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Obesity

My Lords, I thank the noble Earl, Lord Howe, and the noble Baroness, Lady Barker, for their responses to the Statement. The points and issues that they raised highlight the challenge posed by the problem of obesity. As the noble Baroness pointed out, it is a challenge not just to an individual but to their family, their community and society. I want to cover some of the points raised first by addressing the issue of staffing in public health, and then I shall certainly come back to the issue of public health budgets. It is important to appreciate that the enlarged number of staff performing public health duties in the NHS and social care are, rightly or wrongly, not formally coded in our workforce; that includes health visitors, school nurses, general practitioners and other professionals who make a vital contribution to public health. The number of nurses in primary care in community settings has increased by about 40 per cent since 1997, with a 10 per cent increase in public health consultants between 1997 and 2006. Whether that is adequate to meet some of the challenges referred to in the Foresight report remains to be addressed. The report is a challenge to all of us. I am grateful to the noble Earl, Lord Howe, for his ideas and suggestions, which have been very much at the forefront of the recommendations. We have made great progress in breaking down some of the targets in school sports and setting out the standards for school food. I know from my experience of schools in my own environment that changing the content of school meals has been received unfavourably because most kids do not like what we put in front of them. That is a cultural challenge that we need to deal with. Primary care trusts were certainly notified of their revenue allocations for 2006-07 and 2007-08 in February 2005. The allocations separately identified funding to support the initiative set out in the White Paper, Choosing Health: Making Healthy Choices Easier. The PCTs need to determine how to use the funds allocated to them in commissioning services and meeting the healthcare needs of their local population. The balance between so-called national targets and locally decided priorities should be in favour of the latter. Although we have received a number of representations about ring-fenced funding, our position remains that the National Health Service must be free to make its own local spending decisions while we monitor their outcomes. That does not represent a less ambitious commitment—far from it. Our new ambition is bolder and recognises the need to go further and faster. It focuses on healthy weight, which allows us to tackle overweight as well as obesity. It also has more emphasis on overweight and obesity in the broader population while maintaining our priority focus on children. It also reflects the recognition of the need for long-term commitments, with joined-up action across Whitehall and society more widely. The noble Baroness, Lady Barker, raised the issue of bariatric surgery, an area in which I have practised and been involved in introducing keyhole surgery. The threshold in the acceptance of patients has significantly reduced. When I sit with my patients to counsel them about surgery, I always tell them that it is the last resort. Prevention is better than cure and we need to concentrate on efforts in targeting the populations at the highest risk. I wish to see that, rather than more patients referred to bariatric surgery. The market-driven forces across the pond in the United States has driven up bariatric surgery significantly, with growth rates of about 400 per cent, but I would not consider that an example of good practice.