a positive and very strong relationship with Morocco. I understand that

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we are also helping to train Moroccan journalists, strengthening wider democratic participation and increasing public transparency, as well as helping to support the fight against corruption, which is all very much to be welcomed.

Various noble Lords have mentioned the European Union and the fact that it is working with Morocco. I am glad that the United Kingdom is working as part of the EU on development projects and business and educational projects with Morocco. I think that negotiations have begun, or are about to begin, on a free trade agreement between the EU and Morocco, and I would certainly welcome some information from the Minister on that. Given that Morocco is the gateway between Europe and north Africa, it is essential, as noble Lords have said, that we have a very strong relationship between the European Union and Morocco.

I hope that the European Union will also be able to do something to assist Morocco with the problem that it has, and we all have, in relation to youth unemployment. Various noble Lords mentioned the Arab spring, and there was a sort of Arab spring in Morocco. As the noble Lord, Lord Chidgey, said, it fast-tracked constitutional change. We must pay tribute to the political parties in Morocco for the fact that it was a peaceful Arab spring and has led to positive developments. The fact that there was an Arab spring probably arose largely because of the frustration of young people and the fact that the country was not meeting economic needs—and the fact that there are so many young unemployed people in the rest of the Arab world.

Many noble Lords have spoken about the desire for links between British universities and those in Morocco, which is terrific. Clearly, the British Council, as ever, is doing a very good job. The premium that employers put on English in Morocco is tremendous and there is obviously much work to be done.

I had a conversation with my honourable friend Ian Lucas MP, who visited Morocco in March 2012. He was deeply impressed by the infrastructure and the development of renewable energies. The noble Lord, Lord Sharman, mentioned lots of renewable energies, but he did not mention solar energy. There must be an awful lot of sunshine in Morocco and I wondered whether we were working with the Moroccans on developing solar power.

One challenge that Morocco faces is with human rights. In May, the Moroccan Association of Human Rights stated that, since the adoption of a more democratic constitution during the Arab spring, which is welcome, arrests of political activists have increased. I know that Morocco is attempting to improve its human rights record by ratifying UN conventions on torture, discrimination against women and children’s rights. It has also appointed its first Minister for Human Rights. However, criticism of Islam, the monarchy or Morocco’s presence in Western Sahara is still not tolerated, so there is work to be done. I am sure that our Government are doing whatever they can to support Morocco as it strives to improve its human rights record.

That leads me to the problem in Western Sahara with the Polisario. I know that Christopher Ross, who was appointed in January 2009 as a UN special envoy,

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recently described the present situation as “untenable” and called for negotiations without preconditions and in good faith to find a mutually acceptable and lasting solution that would lead to self-determination for the Sahrawi people. It cannot be right that so many people are still living in camps in Western Sahara. There has to be a solution. It also has wider implications for the wider Maghreb, because it affects Morocco’s relationships with Algeria and the trade between those countries.

The position of women has also been mentioned. We are doing some work on the empowerment of women because, as many noble Lords have said, women face a very unequal society in Morocco and there is much to be done, including on human trafficking. A UN independent expert has said:

“Morocco faces considerable challenges as a source, transit, and increasingly as a destination country for trafficking in persons”.

I would be grateful to hear the Minister’s comments about trafficking and what we are doing to assist Morocco with that very difficult problem.

I end on a positive note. We have a shared aspiration with Morocco for a secure, peaceful and prosperous north Africa in which Morocco has a large part to play. One of those parts relates to the creative industries, which have huge potential in Morocco. I was delighted to read that there will be a Marrakesh film festival in November. I did not know about it, and I think that it is really great that things such as that are happening. I end on that positive note. I am very glad that our Government are doing what they can to foster a better relationship, including a trade relationship, with Morocco.

1.47 pm

The Senior Minister of State, Department for Communities and Local Government & Foreign and Commonwealth Office (Baroness Warsi): My Lords, I am grateful to the noble Lord, Lord Harrison, for calling this debate. Morocco is a nation with which we have a strong and enduring relationship. Indeed, as many noble Lords have mentioned, this year marked the 800th anniversary of the founding of UK-Moroccan diplomatic relations. We have heard about the first diplomat who was dispatched by King John to petition support from Sultan Muhammad Ennassir against our then rivals for dominance in Europe.

That first mission laid the foundation for the relationship that continues to this day, exemplified by the visit in 2011 of the Prince of Wales and the Duchess of Cornwall to Morocco as personal guests of King Mohammed VI. Those historical ties have allowed a frank and open dialogue to flourish with the Moroccans—with both His Majesty the King and the Government.

That was clearly demonstrated a little over two months ago, when my right honourable friend the Foreign Secretary hosted a high-level Moroccan government delegation on a visit to London to discuss a range of issues from foreign and security policy through to human rights. The delegation was headed by the King’s principal adviser and included the Foreign Minister, Al-Othmani, in April this year. Some noble Lords asked what further visits have taken place. In 2011, the Foreign Secretary visited Morocco. In 2012, Minister Burt visited Morocco. In 2013, as well as the

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delegation to which I referred, the Interior Minister visited here, and only earlier this month, 11 Members of Parliament from Morocco visited as part of the Westminster Foundation for Democracy programme.

I have never visited Morocco officially. I have visited as a tourist seven times, I think. I have visited most of the country from north to south and east to west and have spent many weeks travelling as a tourist.

Several noble Lords mentioned values. The Government have put values at the core of our foreign policy, and so it is with our relationship with Morocco. Ongoing reform is essential, and I thank my noble friend Lord Chidgey for focusing both on those areas where progress has been made and on where further progress needs to be made.

The noble Baroness, Lady Royall, referred specifically to human trafficking. I do not have anything in my briefing on that but it is certainly something that has caught my interest. I will write to the noble Baroness, because I should like to know the answer as well.

In January, I hosted a seminar on something that is a big personal priority for me—freedom of religion and belief. The Deputy Foreign Minister, Youssef Amrani, participated in it and was able to reaffirm a strong commitment to freedom of religion and belief within Morocco. He gave me strong support for building a political coalition from different nations across the world on this specific area. The seminar also included discussions on early implementation of the new Moroccan constitution, which will bring greater protection for human rights while respecting the conservative and traditional nature of Moroccan society.

The question of the freedom of the press was raised by a number of noble Lords. We have ambitious and far-reaching reform programmes and we have already seen them happening in Morocco. We are working alongside those programmes as part of the Arab Partnership initiative. Noble Lords will acknowledge that this can sometimes be a difficult and sensitive issue, but Morocco’s record on this is much improved. However, there remain some challenges, particularly where the interests of the monarchy or the security services are involved. A free, independent media are, as we all know, one of the vital elements in a democratic society because they are able to hold government to account.

To further strengthen the scrutiny of government, our Arab Partnership programme is active in Morocco. It has provided support worth £1 million to reform projects that will enhance the Moroccan Government’s efforts to strengthen political participation and promote good governance and access to information, and encourage media and civil society engagement in shaping legislation.

Eight Arab Partnership-funded economic reform and job-creation projects are also currently under way in Morocco, underlining the importance of providing a job and a vote in ensuring peace, stability and prosperity.

Morocco has shown that it has the political will to improve human rights in the territory of Western Sahara and that it can play a constructive role. The UN special rapporteur on torture, Juan Mendez, visited

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Morocco and Western Sahara in September last year, reporting an “emerging culture” of human rights and the political will to improve things further. That is happening. However, his report also contains tough judgments for Morocco and includes mention of a systematic pattern of ill treatment. The recommendations will, I think, take time to implement but it appears that they are on the right path.

We fully encourage and support positive measures to address these shortcomings and we remain committed to working to help all parties to reach a mutually acceptable solution to the Western Saharan situation—one that provides for the self-determination of the people of Western Sahara and secures the future of the large refugee population, some of whom have been without a home for more than three decades. This issue features regularly in contacts that we have with the Moroccan Government.

I am pleased to say that it is not only domestically that Morocco looks to support those seeking confirmation of their democratic rights. The Moroccan Government share our aspiration for a secure, peaceful and prosperous Africa. We have been working closely together on the UN Security Council on a range of challenging issues, including, in particular, that created by the conflict in Mali and the surrounding region. Morocco has also shown invaluable support and regional leadership in the continuing international efforts to bring an end to the crisis in Syria through its regional leadership on the UN Security Council and by hosting the Friends of Syria conference in Marrakesh last year.

The UK and Morocco already enjoy an excellent security partnership to address a range of shared concerns, including threats from terrorism, organised crime and drug smuggling. Our intelligence relationship, for example, is important and mutually productive. Shortly we plan to launch a strategic dialogue with Morocco that will focus on wider policy issues and enhance our co-operation on regional security and counterterrorism. Work to finalise the details on the frequency and level of this strategic dialogue is currently in hand, but the principle is there and I am sure that this House will support it.

Just as we have a shared interest in security, so the close links between our nations mean increased trade and increased travel, to which both the UK and Morocco are strongly committed. Last year, bilateral trade between our two countries surpassed £1 billion for the first time. This is a significant achievement. However, there are many opportunities to expand this still further, and it is in both our interests to make the most of them.

Therefore, I am pleased that my noble friend Lord Sharman was appointed by my right honourable friend the Prime Minister as his trade envoy to Morocco. My noble friend Lord Sharman is leading our efforts to increase the presence of British companies in key sectors such as education, renewable energy and financial services. I understand that the Moroccan-British business leaders’ forum could possibly be launched later in the autumn, but I do not want to determine my noble friend’s timetable.

I agree with my noble friend that there is great potential in furthering trade in Morocco. It is one of the best resourced countries in Africa, and trade and

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investment is clearly an area where we can enhance the relationship further. A number of examples have been referred to by noble Lords in the area of trade, and I shall touch on a few. More and more Moroccans are learning English for business and pleasure, as shown by the popularity of the British Council’s LearnEnglish website, which last year had more than 1 million hits. That bastion of Britishness—M&S—opened its first store in Morocco in February and is talking seriously about expanding further. A memorandum of understanding between TheCityUK and Casablanca Finance City, which has been referred to already, shows plans to develop Casablanca as a regional financial services hub. The memorandum was signed in October last year.

I am grateful, as I know is the Prime Minister, for the work that has been led by my noble friend Lord Sharman, and I look forward to further success in the initiative to which he referred—specifically on the development of renewable energy. A specific question was asked about solar energy. I know that in relation to renewable energy a contract has just been signed with a British company. I am told that it is a substantial contract to erect wind turbines. In terms of solar energy, I know from my own travels that almost every rural dwelling in some parts of Morocco seems to have a solar panel on its roof. I should be interested in how that works and whether there is potential for expansion there as well.

The noble Baroness, Lady Royall, and the noble Lord, Lord Harrison, asked specifically about the European Union-Morocco relationship. Negotiations for a deep and comprehensive free trade area between the EU and Morocco were launched on 1 March this year. The first round of negotiations began on 22 April, and a second round is currently taking place in Brussels. The main objective of those negotiations is to bring Moroccan legislation closer to EU legislation in trade-related areas and proceed to the gradual integration of Morocco’s economy into the EU single market. Morocco is the first European neighbourhood country to have begun this process with the EU and we welcome its positive attitude to the negotiations so far.

My noble friend Lord Sheikh asked about Morocco’s role in promoting and contributing to regional stability. I think that I have previously referred to the Friends of Syria conference which it hosted in December 2012; an increased level of contact that it has had with other countries in the Maghreb when there has been instability there; and, of course, it took over the chairmanship of the UN Counter-Terrorism Committee in January 2013. The noble Lord, Lord Anderson, referred to other contributions as well. Noble Lords also asked about support programmes. I have referred to some of them already, such as the Arab Partnership programmes which look at fostering political parties’ place in civil society, more involvement of youth and women, and building journalistic capacity to scrutiny.

