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Public Health

Volume 454: debated on Tuesday 5 December 2006

I inform the House that I have selected the amendments in the name of the Prime Minister in both of today’s debates.

I beg to move,

That this House notes the Government’s failure to improve public health outcomes and to reduce health inequalities; believes that the gap between the public health of the UK and that of comparable health economies is unacceptable; identifies obesity, smoking, sexually transmitted disease, infectious disease control, teenage pregnancy, alcohol and substance abuse, the promotion of healthy lifestyles and screening for treatable disease as areas of particular concern; supports frontline staff striving in adverse circumstances to improve the health of the nation; is concerned about the shortage of public health staff due to the Government’s financial mismanagement; joins with the Chief Medical Officer in condemning the use of public health funds to tackle NHS deficits; and calls on the Government to ensure that funds for public health are spent on addressing remediable health issues.

The Secretary of State has called me to explain that she would be unable to be here, and I quite understand why that is so. We hope that we shall see her later in the debate. I understand that the Under-Secretary of State for Health, the hon. Member for Bury, South (Mr. Lewis), will reply to the debate, and that the Minister of State, Department of Health, the hon. Member for Don Valley (Caroline Flint), will lead for the Government—

Yes, I admire them personally; it is politically that I have a problem.

It is five years since we last had a debate on public health on the Floor of the House. That debate was also on an Opposition motion. Today, we want particularly to look at the Government’s record on public health, two years after their White Paper and four and a half years after the Wanless report was produced for the Treasury. Tomorrow, the Chancellor of the Exchequer will come to the Dispatch Box and present his pre-Budget report. The Treasury has also received a tranche of other reports, including the Eddington report, the Leitch report and the Barker report, which was published today. I guess that the Cooksey report will be published tomorrow. The Chancellor is very good at commissioning reports. The day before his pre-Budget report, let us see how good he is at ensuring their implementation.

Two years after Derek Wanless published his report to the Treasury, he looked at what had been achieved. Let us remind ourselves how important this matter is. His report set out to the Treasury and the public that, looking forward 20 years from 2002, if the NHS were able to achieve what he described as a fully engaged scenario in which productivity improved and technology was fully utilised in the NHS, and in which the public were fully engaged with their own health,the NHS would be spending £154 billion a year. If, however, the worst case scenario—that of a slow uptake—applied, in which those things did not happen, the figure would be £184 billion. There would be a£30 billion difference. He also expressed the difference in terms of life expectancy, predicting a difference of 2.9 years for men and 2.5 years for women by 2022.

The NHS has not achieved the productivity gains that Derek Wanless set out. We also know from the repeated delays and confusion surrounding the connecting for health NHS information technology programme that technology is not being taken up in the NHS in the way that he anticipated. I want to focus, however, on the simple fact that we are not achieving that public health objective.

In 2004, the final Wanless report said:

“the challenge now is delivery and implementation, not further discussion. An NHS capable of facilitating a ‘fully engaged’ population will need to shift its focus from a national sickness service, which treats disease, to a national health service which focuses on preventing it.”

In 1997, the Government said that there would be a new public health drive. Yet again, we have seen good intentions but a failure to deliver.

The hon. Gentleman mentions Mr. Derek Wanless. May I mention to him another gentleman, Professor Alex Markham, the chief executive of Cancer Research UK, to whom I spoke a couple of weeks ago? He said about the smoking ban:

“This is the most importance advance in public health since Sir Richard Doll identified that smoking causes lung cancer fifty years ago.”

Does he agree with Professor Alex Markham?

The smoking ban is important, and it was a decision reached by Parliament, not by the Government. On the day of the vote on the smoking ban, the Secretary of State for Health said in the morning that she would vote for an exemption for clubs, but by the afternoon she was voting against that. The Government will not get any plaudits for that ban.

If the hon. Gentleman does not mind, I shall answer the hon. Member for Dumfries and Galloway (Mr. Brown) first.

We must bear in mind the reduction in mortality rates from cancer, which have been sustained over a period of time, but at broadly the same trend rate. In which period of time was the reduction in the prevalence of cigarette smoking among adults the greatest? The answer is: from 1980 to 1990, when it reduced from 39 to 29 per cent. In the eight years since this Government came into office, it has reduced from 28 to 25 per cent. The previous Government set a target to bring the prevalence of smoking down to 20 per cent. by 2000. That was not reached, and it has not been reached since. If the hon. Member for Dumfries and Galloway is saying that smoking has been historically the most preventable cause of death, he is right. Action on it is necessary.

Does the hon. Gentleman think that allowing tobacco advertising will reduce the prevalence of smoking, given that he and his colleagues voted against the Bill to ban it in 2002?

My hon. Friend reminds me from a sedentary position that we did not vote against it on Third Reading—[Interruption.] If the Minister wants to tell us about smoking, let us deal with that.

Smoking rates are not falling as quickly as they did in the 1980s. Among young women in particular, smoking has not decreased as it ought to have done. This year, did the Government have a national campaign to coincide with national no smoking day? No, they did not. The two preceding years saw a 50 per cent. and a 40 per cent. increase in quit rates in the first quarter as a result of such campaigns. This year, in the absence of such a campaign, quit rates decreased by10 per cent. in the first quarter and calls to the helpline decreased by 30 per cent. Does the Minister wish to tell us why the Department of Health did not have a national campaign to promote giving up smoking this year? That campaign has not happened.

In light of the pervasive cynicism about politics and politicians, and given that it is important that we should practise what we preach, does my hon. Friend agree that the Smoking Room of the House should be renamed and the practice there prohibited?

I am always so grateful to my hon. Friend for his questions. Happily, I am not responsible for any House of Commons matters and will not venture into that territory.

Obesity is now the single most preventable cause of premature mortality. Since 1997, obesity in men has risen from 17 to 23.6 per cent. and obesity in women has risen from 19.7 to 23.8 per cent. In 1998, the Government abandoned the target that existed before 1997, but the Labour party’s 1999 public health White Paper mentioned obesity only once in the context of it being a risk factor for coronary heart disease. It had no strategy for dealing with obesity.

In July this year, the Office for National Statistics published the time use survey, which looks at how people spend their time. Its results astonished me.

Let me explain the point first.

In that survey, 15 per cent. of adults in 2000 said that they spent some proportion of their time during the day in sport and outdoor activities. By 2005—just five years later—that had fallen to 10 per cent. While there has been a complete absence of any strategyto promote physical activity on the part of the Government, what are we getting instead? A dramatic reduction in the number of adults engaged in physical activity, especially sport. Lottery funding for sporthas reduced from nearly £400 million in 1998 to£264 million.

I shall give way to the hon. Member for Northavon (Steve Webb) first.

The reduction of lottery spending on sport by a third has occurred at precisely the same time as a dramatic reduction in the number of people engaged in sporting activity.

On the subject of how people use their time, I take the hon. Gentleman back to how he used his time in May 2005, when he was a passionate advocate for the patient’s passport. Will he explain what impact that would have had on public health?

No, because we are debating public health now.

The Minister told us this morning about pilot projects that deal with physical activity. I am happy that we have had the local exercise action pilots. I am also happy that they have demonstrated some success. However, I am surprised that the Government thought that exercise referral schemes only happened in the context of their pilots.

In a moment.

Representing the constituency that I do, I am sure the Minister will be aware of the south Cambridgeshire physical activity strategy and the exercise referral schemes in the area, which is part of an evaluation conducted with the Medical Research Council’s epidemiology unit. The proposal for that evaluation said:

“A recent review of evidence on exercise referral schemes that included the findings of a Cochrane review reached the following conclusions”.

I shall quote just the first one:

“Exercise referral schemes showed positive moderate sized effect on increasing self-reported physical activity in the short term but evidence of sustained effect beyond 12 months was lacking.”

That is why the evaluation is taking place.

I looked at the so-called evaluation that the Government published with their pilot this morning. It says:

“Overall the data supports the view that exercise referral is an effective intervention for initially engaging and facilitating physical activity change in adults and older adults”.

This is typical of the Government’s gimmicks. We know that physical activity among older adults in particular gives benefits. What we want to know is what schemes are likely to deliver sustained benefits that justify the investment. Those benefits may well justify such investment, but the Government parade, as they always do, the fact that they have done something. They say that there is an evaluation. We know that it has not been sustained beyond 12 months. The Government do not talk about an evaluation that will assess whether exercise referrals work and in what circumstances because, lo and behold, they are happening in south Cambridgeshire.

I thank the hon. Gentleman for finally giving way. As he knows, I have a passion for sport and physical activity. Representing Loughborough as I do, I must not only engage in such activity, but take great pleasure in doing so. Does the hon. Gentleman accept that the last Government’s record—up to 1997—was pretty atrocious, especially in relation to school sports? I admit that this Government took some time to recognise school sports’ full value, but will the hon. Gentleman acknowledge that the investment now being made—two hours of sport per week within the curriculum, possibly four hours by 2010—will make an enormous difference to the future? Will he apologise for the last Government’s record and confirm that enormous strides are now being made, while even greater advances are being achieved in adult sport?

I am glad the House has been spared the need for a speech from the hon. Gentleman, but I do not accept what he has said. The Government said in 2001 that there would be two hours of sport a week for all school children. Currently 80 per cent. of children are getting those two hours, which include preparation and playground time but not actual engagement in competitive or any other sport.

I do not dispute the value of the objective. My hon. Friends on the Culture, Media and Sport team have been first-rate proponents of the delivery of not just sport but competitive sport in schools, and I think it important too. Loughborough notwithstanding, my eldest daughter is reading sport and exercise science at Exeter, my old university; I think that Exeter will serve her rather well.

My hon. Friend is making an excellent speech. On Saturday, I visited the Bollington leisure centre in my constituency. Those in charge of the gymnasium told me that a number of general practitioners were referring elderly people to the gym on prescription, because their health would benefit. Does my hon. Friend approve of that? I believe that such prescription by GPs is a very worthwhile endeavour, and should be extended.

I will pass my hon. Friend a copy of “Fitness 4 Health”, a leaflet which advertises the south Cambridgeshire exercise referral scheme, supported by both the primary care trust and the local authority. In 2004-05, the 176 local health professionals registered with the scheme made 430 referrals. It was particularly important to those with type 2 diabetes.

I entirely agree with my hon. Friend about the importance of such schemes; I do not underestimate it. I am merely saying that the Government should not get away with claiming that they somehow invented exercise referrals, or that they have evaluated them. The same things are happening elsewhere.

We have not yet talked about obesity in children, but that situation is also deteriorating seriously. There has been a 50 per cent. increase in the proportion of boys with a body mass index over 30, and a 40 per cent. increase among girls. Our children are getting fatter faster than children anywhere else in Europe. That returns us to the point made by the hon. Member for Loughborough (Mr. Reed): we need more sport in schools, and also outside them. Conservative Members are committed to ensuring that sport receives lottery funding, but it must be increasingly well used.

I entirely agree with the hon. Gentleman that childhood obesity is the big issue that we must face, given a trebling in the number of obese children over the past 20 years. Does he agree that one way of tackling the problem would be a meaningful ban on the advertising of food that is high in fat, salt and sugar, which should begin at the watershed so that no advertisements for such foods appear until 9 pm? Parents and others understand what the watershed means, and could protect their children from such pernicious advertisements.

I personally think that Ofcom has launched a very sensible consultation to which it is right for us to respond, but there is a bigger deal: enabling parents to construct a good diet for their children. That is absolutely central.

Advertising might have a part to play, but getting the diet right, and parental control of children’s diets, is instrumental. When the former Secretary of State launched the White Paper in November 2004, I said that it was wrong to have a simplistic traffic-light system and that it would be better to have a system that was geared to guideline daily amounts. The Government have now accepted that proposition. They abandoned what they said in November 2004 but so much time has gone by, in which so many retailers and food manufacturers have brought in competing systems, that we continue to have confusion. It would have been much better if the Government had listened to us in the first place and had put in place a system that was GDA-related and used traffic lights, and which could have commanded greater support in the food manufacturing community.

In relation to parents, children and food, the hon. Gentleman will remember the incidents in September at a school in Rotherham when some parents tried to defeat the healthy menu that had been introduced by feeding food through the school railings. Does the hon. Gentleman agree with his colleague, the hon. Member for Henley (Mr. Johnson), who serves as a shadow Education spokesman, and who declared:

“I say let people eat what they like. Why shouldn’t they push pies through the railings?”

No, I do not. I think schools have a responsibility for the food that is provided at school—but, frankly, parents have an even greater responsibility.

There is a great deal that we can do. There is not a lot of disagreement on this subject in the House. We want to make sure that there are fresh foods that are freshly prepared in schools—and if that is not possible as many schools do not have kitchens, technologies and opportunities are increasingly available for fresh food to be prepared elsewhere without it having to be cooked on site, and we should use them.

Let us look at the Government’s record on sexual health. There is an epidemic of sexually transmitted infections. That was not the case up until the mid-1990s, particularly because of the tombstone campaign—the 20th anniversary of the launch of that campaign by Lord Fowler and the then Government is a couple of weeks away. That showed what is possible when a national campaign is conducted that is designed not only to focus on those who are at risk but also to change the surrounding culture. Not only did we have the best record in Europe on prevention of HIV infection, but we had a substantial reduction in other sexually transmitted infections.

What have we had since? Chlamydia is up 147 per cent; syphilis is up 1,653 per cent; and HIV infection is up 111 per cent. The Government have recently promised £50 million for sexual health campaigns but they are actually spending only £3.6 million on them. In the early 1990s, the then Government were spending £15 million a year in real terms on the sexual health campaign. That figure has now fallen below £5 million.

The failure of public health campaigns nationally and the failure to invest in sexual health campaigns is matched locally by deficits in the NHS. That has led to cutbacks in sexual health services in the East Riding of Yorkshire, which is suffering precisely the epidemic that my hon. Friend has been talking about. My constituents want to hear answers this afternoon from Ministers who have let the public down.

That is precisely the point. When Ministers published the White Paper, they said that, in one respect, there would be ring-fenced budgets. That was supposed to be the case for sexual health, which was turned into one of their six priorities. The Department of Health—strictly speaking, I should say the independent advisory group—did its own survey. It went to 191 primary care trusts: 33 of them admitted that they withheld some or most of the funding; 51 said that they absorbed the entire allocation into their general budgets; and 31 said that they were withholding funding from chlamydia screening. On the latest data, only 36 per cent. of primary care trusts have been conducting chlamydia screening, but the figure for that is supposed to be 100 per cent. by March next year. The sexually transmitted infections record is disgraceful compared with that of the past.

I am very interested in the reel of statistics that the hon. Gentleman has given. He seems to be advocating that targets are necessary: targets relating to sexual health and targets for the NHS. I thought he was against targets.

The hon. Gentleman has not been listening. We are against top-down targets that impact on the services that clinicians provide. We are not against public health targets; I have never said that I am against public health targets.

The last Conservative Government had targets. [Interruption.] Perhaps Government Front Benchers would care to listen. Targeting ought to be an instrumental part of the performance-management process. It is not the job of the Department of Health to performance-manage individual hospitals, trusts and health care providers on the front line. It should be the job of the Government—when we are in government, it will be—to deliver on public health, so when in government we will set targets that we will impose on ourselves, and against which we will be measured. In 1992, Virginia Bottomley, the then Secretary of State, published “The Health of the Nation” White Paper, which was regarded as the model of its kind—the first public health White Paper from a major Government. Yes, it set targets, which was the right thing to do.

