To ask His Majesty’s Government what assessment they have made of the number of people affected by malnutrition or undernutrition in England.

NHS Digital reported that between 2021 and 2022 there were 896 admissions with a primary diagnosis of malnutrition, and 9,828 with a secondary diagnosis of malnutrition. Malnutrition is a clinical diagnosis most often associated with underlying disease and is not primarily a result of an inadequate diet. ONS data shows that the number of deaths where malnutrition is the underlying cause is low, but we continue to train health and care staff to spot early warning signs.

My Lords, I thank the Minister for his reply. Age UK estimates that one in 10 people over the age of 65 is malnourished or at risk of malnutrition. The British Association for Parenteral and Enteral Nutrition estimates that 3 million people are affected by malnutrition or undernutrition, and 1.3 million of these are over 65. Can the Minister explain which of the Government’s policies have created this dire situation?

I do not think that any of the policies have created this situation. As I was quite clear with the numbers—which I will happily repeat—the primary cause of people being admitted is actually the result of another underlying disease; they are not there as a result of malnutrition.

My Lords, one group who are undernourished are hungry children from struggling families who have not had breakfast; yet government funding for school breakfasts reaches— at best—only about a quarter of children in the most deprived schools in England, according to Magic Breakfast. In the interests of hungry children’s education and health, will the Government expand their support for free breakfasts, at a time when both family and school budgets are under great strain?

I think we all appreciate the value of the Healthy Start initiative and the school lunch programme. At the same time, data from the national child measurement programme shows that the proportion of underweight children in reception is 1.2% and 1.5% in year 6 children, considerably below the 2% level expected in a healthy population.

My Lords, we have a virtual contribution from the noble Baroness, Lady Brinton.

My Lords, Healthy Start vouchers worth £8.50 a week are available for the lowest-income families whose babies are under the age of one. However, charities including BPAS are reporting that the price of infant formula milk has surged by over 20% this year, meaning that the vouchers are no longer sufficient to pay for the cheapest formula needed to safely feed a young baby. Will the Government increase the value of the Healthy Start allowance to £10 a week for these infants, to ensure that these babies can have sufficient nutrition to give them a good start in life?

I thank the noble Baroness. Clearly, a good start to life in terms of nutrition is vital. That is something that I will take away. We want to make sure that we are always up to date and that everything is right. As I said, the overall position, fortunately, is that we have lower levels than you might expect from a healthy population, but that is not to say that we are complacent.

My Lords, the House has been consistent and united in wishing to see the eradication of food poverty. Will my noble friend the Minister confirm that one of the ways we can do that is to reduce tariff and non-tariff barriers on imported food? I hope the House will be similarly united in wanting to have ambitious trade deals with India, the Trans-Pacific Partnership and the rest so as to remove tariffs that fall hardest on the people who are poorest.

Absolutely. Everything we can do to minimise the cost of food to make it affordable to the most people clearly will be welcomed.

My Lords, does the Minister accept that malnutrition is not just having too little food but eating the wrong food? A lot of the high-fat, high-sugar, high-salt and HBV food sold in our shops is really bad. Indeed, the Financial Times said the other day that 80% of a certain brand of chocolate’s products should not even be on the streets. One thing the Government could do is extend the take-up of free school meals by increasing the limit. At the moment, if you are on universal credit and you earn over £7,400 you are not allowed a free school meal; in Wales it is £14,000 and in Scotland they are free for primary schoolchildren. Could the Minister look at this as a matter of urgency?

The noble Baroness is correct. I learned something in this process, which is always good, which is that malnutrition can be undernutrition or overnutrition. Some of the debates we have had on obesity are absolutely part of this whole agenda. That is why I was pleased to see that the action we have taken to date has been very effective on obesity as well as in this field. At the same time, my understanding is that free school meals are at their highest level of take-up than they ever have been and they play a vital role in making sure that the diet of all our children is healthy.

My Lords, food banks across my diocese are reporting a huge increase in need and a huge decrease in the amount of food being donated, simply because of the cost of living crisis. One of the things that makes a difference for food banks is having enough capacity to freeze food. There is an urgent need to see whether we can help them with freezers. Is there anything the Government can do to work with food banks to help them increase their capacity for storing food when it is spare so that is available at other times?

I will need to look into that. I had the opportunity to speak to Sir Chris Whitty on this subject, given its importance. He related me back to an IFS study in 2008 that looked at the impact then of the economic crisis, in terms of what it meant for people and malnutrition. It found that it did not have an impact, so he is not expecting this cost of living crisis to have an impact on food poverty. That is not to say that we should not look at every measure that we can to make sure that there is plenty to go around.

My Lords, is something not missing from this debate, which is the same as the one we had yesterday about free school meals? It is any mention of family. At the end of the day, families have ultimate responsibility for their children. Without trying to undermine all the very good efforts the Government are making to help those families who need it, breakfast time can be not only nutritionally important but morally, spiritually and socially important for families. We must never forget the importance of supporting families to get on with that prime responsibility. Does my noble friend agree?

I totally agree with my noble friend. We all know that a good start to life is massively helped by families. At the same time, we appreciate that some families need a helping hand, and our Healthy Start programme and free school meals are all about supporting families where they need it.

My Lords, the spiralling cost of living is a major challenge to people being able to eat healthily. Evidence suggests that there is also a need to improve understanding of information about nutrition, as a borne out by the charity Bite Back 2030, which found that while 73% of young people think they are eating healthily, actually only 6% of them really are. What assessment have the Government made of the link between poor nutrition, misinformation and eating disorders among young people and how will they address this?

Clearly, education is a key part of this, and mental health is as well. As mentioned before, the root cause of people being undernourished is not their food intake but other things, such as mental health issues and eating disorders. I agree with the noble Baroness that education and the work we are doing in the mental health space are key.

My Lords, one reason for malnutrition in older people is the belief that weight loss is normal in older people. What are the Government doing to increase awareness that this is not the case and to ensure that weight loss is not taken for granted but is investigated further?

Local health and care providers are responsible for commissioning malnutrition services based on the guidelines to make sure that they can identify people who need help.

My Lords, given that the Government’s White Paper on food, published earlier this year, indicated that the Government have a central role to play in addressing health inequalities and a responsibility to provide a food environment that enables individuals to make healthier choices, will the Minister indicate what work, if any, is being done with the devolved nations and regions through the food data transparency partnership to reduce food inequalities and address malnutrition?

I am aware that we are working very closely with the devolved authorities. We worked with the devolved authorities on the regulations that we brought in recently, which were agreed by this House, about obesity and the placement of food in supermarkets. It is something we all take very seriously.