Finally, the UK strongly supports the process of transformation, institutional change and constitutional reform that is already under way in Morocco. Although there are areas, such as Western Sahara, where we will continue to press for progress, our relationship with Morocco is based on shared values—demonstrating,

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once and for all, that values of democracy, rule of law, human rights, freedom of expression and the right to a job and a vote transcend the boundaries of religion. Morocco’s move towards a constitutional democracy will lay the solid foundations needed for it to build greater security and prosperity. The UK continues to stand ready to assist in any way that it can.

Health: Public Health Responsibility Deal

Question for Short Debate

2 pm

Asked by Lord Clement-Jones

To ask Her Majesty’s Government what assessment they have made of the progress and impact of the Public Health Responsibility Deal.

Lord Clement-Jones: My Lords, it is now more than two years since the then Secretary of State for Health, my right honourable friend Andrew Lansley, local government and the leaders of a number of industries came together in March 2011 to agree the public health responsibility deal. There is no doubt that as a country we face significant public health challenges. Working-age ill health is estimated to cost the UK economy more than £100 billion a year. England has among the highest levels of adult obesity in Europe. We have more than 8,000 what might be described as premature deaths every year from too much salt in our food. Alcohol misuse costs the NHS £3.5 billion a year. Physical inactivity costs it £1 billion a year and the costs to the wider economy from sickness absence have been estimated at around £5.5 billion.

The essence of the PHRD, as the Secretary of State said in his introduction, was to agree voluntary action to ensure we,

“have more progress, more quickly”

with less cost than legislation. There are those who are sceptical about this kind of action. A recent paper in the Lancet by Professor Rob Moodie of the University of Melbourne concluded that the only way to achieve the UN’s goal of halving the mortality rate for diseases caused by tobacco, alcohol and poor diet was through greater regulation. Likewise, Which? is sceptical. Its executive director, Richard Lloyd, last year speaking about the responsibility deal, said:

“We have the worst obesity rates in Europe and diet-related diseases, like heart disease and stroke, are blighting the public’s health. Our audit of progress made under the Government’s Responsibility Deal has shown the current approach is overly reliant on vague voluntary promises by the food industry. This has so far failed to bring about change on anything like the scale needed”.

The BMA in its briefing for this debate said it believes that relying largely on voluntary agreements with the food and drinks industry is inadequate. It, of course, refused to sign up to the responsibility deal.

The question at the core of this is how far is nudging effective? The Health Select Committee in its report last year on the Government’s alcohol strategy said that,

“we do not oppose the exploration of innovative techniques such as ‘nudging’, where it can be shown, following proper evaluation,

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to be an effective way of delivering policy objectives. The Committee were, however, unconvinced that the new Responsibility Deal will be effective in resolving issues such as obesity and alcohol abuse and expect the Department of Health to set out clearly how progress will be monitored and tougher regulation applied if necessary”.

Clearly, issues of physical activity, alcohol misuse and obesity have to be tackled in a variety of ways but I know I am not alone in preferring to see voluntary action initially rather than increased regulation unless the former is shown to have failed. It is far too purist a line to say that industry should not be involved in public health initiatives. In the responsibility deal, different sectors made particular pledges for action, regarding food and diet, alcohol, physical activity and health at work. The essence of the deal was acceptance by signatories of the role they play in improving people’s health—encouraging them to adopt a healthier diet, fostering a culture of responsible drinking, encouraging and assisting them to become more physically active and actively supporting their workforce to lead healthier lives. The organisations involved made a series of collective pledges by sector, individual pledges by organisation, and what were called supporting pledges, regarding collaboration, monitoring and evaluation, information and development of further pledges.

Today, I regard all aspects of the deal as important but, given the time available, I want to focus on two limbs of the deal, relating to food and alcohol. The initial collective pledges by the food industry involved, for example, salt reduction, front-of-pack nutrition labelling, artificial trans fats removal and calorie reduction. One of the recent fruits of the responsibility deal has been the new voluntary UK traffic light scheme for front-of-pack nutrition labelling, which was launched on 19 June this year. This will introduce more consistent nutrition labelling across the UK by providing, on the front of food and drink products, clear information on energy and those nutrients of public health concern that the majority of us should be aiming to limit in our diets. Then of course there are the steps towards calorie reduction by the food and soft drink manufacturers, and the significant actual and planned reduction of salt in food, in supermarket products and catering.

For the alcohol industry, including manufacturers and the on and off-trades, the pledges involved: fostering a culture of responsible drinking; a reduction in alcohol units to remove 1 billion units from the market; a commitment to labels with clear unit content; awareness of alcohol units in the on and off-trades; tackling alcohol sales to those who are underage; action on advertising and marketing alcohol; community action to tackle alcohol harm, and support for Drinkaware. This partly depends on having clear, common understanding of the facts but these are not always straightforward. There are many conflicting statistics and it is not always easy to draw conclusions.

There are many different perspectives on current trends. It appears that national alcohol consumption trends are going in the right direction. Nationally, per capita consumption has fallen from 11.5 to 10 litres of alcohol per person per year, and is now below the European national average. More people drink within the guidelines. There is less drinking at harmful levels and binge drinking is down. There is less alcohol-related

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violent crime, and there has been a very significant drop in drink-driving fatalities over the past 20 years. All these statements are derived from official figures. However, hospital admissions are up, whether this is taken as those where alcohol is the primary diagnosis or those which are simply alcohol-related.

There are anomalies in respect of particular age groups and localities, even where the national picture shows improvement. Areas such as the north-west and the north-east have a disproportionate amount of binge drinking and hospital admissions, due to alcohol-related causes. Supporting Drinkaware, an independent organisation, is one of the key pledges given by the drinks industry. Drinkaware works with young adults to moderate drinking through the “Why let good times go bad?” campaign. It also helps parents tackle alcohol issues with their children. It has recently published an audit of effectiveness which demonstrates the progress it is making, and that its work is being increasingly recognised. Drinkaware says that binge drinking remains a social norm in many areas. We are, it seems, fighting a huge cultural battle so pledges are fine but translation into local action is key. There is clearly a need to target appropriate schemes at particular areas. The drinks industry tells me that it is working with local partners including local authorities, police and the third sector to do this.

There is in fact an impressive array of voluntary schemes. During the passage of the Police Reform and Social Responsibility Bill in July 2011, and in the debate initiated last year by the noble Baroness, Lady Coussins, I talked of the virtues of local voluntary actions designed to combat alcohol abuse. These are through schemes such as Purple Flag, Best Bar None, Pubwatch, business improvement districts and community alcohol partnerships, with central government working with the industry—both the on and off-trades and the manufacturers—and the advantage of those schemes over those imposed in a compulsory way, such as the early-morning restriction orders and the late-night levy. There is of course Challenge 21 and Challenge 25, a strategy that encourages anyone buying alcohol who looks under 25 to carry acceptable ID. There is also PASS, the nationally recognised Proof of Age Standards Scheme. It would be very interesting to know what evaluation has been done for these individual schemes, since each clearly has different objectives and outcomes. I am pleased that licensing authorities will have discretion to offer a discount from the late-night levy up to a maximum of 30% for premises that are part of—or members of—best practice schemes, subject to specific criteria.

A recent positive development is the revised version of the Portman Group’s Code of Practice on the Naming, Packaging and Promotion of Alcoholic Drinks. The new version of the code now specifically states that there should be no linkage to sexual activity, no images of under 25s, and easier promotion of lower strength products. Furthermore, progress on alcohol unit reduction is well under way towards the goal of 1 billion fewer units consumed. The strength of well known brands has been reduced, and new lower-alcohol alternatives have been introduced.

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Of course, at the back of all our minds is the question as to the future of minimum unit pricing, as originally proposed by the Government. I am an agnostic, currently, but the proponents of minimum unit pricing refer to the Canadian experience. What can my noble friend say on that subject?

So what is the future for PHRD? The scoping review undertaken on behalf of the Department of Health by the Policy Innovation Research Unit at the London School of Hygiene and Tropical Medicine concludes that, if properly implemented and monitored,

“voluntary agreements can be an effective policy approach, though there is little evidence on whether they are more effective than compulsory approaches”.

The key questions that the PIRU is being asked to consider are: does the responsibility deal as a mechanism work? Can voluntary pledges achieve the necessary change? Are the pledges themselves amenable to evaluation? In fact, can any cause and effect ever be evaluated? Yet the unit itself believes that the most useful questions at this stage of the development of the responsibility deal are about what it is; its objectives; how it is expected to work; how it can be assessed; and how will we know whether it works—in particular, what further steps are needed. I wonder what we can really expect from the PIRU study at the end of the day.

No doubt there is a considerable task ahead for my noble friend the Minister in replying today, but even more questions remain. Under new leadership, is the department still committed to this approach, and is the deal essentially worth it for all concerned? I look forward to my noble friend’s reply.

2.11 pm

Lord Brooke of Alverthorpe: I thank the noble Lord, Lord Clement-Jones, for this debate. I see that a number of us who have debated these topics previously are present. My interests in this arena are declared in the Register of Lords’ Interests, although I might add that I am frequently sent messages by the All-Party Parliamentary Beer Group inviting me to various events—presumably, where I would get free beer. I assume that when we get the long-awaited review of the register of interests and of how we deal with people who lobby us, it may also have a look at what happens with some of those activities.

I also wait with great interest to hear how the noble Earl responds to this debate and to the questions posed by the noble Lord, Lord Clement-Jones. I, too, have a fair number of questions for him. Noble Lords will recall that, when the public health responsibility deal was launched by Andrew Lansley in 2011, he made much of its benefits accruing through public health, commercial and voluntary organisations working in partnership to agree practical actions to secure more progress more quickly and with less cost than would have been the case with legislation. He emphasised that the strength of the deal lay in the diversity of organisations that it brings together. In the event, those aspirations of bringing several groups together were not met, and fairly early on we saw some of the major players depart from the scene.

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However, I would concede—and I would not be churlish enough to fail to say—that a number of developments have taken place since the scheme was introduced. Like the noble Lord, Lord Clement-Jones, I am very pleased to see the recently announced front-of-pack nutrition traffic lights labelling scheme coming in. That is good progress, but it has taken us years to get to that position. When it was left to the voluntary approach by industry, there were mainly two separate schemes, and they were unable to bring them together to work. We now have people coming together but, regrettably, it is anticipated that 20% will still not comply, even with the voluntary scheme. What will happen in those circumstances, given the consequences that we encounter when we come to deal with health issues, which I shall address later?

It is because of the response that we have had and because the health industry generally, and some of the NGOs, were so unhappy about the way in which they felt that the Government would be influenced by the drinks industry that they wanted to pull away from participating in the scheme overall. In reviewing where it should go in future, I believe that it will be fundamental to assess whether it really has validity if we cannot take the health industry with us. I should like to hear from the Minister what he intends to do about that when we come to the end of the review.

The Royal College of Surgeons and the BMA are the people who are dealing, on a daily basis, with the three major preventable killer diseases that confront us: smoking, alcohol and obesity. As recently as 5 March, their position has been supported by no less than Jeremy Hunt, the Secretary of State for Health, who advises us, following a major study, that Britain is now falling behind many western countries in progress on managing preventable disease. The Secretary of State went on to say that the UK needs a “call to action”, although he did not define precisely what that call to action would be. We all recognise that there is no simple silver bullet that will answer these problems, but there is a multitude of approaches that could be taken. I hope that today the noble Earl will give us an indication of where the Government stand on their approach to those three major topics and on trying to bring them together so that we can start to recover some of the ground which, according to the Secretary of State, we are now losing when compared with a fair number of other major European countries.

In this context, I know that the Policy Innovation Research Unit of the London School of Hygiene and Tropical Medicine has undertaken its scoping review. Will it be engaged to do further work and, if so, what terms of reference will it be given and to what extent will there be consultation among the wider health community, as well as the commercial side, on this further work? I also notice that Drinkaware has recently undertaken a review and audit of its work and that it has identified some quite significant deficiencies in its operations. Questions have been raised about the adequacy of the evidence base used for its campaigning work. Questions have also been asked about its independence. Again, it works too much in isolation and at too great a distance from the NGOs and the health profession. I know that consultations will be taking place over a

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wider front by Drinkaware, but I should like to know the noble Earl’s initial views on that, having read, as I am sure he has, the review that has taken place.