The Government’s teenage pregnancy target is another that they are not going to meet. We are well below the necessary trend; indeed, our teenage pregnancy rates are not only the highest in the EU15, but the highest by a long way. Yet out in the field—in places such as Bexley—family planning clinics are being withdrawn and emergency hormonal contraception is being removed from pharmacies. The teenage pregnancy budget in Coventry has been cut by 12.8 per cent., and 15 related posts are going to go.

On funding, surely the hon. Gentleman accepts that if his party had had its way, primary care trusts would not have had the additional funding that they received because his party voted against it.

That is another example of the limited number of Labour MPs who trouble to come to our health debates not even listening. We have made it repeatedly clear that we have committed ourselves not only to resources for the national health service, but to ring-fencing public health budgets. We are fools to ourselves if we increase resources for the NHS, but do not ensure that such increased resources lead to primary prevention and awareness-raising, so that we can reduce future demands on the NHS.

Will the hon. Gentleman explain to the House this afternoon what advice he is going to give to the Government, so that they can prevent our constituents from having unprotected sex? Unless he can explain that, I am afraid that he is not getting to the heart of the problem.

That, from a Government who abolished the Health Education Authority—terrific!—who have a record on public health of modest, limited expenditure on targeted campaigns, but who never do the thing that experience suggests is absolutely necessary: changing the culture and the climate.

We do not need to look into a crystal ball—we have experience. There is a book showing that there was a time, in the mid-1980s, when a campaign changedthe culture regarding protection against sexually transmitted infections. The next campaign will not be the same, but we must have ring-fenced budgets that are, in part, used nationally to deliver such a culture change.

The hon. Member for Portsmouth, North (Sarah McCarthy-Fry), who has a genuine interest in this issue, might like to consider that, by helping to change the associated culture, the number of instances of drink-driving by young men was successfully cut by two thirds in two years. Money matters, but so does the culture. Does my hon. Friend agree that if the Labour Members who keep intervening on him looked at the last two lines of the Government’s amendment to our rather good motion, they would notice that the Government’s justification for cutting funding for the south coast and elsewhere by about £400 per person is denied by that amendment, for which they will vote? According to that amendment, the differences in morbidity and mortality will be addressed by other issues. The Government might like to give that money to the south coast, so that we can keep our hospitals and accident and emergency departments and treat people where they want to be treated.

I understand the point that my hon. Friend makes; however, he will forgive me if I do not take a long detour in that direction.

It is absolutely right that we ring-fence public health budgets, and part of the reason for doing that is so that they can be set at levels proportionate to the measures and programmes that are proven to have effect, in order that we can deal with health care outcomes directly. That does not mean, however, that that is the only way of dealing with health outcomes—far from it. As colleagues in all parts of the House have made clear, in order to deal with poor health outcomes we must address a range of issues, such as relative deprivation, socio-economic status, poor housing, and diet and nutrition, among many others.

My hon. Friend mentioned alcohol. Alcohol-related deaths have doubled in the past 14 years and there was a 30 per cent. increase in alcohol-related hospital episodes between 1997 and 2004. Professor Roger Williams, a leading hepatologist told me:

“The situation is terribly worrying. We are seeing every week young women with end-stage or very severe liver disease and we never used to see as many before.”

Then there is drug abuse. The number of people using class A drugs frequently has gone up by a third, from 1.1 per cent. in 1998 to 1.6 per cent. in 2005-06. On cannabis, the Department of Health has had no influence on policy. If it had, Health Ministers would have persuaded their Government colleagues that sending the kind of messages they put out on cannabis use is deadly dangerous. There will be an epidemic of schizophrenia if young people in their teenage years—many with a predisposition towards that disease in such circumstances—continue to take cannabis at current rates.

I share my hon. Friend’s concerns about the effects of cannabis. Will he also highlight concern about the lack of attention given to alcohol abuse? The Department of Health’s estimates show that about £1 of every£3 spent on accident and emergency treatment may be related to alcohol misuse. Is not it a scandal that the National Treatment Agency for Substance Misuse has no dedicated funding for alcohol rehabilitation and aftercare services?

I agree with my hon. Friend, who makes a good point, but if he will forgive me I shall move on as I want to speak for only about 10 minutes more.

When we consider infectious diseases, we find that HIV has more than doubled and that there has been a 20 per cent. increase in tuberculosis reports in England in two years. In 2001, Ministers promised a strategy on hepatitis C by the end of the year. It was not published until July 2004. According to the Government’s estimates, a minimum of 200,000 people are infected with hepatitis C but are undiagnosed. Failure to treat them could lead to 100,000 patients with end-stage liver disease some years hence.

As the hon. Gentleman knows, hepatitis C is primarily caused by intravenous drug use. In his discourse, will he outline precisely what his party’s drug policy is, especially in relation to intravenous drug use?

At the last election, my party was clear about our determination to put resources into drug rehabilitation and to present drug users who enter the criminal justice system with a clear choice: either the criminal justice system would take responsibility for them or they would move into drug rehabilitation.

No, I shall not give way again.

What has the Department of Health been doing about infectious diseases over the last year? Statistics issued by the Department last week showed that between 2004-05 and 2005-06 its net expenditure on infectious diseases went down from £1.5 billion to£1.2 billion, which includes the 20 per cent. reduction in the budget of the Health Protection Agency. Given the agency’s current work, one wonders how sensible that reduction was.

The public health budget is not just for primary prevention, but for secondary prevention. The Government’s amendment refers to bowel cancer screening. By the end of December, 500,000 people should have been screened through the new bowel cancer screening programme; the number will actually be only 100,000.

Two years ago, the Government’s White Paper described how pharmacies would be used to roll out new ways for people to access screening services. Only 1.5 per cent. of pharmacies across the country have been commissioned to provide local enhanced screening services. Only 26 per cent. of pharmacies have been commissioned to provide stop-smoking services. During the local elections I visited a pharmacy in Havering—in the constituency of my hon. Friend the Member for Romford (Andrew Rosindell)—and the pharmacist told me that they were in the middle of providing smoking cessation services but had been told to stop because the primary care trust had withdrawn the budget. It is all to do with finances.

We have talked about the smoking ban. Rightly, we concluded that we might save 1,000 lives that way. The bowel cancer screening process might save more than 1,000 lives. Breast cancer screening saves perhaps 1,000 or 1,500 lives a year. What about abdominal aortic aneurysms? Where is the Government’s action on that? Some 2,400 people with ruptured aneurysms go into accident and emergency departments every year; 50 per cent. of them die. What about men who are over 65? A Gloucestershire pilot—I do not know whether the hon. Member for Gloucester (Mr. Dhanda) is present—looked at a screening programme. It is straightforward and involves an ultrasound that is like the ultrasound that pregnant women have during the course of antenatal care. Research on that was published in 2002.

The National Screening Committee said, yes, we should have such a programme. The Minister’s predecessor said that there was going to be an action plan by the end of 2004. It is now the end of 2006. More than 1,000 lives are lost a year from ruptured aortic aneurysms, but there is no screening programme. The Government, through the White Paper, buy 1,200 health trainers, for which there is no evidence base. We have an evidence base for saving lives through a screening programme, but the Government are doing nothing.

No, because I am about to conclude.

In all the ways that I have described, public health has lacked priority and urgency. The Government produce document after document. There is a stack of them. I have a pile of them here and another pile back in the office. However, as Derek Wanless said, we need delivery and implementation, not more discussion. We need research so that there is an evidence base for what is being done. Derek Wanless has agreed with the Conservative party’s policy. I said before the election that we need a Secretary of State for public health, not just a Minister for public health. We need the Department of Health to focus on public health. We need a ring-fenced public health budget and an enhanced chief medical officer’s department. We need directors of public health, jointly appointed by local authorities and the primary care trust, who have those ring-fenced budgets—

No, I am about to finish.

Those people should have the opportunity to use those budgets, using an evidence base, to deliver right across not just the NHS, but the public and private sector. As Professor Liam Donaldson, the chief medical officer, said in his report, which was published this July, we need the public health work force to know that it is supported in that way. He said:

“There is strong anecdotal information from within the NHS which tells a consistent story for public health of poor morale, declining numbers and inadequate recruitment, and budgets being raided to solve financial deficits in the acute sector.”

Frankly, even since he wrote that, the reorganisation of primary care trusts, which Ministers said would not lead to a reduction in public health staff, has led to precisely that. More jobs have been lost among the small number of qualified public health staff. At the end of his article, Professor Donaldson said:

“It is time for things to change.”

That is indeed the case. We need a Governmentwho are focused on public health, who bring the Department of Health’s focus on to that, and who achieve that change. I commend the motion to the House.

I beg to move, To leave out from “House” to the end of the Question, and to add instead thereof:

“welcomes the Government’s trebling of investment in the NHS by 2008 which is crucial to improving public health and tackling health inequalities; notes that this extra investment has enabled a huge expansion in preventive services including extending breast cancer screening to women aged 65-70 which has helped increase the number of breast cancers detected by 40 per cent. since 2001 and the first ever national bowel cancer screening programme which will detect around 3,000 bowel cancers a year when fully rolled out; acknowledges that this Government has done more than any previous government to help people give up smoking, including banning smoking in all workplaces and public places from 1st July 2007; further welcomes the help and support being given to people to live healthier lives including two million 4 to6 year olds now receiving a free piece of fruit or portion of vegetable, new healthier standards for school meals, clearer food labelling, new health trainers and NHS life checks; and recognises the unprecedented action this Government has taken to tackle the root causes of ill health and health inequalities including helping more people find work, lifting a significant number of children out of relative poverty and taking action to tackle poor housing.”

I ask the House to pity Opposition Members, who have to attempt coherent speeches after the confusion, hypocrisy and brass-necked cheek to which that we have just been subjected. The hon. Member for South Cambridgeshire (Mr. Lansley) springs forth with the zeal of a convert to public health, but his conversion to public health is rather like that of an Ebenezer Scrooge who has been awoken in 2006 to the need to changeby the nightmare of a Tory Christmas past. The nightmare reminded him of all that his party could have done with nearly two decades in power, and all that it did to undermine the public health of this country.


The Conservatives were the party that reduced the standards for building public housing; they removed nutritional standards for school meals; they offered a paltry £10 Christmas bonus to pensioners; and they had a cold weather payments system understood only by the weather man, leaving old people unprotected. Perhaps the ghost haunted the hon. Gentleman with memories of the tripling of child poverty and the doubling of pensioner poverty. Let us not forget that the Conservatives reintroduced mass unemployment into British society and presided over recessions and repossessions, with all of the health consequences that followed, thus consigning a generation to the scrap heap.

Although the hon. Gentleman did not mention health inequalities today, he has done so in the past, so I give him credit for that.

I stand corrected. Perhaps the hon. Member for South Cambridgeshire did mention health inequalities in his speech. However, when his party was in power, the phrase never passed the lips of Tory Ministers, who preferred to talk about “health variations”. Labour Members have not shied away from tackling the underlying causes of poor health, however challenging they are. There are no short-term fixes, but there is certainly no excuse for inaction.

I will give way shortly, but let me make this point: is the epiphany that we have witnessed today the result of visits not only from the ghost of Tory Christmas past, but from the ghost of Tory Christmas present? After all, it was the Conservative leader who argued and voted against Labour’s increase in national insurance to pay for increased investment in the NHS. I am sure that my hon. Friends were making a note of all the spending commitments that the hon. Member for South Cambridgeshire made during his speech. It is he and his leader who, after voting against increases in NHS investment, now tell their Back Benchers that more of the money should go to Conservative areas.

Perhaps the hon. Gentleman is having sleepless nights over his other pledge on direct funding to areas with the greatest burden of disease. If that were implemented, the whole Government Front-Bench health team would receive more money for health for each of their constituencies, while each of the Conservative Front-Bench spokesmen would see less NHS money in each of their constituencies.

Let us give Conservative Members some credit. Perhaps the conscience of the hon. Member for South Cambridgeshire has at last been pricked by the ghostof Tory Christmas future warning him that hisshadow Chancellor’s spending rule for a future Tory Administration would lead to spending cuts of£17 billion for public services and huge cuts in the NHS. It is a wonder that the hon. Gentleman is any shape at all to come to the Dispatch Box, given the few nights of decent sleep that he must have had.

Let us have a dose of reality, shall we? On the subject of health inequalities, perhaps the Minister remembers saying:

“the gap in life expectancy and infant mortality has continued to widen since the target baseline. The life expectancy gap has increased by 1 per cent. for males and 8 per cent. for females. The gap in infant mortality has increased from 13 per cent. to 19 per cent.”—[Official Report, 25 October 2006; Vol. 450, c. 1961W.]

Will the Minister also stop wasting taxpayers’ money, such as the £20,000 that she spent on the silly advert on health inequalities that she placed in the Health Service Journal, and put the money where it can really do some good?

It would be very easy to think that we could come to power and, with a wave of the wand, rectify all the unnecessary damage that the Tory Government did in nearly 20 years in power. If one examines the various reports produced during the Tory years—the Black report was just one—one sees that a widening health inequalities gap was being identified in the 1980s—[Interruption.]

We have been very honest and up-front about the widening gaps. Action must be taken to put things right, and I shall make some points about the matter later in my speech.

My constituency represents a clear example of how a determined focus on tackling health inequalities can begin to produce results, using the health trainers about which the hon. Member for South Cambridgeshire (Mr. Lansley) was so scornful. When I was first elected, the health inequality—the gap in life expectancy—between Slough and the rest not only of the south-east, but of England and Wales, was growing. It continued to grow in 1995, 1996 and 1997, but since then it has declined and begun to narrow. That has happened because we in Slough have used health trainers well. Our focus is delivering a reduction in health inequalities, so such a thing can be achieved elsewhere with that kind of determination on the part not just of individuals, but of companies.

My hon. Friend makes an important point. Progress is being made in Slough and in other parts of England. Part of our work at the Department of Health is ensuring that we provide the correct information and advice on how to tackle some serious and challenging targets.

When we were elected in 1997, we faced chronic underfunding of the NHS, increasing waiting lists,staff shortages and the disarray inherited from the Conservative party. I make no apology for the fact that we had to give our attention to that situation and that it had first call on our resources. None the less, we are the first Government to appoint a Minister for Public Health and to work across government to put right the Conservatives’ neglect. We are the first Government for decades to tackle the root causes that undermine health and well-being and to give leadership in response to the nation’s concerns.

The Minister talks about pity and inequality, but does she not pity people in the north-east who are dependent on alcohol? Of every 102 people who need treatment for alcohol dependency, 101 cannot get access to it in the region. What will she do to extent the remit of the National Treatment Agency for Substance Misuse to alcohol?

I do not think that people need pity. They need action, and the north-east provides an interesting example of what we have done. We have mapped what treatment is available, and it is clear that there are gaps. That is why, with the NTA, we have provided models of care for alcohol treatment. It is why, just in the past few weeks, with St. Georges, university of London, and Newcastle university, we have initiated a trailblazer programme of brief interventions for people who are drinking in a way that is hazardous to their health. In that way, we are building the evidence base for why action is necessary and what practical action needs to be delivered on the ground. Different responses are required for chronic alcoholics and for those who go out binge drinking on Friday and Saturday nights.

Tackling public health is bigger than having responsibility for the health service. Through the new deal we have reduced unemployment by helping1.5 million people into work, which I believe helps to improve the quality of people’s lives.

