Tag: Jo Churchill

The statement made by Jo Churchill, the Parliamentary Under-Secretary of State for Health and Social Care, in the House of Commons on 27 May 2021.

I beg to move,

That this House has considered implementing the 2020 Obesity Strategy.

I congratulate my hon. Friend the Member for South West Bedfordshire (Andrew Selous) on securing this important debate on something I know he is passionate about and about which I have met him on many occasions.

Currently 64% of all adults and 30% of children are classified as overweight or living with obesity. This masks the fact that in some areas the figure is as high as three in four adults. It is a complex issue that has a huge cost not to only the health and wellbeing of the individual but to the NHS and the wider economy. It makes individuals susceptible to a plethora of illnesses. Indeed, my hon. Friend the Minister for Care, who was at the Dispatch Box for the previous debate, commented to me that if we could get the general weight of the population down we would help people with more exercise and a better diet, as well as the health trajectory of those who live with dementia.

Covid has shone a light on why it is more important than ever that we need to get the nation healthy. Obesity is the only modifiable risk factor for covid-19 and a major modifiable risk factor for other diseases such as diabetes, cardiovascular, and some cancers—in point of fact, many. We are therefore at a teachable moment in which we can change attitudes, educate and influence drivers around less than healthy dietary and physical activity, and motivate behaviours so that they change. Helping people to achieve and maintain a healthy weight is one of the most important things we can do to improve our nation’s health, and we all have a role to play in meeting the challenge. It is complex. There is no silver bullet. There is no single source of responsibility. It will take action from all of us to work together to achieve our ambition—from the producer, to the processor, to the retailer, to the customer, with quite a dollop of influencing the environment through actions we in Government and in Parliament take and are taking.

Our strategy to meet the challenge, published last July, is far-reaching in its ambition. It reflects the significant work undertaken over the past four years to halve childhood obesity. Currently two out of every five children who enter primary school are overweight or obese. That number rises in the six years they are at primary school to three out of every five children.

Mr Mark Harper (Forest of Dean) (Con)

On the Government’s ambition, the Minister said very clearly, and it says in the strategy, that we want to halve childhood obesity by 2030. The strategy also says,

“reduce the number of adults living with obesity”,

although I looked and could not find a specific target. Is she able to set out what the Government think that trajectory should look like? What I am concerned about—she will see this when I make my remarks later—is that there are lots of practical measures in the strategy, but I am struggling to see how the Government will actually deliver the result, which is fewer people being overweight or obese. Having some milestones on that journey, rather than just waiting until 2030, would be helpful so we can judge whether it is working and make some course corrections.

Jo Churchill

I understand why my right hon. Friend is calling for milestones but, although the problem is a national one, there are different numbers for the proportion of the population that is overweight or living with obesity in each area. We can set milestones, but a national mile- stone may mask whether we are achieving what we need to achieve in the areas—often the more deprived areas in our communities—where we need to help, encourage, support and educate people to get them further on this journey. I will listen attentively to his contribution, as I always do, and then I may come back to him in my closing speech.

Three out of five children are overweight or obese by the time they leave primary school. We know that there is a direct correlation between the dietary habits picked up early in life and behaviour later on. We are working to create the right health environment to support people, and I will set out briefly some of the actions we are taking, starting with out-of-home calorie labelling. Restrictions laid in the House on 13 May will require large businesses in England with 250 or more employees, including restaurants, cafés and takeaways, to display calorie information for non-pre-packed food and soft drink items that they sell. Many have already gone some way in doing that. These regulations will support customers to make informed, healthier choices when eating out or purchasing a takeaway.

As I said, many businesses have articulated to me that they understand fully the importance of providing information and being proactive in leading the way. They recognise the demand from their customers for more information so that they can pursue a healthier lifestyle. Smaller businesses currently do not fall within the scope of the regulations.

We have also listened carefully throughout the consultation period to individuals and stakeholders who have the challenge of living with eating disorders. We feel we have been careful and sensitive and have put in reasonable adjustments to help that group. We have also exempted schools from the requirement to display calorie information, given the concern about children in school settings. We have included a provision in the regulations allowing business to provide a menu without calorie information on request.

Wera Hobhouse (Bath) (LD)

The Minister knows that I have had a number of conversations about calorie counting. What really concerns me is the evidence base for whether this will really reduce the number of people suffering from obesity. As she knows, I am very concerned about the effects on people suffering from an eating disorder, and so far there is no evidence that it will make a significant difference to those who suffer from obesity. Can she provide me with some numbers or assure me that there will be a constant watch on how this is actually affecting those with obesity?