The Government’s strategy on alcohol has been predicated primarily on minimum unit pricing. Under my Government, the balance on alcohol licensing moved towards being in favour of the industry and recent legislation has shifted the fulcrum more to the centre, giving local democracy and local interests against commercialism a better stand. However, I was surprised to learn from the debate in the House of Commons last week that the Government have been contemplating abandoning the time-old tradition of requiring people applying for alcohol licences to publish their applications in local newspapers. There is strong opposition to this in the Commons and I hope that the Government will not proceed with it, as it flies in the face of localism and the chance to try to control what happens within your locality. Again, I should be grateful for the noble Earl’s comments on that.

Finally, I raise a little point that I have been campaigning on for years about including the number of calories in the labelling of alcohol products. We have been running this for about three years and we seem to be no further forward. Is there any chance of an indication that some headway is being made?

My last point does not relate directly to the responsibility deal, because much of the industry does not accept that it is responsible for the harm that alcohol causes. Will the Government give some thought to the concept that a new funding stream for the NHS could be drawn from the private sector to help to meet the cost of the harms which arise from alcohol and tobacco and particularly from the growth of obesity through fats, sugars and salt? We know the problems that the NHS will face in the future, although very little concern was expressed about its funding by the Chancellor yesterday. However, as all parties know, with the ageing population, changing lifestyles and the continuing growth in the cost of technology and drugs, the health service will be in real difficulties in the future. We need new funding streams and we might explore whether the private sector, which has responsibility for some of the harm, should be required to pay for it if it does not respond on a voluntary basis.


Baroness Masham of Ilton: My Lords, I thank the noble Lord, Lord Clement-Jones, for initiating this debate. There are more demands on the health systems than there are resources to deal with them adequately—hence the importance of the public health responsibility deal. If public health is to improve the nation’s health, it is important that all sectors work in communication and co-operation and build relationships: the Government, the health services, industry, academia, the voluntary sector and the public.

A growing problem is the increase in the number of people with diabetes. Prevention, if possible, is vital. Screening for bowel cancer and other conditions is also important so that diagnosis is made early. Health and well-being boards need to encourage integration, influencing strategy and reducing inequalities. There is much to do to improve the health and well-being of the population.

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Over 20 years ago I chaired a committee which looked into the problems of alcohol, crime and young people. One of the problems seemed to be, and still is, the skilful and aggressive advertising of alcohol. What assessment have the Government made of the progress and impact of alcohol abuse within the public health responsibility deal?

There seems to be an increasing problem of people with alcohol disorders visiting over-pressed hospital A&E departments. They can cause disruption to staff and other ill patients by being aggressive and demanding. The increase in patients with liver disease, including very ill patients—many of them young—is putting more demands on hospital wards. Since I asked the noble Earl a question about the pressures of alcohol abuse on A&E departments, I have learnt that there are NICE guidelines, and I have heard that Liverpool has had some success. Will the Minister tell us what the guidelines say and how Liverpool has improved this difficult situation?

I was once told by an A&E consultant from Leeds that one of the most upsetting incidents he had dealt with was when two young boys aged about 10 and 12 were brought in with alcohol poisoning. Both died. Many serious conditions are caused by the combination of drugs and alcohol. I remember as a child attending a Church of Scotland service: the minister was thumping the pulpit and shouting out the dangers of alcohol. Are our messages today strong enough? Should we not have more health education in schools, with clear messages about what alcohol can do to the pupils’ bodies and minds? Alcohol can be a contributory factor in the increase in sexually transmitted diseases, when inhibitions go out of the window and people forget to take precautions. With alcohol, people with a mental health problem can become a danger to themselves and society.

An effective alcohol policy must be based on the evidence of what works—in particular, increasing the price, restricting availability and tougher marketing restrictions. It must be a policy that therefore counters the pro-drinking messages communicated by an industry that spends £800 million in the UK each year marketing its products. Alcohol Concern shares the view of the World Health Organisation that, while the alcohol industry can and should play a role in implementing decisions on alcohol policy, it should not be allowed to influence the marketing of that policy.

It is welcome to see the progress made and the impact that the Food and Drink Federation has had on artificial trans fats removal, calorie reduction, consumer education, workplace well-being and front-of-pack labelling. This will help with the prevention of osteoporosis, obesity and diabetes. There should be healthy balanced eating and people should take healthy exercise.

I declare an interest as I have a small rural riding centre, which provides a healthy interest and occupation for people who want to enjoy the countryside. It gives them an interest away from sitting for hours and playing computer games.

I hope that the Minister will take this opportunity today to give assurances that independent monitoring and evaluation of the pledges and their impact on public health outcomes will be available to all.

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2.25 pm

Lord Addington: My Lords, I, too, congratulate my noble friend on bringing this subject before us today. Any initiative by people who take responsibility for public health should be applauded. Whether this is the right model or one for the future remains to be seen. However, trying to get several sectors to address the problem must be applauded for the simple reason that there is no one answer.

Behaviour, social change and the way we take in information and use it would seem to be the underlying message behind this. We have already heard that if you drink too much you put on weight and it affects your body in various ways; and that if you drink far too much at the wrong time you behave badly. Given the history of Gin Lane, Hogarth and so on, that is hardly news; it is nothing that we have not heard before.

Recently we have been dealing with the backlash of the social trend towards binge drinking. This has happened after the binge of taking pills to get oneself out of it. This habit seems to have died out in certain parts of the country but not in others, and people who have got into the habit of binge drinking seem to be carrying on doing so. People are suffering from liver damage earlier, getting stroppier earlier and losing control earlier. Given that our lifestyle today is one which has easy access to high fat, high salt and high sugar foods which can be consumed easily, and the fact that we do not take much exercise, we seems to be creating a world where it is quite easy to sit still for long periods of time, ingest huge numbers of calories and alcohol and damage ourselves.

How do we change that? There are two prongs to this which have worked in the past, of which smoking is a good example. First, you point out to people that it is damaging them; secondly, you take various supporting actions, through government, to encourage them to change. However, voluntary action is equally important. Every bit of information I have on this subject shows that we do not like being preached at. Talking to people may help them to change their minds over time, or preaching to people subtly and well may do so, but we are all politicians and we know how often we get that right and how often we get it wrong. We have got to strike a balance here.

I agree with the noble Lord, Lord Brooke, about the number of times we have heard about the labelling on food. I have had a number of bizarre meetings, particularly at party conferences, where people have tried to sell their form of labelling to me.

We also resist certain types of activity. I remember during a conference when the previous Government were in power—I think we were in Blackpool but I cannot remember which year—going to a dinner where people were trying to convince me that if we stopped selling what we now call full-fat Coke and other soft drinks in vending machines, children would die in huge numbers because they would cross the roads at lunchtime and, lemming-like, be flattened by cars. You could not make it up. You do not have to after a period of time. The rearguard action by the industries is usually very impressive and creative, but it is possibly one that missed. While we are talking about alcohol,

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by the third glass of wine I was prepared to say that they had missed on this occasion. Let us not knock everything all the time.

To address the issue of physical activity, the same ideas about what is involved in convincing people that exercise is pleasant must surely apply here. There is also the question of who we are addressing. I shall concentrate my remarks here on people taking low-level, casual exercise. Local government can make our parks and pavements, for instance, pleasant places to walk or take moderate exercise, as appropriate. People can encourage their children to have a game of football using two jumpers on the ground for goalposts while they use the swing. That is very appropriate. I look forward to hearing how we can encourage that.

Organised sports clubs can be only a limited aspect of this, because they are often dependent upon this type of activity. We talk a lot about school sport, but school sport can only do so much. A child must take part in physical education and become reasonably fit before they can be trained to take part in a sport and take it seriously. If a child who at the age of five has never moved, who has been plonked in front of the TV and who is carrying large amounts of fat around their waist and backside, is encouraged to go straight into some form of physical activity, the child will not do it. It will be painful and difficult.

If parents do not have access to a pleasant environment, and are not encouraged to give their child the normal amount of time in which to run around, it will not happen. We must address this. If a child or an adult then thinks that it is terribly difficult to undertake activity, they will chose sedentary leisure activities, which often involve watching something. They will take that hit of sugar and salt from fast foods, as we probably call them now, or high-density foods. How do we balance this? How do we encourage people to get out?

I received a series of briefings from the Ramblers Association, saying that people are 72% more likely to walk and to carry on walking if their local area is pleasant, but they are 55% less likely to walk if their local area is unpleasant. If you get that balance right and make walking enjoyable, then people can get involved in it. What action and assessment are we taking to encourage individuals and groups to make sure that physical activity can be undertaken in a pleasant environment? Unless this casual organisation is encouraged, unless it takes into account the fact of this normal reaction, then it takes away from both the introductory levels of more serious exercise and that low-level maintenance which is so important to health. I could go on for much longer, but the clock has beaten me.

2.32 pm

Baroness Coussins: My Lords, I would like to make one general point about the role of the private sector, and then some specific points about the alcohol element of the responsibility deal. First, I declare various interests. I am an independent adviser on corporate responsibility for two drinks producers, Heineken and Brown-Forman, and one food company, Mars. Details are in the register of interests. I emphasise that my

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advice to them is strictly non-parliamentary, and that I had no discussions with any of those companies about what I am going to say this afternoon.

On the general point, food and drink companies often get it in the neck for engaging in the public health arena. They are criticised by cynics who simply cannot believe that companies can possibly be sincere, and think they are really doing no more than watching out for their own commercial interests. The Government are also criticised for letting the industry off the hook with voluntary action.

However, I argue that this kind of partnership is no soft option for the industry. As long as outcomes are rigorously monitored and achieve the desired results, it can be extremely effective. The first reason for this is the very high level of public scrutiny. The companies openly sign up to detailed, challenging pledges, and they will look insincere and incompetent if they do not fulfil them. Secondly, the pledges are crafted in an inclusive way involving Government, health professionals and the industry, so the outcomes are much more sustainable because they are supported by industry from the beginning. Thirdly, of course the responsibility deal is in the commercial interests of the industry. There is a strong business case for companies to help minimise the harms associated with their products. The consequences of overconsumption damage brand image as well as body image. They give the company a bad reputation and undermine shareholder value. It is a good thing that the industry has recognised this. Its businesses would not be sustainable otherwise.

This deal puts the UK streets ahead of our EU partners by showing not just what can be achieved on a voluntary basis rather than through red tape but also how quickly. The pledge on alcohol labelling, for example, will see 80% of drinks labelled with a variety of health-related information and is well on target to be achieved by the end of this year. Mandatory labelling would almost certainly require EU legislation and take years. Another pledge, as we heard, is to take 1 billion units of alcohol out of the market by 2015 by reformulating existing brands to contain less alcohol and by innovating to bring new, lower-strength brands on to the market, helping more people to drink within the guidelines by providing a wider choice of lower-alcohol products. This has become a real growth area, with dozens of new products coming on to the market. Sales of lower-strength beer have grown by 59%, according to HMRC data.

A third pledge is to provide more support for local community schemes such as Best Bar None and community alcohol partnerships. That is vital because alcohol harms in the UK vary hugely across different regions. For example, we know that nationally the vast majority of adults drink within the government guidelines and that per capita consumption and binge drinking have fallen. But we also know that alcohol-specific mortality and liver disease in Blackpool is nearly three times the national average, hospital admissions in Liverpool nearly 2.5 times the national average and binge drinking in north Tyneside 1.5 times the national average. One reason these community schemes work is because they offer a win-win outcome. In Durham

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there has been a 75% increase in trade in pubs that support the Best Bar None scheme because it obviously makes the pubs safer and more attractive places to go. At the same time, figures suggest an 87% decrease in violent crime. There are now more than 50 community alcohol partnerships up and running and some have seen significant reductions in antisocial behaviour.