My hon. Friend spoke about Tory Christmas past and Tory Christmas present, but for my constituents there were no Tory Christmas presents. Through the winter fuel allowance and the Warm Front grants, we have come a long way from the days when Tory Ministers told pensioners in my constituency to knit woolly hats.

My hon. Friend is absolutely right. The Warm Front scheme has helped thousands of families on low and fixed incomes to install central heating or upgrade old and inefficient heating systems; the winter fuel allowance has been a boost to pensioner households; and Sure Start has been vital to starting children off on the road to better health. All those initiatives have had an impact on health, and all have been rejected by the Conservatives, time and again.

May I congratulate my hon. Friend and the Government on something that the hon. Member for South Cambridgeshire (Mr. Lansley) recognised only grudgingly? The national bowel cancer screening programme was started in Wolverhampton and is, I believe, the first health screening programme in the world to cover both men and women.

I thank my hon. Friend for his intervention. I know that he will work to ensure that the programme is working properly in his area. It is easy to pour scorn on such initiatives, but that programme is a world first—just one of many that we are achieving in public health.

Given that alcohol abuse is fuelling violence crime and that reducing addiction is crucial to reducing reoffending, will the hon. Lady tell the House what discussions she has had with the Home Office about the fact that prisoners at Grendon and Spring Hill prisons in my constituency who have committed alcohol-fuelled crimes cannot get access to publicly funded treatment, which they desperately need?

I regularly have conversations with Home Office colleagues. I am happy to follow up the case that the hon. Gentleman raises. Part of our work with St. Georges, university of London, and Newcastle university deals with interventions, whether in a police cell or in an accident and emergency department, when people have drunk too much for their own good, which could result in antisocial or seriously violent behaviour. We are trying to find ways of capturing those moments to redirect people into programmes—not necessarily programmes suitable for chronic alcoholics, but programmes for those who drink hazardously in a way that regularly affects their behaviour.

I can tell the hon. Gentleman that recent figures from the British Beer and Pubs Association indicate that alcohol consumption per head has fallen by 2 per cent. over the past 12 months.

That is the first decline in nine years, but I am not complacent. There are concerns about children and young women. However, the proportion of 16 to 24-year-old women who had drunk more than six units on at least one day in the previous week has fallen to 22 per cent. from 28 per cent. in 1998. We must be cautious about these statistics, but there seems to be a growing awareness of the impact of alcohol. I hope the hon. Gentleman will agree that our campaign to point out to young people that although alcohol makes them feel invincible, they are actually very vulnerable under its influence, will strike home. The feedback from that campaign has been extremely positive.

The Minister announced two years ago that £50 million would be spent on public health campaigning for sexual health. Recently she announced that only £4 million would be spent. Does she share my disappointment at that change? Does she think that £4 million is adequate and that no improvement could be gained from greater expenditure from budgets that have already been allocated?

More to add to the shopping list. I am interested in what works and what is effective. That is why our campaigns in the Department are not only focused on what we do nationally, but are much more targeted at the groups that we most want to reach. We provide PCTs and community organisations with materials that they can use locally. We also work through the magazines that young people— women and men—read, which have an added reach beyond that of TV campaigns and radio adverts.

On targeted public health information, particularly to young people through magazines, can the Minister explain why, if that approach is such a good one, the incidence of various sexually transmitted infections has increased so dramatically? The tombstone campaign in the late 1980s and early 1990s was a high profile campaign to get a strong message across, and right up until 1995-96 we saw a dramatic decrease in levels of HIV and other STIs because of condom use, as opposed to the dramatic increases that have taken place since the introduction of the targeted approach.

I shall be happy to deal with that in more detail later.

In 1994-95 under the previous Conservative Administration UK health departments reviewed their health promotion strategy and came to the conclusion that community-based and self-help groups were often better placed to develop targeted health promotion than Government or their agencies. I believe we need a mixture of both, but I shall come to sexual health later in my contribution, if the hon. Gentleman will be patient.

Public health, as I said, is not just a matter for the Department of Health. Individuals, communities, employers, public services and the voluntary sector all have a part to play in shaping health and well-being, but Government must be willing to lead.

Will my hon. Friend join me in congratulating the jointly appointed director of public health in Hull, who was appointed by the local authority and the PCT, so that there can be joined-up thinking to ensure that public health improves in Hull?

Indeed, and I am pleased that in Doncaster we are following the same route. For the past couple of years we have encouraged closer co-operation with local government. That is starting to pay dividends. One aspect of that is the joint appointment of public health directors at a local level, which can only add to what we can achieve beyond health and in the wider community.

I am sure that hon. Members in all parts of the House will agree that today’s challenges are very different from those of 100 years ago. In the 19th century and early 20th century, most premature deaths were due to infectious illnesses, often striking people down in infancy or in the prime of life. In 1854, 600 people died from cholera caught from the infected water of the Broad street pump in London. But times change and the challenges are different today. We are living longer, so the diseases of middle life and old age are more pertinent now than they were 100 years ago.

Thanks to the investment by this Government, we have made changes that are improving public health. Life expectancy has continued to increase both for males and for females in England as a whole, and for those living in communities with the worst health and deprivation. Sixty per cent of those communities—the spearhead areas—are on track to narrow the life expectancy gap between their areas and England as a whole by 10 per cent. by 2010. The gap that meant that someone was more likely to die of heart disease or cancer if they were poor is narrowing.

The NHS and local authorities are key players in tackling health inequalities. For the first time ever, the issue of health inequalities is one of the Department’s top six priorities for the NHS, and from next April it will be a mandatory target for local authorities through local area agreements. The figures for children dying before their first birthday are the lowest ever, and the latest figures suggest that the infant mortality gap between our poorest families and the rest of the population has stopped widening. We cannot be complacent, as I said, but there are indications that the efforts of many people on the front line are starting to have an impact.

None of this is accidental. One lesson that we have learned is that to prevent these problems recurring from generation to generation we have to intervene early in life. “Healthy Start” and the healthy schools programme are two examples of this. “Healthy Start”, which was launched nationally last Monday, is the first major reform of the world war two welfare food scheme to meet modern dietary requirements. The healthy schools programme lays down the building blocks for our young people. Last year, we decided that we needed to highlight and prioritise healthy eating and physical activity in order for a school to become a healthy school. It is a voluntary programme, but more than 80 per cent. of schools have chosen to participate and are reporting real benefits, including the provision of at least two hours of sport and physical activity. That figure was less than 30 per cent. in 1997-98, when we came into government, so we are making progress.

I am sure that the Minister agrees that one of the most effective ways of combating childhood obesity is to persuade children to walk to school and to engage in more outside activity in their leisure time. Does she accept that one of the reasons why that does not happen is that parents do not trust their children to play outside because they do not regard it as a safe environment? Is that something else that she would like to talk to her Home Office colleagues about?

Of course, tackling antisocial behaviour is a major part of tackling that fear. I have always said that antisocial behaviour is about the victims, who are often children and young people. This is not an anti-child or anti-young person measure—it is about creating the right environment for children to play outside. The Department is researching the reasons why people come to accept the basis for change. That is important. It is not just up to me to have a few bright ideas every day—we have to back it up. As the hon. Member for Rugby and Kenilworth (Jeremy Wright) suggested, we have found that parents who are asked about physical activity and what stops them letting their children play outside say that safety is one of the issues and that they therefore trade off playing outside against watching TV or playing computer games. That is why our work with the Home Office, local government, sports clubs and community organisations is so important in creating an atmosphere that is conducive to encouraging people to be more healthy in their everyday lives.

Good voluntary initiatives do not end with the public sector. The food and drink industry has been working closely with the Food Standards Agency to reduce the levels of salt in processed foods, and excellent progress is being made. Many manufacturers and retailers have accepted the need for simpler front-of-pack labelling of salt, sugar and fat in food. When I came into this job, that was not a unanimous view, and they were discussing whether such labelling was suitable, but we are now at a stage where the industry has signed up to recognising its importance. We have agreed with the industry that there will be independent research to see which system works best for consumers. Early indications show that shoppers have found the multi-coloured, or traffic light,system most useful when they are running busy lives and trying to choose between one shepherd’s pie and another. We will be monitoring the situation and providing independent research with the FSA whereby we can all agree on the best outcome.

The Government’s 2005 election manifesto pledged to restrict the advertising of high-fat, high-salt and high-sugar foods to children. As has been mentioned, Ofcom recently announced its intention to restrict advertising, and we will keep a watch on that situation. That is another example of Government leadership. We made the case that there was an imbalance in the relationship between the advertising of high-fat, high-salt and high-sugar foods and children, and we wanted the regulator to apply itself to the problem. We will see what happens, and how the measure changes the balance, but we have left open the option of legislating in future, if we think that it is the right thing to do.

Money and legislation have never been the Government’s only tools. When a consensus can be reached, we may sometimes make quicker progress towards common goals through voluntary means, and we are open to discussions on those voluntary means. I am proud of the fact that the Government took a lead and contributed to a shift in emphasis, and to a consensus in favour of healthy choices and healthy living.

The Government are impatient to ensure fewer needless deaths. We have a right and a responsibility to intervene more decisively, when that is required. The Health Protection Agency, which is unique and a true world leader, is a one-stop shop dedicated to protecting the general public’s health from infections, chemicals, poisons and radiation. We are the first country in the world to introduce the meningitis C vaccine, and we immunised 13 million children in year one. Deaths from group C meningococcal disease have fallen by90 per cent. in all age groups, including among those not offered the vaccine. Thousand of children’s lives have been saved and 10,000 cases have been averted as a result.

We have continued to promote the measles, mumps and rubella triple vaccine, which saves lives, and which has been shown repeatedly in research to be the safest method of gaining mass immunity to measles, mumps and rubella. I hope that all Opposition parties will support the best medical advice on that important issue. We continue to improve the protection that we offer to children in this country. In September this year, pneumococcal vaccine was added to the vaccines routinely offered to babies. It protects against a serious form of meningitis, and we expect it to save many children’s lives every year. Our flu vaccination programme will offer 15.2 million vaccinations this winter, which is 1 million more than last winter.

Will the Minister remind the House of why, for three years in a row, the Government have failed to deliver the flu vaccine on time?

As the hon. Gentleman will know, this year there was a manufacturing problem with the vaccine that no one could have foreseen, and we had to deal with that. On vaccine delivery, I remind him that we negotiate the total amount of vaccine, based on what we identify to be the need of the population— and, I must say, we have allowed the vaccine to be provided on the NHS to an ever widening group of people. It is up to general practitioners and primary care trusts to make their orders for vaccines.

Of course, we want to improve the system, but the picture varies across the country. In many places, the authorities are on top of the issue, and district nurses provide the vaccine in people’s homes. In those areas, the rates of vaccination are increasing. However, it seems that other areas are not on top of the problem, and we have to understand that. We should support GPs, and we are working on doing that. That is why my right hon. Friend the Secretary of State has asked for a review of the issue, to see how we can improve. However, that should not take away from the positive progress that we have made. We are considered to be one of the world leaders in flu vaccination, and other countries rightly look to us, and our developments in that area.

Our extended breast cancer screening programme, which now includes 65 to 70-year-olds, has screened over 600,000 more women, and it saves 1,400 livesa year. As my hon. Friend the Member for Wolverhampton, South-West (Rob Marris) said, the bowel cancer screening programme, which is a world first, will detect some 3,000 cases each year within three years.

I welcome the extension of breast cancer screening to an older age group, but does the Minister accept that the highest rate of breast cancer is among older women who are not screened? What is she doing to raise awareness among people in that age group?

We continue to consider how we can improve awareness. We must make sure that we are not complacent about providing a screening programme; we should make sure that women of all ages who are currently eligible take advantage of the screening programme. I will pass on the hon. Lady’s comments to the Minister of State, Department of Health, myright hon. Friend the Member for Doncaster, Central (Ms Winterton). We keep all such issues under examination, and, obviously, we want to do the best that we can for women in all age groups, as far as priorities and resources allow.

I must make progress, because I want to give some time to sexual health issues. We have addressed the subject of prevention and the lifestyles that put the public at greater risk. Things have changed since the 1980s, and we have to face up to the ignorance surrounding HIV and AIDS. Today, images of people dying are not as prevalent on our television screens. We have to consider how people perceive HIV and AIDS. That is partly because we are a world leader in medical support and treatment. However, the consciousness of young people has changed, so we must deal with different attitudes to HIV, AIDS and other sexually transmitted infections.

Does the Minister accept that today’s generation is too young to remember that education programme? Young people are ignorant of the serious dangers of HIV, so the use of condoms and other measures have not succeeded in keeping the levels of sexually transmitted infections and HIV down. It is therefore crucial that we do not use targets which, statistics show, are ineffective, but develop a hard hitting campaign so that everyone understands the problem.

It is not an either/or issue. Targeted work is helpful in gay and African communities, but the hon. Gentleman will agree that our most recent campaign—“condom essential wear”—is important, too. We want people to think about taking condoms with them on a night out, as they are as essential as their car keys, lipstick and wallet, and are a good way of preventing sexually transmitted infections. The message applies to everyone—by using a condom one reduces the risk of contracting not only HIV but chlamydia and several other sexually transmitted infections. I welcome the hon. Gentleman’s support, and I hope that he will encourage his hon. Friends to support our campaign, as some of them have not been open about the need for such sex education.

I will not give way, as I wish to make progress.

Our chlamydia screening programme has screened more than 100,000 young people—an increase of 40,000 on the previous year—and we have set targets to ensure that by 2008, everyone referred to a genito-urinary medicine clinic is seen within 48 hours.

I am proud that the Government have moved a step further in their attempts to support people who wish to give up smoking. We promoted smoking cessation on the NHS, which has made a major contribution by persuading 1.2 million people to end their smoking habit since 1998. From 1 July next year, all enclosed workplaces and public places will be smoke-free, which is a landmark step that we were persuaded to take by our hon. Friends and other hon. Members. However, we triggered the debate by saying that we were going to legislate, thus providing the platform for the free vote on 14 February. I echo my hon. Friend the Member for Dumfries and Galloway (Mr. Brown) in quoting Professor Alex Markham, who described that landmark step as

“the most important advance in public health since Sir Richard Doll identified that smoking causes lung cancer fifty years ago.”

The motion offers false promises. The Opposition want improved services, but they refuse to support any action to tackle local deficits. They claim to back local health professionals to improve public health, but they oppose every local reconfiguration of service. They have identified a list of public health issues, without offering the means to tackle them. In one breath, they demand the loosening of Whitehall control, but in the next they demand the ring-fencing of funds for public health from the centre. The Conservatives face all ways, and they do everything that they can to avoid any long-term decision that involves change in any locality. The hon. Member for South Cambridgeshire has shown today that tough decisions are still something his party is unwilling to make. We are leading a huge cultural change in health, by moving from a crisis service dominated by hospitals to a system in which prevention and the promotion of health and well-being take their legitimate place in good health policy. We make no apology for setting targets to reduce health inequalities, or for taking action across government to achieve them, whether by improving housing, home insulation, school diets and opportunities for sport and physical activity, or by reducing unemployment. We are dealing with the problem, and we are getting on with the job and producing results. That is the difference between our party and the Opposition.

I welcome the opportunity to discuss public health, which is undervalued and under-discussed. I wish to set our debate in the context of equality, because while overall health has improved, health inequalities remain. Whether we look at geography, social class, gender or rage, there are inequalities galore.