Jo Churchill

If the hon. Lady allows, I will go through the rest of my contribution. I hope she will take away that this is about building blocks. As I said, it is a complex situation, and there is no silver bullet. We must look at the antecedents of both conditions, including the link to mental health for those who suffer from anorexia and certain other eating disorders, and at some of the broader challenges when we are looking at those who are overweight or living with obesity. They need to be taken in the round, but one cannot be cancelled out against the other.

Mr Harper rose—

Jo Churchill

I am going to push on just a bit, and then I will of course come back to my right hon. Friend.

We are also taking action to stop the promotion of less healthy products by volume and prominent locations online and in store. We want to support shoppers to purchase healthier options and shift the balance of promotions that way by maximising the availability of healthier products. We still need to eat, and we are not banning anything, but we are trying to educate, encourage and make people aware, so that they have the option of a healthier choice by default.

Last December, we confirmed that we will legislate on the promotion of foods high in fat, salt and sugar in stores and online. This will apply to medium-sized and large businesses—those with more than 50 employees—in England, and it will come into force next year. I would like to congratulate and thank those large retailers that are already taking these steps, because the argument is often put forward that it is unaffordable for a business to do this, yet many of the large retailers are doing it.

Richard Fuller (North East Bedfordshire) (Con)

I am grateful to my hon. Friend for outlining some of the measures she is asking businesses to undertake. She will appreciate that the last year has been very difficult for all businesses. As a Health Minister, she perhaps has not been able to have as much engagement with business, so would she take up the opportunity, ahead of the implementation in June, to come and visit Jordans & Ryvita, a cereal manufacturer in my constituency—she may have some familiarity with it—so that she can listen to its points of concern about the proposals she is making?

Jo Churchill

My hon. Friend and I have spoken about Jordans. Indeed, my first job was selling Jordans Crunchy bars at county shows when I was—oh—several decades younger. I will of course be happy to talk to him after this, but I would also gently point out that I have British Sugar, which is also in this food group, in my constituency. I not only meet its representatives on a regular basis, but I also met as lately as yesterday representatives from the British Retail Consortium and the Food and Drink Federation.

Mr Harper

The intervention I was going to make when the Minister was dealing with the hon. Member for Bath (Wera Hobhouse) was on the impact assessment for the regulations she mentioned. I have looked very carefully at the evidence, and it seems to me that the best case for these regulations is that we will reduce the number of calories consumed by 80, which is an apple, and the worst case will reduce it by about eight, which is a 10th of an apple. It seems to me that the cost of these regulations simply is not justified by the outcomes.

Because the Minister did not take my intervention at that time, she went on to talk about the legislation for promotions online, and I have looked at this. The Government’s goal for this legislation is that it reduces the calorie consumption by 8 billion calories. That sounds like a lot, but if we look at the number of children in the period that is spread over, it is equivalent to each child eating one fewer Smartie a day. Given that the children who have the most serious obesity problem are consuming up to 500 calories a day, reducing their calorie consumption by three calories a day simply does not do it.

The Government’s ambition is correct, but I just have a real worry that these particular measures simply will not have the effect that the Government and all of us wish to happen.

Jo Churchill

I am very glad that my right hon. Friend is joining me in the ambition of wanting to get the weight of the nation down. I would gently push back, and say that I do not recognise those calorie figures. I am sure we can have a longer discussion over where that evidence base is drawn from, and about the fact that there is actually a much greater impact. As I have pointed out on two or three occasions, this is about the building blocks of all these different measures coming together, and they will be monitored and assessed as we go through.

Another element of the environment is advertising. Currently, we are failing to protect children from over-exposure to high-fat, salt and sugar products via advertisements on both television and online platforms. I would gently say that if adverts did not influence people, they would not be used. Therefore, to help tackle the current situation, let us just see more advertising of healthy food. It always strikes me as quite interesting when watching a diet programme on the television that each ad break is often interspersed with adverts for high-fat, salt and sugar products. This does not affect the advertising industry’s revenue, because there is still a need to advertise and people still need to eat, but the foods advertised often do not reflect the balance that we need to enjoy a healthy life.

Richard Fuller

Will the Minister give way?

Jo Churchill

I am going to push on, I am afraid.

The Queen’s Speech on 11 May confirmed our intention to take that measure forward through the health and care Bill, and the Government aim to publish the consultation response as soon as is practicable. Many people objected to the sugar drinks industry levy, saying that it would mean a decline in sales. Five years on, we have seen a decline of around 44% in sugar in soft drinks. Revenue raised has often been diverted into sports activities in schools and so on, and sales have risen to over 105% of what they were in the beginning.