Producers have also committed continued support to Drinkaware by not only paying their dues but also using their brand marketing to promote the charity’s campaigns. During the 2012 FA Cup, for example, more than 50 million football fans saw Drinkaware branding through a beer sponsorship that featured Drinkaware on the stadium perimeter. During the semi-final matches, there was a 30% increase in direct traffic driven to the Drinkaware home page. In fact, the number of individuals who go to the Drinkaware website has grown massively, from 2.8 million in 2011 to more than 6 million in the past 12 months. Thanks to the funding it receives from the industry, Drinkaware has proved a tremendous asset to the public health effort to promote sensible drinking. Its progress was confirmed earlier this year, along with some welcome pointers for future improvement, by an independent review panel chaired by Sir Hugh Taylor, chairman of the Guy’s and St Thomas’ NHS Foundation Trust. The industry has pledged to review the codes on advertising and marketing and a revised Portman code came into effect at the end of May this year with several even stricter rules. A new, improved code on sponsorship is due to be launched in the next few weeks.

I end on a specific question or two for the Minister. A deal, by definition, involves more than one party. We know what the industry is doing. Have the Government or the health service committed to specific pledges? For example, will the Government take on one specific suggestion from me and do more to support the industry in its efforts to change EU legislation that currently prohibits winemakers from reducing the ABV of wine by more than 2%? Think how much more quickly we could achieve the pledge to take 1 billion alcohol units out of the market if wine companies could legally do what many beer brands already are doing and reduce the strength of their brands. I know that Defra has done a great deal to assist but this issue was put on the EU table by the industry at least three or four years ago and progress has been painfully slow—mainly, I understand, because there is very little support from other member states. Will the Minister agree to speak to his Defra counterparts and fire them up again to do more to encourage other member states to help change this legislation in the interests of public health?

In my opinion, the beauty of the responsibility deal is that it is a partnership. There is a place for legislation, but if it can be balanced with voluntary action, self-regulation and personal responsibility, behaviour change and benefits to society will follow more quickly and more sustainably.

Earl Attlee: My Lords, I am sure that the Committee would like to hear from the noble Lord, Lord Rea, but if he speaks past 2.41 pm, he will be doing so at the expense of the Front Bench.

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2.40 pm

Lord Rea: My Lords, I must apologise for not putting my name down in time last night; I forgot that that would have to be done early.

I will plunge straight in with my question to the noble Earl, Lord Howe. A recently published scoping review, which has been referred to by two other speakers this afternoon, states in its conclusion that,

“targets should be ambitious and a robust monitoring system should be in place … some of the most effective voluntary agreements are those with substantial disincentives for non participation and costly sanctions for non compliance”.

Does the noble Earl feel that the responsibility deal measures up to those requirements? How will non-compliance be measured and assessed?

It would be interesting if the noble Earl could name a few of the targets of the responsibility deal and describe the process of defining them. Are meetings where they are discussed open, or does the industry cite commercial confidentiality? Can he write to me giving the names of all the manufacturers and retailers who have signed up to the different sections of the responsibility deal and the pledges to which they have agreed? Were any suggestions for pledges made by the Department of Health but not agreed to by participating firms? For example, we know that the drinks industry was opposed to minimum pricing. Once the pledge is made, how legally binding is it and what penalties, if any, are there for breaching it?

In closing, I declare an interest as a trustee of Health Forum UK, which is a well known health policy group concerned with the prevention of non-communicable disease, which gives rise to the greatest cost to the NHS and social services and greatest suffering to the population.

2.42 pm

Baroness Hayter of Kentish Town: My Lords, I should declare that I am a patron of a charity that picks up those with drink problems, the Blenheim Trust. We should all thank the noble Lord, Lord Clement-Jones, for bringing this subject to us today and introducing the voluntary partnership, which is part of the nudge campaign to help people to make healthier choices. However, our Science and Technology Committee expressed its major doubts about the effectiveness of agreements with commercial organisations, particularly where there are conflicts of interests. The Labour Party shares those concerns. We are sceptical whether a voluntary approach can address those barriers to a healthy diet and lifestyle, which are threatening a public health crisis.

The responsibility deal covers alcohol, food, health at work and physical activity. Success on each of those has been questioned. Handing over significant responsibility is part of the reason for that querying, especially where there is no parallel government action. In the case of alcohol, we have seen no reduction of the drink-drive level, zero funding for Alcohol Concern and, despite Mr Cameron’s pledge, no action on minimum pricing.

As has been mentioned, six health bodies, including the BMA, declined to participate in the alcohol deal because of its alcohol commitment, where the industry claimed that it would,

“foster a culture of responsible drinking, which will help people to drink within guidelines”—

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without, of course, any evidence of that. Those health bodies were concerned that the project gave,

“inadequate recognition of the need to reduce alcohol-related harm”,

that there was no indication of alternative actions if the pledges did not reduce harm and that,

“the pledges were those of the alcohol industry rather than of health bodies”.

The BMA, as has been mentioned, considered that voluntary agreement with the industry was inadequate—perhaps I should go on and quote the rest of what it said—because the industry has, “conflicts of interest”. It said that,

“the state should put the health of citizens before commercial freedom”.

On food, the Government have made a welcome announcement on front-of-pack labelling. We welcome that but, within days, it was undermined. Only 60% of foods will be covered, according to our figures, because Coca-Cola, Cadbury, United Biscuits, Unilever and Heinz will not take part. How can food labelling work if key players refuse to sign up? Of course, there are things that the industry can do and has done. Heineken took one high-strength low-cost product off the market.

Central to the problem is that the responsibility deal agenda is that of the industry—that is, education, choice and labelling—rather than of the health bodies, which talk about price and availability. The lesson of cigarettes is that regulation makes the difference. Higher prices and banning smoking in public places are what reduced heart attacks. Professor Hunter, giving evidence to the committee in another place, said that he was,

“disturbed at the shift”,

by the Government,

“from being a nanny to being a nudger”.

He recalled that interventions “shoving people”, such as with the ban on smoking, were effective, whereas the effect of nudging was little supported by evidence.

Where is the shoving? Where is the standardised cigarette packaging? Andrew Lansley said that packaging helped to recruit smokers and wanted to look at the idea of plain packaging. That, of course, was before the Conservatives hired Lynton Crosby, whose company has represented tobacco firms and has campaigned against standardised packaging in Australia.

On physical activity, the Government’s record is abysmal. There has been a drop in sports participation, an end of free swimming for the under-16s and over-60s, and reduced funding for the School Sport Partnerships. Where is Mr Cameron’s promise on minimum unit pricing? Has that disappeared because of lobbying by the drinks industry? It started in Scotland, first against the policy and then by a legal challenge; now in England it is at it again, with a campaign entitled, “Why should responsible drinkers pay more?”, even though it would cost moderate drinkers only 28p a week. Its website urges people to tweet the message to MPs.

The Opposition support anything that the industry does to reduce the cost of alcohol to the NHS and elsewhere. The noble Baroness, Lady Coussins, has mentioned some of the companies with lower alcohol

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strengths—Stella, Budweiser, Becks, John Smith’s, Carlsberg and Strongbow. There is a long list, and there are some new lower-strength drinks such as Carling Zest, Foster’s Radler, Carlsberg Citrus and Guinness Mid-Strength. These are to be welcomed and enjoyed—particularly, in my case, the Guinness Mid-Strength. But we need smaller glasses in pubs and restaurants and smaller containers, including 250 millilitre cans for beer. Is it really acceptable that a large wine glass with 14% wine contains more than the daily safe drinking level for a woman? How responsible is that?

Let us ask the industry to focus on what is in its remit—alcohol strength, measures and responsible advertising. However, along with the Independent and the WHO, we agree that we should not let the drinks industry set policy on alcohol. And where are the Government? The pledges are supposedly underwritten by the threat of legislation, but where is that? Could the Minister outline the Government’s responsibility for the targets that have been mentioned and for reducing alcohol-related harm? Could he tell noble Lords when David Cameron’s commitment to minimum unit pricing will be implemented?

2.49 pm

The Parliamentary Under-Secretary of State, Department of Health (Earl Howe): My Lords, I thank my noble friend for securing this debate and all speakers for their constructive and thoughtful contributions.

The responsibility deal is an ambitious and far-reaching challenge to business to lead the way in creating an environment that helps people to make healthier choices. It is a wide agenda; essentially, it taps into the potential for businesses to improve public health in areas where doing nothing is simply not an option. However, the something to be done is not necessarily best done by Government. Organisations signing up to the deal commit to take voluntary action to improve public health; there is no legally binding element to this. These actions are expressed as a series of pledges covering food, alcohol, physical activity and health at work. The deal has always had strong ministerial support. The Secretary of State chairs a plenary group of senior representatives which oversees the deal. Furthermore, each network is supported by a Minister, and both the Secretary of State and his ministerial team continue to hold meetings with both potential and existing responsibility deal partners.

In the two years since launch, the number of partners has tripled to over 500, with new partners joining every week. People are already benefiting from the deal. For example, the World Health Organization considers us to be a world leader on salt reduction; between 2001 and 2011, average daily salt intakes dropped from 9.6 grammes to 8.1 grammes. Through the responsibility deal all the major UK retailers, together with a number of key manufacturers and caterers, have committed to achieve further reductions. Every one gramme reduction in people’s average daily salt intake will prevent over 4,000 premature deaths and save the NHS £288 million every year.

Responsibility deal partners are also providing consumers with more information about their food

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through the out-of-home calorie labelling pledge. Over 70% of high street fast food and takeaway meals sold have calories clearly labelled. Partners signed up to this pledge provide one-third of all meals sold on the high street. As regards alcohol, we now have over 90 companies committed to putting labels on drinks by December 2013, with clear alcohol units, lower-risk drinking guidelines and warnings about drinking during pregnancy. This will help people to understand better how much they are drinking, and to drink within the lower-risk guidelines.

Following the success of the London 2012 Olympic and Paralympic Games, there has never been a better time for organisations to promote the benefits of being active. The physical activity pledges cover increasing participation by employees, for example by walking and cycling to work, and working with local communities. Over 300 organisations have signed up to the health at work pledges. These pledges include ensuring that employees with chronic conditions and mental health conditions can remain in work and are managed in the best way possible, and promoting stop-smoking services and staff health checks. Encouraging workplace health schemes which contribute to individual health and reducing absenteeism will also improve productivity.

In recent months we have concentrated on two pledges which, as mentioned by many noble Lords, could have a great impact: calorie and alcohol unit reduction. So far 34 leading food companies have signed up to a pledge to help the population reduce its calorie intake. They have committed to actions including product reformulation, reducing portion sizes, providing information and shifting their marketing mix towards lower calorie options.

The alcohol unit reduction pledge brings together over 30 producers and retailers. By December 2015 they will reduce the number of alcohol units in the annual UK market by one billion, a drop of around 2%. It is estimated that in a decade this will result in many hundreds fewer alcohol-related deaths and many thousands fewer hospital admissions.

We will continue to increase the reach and impact of the deal by signing up new partners, making sure that there are appropriate pledges for all sectors and, where needed, developing new pledges. For example, a new front-of-pack nutrition labelling scheme was published last week, as noble Lords have mentioned. We welcome the support of the retailers and manufacturers that are pledged to adopt the scheme, which will help consumers to choose healthier, more balanced diets. The noble Lord, Lord Brooke, and the noble Baroness, Lady Hayter, were right to say that there is still a way to go before we sign up anything like enough, but we are confident that more organisations will agree to support the scheme over the coming months. Those who have signed up will want to make sure that they provide information which is helpful to their customers.

We also announced a pledge on domestic violence. This includes guidance to help organisations support colleagues experiencing harassment, stalking, violence or abuse. The Government are committed to evidence-based policy. In addition to the updates that partners submit each year, the Department of Health has commissioned an independent evaluation of the

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responsibility deal. The deal is a complex public health initiative and an assessment of its impact is challenging. Our strategy is therefore to evaluate the specific aims and objectives of the deal as a whole and a small number of pledges. The evaluation will be undertaken by researchers from the Policy Innovation Research Unit at the London School of Hygiene and Tropical Medicine.