I may not have heard the Minister correctly, but I thought I heard her say that inequalities were narrowing. In a parliamentary answer in October this year she said:

“In England average life expectancy for males is 76.6 and for females 80.9, in the spearhead group it is 74.6 for males and 79.4 for females. The slower rate of improvement has led to a widening of the relative gap in life expectancy between England and the spearhead group.”—[Official Report, 25 October 2006; Vol. 450, c. 1962W.]

That strikes me as very disappointing. Given the extra money put into the spearhead PCTs, I would be interested to know whether it reached through to public health budgets. If so, the money is clearly not yet being spent in the most effective way. When the Minister sums up, I hope that we will hear what is being done about that problem. Some of the spearhead PCTs are back on track, but more than 30 are currently off track to meet their share of the 2010 target.

It is useful to take a cradle to the grave approach. I hope that the Government will accept that good health starts in the womb and that good antenatal care is vital. Although antenatal care is a key factor in the spearhead PCT programmes, the Minister will know from a previous debate that in some areas, mine included, antenatal education has been axed as a result of deficits. The explanation put forward is that mothers have a one-to-one with their midwife to discuss birth options, but surely the Minister would accept that one of the wider benefits of antenatal classes is ensuring that women receive good targeted public health messages. Some of them are about diet and exercise, which can help to get children off to a good start. If the Minister would commit to investigating the demise of antenatal classes, many people would be thankful.

It is at birth that inequalities begin. Recent figures show that a baby boy born in Kensington and Chelsea can expect to reach, on average, the ripe old age of 82.2. In Glasgow, however, the age falls to 69.9. That is a devolved matter, so to stick to the English exampleof Manchester—closer to home for some Health Ministers—the age is 72.5. Women are a little luckier as the comparable ages are 86.2—an extra four years over the men—in Kensington and Chelsea, 76 in Glasgow and 78 in Manchester.

After the birth of their child, mothers have to make a choice about feeding and it is widely acknowledged that breast feeding is best. Again, it is strongly associated with social class. Figures comparing breast feeding rates between 2000 and 2005 show that the overall rate has fallen—and mostly in the lower social classes. I welcome the new scheme for food—[Interruption.] Yes, healthy start is right, and I welcome the healthy start scheme, but surely alongside it there should be some targeted information about healthy breast feeding.

The hon. Member for Cleethorpes (Shona McIsaac) intervenes from a sedentary position, but the information that the Minister sent me shows no evidence that there is such information. I look forward to seeing it, as providing it is an opportunity worth taking.

Another problem for the Minister to deal with is the World Health Organisation code on milk formula. We all know that advertising of formula is banned, but there are few restrictions on follow-on formulae. Some baby milk manufacturers use misleading adverts, making it difficult to see that they are actually advertising follow-on formula milk. I suggest that some of the messages coming through to women from parenting magazines, which are read by many, are counter-productive.

Although I welcome my hon. Friend’s comments about encouragement for breastfeeding through the healthy start programme, is she aware that it includes vouchers for powdered milk? Does not that send mixed messages in the context of encouraging breastfeeding?

It sends a mixed message, but it is better than the welfare food scheme that preceded it. Under that, I believe that one could not spend the vouchers on anything but milk.

In answer to the point that the hon. Member for Northavon (Steve Webb) made, we had to strike a balance with an individual’s right to make decisions—and, clearly, breastfeeding is not possible for some women for several reasons. However, we are phasing out the further discounted infant formula that used to be available in our baby clinics so that we can focus more on promoting breastfeeding.

Sure Start has been mentioned. It is easy to “knock, knock, knock” in such a debate—and plenty of material exists for that, as my Conservative colleagues demonstrated—but we must pay tribute to schemes that have worked well.

No, there is no “but”.

I pay tribute to the Sure Start scheme. My only criticism, which is mirrored throughout the country, is that a ward in my constituency has a deprived area, but because it is a large ward that also encompasses an affluent area, interventions in the deprived area were obtained only through a little jiggery pokery. However, we got there.

The Government’s commitment on school nurses is interesting and I welcome it. It appears to be an about-turn. School nurses, especially those based in secondary schools, are well placed to provide much information, but figures for them were not collected until recently. Answers to a parliamentary question in May showed that, of the 309 PCTs that existed then, 103 did not employ a single qualified school nurse. I appreciate that the target is not meant to be reached until 2010, but clearly much work remains to be done, and it would be interesting to learn how it will be made a priority.

Although the Minister was positive about the meningitis vaccine, childhood vaccination rates have fallen. That is probably partly due to the adverse publicity surrounding measles, mumps and rubella, but I hope that we shall learn in the wind up how the issue will be tackled.

Other inequalities that have not been mentioned include those in dentistry. The British Association for the Study of Community Dentistry surveyed 5-year-olds in 2003-04. There was a sevenfold difference between PCTs with the best dental health and those with the worst. People in social classes 3, 4 and 5 are three times more likely to lose their teeth than those in classes 1 and 2. Given that in many parts of the country it is difficult for children to gain access to a national health service dentist unless their parents go private—some PCTs have recently put a stop to that—what are the Government doing to improve dental health and the public health messages about oral health in young children? Many parents simply cannot access an NHS dentist, although I appreciate that provision is patchy geographically.

Let us consider the growing problem of obesity—perhaps I should not have put it in that way. The figures are stark. The British Medical Association estimates that there already 1 million obese children under 16. If the trends continue, one fifth of boys and one third of girls will be obese by 2020. I welcome the moves to restrict food advertising, but that does not give the complete picture because societal influences are far more complex than that. The “McDonald’s mothers” have been mentioned, and it is not helpful when politicians, whatever their party, claim that there is nothing wrong with feeding pies through the school gates.

There is clearly a big educational task. Perhaps there is a way to use Sure Start or ante-natal classes to ensure that mothers are better equipped to feed their families healthily. In schools, they often do not receive the necessary education on providing a healthy diet.

Does the hon. Lady deplore the proposal by her Lib Dem colleagues in Hull to remove the free healthy school meals in all our primary and special schools? Those meals give our youngsters a very healthy start.

I cannot really answer for my colleagues in Hull—[Interruption.] I do not know the full story. It might have been prompted by a funding problem from central Government—[Interruption.] What would hon. Members expect me to say? It would be unfair to comment on that situation when I do not have the full facts.

Much has been said about sport, and I want to take issue with what the hon. Member for South Cambridgeshire (Mr. Lansley) said about the need for a lot more competitive sport. Those children who are a towards the end of the queue when the teams are being picked soon get the message and decide that they do not want to exercise because they do not want to make fools of themselves. That is not a positive experience. I have a pet hate about school sports days. Children who have little sporting ability in the traditional sense are often forced to enter races and be publicly humiliated.

I will not give way at the moment. I want to finish my point.

If a child cannot read, they are not put on a stage and made to stumble through the alphabet or a passage of Shakespeare, yet little thought is given to the children who do not excel at sport. Too little thought is given to other ways in which children can take exercise healthily and find a method of exercise that is suitable for them. That could involve dance, games and all sorts of other things. I would ask that we try to get away from competitive sport in schools and think about increasing exercise and activity. This is happening more and more, but I worry when I hear people saying, “Let’s get back to good old hockey and football and other competitive sports.”

Is the hon. Lady aware that one of the great successes in school sports under this Government is that the biggest increase in participatory sport in primary schools has been in the use of non-competitive climbing walls? Schoolchildren of all shapes and sizes are using them in increasingly large numbers in our primary schools.

I am pleased to hear that, because that is the kind of diversity that we should be encouraging. Children often want to try something new and different, and they could be hooked into exercise in that way. The traditional patterns work against that. Many adults feel that exercise is not for them because they were made to play team sports at school, rather than being encouraged to find a form of exercise that suited them—

I remember watching my youngest son run around a running track and come last in his race, but that did not stop him. It encouraged him to go further, and he is now a pilot in the RAF. The hon. Lady is talking complete bunk.

I am not quite sure that coming last in a school race is necessarily a proven route to becoming a super fighter pilot in the RAF, but I am willing to be persuaded.

It would be useful if we could look at ways of increasing the facilities for families to engage in sport together. It is often a positive experience for families to exercise together. Recently, I went to a “Skip to be fit” session at one of my local schools. Everyone has done skipping at school, but this involved digital skipping ropes, and the children were quite excited. The emphasis was on learning to skip on a six-week programme with a personal improvement assessment at the end of it. The children were not measured by their peers, but by themselves. Such personal improvement initiatives are much more positive and inspiring for children than those in which their performance is compared with that of others.

I was intrigued by the fact that the Government have spent £27,000—quite a lot of money—on pedometers. I have several pedometers, all of which seem to register different things. Most people wear them for two or three days and then chuck them into a drawer. What evidence base prompted that purchase? What analysis has been made of the cost-effectiveness of pedometers? We frequently talk about evidence bases: a new medicine cannot be licensed without a convincing evidence base. However, it seems that many well-meant public health interventions do not have an evidence base. With the varying inequalities in different parts of society, a little evidence about what works in different socio-economic or ethnic groups or on a gender-specific basis would be useful.

Does the hon. Lady agree that although £27,000 is a lot of money, it is probably better spent than £20,000 on a piece of soft propaganda in the Health Service Journal? In the context of public health, does she agree that it is important to ensure that public money is spent in a reasonable and worthwhile way?

It strikes me slightly that the Health Service Journal is preaching to the converted. An evidence base is needed to decide whether that is a more effective use of money than pedometers. I do not have the answer to that question.

I now want to move on to sex education. We have heard statistics bandied about on the subject today. A few years ago, the Select Committee on Health undertook an extensive inquiry on sexual health, and one of its recommendations, which is also one of my party’s recommendations, is that sex education should start at primary school. Children at that age do not need to know everything, but it is important that they start to talk about relationships, which are an integral part of sex education. What conversations has the Minister had with her ministerial colleagues about that?

Teenagers to whom we have spoken say that teachers are often embarrassed about discussing sex. Logically, geography teachers are interested in geography, so that is what they teach, but schools do not have specialist sex education teachers—unfortunately, geography teachers’ attempts to teach sexual health were often slated. Will the Minister consider having properly trained, expert teachers, who are not embarrassed by the subject, delivering that part of the curriculum? The input of parents, who are keen to know what their children are learning at school, might also be useful.

Since 1996, gonorrhoea rates have increased by50 per cent.—by nearly 61 per cent. in men—syphilis rates have increased by more than 2,000 per cent., and chlamydia rates by 197 per cent. Disappointingly, despite the chlamydia screening programme, even the last year-on-year increase was 4 per cent. Although the screening programme is welcome, its roll-out around the country seems to have taken quite a long time. Why does that programme screen 14 times as many men as women—[Interruption.] Some of the early statistics show that it did. The disease is carried in equal numbers and most women are infected by a man. What has been done to address that inequality and to improve access to screening?

The latest sexual health awareness campaign is aimed at 16 to 24-year-olds. In an earlier contribution one hon. Gentleman—I shall not embarrass him by mentioning him by name—claimed that the campaign was effective because his children of that age watched the relevant programmes, but it neglects the older age group, among whom there has also been a significant increase in sexually transmitted diseases. I have in mind the generation who have had a long-term relationship, have split up, are back on the circuit, although I hate to call it that, and are sexually active again—presumably they were sexually active during marriage, so perhaps I should say that they are introducing themselves to new partners the second time around. They may not have appreciated the messages the first time, may have forgotten them or may have thought that they applied only to the young. What is being done to address that group?

The point was made that sexual health clinics for young people have been cut because the earmarked funding has not reached the front line. The 48-hour target for accessing sexual health services has not been met. The Health Protection Agency said in August that it was being met in 57 per cent. of cases, but we used an intern to do a mystery shopper exercise over the summer months and the figure for access was 31 per cent. Clearly, there is some way to go before that target is met. What is being done to achieve that?

Vaccinations have been mentioned, and a promising new vaccine will reduce the rate of cervical cancer. A decision on it is likely to be made in February. What discussions has the Minister had on vaccinating young women in particular? Can she say at this stage when a targeted vaccination programme for cervical cancer is likely to be rolled out for young people, and what age group it will cover?

I mentioned the sexual health inquiry by the Health Committee. The young people that it talked to referred to strong links between their behaviour and other factors and various pressures. There was peer pressure and media pressure, but one of the biggest determinants of whether people had unplanned sex was probably the use of alcohol, which is the most commonly abused drug. Children are drinking at an earlier age. Government figures show that the cost of alcohol-related harm is approximately £20 billion a year. The national alcohol harm reduction strategy was launched a year ago in a blaze of publicity, but some of those key commitments have not been met. The audit of treatment services has not been finalised and no targets have been published. Only one in 18 people who need treatment get it. That masks a huge regional variation because in the north-east only one in 102 people who need alcohol treatment services can access them.

Alcohol Concern has called for the Treasury to have a public service agreement with the Department of Health and the Home Office. It also wants targets because it feels that things will not be taken seriously unless they are set in the same way as they are for drugs.

Gloucestershire has an alcohol arrest scheme—I shall not call it by its acronym. It works in the same way as a drug treatment and testing order, and is very successful. For some time we have been asking for that scheme to be national. Does the hon. Lady agree that it is just the sort of scheme that should be taken forward so that we can try to deal with the issue when people are most acutely aware of the problem that they cause, which is when they are in the cells? If they take advantage of the help offered by the scheme, they realise that it has a high evidence-based result in dealing with alcohol problems.

That sounds good to me, but I think that the hon. Gentleman should address his remarks to the Minister, who has the power to do something. I wish him luck, if the project really is evidence-based.

The problem with planning alcohol services is that there is no idea of which people need treatment, what treatment they need and where they are clustered. Unless that is monitored as it is for the purpose of drugs services, it will be impossible to develop alcohol services in the same way. Information on progress would be most welcome.

The British Medical Association is concerned about the threat to public health specialists from recent reconfigurations. It is feared that, because of deficit recovery plans, primary care trusts will seek to reduce rather than increase the number of consultant public health posts. It is probably too early to predict the number of displaced public health clinicians—the information is unlikely to be available for a few months—but may we be reassured today that the specialists’ work force will not be reduced?

What is the way forward? We need a greater evidence base. Statistics are finally being collected, which will help us to target interventions, but there is still far too little evidence about what really works. Links with education need to be strengthened so that children can build on personal, social and health education at school, and are educated for life. We also need a wider and more flexible use of the work force. There are a good many people with access to the public, such as nurses, health visitors and midwives. Pharmacists were mentioned earlier. I probably speak with a small amount of self-interest, but in pharmacy staff we have in-built health trainers who do not need to be trained themselves. Some are already being used, but the opportunity is not yet being maximised.

Another problem is that when services are commissioned, the commissioners often do not think about the wider public health benefits. Evidence relating to the new contract shows that what is being commissioned is pretty much what was in place before, and that the opportunity to pay for more services has not been grasped.

We should be clever in our use of the media. The Minister spoke of links with local government, but they could be stronger. In many instances the quality of housing is still far too low, and housing is one of the main determinants of future health. Transport is important, too. It has been demonstrated numerous times that when cycle lanes are introduced children cycle to schools, but there is not much of a Government imperative to make that happen.

More joined-up working would be welcome. I hope that in five years’ time we shall see more progress.