Information helps the consumer; it also helps manufacturers and retailers to look at diversifying their products, and much of the customer research, including the McKinsey report—I think it was put out by the Food and Drink Federation, but it might have been the British Retail Consortium—shows that this is the direction in which customers want retailers and manufacturers to go.

We want to take this measure into alcohol labelling, as well. As we know, each year around 3.4 million adults consume an additional day’s worth of calories each week from alcohol, which is the equivalent of an additional two months’ worth of food a year. Despite that, the UK drinks industry is not required to provide any information on how many calories each drink contains, and up to 80% of adults have no knowledge at all.

Action to ensure that people can make an informed, educated choice is what we want, and we will be publishing a consultation shortly on the introduction of mandatory calorie labelling on pre-packed alcohol and on alcohol sold in the on-trade sector. Once again, it is interesting to note that this labelling happens to a large degree with most low-alcohol content drinks and in many own brands, so the measure is merely about ensuring that customers can feel fully informed.

Turning to weight management services, on 4 March, we announced £100 million of extra funding for healthy weight programmes to support children, adults and families to achieve and maintain a healthier weight. More than £70 million of that will be invested into weight management services made available through the NHS and local authorities, enabling some 700,000 adults to access the support that can help them lose weight. It includes digital apps, weight management groups, individual coaches and specialist clinical support.

There has been a fantastic response from local authorities to the planned roll-out of these services. It shows the widespread need and support for helping people achieve a healthier weight and is an example of the importance of partnership in action. The remaining £30 million will go to: funding initiatives to help people maintain that weight, because we know that weight lost can often be quickly regained; giving access to the free NHS 12-week weight loss plan app; continuing the Better Health marketing campaign to motivate people to make healthier choices; improving services and tools to support healthy growth in early years and childhood; and helping up to 6,000 families and their children to grow, develop and have a healthier lifestyle and weight. In addition, we will invest in helping people access the weight management services and support they need through a range of referral routes across the health system.

We are also looking at incentives and incentivising healthier behaviours. We have committed £6 million to developing a new approach to health incentives. The aim is to support people towards adopting healthier behaviours. That work will be supported by Sir Keith Mills, who pioneered reward programmes such as air miles and Nectar points. It will look at the best innovation to motivate people drawn from not only the public sector, but the private sector.

Since it is critical that a child has the best start in life, we are also working to improve infant food and the information around it. We will consult shortly on proposals to address the marketing and labelling of commercial food and drink products for infants and young children—to reiterate what Dame Sally Davies has said, there is the halo effect, where we think what we are purchasing for our children is healthy, but potentially it is not—so that parents and carers can have clear and honest information that aligns with advice on the products that they feed their children and babies, giving every child the best start in life.

We are not alone in working to address the challenges of obesity; it is pretty much a global problem. The effect of collaboration internationally is critical for us all to learn. The UK has established effective working partnerships with, for example, Mexico, Chile and Canada, as well as international organisations such as the World Health Organisation. I have had discussions with some of my counterparts across the world, including those leading on measures such as health incentives. Through partnerships we share best practice and ensure our interventions are based on experience and the evidence.

Tackling obesity and helping people to maintain a healthy weight is, as I have said, an extremely complex issue, and that is reflected by the wide range of action we are taking. Of course, we would like to move more quickly and have a magic solution, and there is more that we want to do, but I recognise the scale of the policy we are bringing forward. It is a far-reaching and radical plan to reduce obesity in our society; I do not want us to carry on being second in a league table in which we should not be proud of being second.

The high prevalence of obesity in adults and children has been decades in the making. It is going to take time to see results from our interventions, and we may want to go back and change some of them. There is no single fix and no single point of responsibility. We all have a part to play and it is vital for us all—Government, Parliament, industry, employers, the health service, the wider public sector and all of us as individuals—to work together. I am really looking forward to what I anticipate will be a very varied set of contributions this afternoon.

The speech made by Jo Churchill, the Parliamentary Under-Secretary of State for Health and Social Care, in the House of Commons on 25 May 2021.

First, I congratulate my hon. Friend and Suffolk colleague the Member for Waveney (Peter Aldous) on securing time for this important debate. I also congratulate my hon. Friend the Member for North Norfolk (Duncan Baker), who for the second time today has spoken about the challenges of dentistry that we have.