A scoping study has been completed and included an international review of voluntary agreements between Governments and business, published in the journal Health Policy. The key message is that voluntary agreements, if properly implemented and monitored, can offer an effective policy approach. The main evaluation started this year and will run over three years. It is made up of a number of strands including examining the overall operation of the deal by engaging with its partners and key stakeholders; an in-depth analysis of a number of case studies; and measuring the public health impact of selected pledges. We will receive interim feedback wherever that is possible.

I have been asked a number of questions and I will cover as many as I can. I undertake to write to those noble Lords whose questions I have not covered. My noble friend Lord Clement-Jones spoke about the evaluation. I want to emphasise that the responsibility deal is only one stream of our policy activity. The evaluation of the deal looks at the mechanism as a whole plus a selection of case studies across the networks. The excellent schemes that my noble friend referred to have been operating for a number of years and are organised by other bodies, so they will not be evaluated as part of the responsibility deal evaluation.

A number of noble Lords, including my noble friend and the noble Baroness, Lady Hayter, have expressed scepticism on the concept of nudging. There is a difference between nudging and what we are trying to do with the responsibility deal, which is to bind companies into voluntary agreements. Nudges, such as providing information or advertising healthy products, form an effective part of a range of different public health interventions set out in the Nuffield ladder of intervention. Actions further up the ladder include enabling choice, guiding choice and restricting or even eliminating choice.

We adopt a range of approaches across our public health policy, depending on the level of harm caused and the target population. For example, we take actions higher up the ladder of intervention where children are at risk. The responsibility deal is, I emphasise, just part of this. Moreover, not all the actions taken within the deal are nudges. For example, the removal of trans fats from a wide range of companies’ products restricts choice and is not a nudge.

In answer to the noble Lord, Lord Rea, pledges are not proposed by the department but are proposed and developed by members of the respective networks. That is appropriate because we want meaningful pledges to which companies can put their names and undertake to abide by. The scoping review’s recommendation on voluntary agreements and robust targets was another issue raised by the noble Lord, who also asked whether targets were the same as pledges. The answer is no:

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some of the deal’s pledges, such as out-of-home calorie labelling, alcohol labelling, alcohol unit reduction and salt reduction, include milestones or targets in their wording. For other pledges, mainly those relating to health at work and physical activity, it would not be suitable to include a target. I will send the noble Lord a complete list of the organisations who have signed up.

The noble Lord, Lord Brooke, spoke about public health industry support for the deal and whether the deal was valid without it. A number of key public health organisations, including the Faculty of Public Health and the Association of Directors of Public Health, support the deal and are signed up as partners to it.

I agree with the noble Baroness, Lady Masham, that there is a need to educate young people on the risks of alcohol consumption. We are introducing an education and prevention pledge for schools which will secure investment to co-ordinate and initiate well evidenced alcohol prevention and education programmes for children and young people. We expect to launch that later this year. The noble Lord, Lord Brooke, asked what was being done on minimum unit pricing. The answer is that no decision has yet been made. We have received extensive submissions in response to the recent consultation and are considering all the views and all the evidence before making a decision in due course. Alcohol calorie labelling is a complex issue, which I know the noble Lord is aware of, but it is something that the Alcohol Network is looking into, and I will pass the noble Lord’s comments to the chairs of that network.

I apologise to other noble Lords that I have run out of time, but to tackle these challenges—obesity, harmful alcohol consumption, physical inactivity and reducing the prevalence of non-communicable diseases —we should not be scared to engage in and use the reach of business to achieve mutually beneficial aims. I thank the noble Baroness, Lady Coussins, for what she said in that context. Improving public health will always be the cumulative effect of sustained collective activity over time. There is no silver bullet. Public health is everyone’s responsibility and I hope that I have reassured my noble friend, in particular, that the responsibility deal is a fundamental part of an ongoing process to improve the health of the nation over the lifetime of this Parliament and beyond.

NHS: Association of Medical Research Charities Report

Question for Short Debate

3.02 pm

Asked by Lord Turnberg

To ask Her Majesty’s Government what is their assessment of the report by the Association of Medical Research Charities, Our Vision for Research in the NHS.

Lord Turnberg: My Lords, one of the biggest problems facing a Government is how to get their policies implemented when, as always, that depends on others

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putting them into action. The world is full of people with bright ideas but rather fewer who can make sure that they are put into practice. Such is the case with the good intentions of the noble Earl and his colleagues to embed research in the NHS, which may be frustrated by poor take-up by those on the ground who have to implement them. But help is at hand. It is here in the AMRC’s report on a vision for implementation.

Here I express my interest as scientific adviser to the Association of Medical Research Charities. I should mention, too, that the AMRC is an umbrella body for more than 120 medical charities covering a wide spectrum of diseases, including Cancer Research UK, the British Heart Foundation, Alzheimer’s disease, Parkinson’s disease and diabetes, as well as the Wellcome Trust, and as such, speaks for a very large number of patients and their carers. They are desperately keen to see research into their diseases actively pursued to the extent that they pump £1.2 billion into research every year. It is that commitment to research that prompted the publication of this vision.

Of course, it did not come out of the blue; it came on the back of a number of government initiatives to promote research in the NHS. We have had many a fine word from Ministers, the Treasury and even the Prime Minister about the value of medical research, and we now have the duties spelt out in the mandate for NHS England and the CCGs to promote research. It makes economic sense, too, as we know, that there are excellent economic returns from investing in research—a fact that new figures that are about to be published will no doubt confirm.

Public funding of research is very successful in leveraging private capital input too. The Government’s investment proposals announced today and yesterday, including protection of the science budget and investment in health research infrastructure, including regenerative medicine, are very welcome. The scientific community is, of course, extremely pleased by that. The National Institute for Health Research and its networks and centres are poised to do great work. Couple all that with our very strong background in basic biomedical research and the fact that we have a National Health Service in which every patient is involved and available to engage in clinical trials and you have a fantastic opportunity to conduct research of benefit to patients. I do not have to explain today how research has enormous potential to improve the care not only of future patients but also of those who take part in research themselves today.

However, achieving these ambitions is not straightforward and there are several uncomfortable barriers that can get in the way. They range from the need to maintain adequate public funding—and we have had some of that today—improving and rationalising the complex regulatory network—here the new health research authority’s role will be critical—and improving taxation policy to encourage more private and venture capital investment. Perhaps one of the biggest barriers is trying to change the culture within the NHS. The AMRC’s Visiondocument focuses on the people who have to do the implementing—the patients, doctors, nurses and other healthcare workers. Are they ready to take advantage of the valuable basic work going on in

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Newcastle on mitochrondrial disease, as that becomes ready to be translated into treatments?

The report envisages a future in which, first, every patient is given the opportunity to engage in research; secondly, every health professional understands the value of research and ensures that innovations in treatment are transcribed rapidly into practice, and thirdly, the NHS as a whole conducts high-quality research and adopts new treatments. We have a long way to go because there is a very patchy, variable picture in practice now.

There is a statement in the NHS constitution that commits the NHS to inform patients of,

“research studies in which you may be eligible to participate”.

Yet despite that, a mystery shopper survey by NIHR revealed that barely 10% of NHS trusts provide patients with any information and there were very few notices about it anywhere. Another survey, by Breast Cancer Campaign and Arthritis Research UK, found that very few patients ever asked their doctors about research or clinical trials and many doctors were unaware of existing sources of information they could give to their patients. This survey also confirmed, as many had suspected, that GPs were not all switched on to doing research or even supporting others to do research. While 80% of GPs contacted felt that research was important, only 20% thought that they should be involved themselves. They quote a lack of time as a major disincentive, but equally a lack of support and a lack of information about where to get that support. This is all true, albeit to a lesser extent, of hospital doctors. Perhaps equally disturbing is the observation that only a third of GPs thought that research was of any value in helping them to offer their patients more treatment options.

There is much to do at the coalface if we are to deliver on our potential but there are causes for some optimism. The academic health science centres and networks funded by the National Institute for Health Research are enormously valuable in engaging with healthcare workers. Figures published today show that, in the past year, NIHR engaged a remarkable 630,000 patients in 1,592 studies, a considerable increase from the previous year.

Another good example is the Greater Manchester network that I visited. It has managed to get every GP and pharmacist in Salford signed up to clinical trials—to the extent that GSK has seen fit to invest heavily in trials there. It has also managed to get the rate for R&D approvals for clinical trials down from 60 days in 2011 to 17 days in 2012. Many other good examples of what can be achieved are described in this report, but there is very much more to do to change the culture more widely across the NHS.

The Vision document makes a large number of recommendations but I shall mention just a few where the Government may be able to help. First, can we encourage NHS England to appoint someone at board level who can take responsibility for promoting research, and can we make sure that the CCGs have the leadership

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and guidance they need to promote research? How do we make sure that non-NHS providers are encouraged to engage in the research agenda?

Then there is a clear need to spread more and better information about research opportunities to patients and doctors, so can the noble Earl encourage the NIHR to get relevant information out to NHS trusts and GPs to ensure that both patients and staff know more about research, including its benefits? He may find that he is pushing at an open door there. Can he ensure that employment contracts for consultants include sufficient time for research, and can he help to reduce discrimination against those who engage in research by ensuring that those responsible for giving out clinical excellence awards at the local and national levels take this into account by including research activities in their assessments?

Can the noble Earl reassure us that the responsibilities of Health Education England and of the local education and training boards that we are debating in the Care Bill will incorporate the specific need to include research in the training programmes of all clinical trainees? Training programmes should be flexible enough to allow time out for them to undertake research.

Can we make sure that GPs are encouraged to share their practice data with the Clinical Practice Research Datalink in a safe and secure way? Can we also encourage them to respond positively to requests to invite their patients to take part in research trials by other researchers? There has been a fair amount of resistance at that level.

Finally, dare I say that perhaps we can make the AMRC’s Vision document required reading by everyone in the NHS? After all, it comes from organisations made up largely of patients themselves.

I look forward to hearing the speeches of noble Lords and, of course, the noble Earl’s response.

3.12 pm

Baroness Sharp of Guildford: My Lords, I am speaking today substantially in place of my noble friend Lord Willis, who, as noble Lords may know, had a heart attack two or three weeks ago. He is making very good progress and, in fact, is hoping to be back before we go into recess. However, he was anxious that somebody from our Benches should speak on this subject. My noble friend, as chair of the Association of Medical Research Charities, played a very substantial part in helping to develop this Vision document. Before that, as the noble Earl knows very well, he played a seminal role in ensuring that the Health and Social Care Act 2012 incorporated clauses that put on the Secretary of State and others in the NHS the duty to promote,

“research on matters relevant to the health service”,


“the use in the health service of evidence obtained from research”.

All are agreed that the Act is a major milestone which has helped to embed research within the body of the NHS.

In many senses, I think that this vision is a natural sequel to that achievement. The AMRC, working with member charities, has attempted to put flesh on the

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bones of phrases that were bandied around at the time of the Bill being discussed in this House—phrases such as, “placing research at the heart of the NHS”.

As the noble Lord, Lord Turnberg, mentioned, Our vision for Research in the NHS was written after wide consultation among professionals on the one hand and patients on the other, and it is built on three key concepts that emerged from that consultation. The first is involving patients: telling them about research being undertaken, how they can find out more about that research and how they can participate if they wish and it is relevant to their care. Secondly, there is involving staff so that they understand the benefits of research, are motivated to engage with it and know how to take part in it and use its findings. Lastly, there is ensuring that the NHS is open to and about its research, and develops among its staff a group of leaders who will champion research and help embed good researchers and good research practice into the NHS.