I am sorry that I had to be absent for some of the speech of the hon. Member for Romsey (Sandra Gidley), and also some of the speech of my hon. Friend the Minister. I was asked several weeks ago, as Chairman of the Health Committee, to speak at a reception on the Terrace given by the all-party thrombosis group.

My hon. Friend said that the official Opposition had a brass neck to table this motion, and I have to agree with her. The motion claims that

“the gap between the public health of the UK and that of comparable health economies”

is too wide. Anyone who studied the past 20 or 30 years of public health investment would probably begin to understand why that is so. When in government, the Opposition paid scant regard to the issues that created our present health inequalities and bad health care indexes. They rejected—presumably for ideological reasons—the notion of a direct link between social class and health, placing responsibility entirely on the individual with no reference to housing, environment, occupation or income. I have been in the House for some years—for two decades, in fact—and remember many debates on public health.

Does my right hon. Friend remember the Black report on inequalities in health, which is generally regarded as a seminal work on the connection between inequality and ill health? It was smuggled out in photocopied form over a bank holiday weekend by the previous Government.

I shall give way later.

The Conservative Government just did not believe what the Black report said—or many other reports by individuals and organisations that had for years been saying why we suffered health inequalities in this country and why public health in some communities was not what it should be.

In similar vein, does the right hon. Gentleman remember the Acheson report that dealt with the same social model of disease, and does he remember the treatment that Labour Ministers gave to that report?

In that case it was published during the middle of the last Conservative Government’s term in office. What should Labour Front-Bench Members have done on that occasion?

I am surprised that the right hon. Gentleman, who is Chairman of the Health Committee, does not know about this, but for his information it was published in 1998, and it was one of the first reports that the Labour party commissioned on coming into office.

Yes, I remember that now.

Let me move on. There has been a conversion in recent weeks and months—it has happened over the past 12 months since the right hon. Member for Witney (Mr. Cameron) took over the leadership of the Conservatives—and it seems remarkable to people who have been involved in the health debate over many years. I am not sure what lessons have been learned.

The last time I spoke in an Opposition day debate, I discussed issues referred to in the national health service campaign pack that was put out by the Conservative party. It accused the Chancellor of the Exchequer of causing all the problems in the national health service—presumably by almost trebling the budget in the comparatively short time that we have been in office. In that campaign pack, it is also stated that the current NHS funding formula is unfair:

“Labour have specifically added an element to the allocation formula which aims to tackle health inequalities”.

If the Conservatives do not recognise why the funding formula has to be weighted in some areas in thatway, they do not have, and never have had, any understanding of the causes of ill health in this country. Sadly, communities such as those that I represent have had health inequalities compared with other parts of the country for probably all of the past 60 years when the national health service has been in place and in years before. That has never been tackled, but the Government are now tackling it.

What have the Government done on smoking since 1997? We have now got a ban on advertising and promotion in the UK, and it has been argued for abroad as well. What happened in 1993-94 when there was a Conservative Government and I introduced a private Member’s Bill to ban tobacco advertising and promotion from the Opposition Benches? It was talked out by the Conservatives and not supported by Ministers. Two years later, what happened to warnings on cigarette packets about ill health when the then Member for Worsley, Terry Lewis, introduced a private Member’s Bill on that? It was talked out and not supported by Conservative Members who then sat on the Government Benches.

I could go on about tobacco, but let me ask this: what other Government have matched what this Government have done on tobacco? They have brought smoking cessation targets into communities that suffer ill health because of smoking. That link has been known for decades, yet it has been denied in this House when Members have wanted to introduce legislation to put things right.

The banning of smoking in public places is also good, although I should say that when the Bill was first published last year my view was that it could have been a bit better—and, indeed, it was a bit better after it had passed through this House and the House of Lords and this House had a vote on it. As a consequence, we are going to bring in the biggest and most comprehensive smoking ban in public places. It is bigger than any of those that have been introduced in the seven states of the United States and than those in Ireland and Scotland, and Wales and Northern Ireland might come in before 1 July next year. It will be probably the biggest public health promotion that any Government have taken on. In campaigning against the smoking industry because of the ill health and deaths that it has caused over the years, I have received very little support from the Conservatives.

The right hon. Gentleman is making a passionate case for the significant increase in NHS expenditure, but is he happy with the current situation? For example, patients with conditions such as age-related macular degeneration are subject to a postcode lottery. After nearly 10 years of a Labour Government, such patients are literally going blind in one eye before they are even prescribed the drugs that they need to treat their condition. Is the right hon. Gentleman content with that?

I have met representatives of the Royal National Institute of the Blind and of one of the drug companies that is introducing a drug for AMD. Such drugs have yet to be licensed and when they are, they will go before the National Institute for Health and Clinical Excellence before they are prescribed—if that is what NICE decides. However, we need to bear in mind certain issues, which I discussed with a health Minister in some detail. I am concerned not about the situation now, but about what might happen when such drugs are licensed. For example, our constituents will be pressing to receive such treatment, but perhaps NICE will take that into account. If the hon. Gentleman is interested in this issue and wants to chat to me about it, I would be more than happy to do so.

In the Government’s amendment to the motion, which I support, they talk about some of the steps that we have taken, such as providing 2 million four-to-six year-olds with fresh fruit at school. I saw for myself last week the trays of apples that a school in my constituency provides for its children. That contrasts greatly with a previous Government, who not that long ago withdrew the provision of milk in primary schools in my constituency. It is true that this Government could do better and could provide more; nevertheless, that contrast is the truth of the matter. As my hon. Friend the Minister said, it was the freshly elected then Conservative Government who, in 1980, reduced the nutritional level of school meals, and I still do not for the life of me understand why. Although this was not true of my family, for many of the families that lived on the estate that I lived on as a child, sadly, the school meal was probably the only hot meal that their children got. That any Government anywhere could reduce the nutritional levels of school meals is farcical.

On the new healthier standards for school meals, the Opposition have really come into their own. During an earlier intervention, I referred to an incident in September in a neighbouring Rotherham constituency that did not really put Rotherham in a good light. We had the spectacle of two parents pushing a supermarket trolley loaded with burgers, chips and the like through a graveyard and then passing them through the school railings to children who did not like the new school meals introduced by Rotherham metropolitan borough council. The council has been recognised nationally for its healthy school meals initiative, and the vast majority of the schools in my constituency have met all the standards that have been set; in fact, some were meeting them years before they were introduced. I have been interested in this issue for many years, and when I have visited schools during my time as an MP, I have always talked to them about it.

However, during the week of the Conservative party conference, the Opposition Front-Bench higher education spokesman, the hon. Member for Henley (Mr. Johnson), said:

“I say let people eat what they like. Why shouldn’t they push pies through the railings? I would ban sweets from schools, but this pressure to bring in healthy food is too much.”

This is someone who is supposed to aspire to government—who, as an Opposition Front-Bench education spokesman, is responsible for education matters. I realise that his brief is higher education, which is a slightly different matter; however, how irresponsible can someone in his position get?

That was a dark time for Rotherham. Anyone who listens to the debate in Rotherham and who reads the letters in the local weekly paper that I am quoting from will realise what the reaction was. There was a heavy reaction against what those parents were doing. However, the result may be that we are having a better debate about food and health.

Some people think that the hon. Gentleman is something of a hero. One person said:

“I would welcome him on to the campaign—it would be very useful to have someone high up on our side…I wouldn’t know him if I fell over him but I don’t understand why he can’t say what he likes. Everybody should be allowed to eat what they want without having to be told.”

She capped off her comments by saying:

“There is all this talk about obesity but there is not one obese child in that school…there are a few chubby ones.”

She went on to say, “I’ve got a bit of weight myself”, or words to that effect.

If that is seriously the level of response from Opposition Front-Bench Members to the incidents in Rotherham—[Interruption.]

The level of Opposition Front-Bench Members’ response to the incidents in Rotherham following the introduction of healthier school meals in September shows that they have a long way to go before they will believe even half of the motion they tabled today.

Last Friday, I visited the Whiston and Worrygoose junior and infant school in my constituency, because it had just received its second basic skills award for literacy and numeracy. I always make an effort to go to primary schools when such awards are made because, in constituencies such as mine, decades of under-attainment in literacy and numeracy have led to many problems, including ill-health, as has been well recorded by public health professionals.

The school meals are cooked on site, and I held an impromptu discussion with some year 6 children about the new menu, which I had already had a look at during my visit. The level of their debate was far higher than the hon. Gentleman’s comments about what happened at Rawmarsh school. As I said earlier, Opposition Front-Bench Members have a long way to go before they start tabling motions about public health, and especially about obesity.

In general, public health issues are far more challenging than for the past 150 years. In the past, it was simpler to deal with things that had an impact on public health, such as sanitation, the lack of fresh water, bad housing and dirty air, before the clean air legislation of the 1950s. All those things had a bad effect on public health but they were reasonably easy to tackle—be it by central Government or, in most cases, by local government. Of course, that is not to say that there is no bad housing or that housing could not be better, but its public health effects are not as great as they were in years gone by.

The issues that will lead to public health problems in the 21st century are affected by the individual decisions we take each day, in terms of our lifestyles and of what we eat and drink. The Government have to tackle those things. In part, that can be done by education. Educational campaigns are a cheap and effective way of raising awareness of health problems, but evidence suggests that awareness does not always translate into changed behaviour. Adolescents do not necessarily smoke or drink less as a result of health education programmes. I have campaigned against smoking for many years and I have always felt that we will never completely stop young children trying cigarettes. There will be some success but it will never be total while cigarettes exist. The important thing is to continue those education programmes.

Another area where there can be success, and has been success in the past, is taxation. One thing to the credit of the Opposition is that, when they were in office, the then Chancellor of the Exchequer, the right hon. and learned Member for Rushcliffe (Mr. Clarke), put a health tax—an above-inflation tax—on cigarettes. The figures show that that reduced consumption. When the Conservatives went into opposition, he got a job as vice-president of British American Tobacco. I do not know whether that was cause and effect, but the people there were not very happy with him at the time. Taxes on alcohol also reduce consumption. That does not mean to say that people will stop drinking or smoking, but there is an effect.

One thing that we could do, and that has been effective in the past, is to bring in restrictive measures, such as the banning of tobacco advertising. Some of the big public safety areas—outside this area—include things such as seat belts in cars. I remember them being put in when I was first driving, when it was not compulsory to wear them. It was only when legislation was passed that take-up levels of people wearing seat belts became as high as they are today. The same could be said in relation to drinking and driving. When measurement was brought in and we said, “This is an offence. You will lose your licence,” things quickly got a lot better.

I want to finish with two points about where we should go in the future. As I said, I do not think that all these things are a matter for the state. I certainly do not think that they are necessarily a matter for the national health service. There is a lot evidence that other organisations—I think that the Government call them non-governmental organisations or the third sector—can have great influence in relation to what is happening in our health care system or, perhaps I should say, individual needs.

A note was passed around earlier about weight loss programmes in South Cambridgeshire. I have with me the outcome of research that was done on a slimming referral service in Derbyshire. The report is from the journal of the Royal Institute of Public Health. It was a collaboration between the Southern Derbyshire health authority as it was then, and Slimming World, which is a high street company that helps people to lose weight. I know that Weight Watchers does that too, so I am not advertising one against the other. The referrals are beginning to work. There is no question about that, looking at the report that I have here. It provides evidence that, sometimes, these types of referral schemes are better than going to see a dietician locally and being told to go away and lose weight, and getting advice such as, “Don’t eat this. Don’t eat that.” Instead, people sit in the village hall with somebody who has been through the process, who usually leads the class, and can tell people about how easy it has been.

One of the things that struck me about this scheme is that, of the 107 patients who were originally referred, 97 enrolled, 62 completed the free 12-week course and 47 went on to self-fund the next 12-week course and did it themselves, and stayed with that weight-referral programme. There are experts out there—not necessarily working for the national health service, but working close by—who can help in many ways with individuals who have weight-loss issues, which, if not tackled, will certainly lead to disease and, potentially, an early death in years to come.

GlaxoSmithKline nutritional health care had a study done about how to get families involves in physical exercise, as well. We had a debate about rugby or football at school. Well, all that stops at 16 anyway, but what about the vast majority of kids, who are not much good at rugby or football at school? We always think that exercise is about people who are involved in one sport or another, but exercise could be going to school or work on a bicycle. It could be many things. We need to learn where there is evidence—not just in the national health service; in wider organisations—and make sure that that evidence base is the real area where we start decision making. The national health service should have been taking evidence-based decisions for the past 60 years, but, sadly, its track record on that has not been good. It is about time that we got better, especially in areas in which individual lifestyles will have an impact on public health in the years to come.

I intend to be reasonably brief. I congratulate my Front-Bench colleagues on focusing the House’s attention on public health as the core of this country’s health policy. When we discuss the national health service and health policy, we focus too often on the machinery of health delivery, rather than the objective of delivering public health standards. The House of Commons is today holding the Government to account on the delivery of health outcomes using the national health service and all other instruments of public policy at their disposal, which is what they should be accountable for.

As my hon. Friend the Member for South Cambridgeshire (Mr. Lansley) said, the fact of the matter is that there have been disappointing trends in a wide range of health outcome measures, such as alcohol and drug-related disease, the incidence of tuberculosis and sexual health. Those three measures have already been mentioned, but one could continue to list other measures of health outcome on which the value that the taxpayer—and the patient, more importantly—has received from the money spent on the national health service has been disappointing throughout the past decade.

The hon. Member for Sherwood (Paddy Tipping), who is no longer in the Chamber, latched on to part of the speech made by my hon. Friend the Member for South Cambridgeshire and said, “Oh, now what you’re interested in is targets.” However, targets for health outcomes are precisely what the Government should be setting, before holding themselves to account on the delivery of those targets. We were the first Government in office to do precisely that. The White Paper “The Health of the Nation”, which, I think, was published in 1991, set health outcome measures that defined the objectives for the delivery of health policy. The disappointing aspect of the past few years is that we have not used taxpayer pounds effectively enough to deliver those health outcome objectives.

My hon. Friend could have gone on to talk about not only average health outcomes, but differential outcomes in various parts of the country and health inequalities. It is often said—it has been said again today—that the Conservative party has somehow denied the existence of health inequalities or the link between social class and health inequality, but that is simply not true. It is one of those oft-repeated assertions that does not reflect reality. Of course it is true that social background and a wide range of other issues influence health outcomes and form someof the background to health inequalities. One of the criticisms of the Government is that their management of the health service has been insufficiently focused on using taxpayer pounds to address precisely the reasons why the national health service was established: to narrow health inequalities and to even up the experience of health treatment in different parts of the country.

It is not difficult to find out why the Government’s record on delivering those objectives has been disappointing. Indeed, one does not need to look further than the July 2006 report of the chief medical officer to read many of the causes of that disappointing record. The situation is easily summarised. A vicious circle has been allowed to generate over the past decade, and weak public health discipline in health service management has led to weak commissioning. Indeed, for part of the Government’s period in office, they were not even interested in the principle of commissioning. I am pleased that they now recognise the importance of commissioning in the management of the health service, but they are disabled from delivering strong, effective, evidence-based commissioning because of their long period of disinterest in both commissioning and the development of the public health discipline as the key evidence base for strong commissioning. Weak commissioning has led to misdirected spending in the NHS, which has led to poor outcomes when measured against health outcome objectives.