As my hon. Friend the Member for Waveney said, this is not a new problem; it was a problem and challenge pre-covid. The pandemic has definitely shone a light, and things have become much more challenging in the world of dental provision during the pandemic. Dentistry has been significantly impacted because of the risks associated with the aerosol-generating procedure that dentists do and, obviously, with the saliva generated when someone is carrying out a procedure on someone else’s mouth. In response, dental practitioners have been required to wear full personal protective equipment to keep them, their teams and their patients safe.

Public Health England is reviewing the current guidance on infection prevention and control. I mention this because it goes to my hon. Friend’s point on fallow time—the time between the dentist putting their instrument down and cleaning down their room, and then seeing the next patient. These things have been big constraints in trying to have a rapid throughput of patients through the consulting room. Fallow time now is as low as 10 minutes in many cases, although that does depend on material factors such as the ventilation and so on.

I am talking to NHS England about the use of ventilation and the ability to support dental practices in putting ventilation in, but I gently point out that what sounds easy in a sentence in this place is often challenging. The buildings are not always owned by the dental practices, and in order to put ventilation systems in we have to take the rooms being used to deliver care out. So there is that combination of challenges, but there is new research on ventilation and lighting, and we are constantly looking at these things to see how we can further support the profession.

An important step forward has been to reduce the amount of time between seeing patients, in order to facilitate more care for more patients, but we have taken the action we have because infection control sits at the heart of what we have to do. I stress that because, with the variant of concern in some of our towns and cities around the country, we have to very mindful that we are looking for progress as to how we proceed with dentistry. I agree with much of what my hon. Friend said about making sure we are looking for opportunities, but we have to be mindful of the fact that we are not yet clear of this pandemic, and that brings enormous constraints.

The thresholds that have been set for dental practices since the start of the year have been based on data on what is achievable while also complying with infection prevention and control. My hon. Friend alluded to the 45%, which was the level of dental activity placed on practices in the fourth quarter of last year. That figure is now 60%, and 80% through orthodontics. This is the tension that exists in this whole area. Sixty per cent is still 40% lower than what we delivered in pre-covid times—obviously. The challenge is to make sure that we are able to see the backlog, that we drive forward with looking after the most vulnerable and those with the highest degree of need, and that we do not lose ground on what has gone before, while also having to deal with complexities such as retirements and contracts coming back and so on and so forth. However defective the 2006 UDA contract is, it is not just a question of swapping one for the other.

The current thresholds are monitored on a monthly basis, and the new thresholds have been put in place for six months. Dental practices have been asked to deliver as much care as possible, prioritising urgent care, particularly for vulnerable groups. They are delaying planned care, ensuring that they are dealing on a needs basis with those in the most acute need.

In addition to these activity thresholds, NHS England has provided a flexible commissioning toolkit. I am very keen for the profession to get real-world examples of what can help deliver the service, based on the successes that have been achieved locally. Some of those successes have been achieved in our own particular area. Flexible commissioning is used to convert units of dental activity, or UDAs as my hon. Friend has referred to them, to activity that focuses on priority areas, such as improving access to urgent care, or targeting high-risk patients, which was exactly what he was asking us to look at in his speech. We are already doing that. It is good practice and regional commissioners can implement it. I am very keen to make sure that that practice is being used as much as it possibly can be. I am having very frequent discussions with NHS England to make sure that we are monitoring the use of these measures.

As well as flexible commissioning, support is also available to local NHS commissioners to put that capacity where we need it most. In the east of England, NHS England has developed the transformational dental strategy, the aim of which is to prioritise urgent care, prevention and inequalities. Despite our efforts to increase services, we know that patients are still experiencing acute difficulty in finding an NHS dentist—that is also true in my constituency.

A feature of the debates that we have had today is the availability of private provision in areas where there is no NHS provision. NHS England is charged with commissioning to the need in an area. Making sure that we commission to the need in an area is something that contract change, which I am very keen to see delivered by April 2022, addresses, but it is highly complex. I have met stakeholders in the UK. Some people suggest that the Welsh system is better. Others favour the French system or the one that exists in some of the Scandinavian countries. I have met members of the dental profession from all those places and, actually, no one has a perfect system. We are trying to take what is good about the various systems and ensure that we deliver in localities so that people can have access to care when they need it, with a particular focus on prevention.