I have just three questions for the Minister. First, there is the matter of clinical trials. As I said, one key issue is the NHS being open to research, but there is concern that it is losing its share of global clinical trials. Back in the 1980s and 1990s, when I was doing more research on the pharmaceutical industry, the UK was a favoured location for clinical trials. Many multinational companies put their research laboratories here in the UK because of that. The Science and Technology Select Committee, of which I am a member, recently made a study of regenerative medicine. In the process of taking evidence for that, we learnt that despite the recognised quality of our research, it is no longer the case that we are among the leading countries doing clinical trials. One reason cited most frequently for this was the sheer complexity of procedures, especially the number of regulatory bodies involved. I noted in reading the report that this comes up yet again:

“40% of hospital doctors polled cited difficulties navigating regulatory processes as a barrier to them taking part in medical research in the last two years”.

I know that the UK Clinical Trials Gateway has been set up to simplify procedures, but can the Minister offer us any reassurance that the situation is likely to improve, and in particular that the Health Research Authority might in time become the one-stop shop that everybody is looking for?

My second question relates to co-operation between the NHS, universities and medical schools. Yesterday I attended the lecture given by my noble friend Lord Heseltine to the Industry and Parliament Trust, and I was amused when he talked about how, in the 1970s, the public sector—the Civil Service—and private sector industry were two separate worlds that worked in their own spaces and failed to recognise the benefits of working together in such areas as regeneration. In some senses, it seems that one hits the same problems between the NHS and the world of research, particularly university and medical school research:

“Our survey of almost 400 health professionals including 130 GPs found that around half knew something about the National Institute for Health Research and the NIHR Clinical Research Network … Awareness fell to around a quarter for Academic Health Science Centres, Biomedical Research Centres and Biomedical Research Units”.

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Again, we know that a lot of effort is being made to bring together and develop these academic health science networks, linking up the local NHS organisations and universities. Nevertheless, that vision raises questions as to how these networks will share best practice. Can the Minister tell us a little more about how they will function?

Finally, I raise a question that was to a large extent raised by the noble Lord, Lord Turnberg. How can CCGs embed research throughout the NHS? There is considerable scepticism as to how far the CCGs will be able to do this. To help them, the report sets out on page 31 a research charter. How far does NHS England accept that charter and how much will it encourage CCGs to take note of and follow those procedures?

Baroness Garden of Frognal: My Lords, I apologise for intervening, but there are no spare minutes in this debate, so it would be helpful if Back-Benchers could keep their remarks to within the six minutes.

3.19 pm

Lord Kakkar: My Lords, I join in thanking the noble Lord, Lord Turnberg, for having secured this important debate and the Association of Medical Research Charities for having undertaken this very important work. In so doing, I declare my interest as professor of surgery at University College London, as chair for quality of UCLPartners, which is one of the five designated academic health science centres, as a member of the General Medical Council, and as vice-chair of the All-Party Parliamentary Group on Medical Research.

This report is fundamentally important because it highlights three vital issues with regard to the future of research in our NHS: that we must develop a culture, as we have heard from the noble Lord, Lord Turnberg, so that every patient is given the opportunity to participate in research; that all those who work in our healthcare system are made aware of those opportunities and are given the opportunity to develop as researchers; and finally, that the NHS, having promoted and facilitated all that important research actually adopts its findings to improve clinical outcomes and, indeed, to ensure that we use vital resources for healthcare much more effectively.

There is no doubt that Her Majesty’s Government need to be congratulated in this regard, because for the past three years, we have seen a relentless commitment to medical research in the legislation that has been brought before this Parliament. In particular, for the first time, legislation enshrines in statute the obligation of the Secretary of State to promote research and provides for the new arm’s length bodies to have a statutory obligation for research, which is vital. The reasons for this are clear. In terms of health gain, there is no doubt that the adoption of innovation into routine clinical practice will help us improve clinical outcomes for large numbers of patients, while in terms of the efficient use of resources, there is no question that some of the currently available innovations will help us to ensure that the funds available for routine healthcare can be used more effectively.

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In broad economic terms, we know, for instance, that the life sciences industry—another area of government focus—is vital to future economic development in our country. As an industry, it is responsible for about £50 billion of economic activity annually, with 160,000 employees in this country. We also know that it is a net exporter, bringing in vital revenue to the country of some £7 billion per annum, and that from the point of view of investing in research, be it public or charitable funds, every £1 invested will provide 39p in economic return in perpetuity to our economy, so that is vital too.

It is not only in economic terms that the Government have started to look at the opportunities here. They have also done so in terms of the structures that might be provided to facilitate research, which is where this important research provides vital insights. However, a large number of bodies have been created recently to promote research in our NHS. We have heard about the academic health science centres. There are, of course, also academic health science networks, which will appear across the NHS in England and bring together academia, industry and the National Health Service. We have the clinical research networks, which are there to promote research at the local level within the footprints and geographies of the academic health science networks. We have the local education and training boards, which will play a vital role in the education of future academics and those who wish to participate in research, both clinicians and other healthcare professionals. We also have the centres for leadership in applied health research and care, which will promote research into outcomes in the NHS. How are these important structures to be co-ordinated at a local level to deliver the benefits envisaged?

We also have, at national level, Health Education England, which will have an important role in training academics and in setting a national priority in that regard. We have the Health Research Authority, the Medical Research Council and the Department for Business, Innovation and Skills, where the Higher Education Funding Council’s funding for medical schools rests. Again, those important national bodies will, with the National Health Service Commissioning Board and NHS England, all have an important role at national level to ensure that vital funds and resources are properly co-ordinated. How are we in this Parliament to know that all these new structures are working successfully and delivering what is envisaged? What metrics have been defined at the birth of these organisations with regard to their performance in research in the NHS? How will this Parliament hold those organisations, and indeed Her Majesty’s Government, to account regarding the investment of public money in those organisations and the outputs that are achieved?

For the first time, the Health and Social Care Act includes an obligation on clinical commissioning groups to promote research. What measures were undertaken in the authorisation of CCGs to ensure that there was a definition of their contractual obligations to NHS England to deliver that research agenda? How will the CCGs be held to account? If they fail to promote research, what sanctions are available against them to ensure that they deliver the research agenda?

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I come finally to the question of regulation. I have spoken a number of times in your Lordships’ House about the problem of the European clinical trials directive. We heard about the deterioration in research activity in clinical trials, which is a result of the application of that directive over 10 years. What progress has been made regarding the renegotiation of the clinical trials directive in Europe?

3.25 pm

The Earl of Selborne: My Lords, I start by congratulating the noble Lord, Lord Turnberg, on giving us the opportunity to discuss this most important report. I pay tribute in his absence to my noble friend Lord Willis, who is chair of the AMRC. As everyone does, I strongly endorse the case made so powerfully by the report to ensure that every patient has the opportunity to take part in research. However, my plea today is really about ensuring the realisation of the potential of the vast amount of data held by the National Health Service.

The scope of the National Health Service’s database is one of its greatest assets. The potential of these huge datasets, which could be drawn on for research, is much greater than the present rate of exploitation. That is not to say that there is not some excellent work being done. I draw attention to the press report which came out when the survey was published, as referred to by the noble Lord, Lord Turnberg. Professor Peter Weissberg, medical director of the British Heart Foundation, stated that:

“It’s vital we create a system where researchers have better access to patient data so we can use it to help find new life-saving treatments for heart patients”.

After “heart-patients”, read “and every other patient”. We should take great lessons from the example of 10 years ago, when the Medical Research Council and the Wellcome Trust established the UK Biobank to support the investigation of risk factors for the major diseases of middle and old age. The recruitment of more than half a million men and women aged between 40 and 69 was successfully achieved, with a great deal of support from the public, and their health has been monitored long-term. When the House of Lords Science and Technology Select Committee published its report on genomic medicine four years ago, it quoted the evidence of the Wellcome Trust Sanger Institute:

“The UK Biobank initiative has set a gold standard for ethical principles and guidelines concerning the large population studies”.

In other words, there was recognition that there was a need to protect patient privacy and to reassure the public that their concerns about the data being abused or misused were being adequately and most properly addressed. The procedures for ensuring the protection of personal privacy were considered exemplary. Yet Professor Collins of the UK Biobank told the Select Committee that if he were able to make one recommendation, it would be to remove the bureaucratic obstacles to using health records to improve the health of people in the United Kingdom. The report came out just after the Information Commissioner at the time, Richard Thomas, and Sir Mark Walport, now

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the Government’s Chief Scientific Adviser, had conducted a data-sharing review in 2008. This review concluded that,

“the complexity of the law, amplified by a plethora of guidance, leaves those who may wish to share data in a fog of confusion”.

What has changed over the last four years? First and foremost, the technology has changed. The ability to collect, store, share and integrate ever greater volumes of data has advanced exponentially. However, our ability to unlock more of the vast database that is available from the National Health Service has not matched these advances in technology. We are still not using these data to their full potential, to ensure that research findings are transferred to clinical and therapeutic use. The huge datasets that could, with public support, be drawn from the National Health Service and which could underpin new and exciting opportunities for the diagnosis and treatment of disease are still waiting for full exploitation.

The biobank has been an outstanding example of what can be achieved. When the public are effectively engaged, there is overwhelming support for their own data to be used to support the public good. It is therefore essential to reassure the public that their data will be handled safely. This requires effective systems and good communication among practitioners, researchers and patients—and, indeed, among all healthcare professionals. The UK Biobank has shown that this can be done.

3.30 pm

Lord Aberdare: My Lords, I should like to focus on only one area of NHS research—namely, research relating to pancreatic cancer, which is probably not to the great surprise of the Minister. In doing so, I thank the charity Pancreatic Cancer UK for its briefing, James Tobin at the House of Lords Library for his typically helpful briefing pack and I congratulate the noble Lord, Lord Turnberg, on obtaining this debate.

Pancreatic cancer accounts for 5% of cancer deaths in the UK but it currently attracts only 1% of research spending. So perhaps it is little wonder that outcomes in survival rates, for example, have shown little if any improvement in 40 years, yet evidence from other cancers, such as breast cancer, shows that increased research effort can lead to significantly better outcomes.

For research to be effective in this way, a number of essential infrastructure elements need to be in place, several of which are rightly identified in the AMRC report. There need to be recognised centres of research excellence covering areas such as pancreatic cancer; an adequate body of appropriately qualified and skilled researchers; an ability to attract new young researchers into the specific field; and a strong pipeline of good research proposals. Beyond that, research needs a critical mass, estimated to be at least £10 million to £12 million a year, as opposed to the current spending level of £5 million for pancreatic cancer research.

The first part of the AMRC report focuses on patient involvement in research and sets out three aims: every patient should be able to take part in research; research should be patient-centred; and research should be embedded in patient care. I ask the Minister:

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what can he and the Government do to ensure that these three aims are achieved for pancreatic cancer patients?

Specifically, pancreatic cancer patients are often unable to access clinical trials. Lower levels of investment in pancreatic cancer research mean that there are fewer clinical trials available. One study found 91 breast cancer clinical trials taking place against only 15 for pancreatic cancer. Less than 10% of pancreatic cancer patients say that they have been involved in any discussion about clinical trials, and less than 12% are enrolled in such trials, against about one in six cancer patients overall. In any case, many pancreatic cancer patients are diagnosed too late to be fit enough to participate in trials. So how can the Government help to ensure that more pancreatic cancer patients can access clinical trials? I hope the Minister will have some ideas.

The third part of the report relates to conducting high quality research and adopting new treatments. Apparently, much pancreatic cancer research tends to be researcher-led—there is little in the way of strategic direction from funders—unlike some other countries, such as Australia, which have clearly defined research priorities and achieve more impressive results. How can the Minister help to ensure that government engages with relevant research bodies in a collaborative effort to develop a strategic research agenda for pancreatic cancer?

I ask the Minister to look at a number of other measures, such as encouraging existing cancer research centres to increase their focus on pancreatic cancer; providing support to develop more skilled researchers, specifically in pancreatic cancer, and to ensure that this field of research is seen as offering a good career path, which is clearly one of the challenges at the moment; helping to raise the profile of pancreatic cancer within the research community, perhaps by the appointment of a UK pancreatic cancer research champion; and ensuring that the UK learns from experience in other countries and that research findings are freely shared internationally.