That has resulted in what taxpayers overwhelmingly now recognise in the record of the present Government. A huge sum of money has been spent on health care in our country—a sum of money that, I am pleased to say, the Conservative party strongly supports. Government Members like to assert not only that the Conservatives are blind to health inequalities, but that we oppose the Government’s health spending programmes. Neither assertion is true. What we oppose is unloading such a sum of money on the health service at the same time as weakening its management and thereby undermining its capacity to deliver good value for money.

Over the past decade, the national health service has failed to target resources on the real health priorities, partly because, in his time as Secretary of State for Health, the right hon. Member for Holborn andSt. Pancras (Frank Dobson) set out to abolish and destroy the structures that allow NHS management to target resources at genuine health need. Now, those structures have been reintroduced and the Government are struggling to make up the ground that they lost in their early period in office.

The House does not have to take my word for that, or the word of my hon. Friend the Member for South Cambridgeshire. As I have already said, the position is set out clearly in the report of the chief medical officer, published in July. He says:

“public health departments have been caught up in a great deal of reorganisation,”

and he makes it clear that that reorganisation has weakened the capacity of public health managers to direct resources at need. He continues:

“Public health budgets are regularly ‘raided’ to find funding to reduce hospital financial deficits”.

It is a classic case of the urgent squeezing out the important.

More positively, the chief medical officer recommends a series of actions. There is no point in well paid and, more importantly, authoritative public servants issuing statements recommending action to Ministers, who should heed those recommendations, if Ministers let the reports simply gather dust on the shelf.

Did the right hon. Gentleman take all the action that the CMO recommended he should take when he was Secretary of State for Health?

I doubt that I did everything that the chief medical officer recommended that I should do, but I would never have objected to anyone pointing out to me what the CMO had recommended and asking me why we were not doing it. My challenge to Ministers takes the form of the three recommendations in relation to the public health discipline that the CMO made, publicly, in July.

The first recommendation is:

“Consideration should be given to establishing a comprehensive review (the first in almost 20 years) into arrangements to improve and safeguard the health of the public.”

Earlier in the debate, a misunderstanding arose between my hon. Friend the Member for South Cambridgeshire and me. The last review of the public health discipline in this country was carried out by Donald Acheson, who published his report in 1988—almost 20 years ago. The present chief medical officer recommends, and I agree, that it is high time that that work was reviewed, not least because Donald Acheson recommended a level of commitment to the public health discipline by 1998 that in 2006 is still not matched. I hope that Ministers will tell the House when they intend to honour that first recommendation.

The CMO’s second recommendation is that

“Health service commissioners should take steps to satisfy themselves that expenditure on public health reflects the needs of their population.”

I believe that Ministers accept that now. It is a pity that during the 10 years in which the Labour Government have been in office, they have not focused resourceson need through commissioning—[Interruption.] The Minister says that they have, but her predecessors in the period in which the right hon. Member for Holborn and St. Pancras was Secretary of State for Health did not believe in commissioning and made it clear that he intended to wind it up, so it is hard for her to make that claim for the whole 10 years in which Labour has been in office.

The third recommendation is that all NHS bodies should ensure that their public health capacity and capability are sufficient for their proper functioning. In his report the CMO makes it pretty clear that he does not believe that the present level of public health commitment is fit for purpose. Furthermore, he draws attention in his report to the fact that there is a twentyfold variation—this is a health inequality among the different parts of the country—in different PCT areas in their commitment to the public health discipline. That cannot be the record of a Government who accept the importance of public health as the backbone to well informed commissioning.

I conclude with the simple thought with which the chief medical officer heads the chapter on the subject in his report—“Raiding public health budgets can kill”. It is like the advertisement on cigarette packets. Raiding public health budgets can kill: that is what the Government are doing, and that is the consequence for which they must accept responsibility.

I am delighted to take part in the debate as I am co-chair of the all-party group on primary care and public health, and as the House knows, I still do some work as a practising general practitioner.

I am particularly pleased that the Government have set 1 July as the date for the implementation of smoke-free legislation in England. I hope that the Minister will follow that up with the announcement of a major public education campaign to ensure that the public and licensees are fully aware of the implications of the new legislation.

Next year’s date will also provide a major incentive for smokers to quit. As well we know, of the 12 million smokers in this country, at least 8 million at any one time would love to give up smoking. I hope that they now have a date to work to, so that they can plan their strategy. I am pleased that in general practice we can prescribe nicotine replacement therapy and that most practices, if not all, have nurses who are well trained in helping people to stop smoking. Coupled with the prescriptions that we are able to give on the NHS thanks to the Government, that is making an impact on the number of smokers whom we see. That will reduce the burden of ill health in the future to a welcome degree.

In line with the polluter pays principle, I would like to see a profits tax on tobacco companies thatwould fund educational programmes on the health risks of passive smoking and the monitoring and implementation of smoke-free public places. I know that that is controversial, but it would show that the Government meant business by making sure that the companies that profit from smoking put something back into the community to educate people on the ill health which that causes.

I also support proposals to raise the minimum legal age for the purchase and sale of tobacco from 16 to 18. Far more needs to be done to discourage children from smoking, and increasing the limit to 18 would be a step in the right direction. Raising the legal age would also send a strong clear message to young people about the dangers of tobacco, and in conjunction with other anti-smoking strategies would, I hope, help teenagers resist taking up a habit that many of them will live to regret in their shortened lives.

It has been stated that alcohol is implicated in about 40,000 deaths per year in this country and is directly responsible for 5,000 deaths a year. That is a jumbo jet full every month. The World Health Organisation recently identified alcohol as the third highest risk to health in developed countries. Almost 40 per cent. of men and 25 per cent. of women exceed daily benchmarks of three to four units for men and two to three units for women on at least one occasion a week. Twenty per cent. of men and 10 per cent. of women drink more than double the daily limit in one session at least once a week.

The rate of binge drinking is even more alarming among young adults: 37 per cent. of 16 to 24-year-old men and 27 per cent. of 16 to 24-year-old women binge drink regularly. Between 1988 and 2000 the number of women consuming over 14 units a week rose by 70 per cent. Approximately one in four 16 and 17-year-olds are hazardous drinkers—that is, they have experienced immediate problems, such as loss of memory, injuries or failure to do what is expected of them, after a night’s drinking. Among 16 to 24-year-olds, this figure rises to 42 per cent.

Even more alarmingly, 11 to 15-year-olds who drink alcohol now consume nearly twice as much as they did in 1990. They consume on average 9.8 units a week, compared with 5.3 units a week in 1990. Since the early 1970s there has been an eightfold increase in deaths from chronic liver disease among men aged 35 to 44, and a sevenfold increase among women of the same age group.

It has been estimated that alcohol costs the NHS up to £3 billion a year in hospital services alone. Every Friday and Saturday night, 70 per cent. of all accident and emergency admissions and 80 per cent. of pedestrian road deaths are alcohol related. One in four acute male admissions is alcohol related. The cost of alcohol abuse to the wider economy is estimated at£20 billion a year.

There are two key factors in the increase in heavy drinking, particularly among young adults—price and availability. Alcohol is getting cheaper. In the past40 years, consumption per person has doubled and the price of alcohol relative to income has halved. The number of shops selling alcohol has risen sharply, and a third of all 24-hour licences granted were given to supermarkets, where alcohol is cheapest.

I do not want to be a killjoy at Christmas, but the fact is that alcohol will wreck many lives over the festive period, and we need to take firm action. I propose that the Government should move towards legislation on banning the advertising of alcohol as they have for cigarettes. We need to emphasise the impact of alcohol abuse in young people on the development of drug habits and to improve recognition of the need for counselling and treatment services, particularly for young people. There is also an urgent need for more school-based education founded on an understanding of young people’s perceptions of drinking.

There are about 1 million obese children under the age of 16 in the UK—three times as many as 20 years ago. Those soaring obesity rates have led to an increase in childhood type 2 diabetes, which will lead in future to more heart disease, osteoarthritis and certain cancers. Estimates indicate that if current trends continue, at least one fifth of boys and one third of girls will be obese by 2020. I am pleased that Ofcom has finally put forward proposals to restrict the number of advertisements for foods high in fat, salt and sugar, but they do not go far enough.

If my hon. Friend were public health Minister in a future Administration, would he follow the example of Canada, which has banned the use of trans fats in processed foods? Trans fats have double the damaging effect of saturated fats and are a serious health risk that has loomed large over the horizon. Does he agree that that issue must rise up our own Government’s agenda?

I thank my hon. Friend for an interesting observation. As he says, trans fats have been implicated in significant levels of disease. I am pleased that Canada, among other countries, has outlawed them completely, and I would like this country to move towards doing so. There is no technical reason why the food industry cannot use the available alternatives—it is just a matter of the will to do so. I hope that the Government will be able to push food manufacturers in the right direction on that important issue.

We need to go further on banning advertising of foods high in fat, salt and sugar, mainly because the fact that Ofcom’s proposals will not affect some of the programmes popular among children, such as soaps and quiz shows, will significantly undermine the impact of the ban. It would be far more effective and meaningful if the cut-off point were extended to the9 o’clock watershed, which all parents understand.

There is very little evidence about the effectiveness of intervention. More research is needed on the effectiveness of weight management and treatment programmes, the longitudinal impact of obesity on individuals and society, and the impact of physical activity on obesity and co-morbidities.

Two aspects contribute to obesity—lack of activity and taking in the right foods. How would the hon. Gentleman weigh those factors in terms of reducing obesity?

The hon. Gentleman makes an important point. Obviously, the food manufacturers would say that it is all about activity, while other specialists, particularly those from the National Obesity Forum, say that it is a much more complex interaction between calories in and calories out. Nothing like enough is known about the relative merits of calories and activity. There is clearly a relationship between the two, but it is necessary to do far more work to find out exactly where the problem lies so that we can come up with more effective strategies.

One of the most worrying aspects is that many parents do not have enough information to make healthy choices for their children. A MORI poll carried out some years ago found that 70 per cent. of parents said that they did not have the information that they needed to ensure that their children ate a well-balanced and healthy diet and that much more needed to be done. We need a much more sustained and consistent public health campaign to improve parents’ and children’s understanding of the impact and benefits of healthy living. Families need to be educated and empowered through guidance that recognises the impact of those factors on children’s development of lifelong habits to do with eating and activity.

There is a strong case to be made for the establishment of a national obesity institute to improve collaboration between stakeholder groups. In addition, extra funding should be available to establish and sustain training programmes for those involved in the care of children with obesity. That should be complemented with resources to allow children to gain access to specialist regional obesity services. We simply need more specialist nurses and GPs. Every primary and secondary school should have a school nurse to advise children on healthy living and other lifestyle issues. At present, there is only one school nurse for every 10 or 11 schools in the country, and we should improve on that significantly.

There should be increased access to subsidised sporting facilities for children and their parents. Ready access to such facilities is particularly important for those from lower socio-economic groups. “Exercise on prescription”, provided at reduced cost, or free of charge, should be expanded. I was pleased to hear the Minister’s recent announcement about prescribing more exercise classes; that is a welcome step in the right direction.

We have heard a fair amount about sexually transmitted infections this afternoon. The latest report from the Health Protection Agency presents data for 2005. Through the presentation and description of epidemiological data, the report highlights the fact that, despite the increasing complexity of the situation, our HIV and sexually transmitted infection surveillance systems have evolved to become among the most comprehensive and informative in the world, and that is very welcome. It is essential to campaign for education strategies that increase young people’s knowledge of the full spectrum of sexually transmitted infections.

Well-designed sex education programmes have been shown to be effective. The Men’s Health Forum recently carried out a project, aimed to reach men with messages about chlamydia and sexual health, and it was a good example of an effective education programme. The project was backed by the Department of Health and Roche Diagnostics, and it worked with male students and soldiers to increase understanding of young men’s attitudes to sexual health. It was followed by a programme in which testing kits for chlamydia were made available for collection from men’s toilets, including some in university colleges. Positive health behaviours must be promoted among individuals who are infected, so that they come forward to seek treatment and go on to practice safer sex. We must ensure that we go ahead with improving access to GUM—genito-urinary medicine—clinics. I am pleased that my hon. Friend the Minister announced an aim of reaching the 48-hour target by 2008; that is very welcome.

We have already heard about the importance of maintaining a specialist public health work force. The recent reconfiguration of strategic health authorities and primary care trusts has so far led to a reduction in the number of directors of public health from 303 to 152. I hope that all the people displaced by the reorganisation will be re-employed as public health consultants, because we must make sure that we do nothing to undermine or reduce the important work done by directors of public health and their departments.

I hope that, in partnership with local authorities and voluntary organisations, directors of public health and public health consultants will continue to ensure that the local population’s needs are assessed and addressed through public health programmes. They currently provide leadership in three domains of public health: health protection, health improvement and tackling health inequalities. I am concerned to make sure that the reconfiguration of PCTs and strategic health authorities in no way reduces or dilutes the work that is currently carried out.

For us Labour Members, the story has been one of good news: the reduction in mortality rates for heart disease, strokes and cancer are impressive, and, as we heard, there has been a significant extension of the childhood immunisation programme, which has certainly prevented many hundreds, if not thousands, of preventable deaths among young children. We have every right to be very proud of our record, but the old adage is true—a lot has been done, but there remains much to do. I am keen to work with my colleagues on the Front Bench to make sure that the improvements made in recent years on public health are maintained.

I shall focus on sexual health, but first I should like to pick up the Minister on a comment that she made about flu vaccines. She said that she “allowed” an increase in flu vaccine provision this year, but may I remind her that the only allowing that takes place is on the part of the British public, who allow us to come to the House to serve them? Her comment may be indicative of the extent to which the Government are out of touch with the British people; we do not “allow” the British public anything.

An entire generation has been let down and blighted by the Government’s failure to protect our teenagers in respect of sexual health. The Government knew that there was a problem with sexual health, and that is why the Secretary of State announced that £50 million was to be spent on a sexual health campaign, but only£4 million was spent. We can see a pattern emerge: when any investment is made, or when the Government want to take credit for any inward investment, they do so, but the minute that there is a problem, they blame the hospital managers. However, hospital managers cannot be blamed for the statistics. In 2004-05, cases of syphilis were up 23 per cent., chlamydia was up 5 per cent., genital warts was up 1 per cent., and genital herpes was up 4 per cent. Newly diagnosed cases of HIV doubled in 10 years and, among women, there was a sixfold increase in 10 years, with 3,036 cases now being diagnosed a year. That cannot be blamed on hospital managers.

Despite those figures, hospitals are deciding to cut their genito-urinary medicine departments completely. A local newspaper ran a story about my local hospital, Bedford hospital, saying:

“The next round of cuts at Bedford Hospital will be unveiled today, with sexual health the main casualty…The document proposes that Genito Urinary moved out of the hospital, to be dealt with by GPs”.

I had a quick ring-around of my local GPs, who said that they have no specialist training in genito-urinary medicine, and have absolutely no idea how they are supposed to cope with genito-urinary medical problems in their surgeries, given the increase in sexual health problems.

Some people criticised the AIDS campaign of the 1980s, which was mentioned earlier, because of the tombstones and the eerie images, but at least it gotthe message home. It meant that the general public knew how important safe sex was and what the consequences of not having safe sex could be. It is hardly surprising that new cases of HIV have risen dramatically. According to the Department of Health’s own statistics, two thirds of men and women newly diagnosed with HIV said that they received no written or televised information, and that no information that they received had affected their sexual health. The same set of statistics, revealed by the Government, show that most people learn about HIV and AIDS through television soaps, so people learn more about AIDS from EastEnders than from the Government.