We have a web-based programme in the east called service provider, which provides up-to-date information on dental services that are available. Patients experiencing difficulties are able to contact NHS England’s customer care centre and call 111 for help in accessing emergency dental care. All NHS dental practices in the east of England have been asked to reserve at least one slot per day for urgent dental care to improve capacity and, as my hon. Friend the Member for Waveney said, allow greater access. In addition, we have not stood down the 600 urgent dental centres that we had across the country during the height of the pandemic; we have left those in place, and we have a network of them across both Norfolk and Suffolk.

However, we know that information on NHS dentists is not always easy to access. Alongside increasing access for patients, it is crucial to support NHS dental practices and mixed practices—and, arguably, private practices—in order that we can start to have a more balanced approach. As my hon. Friends the Member for Waveney and for North Norfolk mentioned, part of the challenge that we have is retention. That is the case particularly in our area, but it is something that I have discussed with Cornish colleagues too; my hon. Friend the Member for St Austell and Newquay (Steve Double) and I have discussed at length how the problem is not unique to the east of England.

Practices have continued to receive their full contract payments minus agreed deductions, providing that levels of activity are met. An exceptions process has also been put in place for practices that have been disproportionately impacted by the pandemic. It is wrong to say that we want anyone to feel that they are not supported to deliver what they can. We have also made personal protective equipment available free of charge through a dedicated portal; and as of a week ago, we had delivered more than 367 million items free to dentists, orthodontists and their teams.

If it has done anything, the pandemic has continued to highlight the fact that transformation in dentistry is necessary, particularly if we want to make sure that we drill down on the oral health inequalities that exist across the country. I am meeting the chair of Healthwatch tomorrow, and I am sure that, among other things, we will discuss access to dentistry at some length. We need to develop a sustainable, long-term approach to dentistry that is responsive to the population. It needs to provide high-quality, urgent treatment and then restorative care where clinically necessary, but prevention must sit at its core.

The majority of oral health failures are preventable. My hon. Friend the Member for Waveney spoke about children. There is nothing more upsetting than a child being in acute pain and having all their teeth removed. That is a broader problem. Through flexible commissioning, we can ensure that we are doing supervised tooth brushing by encouraging local authorities to put that in, but we can also enable parents to do their part and ensure that they can help their children learn good habits right from the early days. Parents can encourage their children to look after their teeth by rubbing their gums before their teeth even appear, making sure that they understand how important it is.

In addition, any system that we design must improve patient access and oral health, and offer value for money for the taxpayer. It must also be designed in conjunction with, and be attractive to, the profession. NHSE is leading on dental contract reform work. Importantly, it is engaging with stakeholders, including the ADG, which my hon. Friend spoke about. It will be looking at what changes can be made to dental contracts in the short term to offer some improvements and some relief and respite to everyone, while details of the next stage of reform will be agreed by April 2022. Making NHS dental contracts more attractive to the profession will help with vital recruitment and retention, and I know that all my hon. Friends in the Chamber, particularly across rural and coastal areas, will welcome that.

Health Education England’s Advancing Dental Care programme has also been exploring opportunities for flexible dental training pathways and how we train our dental workforce to improve recruitment and retention. I am also very keen to make sure that we use the broader dental team as efficiently as we can, because dental technicians, dental nurses, hygienists and so on hold many skills that, particularly, could be used for prevention. However, with another hat in my portfolio on, I think of the obesity agenda and making sure that we all look after ourselves a bit better and have healthier lifestyles. Everything that we consume goes in through our mouths. Dentists are wonderfully placed, as are their teams, to help to encourage us to have a healthier lifestyle and to eat a little less sugar.

We remain committed to prevention and improving oral health, and I am pleased that my hon. Friend the Member for Waveney supports—I think, from his asks—the direction that we are trying to go in by changing the UDAs, concentrating on making sure that we have the skill mix right, focusing on prevention and looking at retention. As he said, however, this is a complex area. I am also having discussions with the GDC—he spoke about recognising dentists who have trained overseas and making sure that once we are assured of standards of education and so on, things are a bit simpler.

On making sure that we can expand schemes, subject to funding being secured and consulted on, I want to look at the expansion of fluoridated water. As my hon. Friend said, it is one of the simplest ways that we can improve oral health intervention, and we could significantly improve children’s health across the country. It is unacceptable in this day and age that young children have total dental clearances due to preventable tooth decay. The return on investment on fluoridation is very compelling and there needs to be a renewed focus on the investment in prevention.

We are committed to increasing dental access both in the short and the long term so that we can ensure equality of access no matter where in the country a patient lives. But this is complex. We are working hard at it. We are working with the profession, but we all need to double down both on prevention and making sure that we are all walking in the same direction to bring accessible oral healthcare to people.