Pancreatic Cancer UK is doing its bit, for example with its own research innovation fund and future research leaders fund. I hope the Minister can tell us how government will add weight to efforts such as these so that we can put in place an effective research programme which will finally start to turn the tide of dismal pancreatic cancer outcomes and bring some real hope to sufferers from this dreadful disease and to their loved ones.

3.34 pm

Lord Saatchi: My Lords, I join other noble Lords in congratulating the AMRC on the report and the noble Lord, Lord Turnberg, on bringing it to our attention. I share with the noble Lord the view that grief is not a disqualification from rational thought. I particularly congratulate Sharmila Nebhrajani, the chief executive of the AMRC. Reading this report, she reminds me of Adlai Stevenson’s striking description of President Kennedy: an idealist without illusions.

She is certainly a realist to say that,

“we still have quite a way to go if we are to get close to the government’s goal of every clinician a researcher and every willing patient a research participant”.

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In saying that, the AMRC is reflecting the Prime Minister’s speech on life science in December 2011. He speaks about 34 Nobel prizes in medicine in the context of the global race in which, he says,

“we must ensure that the UK stays ahead … to keep pace with what’s happening we’ve got to change quite radically … the way we innovate”.

As has been said, the Prime Minister sees the NHS as an amazing asset to innovation because it has,

“a huge wealth of information all consented to, all anonymous—and that is helping them find new answers”.

The Prime Minister concludes that,

“the end result will be that every willing patient is a research patient; that every time you use the NHS you’re playing a part in the fight against disease”.

He reflects the view of his life science adviser, George Freeman, who also in a recent article wants to see every willing patient a research patient.

Unfortunately, the shared vision of the Prime Minister and the AMRC is about to hit a roadblock because, as T S Eliot put it:

“Between the idea And the reality … Falls the shadow”.

In this case, the irresistible force of their idea, their dream, will soon meet an immovable object, which is the law. Current law obliges the doctor to follow the status quo, even though he or she knows that it leads only to poor life quality followed by death. This is why all cancer deaths are wasted lives. Science learns nothing from those thousands of deaths—scientific knowledge does not advance by one centimetre—because current law requires that the deceased receive only the standard procedure, the endless repetition of a failed experiment. The pre-eminence in law of the standard procedure is a barrier to progress in curing cancer.

I had better close with this. There is not time to take your Lordships through the case law that I have here but I will summarise it like this. Under present law, any deviation by a doctor from the standard procedure is likely to result in a verdict of guilt for medical negligence. Current law defines medical negligence as deviation from standard procedure. However, as innovation is deviation, non-deviation is non-innovation. That is why there is no cure for cancer. That is why the AMRC vision of every clinician a researcher cannot be realised without a change in the law.

We do not want patients to be treated like mice but, on the other hand, we want bold scientific innovation, which alone can bring a cure for cancer. It is well known that in politics, when a man says, as I say now to the noble Lord, Lord Turnberg, “I agree in principle with this report”, it usually means, “I intend to do nothing about it in practice”. On the contrary, I say to the noble Lord, Lord Turnberg, that not only do I intend to do something about it in practice, I intend to devote my entire life to ensuring that the dream of the Prime Minister and the AMRC comes true.

3.38 pm

Lord Rea: My Lords, I apologise for missing the deadline yesterday and hence being squeezed into the gap. I wanted to say a few words about the position of general practice in the health service. As my noble

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friend pointed out, the AMRC report finds that fewer GPs than hospital doctors are interested or involved in research, most of them citing time as the reason. Setting aside dedicated time for research is not easy in the average primary care setting. It is also possible that fewer GPs are research-minded and that, except for academic general practice, publishing peer-reviewed research papers is less important in their career advancement.

However, research in general practice is alive and well. Every medical school now has an academic department of primary care linked to the Royal College of GPs, supporting research in primary care through the RCGP innovation and research centre. The director of the centre suggested to me that the academic status of general practice would be enhanced if more research-minded and bright medical students or doctors could be recruited into general practice. One way in which to do this would be for the NIHR to proactively offer to fund PhD or MSc fellowships in general practice. This would be attractive to research-minded medical students or practitioners contemplating a career in general practice but uncertain about its research possibilities. Does the noble Earl have any influence over the funding decisions of NIHR? I suggest that this might be promising territory.

My experience, in answer to various noble Lords who have mentioned patients in research, is that patients are nearly always willing to take part in research projects if it is recommended to them by a doctor, hospital or care unit that they trust and its purpose is fully explained to them.

3.41 pm

Baroness Wheeler: I, too, congratulate my noble friend Lord Turnberg on securing this debate, especially his timing following hot on the heels of our scrutiny of the Health Research Authority under the Care Bill. My noble friend is a much respected and tireless champion for research and innovation, leading to improved quality care for patients, and we in our party rely strongly on his expertise and support.

My noble friend and other noble Lords from across the House between them ensure that the importance of research and innovation to the NHS is kept to the fore, by this debate and, for example, in recent debates by the noble Lord, Lord Kakkar, on the impact of the EU healthcare in the UK and the concern over the UK losing its global allocation of clinical trials, and in the powerful debate earlier this year of the noble Lord, Lord Saatchi, on medical innovation, which reinforced the need to deal with the regulatory burden, to which noble Lords have referred, and to speed up the availability of innovative treatments.

Like other noble Lords, we welcome the progress on speeding up research approvals made by the HRA through the single portal of entry and single application procedure and bringing together the various research ethics committees. However, the point about the need for progress in getting the local R&D committees of NHS trusts singing from the same hymn sheet is well made and I look forward to the Minister updating us on the action that the Government are taking.

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Like other noble Lords, I congratulate the AMRC on its excellent report and the accompanying survey of healthcare professionals’ views on the importance of research to the NHS and to staff working for it. Under the Care Bill, the need for Health Education England to ensure that research and innovation are incorporated into education and training for healthcare staff was a major theme, echoing the Joint Select Committee on the Bill on this issue. All NHS staff need to be able to make use of research throughout their careers and should be equipped with the tools to understand and support research and to assess and use evidence to inform their decisions when caring for patients or supporting clinical staff.

As noble Lords have pointed out, the association’s survey showed the challenges to be faced. The good news was that staff overwhelmingly recognised the value and importance of research, but the barriers to taking part in research, identified by the majority of staff surveyed, including doctors and nurses, was deeply worrying. It is clear that these barriers of lack of time, problems over funding and support and the difficulties of navigating regulation have to be overcome, particularly the need to develop stronger support among GPs to become personally involved in research. After all, they are such an important gateway to spreading the message to get patients interested and involved in research. As my noble friend put it, there is still much to do at the coal face. This is where the ARMC report is so valuable. It offers an authoritative but very practical vision of how the goal of having every clinician a researcher and every willing patient a research participant can be progressed and achieved, as well as how the leadership and support that the NHS staff need can be developed and built into a service-wide research culture.

The case studies in the report are particularly informative, providing examples of excellence and best practice in cancer, arthritis and other key research areas of patient consultation and involvement, and of building staff support and confidence about participating and using research findings so that they can show their patients the benefits of them taking part.

In the context of this debate it is important also to reflect on the progress being made on the UK life sciences and the innovation, health and wealth strategies, the central aim of which is for innovation to become the NHS’s core business. No one reading these reports and the recent one-year reviews can be in any doubt of the dramatic pace and scale of change in the medical and life sciences, such as the breakthrough in genomic medicine, which is changing fundamentally the way disease is diagnosed, prevented and treated, and the progress on regenerative medicine, which are all breathtaking to a lay person such as myself.

There are important developments on the service side, too, as part of the high impact innovation programme, such as in wheelchair design. Can the Minister update the House on progress on implementing the strategies? I could not find any details on the website about further review reports or of the Government’s response to the MHP Communications review of the strategies, which charted good progress but also some continuing problems, including implementation of NICE technology appraisals by

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NHS trusts and the poor level of awareness of the IHW strategy; only 30% had discussed the strategy at board level. How are these issues being addressed?

Finally, on the association’s vision, I would reinforce the need to keep our foot on the pedal to ensure that we continue to be a world leader in clinical research. We must ensure that CCGs in the absence of SHAs and PCTs continue the focus on research and do not allow it to diminish. The AMRC vision highlights the need for leadership and guidance to CCGs to promote research; to encourage NHS managers so that they understand the value of research and actively support it through their management decisions and processes; and to ensure that all parts of NHS support research, including primary care and all non-NHS providers. I look forward to the Minister’s response updating the House on the Government’s actions to ensure that real progress is made on all these fronts.

The Parliamentary Under-Secretary of State, Department of Health (Earl Howe): My Lords, I begin by thanking the noble Lord, Lord Turnberg, for having tabled this debate. He has spoken with both authority and passion about Our Vision for Research in the NHS, the report by the Association of Medical Research Charities. The Government welcome the report; it is a challenging and insightful contribution to the debate on optimising the research potential of the NHS.

It is now more than seven years since the National Institute for Health Research was established in April 2006. The NIHR has a wide-ranging role that is central to our debate today. It provides the framework through which the Department of Health can position, maintain and manage the research, research staff and research infrastructure of the NHS in England as a national research facility. Indeed, together, NIHR people, facilities and systems represent the most integrated clinical research system in the world—driving research from bench to bedside for the benefit of patients and supporting economic growth.

My noble friend Lady Sharp referred to the importance of clinical trials, and of course, that is centre stage for the NIHR. As a result of the NIHR, large numbers of patients have the opportunity to take part in research. In the past financial year, more than 630,000 participants were recruited to trials and studies hosted by the NIHR Clinical Research Network Portfolio, and more than 99% of NHS trusts were involved in the recruitment. During the whole of 2013-14, the NIHR is promoting the fact that, “It’s okay to ask” about clinical research. We want everybody to get involved—patients, medical professionals and the public to support the campaign.

In March 2013, the Government published the revised NHS constitution, which contains a pledge to inform patients of research studies in which they may be eligible to participate. The pledge aims to give people better access to the potential benefits of participating in research studies, including clinical trials. We have already improved the amount of information available to patients, clinicians and the public about clinical trials by establishing the UK Clinical Trials Gateway. I just say to the noble Lord, Lord Aberdare, who spoke very powerfully about pancreatic cancer and the need to enlist more patients into trials for that condition, that the launch of the gateway was promoted

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through leaflets and other printed materials, including postcards and posters, and the gateway is also being actively promoted by INVOLVE, which is the NIHR-funded patients and public involvement body. In the course of just one month, May of this year, there were 11,570 visitors to the gateway website. Although not all of them will be related to pancreatic cancer, I hope that that gives an indication of the powerful influence that we hope the gateway will have in alerting patients to relevant studies.

Crucial to all this activity is the need to both protect and promote the interests of patients and the public in health research. That is why we established the Health Research Authority in 2011, and provisions in the Care Bill will give it added stability and independence. To my noble friend Lady Sharp I would say that the HRA has a programme of work to enable the implementation of a unified approval process and to support the authority in promoting consistent and proportionate standards for compliance and inspection. The programme includes a feasibility study with a number of pilots to test the effect of rationalising and combining elements of NHS study-wide review with elements of the research ethics committee review into a single HRA assessment. The findings are expected to identify and show how to release the potential to improve both study set-up times and the quality and consistency of ethical review.

The noble Lord, Lord Kakkar, very helpfully acknowledged that enactment of the Health and Social Care Act is a milestone for research in the NHS. It recognises the need to promote research and the use of research evidence and created unprecedented powers and duties at all levels to meet that need. The Government’s mandate to the NHS Commissioning Board—now NHS England—sets an objective to ensure that the new commissioning system promotes and supports participation by NHS organisations and patients in research funded by both non-commercial and commercial organisations, most importantly to improve patient outcomes, but also to contribute to economic growth.