Recently, the Minister decided that there should be a supermarket-wide poster campaign teaching children how to eat bananas.

I thank the hon. Lady for giving way, because it gives me the opportunity to put the matter straight. It is not the case that I was encouraging a campaign with that aim. I went to an event organised by Sainsbury’s that involved parents, who said that, if they were to try more fruits and vegetables—not bananas and apples, but other, perhaps less common, fruits and vegetables—it would be great if the supermarkets allowed tastings in their stores. Parents, particularly those on low incomes, felt that they might then spend their money on trying a variety of fruit and vegetables. That is about listening to parents on how they think that the industry, and supermarkets, could help.

I can only suggest that the Minister take the matter up with the BBC, which widely reported that there would be a supermarket-wide campaign, teaching children how to eat bananas. Those are the exact words taken from the BBC website. In an age of over-sexualisation of children, where teenagers are constantly under pressure from television, magazines, cinema, peer-group behaviour and retailers, does the Minister not think that it would be more important to send out clear messages on sexual behaviour and personal values, and does she not think that we should spend some of the £50 million that was promised on hard-hitting advertising campaigns?

Research suggests a strong link between social and economic disadvantage and early initiation into sexual activity. That wealth distinction is also evident in the number of teenage pregnancies and teenage mothers. Teenage girls from poorer backgrounds are four times more likely to give birth than those from affluent backgrounds. We have the highest rate of teenage pregnancy in Europe and one of the highest abortion rates. What kind of testament is that to a society, and what are the Government doing about the issue? I am sure that all hon. Members have heard of the morning-after pill, which works before the ovum attaches itself to the wall of the uterus. It works better the earlier it is taken. If someone wants to get hold of it, they can ring their GP. The highest users of the morning-after pill belong to the ABC1 group. They may ring up their GP practice to make an appointment, only to be told that one is not available for five days. However, they will insist that they see a doctor or, alternatively, they can go to the pharmacist and pay £25 for the morning-after pill, because they can afford to pay it. [Interruption.] Hon. Members may wish to know that the morning-after pill is free from a GP practice, but it costs £25 at the pharmacy.

Is the hon. Lady not aware thatin many areas, under a patient group directionthe EHC—emergency hormonal contraception—is available free of charge at pharmacies that adhere to certain protocols?

In fact, it is not available in many areas. It should be available in all areas, so that other groups can gain access to it. It is another case of the postcode lottery. In certain parts of the country, women have to pay £26 for the morning-after pill atthe pharmacy, which is open all hours, including Saturdays—anyone can walk into one—but that is not the case in other parts of the country. It is free in only a small number of areas, but to reduce the number of abortions in the UK—there are 600 a day—we should make it free at all pharmacists. After all, it is provided free by GPs.

Does the hon. Lady agree that women should have the right to request abortion in the first 12 weeks of pregnancy without needing to secure a doctor’s approval?

I do not have any thoughts one way or the other on abortion in the first 12 weeks, but I believe that the limit for abortions should be reduced from24 weeks to 21 weeks, as I have argued previously in the House.

The Minister should keep her eye on the ball, and spend some of that £50 million on sexual health campaigns, as poor sexual health has blighted the lives of many teenagers. I urge her to make the morning-after pill free on demand at pharmacists, particularly in areas with the highest numbers of teenage pregnancies. I urge her to look at research that shows that women who have abortions suffer mental health problems later in life as a consequence, and to provide public health information to parents. She is throwing money at British pregnancy advisory service clinics, but will she look at more effective ways of reducing the number of abortions, instead of continuing to fund a growing industry with NHS money?

I am grateful for the opportunity to follow the hon. Member for Mid-Bedfordshire (Mrs. Dorries), as I should like to pick up some of the issues that she raised. I thank the Opposition for again offering the House a chance to debate a hard-core Labour issue. Time and again, the Tories choose to debate the policies on which we are strongest, pursuing hollow lines of attack without presenting clear policies or alternatives that we can debate. In their constant to-ing and fro-ing, defence appears to be the best form of attack. They have been at it for several hours without providing any proper debate, which is rather tiring. However, I thank them for raising the issue of public health in the House.

Public health, as I said, is one of Labour’s great success stories. As the Opposition said, for the first time we have a Minister with specific responsibilities for public health, who liaises closely—this is a key point—with officials in the Department as well as with welfare officials, with the Treasury on matters such as income equality, with education officials and, most importantly, with the social exclusion unit. Our strongest achievement in public health is the social exclusion agenda. We introduced the national minimum wage and tax credits, both of which have helped to tackle low income—a major factor in poor public health. We introduced welfare reforms—along with some Opposition Members who have participated in today’s debate, I served on the Committee that considered the Welfare Reform Bill—that command widespread consensus.

Public health is the key to delivering the welfare reform agenda. For example, encouraging people into work helps them to achieve better health. Today’s debate, however, has had a narrow focus. We have looked at teenage pregnancy—an important issue, I accept—but it would be nice to broaden the debate. Since we have been in government, we have delivered phenomenal achievements in education. We have never seen anything like Sure Start and children’s centres, which have revolutionised the way in which we deliver public health, enabling us to engage with young parents, including teenage mothers, in a radically different way. I have made any number of visits to Sure Start projects and children’s centres in deprived communities in my constituency. I have seen children eating fruits that I have never seen before, and they were enjoying the experience. Recently, I visited a children’s centre in the most deprived ward in my constituency. The vast majority of kids were from Traveller families, and a third of the children at the centre had special needs. Staff engaged not just with the children but with their parents, bringing them into contact with education, to which they have not had access before. That is public health, and we have delivered it.

Sexual health is an important issue, but it is difficult to discuss, both inside and outside the House. Parents, for example, are uneasy talking about sex education, sexually transmitted infections and contraception. We need to be more adult in our approach, and we must continue to raise the issue without embarrassment. The Labour proposal to employ nurses in schools is quite brilliant, as it would go a long way towards removing the embarrassment factor in sex education. I would argue, however, that the introduction of sex education at secondary-school level is too late. It should be offered in primary schools, and we should introduce legislation to that effect. It is fantastic that 80 per cent. of schools have taken part in the health schools campaign. It proves that if the will is there we can introduce change, so we should provide sex education in primary schools.

We need to tackle sexually transmitted infections more effectively. It is important to make contraception far more readily available, but the Department of Health has ring-fenced £300 million—that figure is separate from the £4 million for national campaigns on sexual health—for primary care trust budgets. Some PCTs—not my own, I hasten to add—have used that money to pay off deficits, which is wrong. We must make sure that others do not do so, but it is important to accept that that £300 million has been ring-fenced.

If that is the case, why did Lord Warner say that most of the money was still sitting in NHS coffers?

The Opposition cannot have it both ways. If they wish to argue that PCTs are spending that money on their deficits, it cannot be sitting in Department of Health coffers. That £300 million is targeted at sexual health services, which the Government have listed as one of their top six priorities, so it will make a fantastic contribution.

Lord Warner said:

“My Lords, it is stored carefully in the coffers of the NHS. As the noble Earl is aware, the NHS is a very cost-conscious organisation, which tries to ensure that it uses its money wisely…we have to evaluate each of these campaigns to see how effective they are and then consider the next steps.”—[Official Report, House of Lords, 21 November 2006; Vol. 687, c. 231.]

Steps to allocate the money, however, have not been taken.

I shall not even bother to answer that.

I would like to pick up one of the points that the hon. Member for Mid-Bedfordshire made earlier about sexual health services being taken out of acute units into general practice surgeries. That is a key element of what we are trying to do—to localise, to make more familiar and to make it easier for young men and women to access those services. I do not know how many gynaecological units the hon. Lady has visitedin her own constituency or elsewhere, but those environments are not as friendly as general practices.

May I say that our genito-urinary medicine unit consultant, Dr. Pat Munday, resigned because she was short-staffed after posts were frozen? She operates a drop-in unit. She says that people do not always want to go to their GP, as they want the facility of sexual health units, so it is no good just saying that everything can be moved back into GP surgeries.

Obviously, diversity of choice is an issue and people should be able to go wherever they feel most comfortable. We also need to recognise that confidentiality is a big issue. These services shouldbe available at GP clinics, at polyclinics, which are absolutely key in this sphere, and at acute units. The real issue is that we need to ensure that those services are available and can be accessed, especially by young men and women, so that we tackle sexually transmitted infections. I end there.

Order. It is anticipated that the winding-up speeches will start at about half-past six, and four hon. Members are seeking to catch my eye, so the arithmetic is self-explanatory. I hope that Members will bear that in mind as they make their contributions.

First, it is a pleasure to follow the hon. Member for Dartford (Dr. Stoate) in this debate, as both he and I have put some of the issues that we have talked about into practice. We both entered a competition for MPs’ fitness with Men’s Fitness magazine. I pay tribute to the hon. Gentleman for winning the competition, but I warn him that I came top on the running machine, so I hope that he has the stamina to listen to what I have to say.

It is also a pleasure to follow the hon. Memberfor North-East Derbyshire (Natascha Engel) and I want to answer her central question. She asked whythe Opposition have brought about today’s debate. The reason is very simple: a central plank in the Government’s public health policy—addressing health inequalities—has been a failure.

There has been much discussion this afternoon about the distant past, but in the near past—the last nine years—life expectancy has still been seven to eight years lower in the poorest parts of the country and the inequality has widened by two years for men and five years for women. The crucial reason is not a lack of good intentions, but a lack of understanding that investment in public health—not in clinical services, however critical—is most important for successfully addressing health inequalities.

The chief medical officer’s annual report on public health spelled that out very clearly. He said that investment in public health was falling as a proportion of expenditure in the NHS, that the number of public health professionals was static and that public health budgets had been raided and used to fund deficits. We heard a raft of statistics showing why the Government’s policy is failing. Alcohol-related deaths are up; tuberculosis infections are up; syphilis up; chlamydia up; obesity rising; and smoking declining, but inequalities persist among smokers.

The failure to understand the difference between morbidity and mortality is critical because, in the end, the incidence of poor public health has to be matched with investment in public health and the incidence of disease has to be matched with investment in clinical services. The result of that misunderstanding is a grossly unfair funding formula.

I would like to tell the House about my own area of Guildford and Waverley. The hospital and community health services budget for 2007-08 is increased by 2 per cent. because there are many older people, but it is reduced by 25 per cent. because of a lack of deprivation. What is the impact? Last year, my constituents had to wait twice as long as people in Manchester for ear, nose and throat elective surgery. They had to wait nearly twice as long for breast surgery compared with people in the Health Secretary’s Leicester constituency; and three times as long for trauma and orthopaedic work as people living in the Prime Minister’s Sedgefield constituency.

This year, as a result of problems in the funding formula, my constituents face the closure of Milford hospital, a community rehabilitation hospital, and of the Royal Surrey County hospital—one of the top accident and emergency hospitals in the country, which happens to have the joint lowest mortality rate, as well as being a foremost cancer specialist centre.

I want to brief, so I shall make just one final point. Another vital factor for public health is stability in budgets, but in my area of Guildford and Waverley, there was a budget increase of £9 million last year, while this year it has been told to reduce spending by £16 million. There is a phrase for that—boom and bust. If we are to change people’s attitudes—we have talked about the importance of doing that this afternoon—it requires sustained investment over a period of time, not boom and bust.

Today, the Prime Minister is reported to be telling the NHS Confederation that service improvements in NHS hospitals are being implemented to ensure that the very sick have speedy access to specialist care, but also to treat people more conveniently closer to home.

On that very point of access to specialist care and specialist nurses, two out of four specialist breast cancer nursing posts have been frozen in my hospital owing to cuts and deficits, yet there has been a target that all those diagnosed with breast cancer should have access to specialist nursing—a targetmet only in 74 per cent. of cases in my area.By withdrawing funding and making cuts, the Government are penalising specialist nurses.

From what my hon. Friend says, it is clear that my constituency is not the only area suffering from boom and bust.

I return to what the Prime Minister is saying. He talks about all these so-called improvements, but which part of the country is he talking about? In my part of the country, he is closing our local hospitals, closing our accident and emergency services and health inequalities are rising. Inequality in access to health care is rising and the Prime Minister has delivered a boom that has become a bust. People are saying that enough is enough.

I have a few questions for the Minister. The healthy living project in my constituency has the ambitious vision of becoming a centre for sport and learning with a GP practice, community nurses and youth workers built into it. Will the Minister take a particular look into that idea, not least because the aim is to build health facilities on a school campus in order to create a new concept of an extended school?

Secondly, will the Minister look into the “Do it4 Real” project run by the Youth Hostel Association, which the Minister with responsibility for youth is currently considering refunding? It is important to see how children from disadvantaged communities are being engaged in a summer school for all kinds of backgrounds and communities—with healthy and active living as a theme. Will he reflect on the uniqueness of that external organisation and how it has helped to provide opportunities for the development of basic cooking skills for today’s microwave generation? Could that particular programme be taken to another level—perhaps with slightly older children—and develop some key skills that children will require for healthy living as they get older?

Thirdly, will the Minister look into the possibility of conducting a longitudinal study, comparing three-to-18 schools with schools to which children change at age 11, to assess whether the engagement of young people is any different in the different types of school, particularly in respect of their involvement in healthy lifestyles? That involves both the food that children eat at school and their active participation.

My fourth question is aimed more at the Opposition and I am sure that Conservative Front Benchers will want to illuminate an issue that has remained unclear for some time. Will the hon. Member for Westbury(Dr. Murrison) clarify his party’s precise drugs policy on heroin injecting rooms, which have been supported on a number of occasions by his party leader? How precisely will they fit into a public health agenda, should the Conservative party ever be returned to power?

Conservative party policy at the previous election was to provide rehabilitation places for 18,000 under-18s. However, it has not yet explained its policy on the 200,000 adults who have an addictive drug problem. Where will they be treated?

The motion refers to “comparable health economies”. On drugs policy, it would be helpful to know which country, in the opinion of Opposition Members, mirrors Conservative party policies on drugs most closely.

It is a great pleasure to follow the hon. Member for Bassetlaw (John Mann), who made his points succinctly.

The amendment claims that the Government are tackling inequalities. In their 10th year in power, they have failed miserably and completely to do that, especially in north Northamptonshire. It was right for Her Majesty’s Opposition to use the Opposition day to highlight the Government’s failure to reduce health inequalities.

Let me begin by setting out the founding principle of the national health service. It is that everyone should have access to similar health provision wherever they live in the country. [Interruption.] That was greeted with derision by Government Front Benchers. It is unfortunate that they do not believe in the founding principle of the NHS. That principle is that all people should be treated fairly. However, in my area it is not upheld. Under the Government, my constituents do not benefit from a national health service, but are instead victims of a postcode lottery health service.

In my constituency, I run the Listening to Wellingborough and Rushden campaign. I formed it several years ago and its purpose is to listen to the views and opinions of local people and campaign on their behalf. One cannot campaign about people’s concerns without first finding out what they are. My listening campaign continually strives to ascertain local opinion through surveys, leaflets, meetings and events. One issue that consistently shows up in my Listening to Wellingborough and Rushden survey as either the biggest or the second biggest concern is health care and the lack of local provision. I pay tribute to the excellent work of the doctors, nurses, support staff and medical professionals who work in my area. I am also grateful to the staff who run the two hospitals that my constituents use—Kettering hospital and Northampton general hospital—and those who run my local primary care trust. They daily struggle to provide top quality patient care while having to keep Government accountants satisfied. That is not an easy job and I thank them for their hard work in challenging times.