The noble Lord, Lord Kakkar, specifically asked how CCGs will be held to account. The mandate asks for demonstration of progress against the five domains and all the outcomes indicators in the NHS outcomes framework. The framework document emphasises that vital to the quality and delivery of these outcomes will be continued research and the use of research evidence in the design and delivery of services at a local level.

NHS England welcomes the vision for research set out by the AMRC and shares its aspirations to empower patients to take part in research; to engage clinicians and other NHS staff; and to implement research findings to lead to better outcomes for patients and the public. Although NHS England is a new organisation, the NHS—as I do not need to tell the noble Lord, Lord Turnberg—has a strong existing culture of research, although we want to strengthen that culture. There is a wide wealth of research activity already taking place and considerable expertise within organisations. However, NHS England recognises there is further work to do to ensure that all NHS commissioning staff embrace a research culture, which was the theme of my noble friend Lord Saatchi’s excellent contribution, that they

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have access to research evidence and use it to inform commissioning decisions. It has recently recruited a team to lead the research agenda and develop and implement its research strategy. It is anticipated that a draft strategy will be in place by autumn this year, when extensive consultation with key stakeholders and partners, including patients, will be undertaken.

The noble Lord, Lord Turnberg, and my noble friend Lady Sharp rightly referred to the vital role of clinical commissioning groups within the new system. Through their formal declaration of compliance, all these groups have confirmed that they understand and will comply with their statutory responsibilities regarding promoting research. They have also confirmed that they are committed to following the policy of ensuring the NHS meets the treatment costs for patients taking part in research funded by government and research charity partner organisations. Alongside NHS England, Health Education England has responsibility for promoting high quality education and training that is responsive to the changing needs of patients and local communities. It will work with stakeholders to influence training curricula as appropriate.

HEE will work to build a workforce that is research-literate, with the skills and confidence required to diffuse the latest ideas and innovations. HEE will establish mechanisms to ensure that ongoing engagement takes place with a wide range of partners. This will include building relationships with academic health science networks and academic health science centres to align education with research and innovation. The noble Lord, Lord Turnberg, referred to the role of LETBs, which are responsible for commissioning education and training and securing quality and value from education and training providers. Indeed, they will need to ensure that the education and training that they commission is in line with national objectives, which include building a flexible workforce that is receptive to research and innovation. HEE and the LETBs are working with the NIHR to ensure appropriate investment in education and training, to develop clinical academic careers and to increase the number of staff accessing academic careers programmes across all clinical and public health professions.

I say to the noble Lord, Lord Rea, that the NIHR supports a wide range of programmes for research training and career development. The purpose of these is, self-evidently, to create the next generation of researchers focused on people-based research. The programmes provide support for the academic training paths of all healthcare professionals and other key disciplines involved in health and social care research, including, importantly, general practice. The NIHR is actively building research in general practice—for example, through its School for Primary Care Research. Through its integrated academic training programme, the NIHR has already taken a lead in reversing the decline in clinical academic careers.

The noble Lord, Lord Turnberg, spoke about investing in research, and of course I very much identify with the need to do that. As part of the commitments announced by the Government yesterday to invest in Britain’s future, the department will provide £150 million

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of capital investment in 2015-16 to fund health research infrastructure in the areas of dementia, genomics and imaging.

As regards clinical excellence awards and the consultant contract, discussions are ongoing between the UK government health departments, NHS employers and the BMA about changes to the consultant contract. The aim is to agree a heads of terms next month and to move to detailed negotiations. I will write to the noble Lord with further details about that.

My noble friend Lord Selborne spoke very powerfully about data from the NHS. One million people have some form of contact with the NHS every 36 hours. That produces, as he rightly said, a staggering amount of data, which can be used to drive forward research into new treatments. The NHS is in a unique position in that sense. We can draw on linked datasets on a scale unprecedented elsewhere in the world. Provided that we ensure confidentiality and privacy for individual patients, the opportunities for research and innovation are vast. In April last year, we established the Clinical Practice Research Datalink, which enables access to anonymised patient records to support the development of novel treatments. I can reassure the noble Lord, Lord Turnberg, that the CPRD is working with the NIHR primary care research network to recruit more GP practices to contribute their data to the CPRD’s data assets.

The clock is moving against me, so noble Lords will have to forgive me if I do not cover all their questions today but I undertake to write to those noble Lords whose points I have not covered—and there are many. I hope that the noble Lord, Lord Turnberg, in particular, has gained a sense of the importance that the Government attach to promoting research in the NHS, and a sense that we need, and have, a whole-system approach to this agenda, which is so vital for the future health and prosperity of our nation.

Local Authorities: Regulatory Services

Question for Short Debate

4 pm

Asked by Baroness Crawley

To ask Her Majesty’s Government what plans they have to ensure that local regulatory services, including trading standards and environmental health, are fit for purpose, in the light of recent cuts to those services.

Baroness Crawley: My Lords, this is an unashamed shout-out for those local services that protect our citizens across the country and that promote legitimate businesses at a time when economic growth is not only desirable but essential.

Why do these regulatory services need our advocacy? Their strong focus on prevention can make them less visible than other public services. As one environmental health officer told a recent UNISON survey, our success is that nothing happens, meaning that nothing bad happens. However, it takes a considerably robust infrastructure to maintain that status quo. Those Peers

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who have glanced at the title of this debate and thought, “Ooh, that sounds dull,” will wish that they were here and will probably say that they were here, to misquote Shakespeare, because this is a story of disease and pestilence and contagion; it is a narrative of small-time scams and mis-selling, of international-scale fraud, of injustice and of heartbreak for those caught up in it all.

I see that the Minister is from the Department for Business, Innovation and Skills and I welcome him to our debate. While I have very cordial relations with his department through my involvement in trading standards, many of the points that I make this afternoon will also be directed at his colleagues at the Department for Communities and Local Government. However, as I was frequently told when I sat where he is sitting now, at the Dispatch Box you speak for the whole Government, as I am sure he is well aware.

Environmental health might include food safety, health and safety at work, environmental protection, public health nuisances, private sector housing and, of course, licensing. Trading standards might include business advice, fair trading, product safety, under-age sales, weights and measures, food standards and farm animal health and welfare. These services are under crippling pressure, as never before. Will the Minister explain how these services will be fit for purpose into the future, given the hit that they have taken under the austerity agenda and given yesterday’s spending review announcement of a further 10% reduction in local government spending? I ask the question as president of the Trading Standards Institute and as a firm believer in our local public services being an anchor of our democracy.

I thank all noble Lords for taking part in this debate. I am particularly happy to see the noble Baroness, Lady Seccombe, in her place, an esteemed vice-president of the Trading Standards Institute, as I am to see my noble friend Lord Harris of Haringey, who chairs the recently established National Trading Standards Board.

There are two key pillars for an effective regulatory system. The first is that the system is underpinned by well constructed legal instruments. The second is that the enforcement of such a system is well resourced. I will deal with the resource issue first. A well resourced regulatory system brings about significant benefits to society. A cut to trading standards and environmental health is a cut to community health, a barrier to preventing crime, a boost to fraudsters and a shot in the arm for those who distort our economy and make it extremely difficult for honest enterprises to survive. In a survey by UNISON of more than 300 trading standards officers carried out in the last few years, over 95% of respondents said that they now had fewer staff, three-quarters said that they now undertake fewer inspections, 70% said that they had stopped providing some services altogether, 70% said that they did less preventive work and half said that they were less equipped to deal with new forms of scams in our digital age. That is hardly the picture of a healthy regulatory system. In addition, it is estimated that UK consumers spend 59 million hours a year trying to resolve disputes with traders, which costs our economy

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more than £3 billion a year. As the Audit Commission and Audit Scotland said in their 2013 report:

“The long-term viability of councils’ trading standards services is under threat and urgent action is needed to strengthen protection for consumers”.

As well as the day-to-day running of the service, there are the emergencies—those dreadful, nasty surprises such as the horsemeat scandal. The food industry was shaken to its core earlier this year by the adulteration of meat products. Members of the public, as well as Parliament, were calling for more resources, more sampling and for the service to carry out more unannounced checks. How will the Government avert a future adulteration of the food chain and how do they intend to strengthen our enforcement procedures? Is the Minister satisfied with the welcome but very modest budget set aside by BIS for kick-starting the additional work that trading standards has taken on in the new consumer landscape? I declare an interest as chair of the Consumer Codes Approval Board. Do the Government believe that the balance between local and national funding of trading standards is the right one?

While I have so far concentrated on trading standards, the story of our environmental health services—they, too, go back to Victorian times—is very much the same. UNISON’s 2012 survey of 4,000 environmental health officers found reports of increases in pest infestation, landlords cutting corners, poorer housing conditions, overcrowding and increases in disease. Using DCLG’s own departmental figures, we can compare spending for 2012-13 with the actual spending in 2010-11. We see the following very worrying changes. There are falls in spending of 8% on food safety, 6% on private rented housing standards, 28% on pest control, 14% on health and safety and 47% on port health—the officers at ports of entry monitoring possible contamination of food and so on following events such as the Fukushima nuclear incident in Japan. Moreover, 31% less was spent on animal health and infectious disease control. How do we deal with the next major incident of Legionnaires’ disease—or more importantly prevent it—with these figures in our heads?

At the start of my contribution, I suggested that two key pillars underpin our work in regulatory services: adequate resources and effective legal instruments. I wonder how the draft consumer rights Bill, much of which I welcome, can put forward a proposal to insist legally that trading standards officers give two days’ written notice before many inspections can be carried out. What self-respecting fraudster is likely to leave evidence on their premises when they know that there is going to be a visit from the trading standards officer? I would be interested in the Minister’s view.

In conclusion, some would say, perhaps indeed the Minister will, that the answer to saving these invaluable services in a time of unprecedented austerity is through reorganisation—maybe sharing organisational boundaries, having a regional solution instead of a local one, better procurement or outsourcing privately. While I am not opposed to many of these measures—indeed, some are simply common sense, and I welcome them —they are already being undertaken and they have their problems as well as their solutions. There is a big question mark over the ability of reorganisation alone

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to make up the shortfall in spending on these vital services. The accountability to our citizens that local government gives our regulatory services has long been a part of our democracy and I am sure that we would all want that to continue despite the times we are living through.

4.10 pm

Baroness Seccombe: My Lords, I have the honour to be a vice-president of the Trading Standards Institute, an organisation that I much admire, and so it gives me great pleasure to thank the noble Baroness, Lady Crawley, the president of the TSI, for securing this important debate.

The work of local regulatory services may not be an area of government that receives a great deal of attention when it is going well, but it is vital to upholding the rights of consumers, providing protection to the public and acting as a source of information to businesses and the community. Indeed, it is perhaps a sign of encouragement that we rarely see these services reach the national news for anything other than good news.

The noble Baroness, Lady Crawley, has highlighted the reduction in budgets in many services, but we have to remind ourselves of the climate under which this Government are operating. A horrendous fiscal deficit alongside an uncertain and shaky global economic climate has meant that tough decisions have had to be made in a variety of areas where many of us would not naturally wish to see less spending.

However, the Government have also been innovative in their approach. Spending less money does not necessarily mean a worse service or declining satisfaction. In many areas the Government have helped to identify new and more efficient ways of delivering services. A scrupulous review of all areas of government spending has allowed for innovation while protecting many taxpayers from having to increase their contributions to what, in many cases, was inefficient spending or unnecessary programmes. This has been particularly true in local government, which accounts for around £25 billion of the Exchequer’s expenditure. Does the Minister agree that the Government’s decision to freeze council tax has not only allowed households that are feeling the pinch to get some relief but also encouraged local authorities to look for new and innovative ways of delivering services?

Often without these budgetary pressures, similar organisations with similar remits can grow side by side without co-operation or without people taking the tough decisions that are needed. This is particularly true when it comes to consumer rights, an area of government that is obviously vital to protecting customers and business but in which many people used to get confused between the plethora of organisations involved, including the Office of Fair Trading and trading standards. Can the Minister clarify whether this duplication and confusion have now been clarified and, if so, whether this has improved the situation for consumers?