There is a major problem with health care provision in my area. I have raised it in this place previously and I will continue to do so until the Government do something about it. It is the historic underfunding of health care in north Northamptonshire. [Interruption.] Does the Minister want to intervene? No. The Leicestershire, Northamptonshire and Rutland strategic health authority is the worst funded SHAin the country, and within the SHA, north Northamptonshire is the worst funded area. How do my constituents stand a chance of having a fair and equitable share of decent health care when we are the worst funded area in the country relative to the capitation formula?

I congratulate my hon. Friend on making a powerful and pertinent point. Is not the position even worse than he describes because north Northamptonshire has some of the sharpest inequalities of any region in the country?

As usual, my hon. Friend makes a pertinent intervention.

“We are however the worst funded SHA relative to the national capitation formula which seeks to enable a fair, equitable distribution across the NHS…Indeed North Northamptonshire is our most pressurised health community. Northamptonshire Heartlands PCT which covers this population (including Corby with its severe health problems) is £32 million (9.9 per cent.) below capitation”.

Those are not my words, but those of Sir Richard Tilt, former chairman of the SHA. Funding for the NHS in any area is based on the national capitation allocation formula. That determines what each PCT should get to ensure fair and equitable distribution of funding throughout the country. I have a problem not with the capitation formula, but with the Government’s refusal to fund my area with its full capitation amount. Only last week, the Minister of State, Department of Health, the hon. Member for Leigh (Andy Burnham), confirmed:

“By the end of 2005-06, the PCT was 4.4 per cent. belowits target allocation.”—[Official Report, 28 November 2006;Vol. 453, c. 962.]

What is the point of a funding formula if one does not stick to it?

I am aware that I need to finish by 6.30 pm. I should like to refer to a couple of points that have not been mentioned—there is little point in rehearsing the arguments that we have heard. I was losing the will to live after the Opposition’s opening remarks about public health, given its genuine complexity and their approach to it. I am grateful that many more thoughtful speeches followed.

We are considering a complex subject, but it is rooted in poverty, ill health and poor housing. The Government are tackling it properly, as they should. I remember only one line in the speech of the hon. Member for South Cambridgeshire (Mr. Lansley) about health inequalities, but on many occasions Labour Members have identified that as the root cause of public health problems in our communities.

I listened with interest to the hon. Member for South-West Surrey (Mr. Hunt), who was naturally upset about the time that constituents waited for surgery. Of course, that time is much less than when the Conservatives were in power, but we are all missing a point if we do not do the work in our constituencies. However, one should not assume that South-West Surrey is the same as an inner-Manchester seat in the context of public health and waiting times. People in the former come forward much more easily and quickly for surgery—there are definite health inequalities in some of our inner-city areas that we need to tackle. Until we have a proper intellectual debate in this place, that will not happen.

I was upset to hear many Conservative Members’ comments about the fantastic work in our constituencies in the local strategic partnerships. They consider the way in which organisations such as local authorities and PCTs come together to tackle health inequalities in our constituencies. They deal with the fact that there may be huge inequalities in those constituencies and they have to micro-manage some aspects. That is why Sure Start has been so successful in getting into those areas.

We have heard much about the edifices of health care and how some Members are stuck on having to defend a specific hospital because any closure is perceived as a cut, when innovative thinking is about getting away from such perceptions—[Interruption.] It is difficult. I understand why Conservative Members have to laugh because innovative thinking is the real agenda and they miss the point about, for example, breastfeeding services in our town centres and getting breastfeeding champions out there, and reducing childhood obesity by ensuring that women are able and supported to breastfeed, not in some hospital but in our communities. That work is being carried out in a positive manner.

The ludicrous to-ing and fro-ing about who hasnot achieved what misses the point about what is happening in many of our communities. The subject is complex, but we must understand the difficulties and why young people risk their sexual health—the madness on the streets—and do not think about protecting themselves. There are myriad reasons for that and today’s challenges are different from those of many years ago.

The new public health challenges are different and need a great deal of thought. The Government are giving them that thought and using evidence to tackle many of the problems. They have stopped the silly to-ing and fro-ing that we get from the Conservative party and are tackling what is happening in our communities.

We have had an entertaining debate this afternoon, although the quality has been mixed. We have heard a total of10 Back-Bench contributions, but before commenting on them I would like to quote Polly Toynbee in The Guardian newspaper on 12 November.

I might in a minute, but I would appreciate it if the hon. Gentleman would allow me to get into my stride.

Polly Toynbee said:

“For the first time since polls began, the Tories are winning on the NHS.”

And, just for balance, I would also like to quote Winston Churchill, who, on 2 March 1944, said:

“Our policy is to create a national health service in order to ensure that everybody, irrespective of means, age, sex or occupation shall have equal opportunity to benefit from the best and most up-to-date medical and allied services available.”

That gives the lie to the assertion by the right hon. Member for Rother Valley (Mr. Barron) that our party does not wish to address health inequalities. Winston Churchill’s statement was made in 1944, before the inception of the NHS, and it is clear that throughout the history of the national health service we have been committed to tackling health inequalities, and we will continue to do so.

I pointed out a number of issues relating to smoking and ill health and to the attitude of the previous Conservative Government in that regard. The hon. Gentleman was not here at that time, but does he think that those were the actions of a Government committed to getting rid of health inequalities?

I cannot comment on that, but I can comment on the absolute catastrophe of the position taken by the Secretary of State for Health on smoking. We all remember the U-turns involved, and what that did for the debate.

I will in a minute.

My right hon. Friend the Member for Charnwood (Mr. Dorrell) restored us to a sense of reality withhis magisterial contribution. He clearly shares my sense of disappointment that health outcomes have not matched intermediate outcomes. The Government have done a great deal to address various aspects of public health, and they will have the figures to prove it, but they have not materially improved health outcomes—and that is what we mean by “public health”. One director of public health recently told the BBC:

“When money is tight, it is all too easy to raid public health budgets. In the end, public health loses out, storing up problems for the future. It is depressing.”

It certainly is, as I am sure my hon. Friends the Members for South-West Surrey (Mr. Hunt) and for Wellingborough (Mr. Bone) will agree.

May I ask the hon. Gentleman a question about Conservative policy? I understand that it is their policy to have an independent NHS, yet I gather from today’s debate that there would also be public health targets set by politicians. How can they possibly have both?

I am not sure that I fully understand where the hon. Gentleman is coming from. Of course, it is right and proper to aspire to improving public health outcomes, and it is those outcomes that we are focusing on, rather than intermediate outcomes. Had the hon. Gentleman been here earlier to listen to my right hon. Friend the Member for Charnwood, he would have heard that point being explained extremely well.

Several public health issues have been ably raised by hon. Members today. My hon. Friend the Member for Mid-Bedfordshire (Mrs. Dorries) majored on sexual health, and she was quite right to do so. Ministers have said that by 2008, everyone referred to a genito-urinary medicine clinic should be able to have an appointment within 48 hours. However, as the average wait at the moment is 15 days, it would stretch our credulity to suggest that that target will be met.

The pièce de résistance is that the Government have not yet launched their £50 million advertising campaign on sexual health. On 11 November, almost two years after the then Health Secretary first announced the campaign, the Minister of State, Department of Health, the hon. Member for Don Valley (Caroline Flint), launched a £4 million advertising campaign to encourage the use of condoms. Asked by the shadow Health Minister Earl Howe where the remaining £46 million had gone, the Health Minister Lord Warner said that

“it is stored carefully in the coffers of the NHS.”—[Official Report, House of Lords, 21 November 2006; Vol. 687, c. 236.]

What utter nonsense is that? We all know that the money has not been squirreled away safely in the coffers of the NHS—it has been used to sort out NHS deficits. All the public health money in my area has evaporated in this way.

On a point of order, Mr. Deputy Speaker. Is the hon. Gentleman out of order in failing to declare his entry in the Register of Members’ Interests relating to the Wessex Pharmaceutical Group?

Order. These matters can safely be left to hon. Members. If the hon. Member for Westbury (Dr. Murrison) had been out of order, I would have stopped him.

I am more than happy to declare my interest if the hon. Gentleman thinks that it is relevant to what I have already said. When I think that it is relevant, I will announce it in the proper way. I am pleased to be an adviser to the Wessex Pharmaceutical Group, which covers a large part of the south-west, which I represent.

My right hon. Friend the Member for Charnwood referred to the fact that the chief medical officer’s annual report states:

“Raiding public health budgets can kill”.

That gives us the verdict from the horse’s mouth.

Finally, how about the Government’s attention to infectious diseases in general? In the year ending31 March 2006, they spent £300 million less than in the previous financial year. What commitment does that show to tackling new and emerging infectious diseases, as well as the antique infectious diseases that have once again raised their ugly heads in our country?

I want briefly to mention oral public health. The reason that I am interested in this subject is that, two weekends ago, I spent an enjoyable weekend learning how to put in fillings and to treat dental pain. That is something that the Secretary of State knows all about, because it is no longer categorised as a dental emergency. Oral public health means the services provided by dentists in the course of their work to ensure that there are no cancers and to give general advice on health issues. We find that, despite the protestations in the “Choosing Health” White Paper, access to NHS dentistry has shrunk. How on earth is that improving public health?

The hon. Member for Dartford (Dr. Stoate) discussed raising the age of sale for tobacco, and I am pleased to say that we support this proposal. I seem to recall that my right hon. Friend the Member for North-West Hampshire (Sir George Young) was in the forefront of the argument that the age of sale should be raised to 18, and I entirely agree with him.

The hon. Member for Bassetlaw (John Mann)talked about substance abuse and asked about the rehabilitation places that we would establish when we are returned to government. Of course there will be a mixed provision of drug rehabilitation places, as I imagine there are under this Government, and I would cite the example of Clouds house in my constituency, which does excellent work in this respect.

It is essential that our public health policy shouldbe firmly rooted in the evidence. Public health interventions impact on people’s lifestyles, and can impact on our personal liberties. It is therefore doubly important that anything that we do in this place should be firmly rooted in the evidence. We must have fad-free public health. It is difficult to conduct large-scale randomised control trials in public health, and the Cooksey review appears largely to ignore the issue. The discipline is bedevilled by its precarious evidence base. The right hon. Member for Rother Valley (Mr. Barron) referred to fruit, and of course fruit is important. My children enjoy it at school, but we have to assess the long-term implications of that policy. It is by no means clear that that particular intervention will be sustained in the longer term.

On 9 October this year, the Minister admitted that the results of an evaluation conducted by Leeds university in September 2005

“showed that increased consumption of fruit and vegetables was not sustained when children’s participation in the scheme came to an end.”—[Official Report, 9 October 2006; Vol. 450, c. 633W.]

That is important, and I hope that the Minister will enable more research to be carried out to determine whether this intervention will be sustained in the longer term.

We do not have evidence of the efficacy of health trainers, as several right hon. and hon. Members have pointed out. There is evidence, however, of the efficacy of abdominal aortic aneurysm screening, as my hon. Friend the Member for South Cambridgeshire mentioned. Between 2,000 and 3,000 lives could be saved each year by that screening, yet I know that the Minister has to date refused to meet the consultants who are conducting the pilot on that intervention, which is a great pity. Annually, that programme could save more lives than are likely to be saved by the smoking clauses of the Health Bill. We need to reflect on that.

I hope that the Minister will comment on malnutrition among the elderly, about which Age Concern is particularly exercised. If the Minister wants a public health intervention that might work, remedying malnutrition among the elderly—which, scandalously, often gets worse when they are admitted to hospital—would be such an initiative.

Hepatitis C needs to be addressed urgently. According to the Hepatitis C Trust, we face a public health time bomb. It says that there is a delay in producing a comprehensive strategy to tackle the disease, a failure to ensure that PCTs implement Government strategy once finally produced, and an ineffective awareness-raising campaign. Delay, failure and ineffective—those seem to be pretty good bywords for this Government’s approach to public health. The trust wonders why hepatitis C screening is not part of the quality and outcomes framework—and given the scale of the damage likely to be caused by hepatitis C, so do I. It points out that the Department of Health awareness campaign on the subject cost £2.5 million, as against the £280 million spent on persuading people to switch to digital television. The campaign has been a failure, as the number of diagnoses has remained static. The cost of failure is likely to be enormous and I see nothing in the Government’s plan for the national health service that will accommodate that failure through investment in hepatology. Given the Minister’s failings on public health, she needs to give that close attention.

Belatedly—I try to be fair when I can do so—the Government have set up the Public Health Interventions Advisory Committee under the auspices of the National Institute for Health and Clinical Excellence. It might start by considering the areas of neglect highlighted today. It might also try to stop up some of the rabbit holes down which consecutive Public Health Ministers have been tempted—chasing headlines, I am afraid, rather than public health.

Public health medicine needs to be repaired. The hon. Member for Romsey (Sandra Gidley) was concerned about the decline in the number of public health doctors. The chief medical officer tells us that variation in senior public health staffing is unrelated to need and incompatible with Wanless’s “fully engaged” scenario. We cannot go back to the position in 1974, when public health doctors were directly employed by local government. We can, however, encourage joint appointments between primary care trusts and local authorities. Directors of public health, however, must hold budgets and have functional accountability to the chief medical officer.

In public health medicine, what matters is what works. In contrast to Labour’s failure, the Conservative party has a proud tradition of effective public health. From Harold Macmillan’s home building programme of the 1950s, to our seatbelt legislation that has saved more than 60,000 lives, to the magisterial social marketing campaign of the 1980s that halted the advance of HIV/AIDS in its tracks, we have a pedigree in public health that gives us every right to table this motion.

The Conservative party has no shame whatever. It abolished the word “poverty” from public policy, while allowing it to become a reality for one in three children. Too often, it has cried “Nanny state” when it should have offered responsible leadership. The Conservative Government left behind a battered and scarred society, in which public squalor and human misery were the reality for too many families and communities.

Increasingly, however, the Conservative party is caught out facing two ways. In response to the announcement by my hon. Friend the Minister with responsibility for public health of an expansion of activities programmes for inactive people, the hon. Member for Hemel Hempstead (Mike Penning) said in yesterday’s newspaper that there is a financial crisis in the NHS, jobs are being lost and wards are lying empty, while money is being wasted on this gimmick. “It is a disgrace,” he said. However, the shadow Health Minister, the hon. Member for East Worthing and Shoreham (Tim Loughton), said that we have to consider imaginative solutions to get people active. He said that programmes such as “Strictly Come Dancing” have seized people’s imagination, and that such a good way of keeping fit could keep people healthy and out of hospital.

In The House Magazine, the organisation Forest recently had an advert saying, “No thanks” to the nanny state, which, it says, tells people not to eat, drink, smoke or think. It attacks politicians for having a dialogue with people about responsible approaches to their health. Big government, it says, is watching. It says, “Eat, drink and smoke.” At the Conservative party conference in Bournemouth, however, almost 400 people tried to get into Forest’s fringe meeting, and hospital staff were forced to turn people away, citing health and safety reasons.

The hon. Member for Westbury (Dr. Murrison) seems extremely annoyed about the Health Service Journal publication. He says that it is propaganda. I cannot work out whether it is the photograph of my hon. Friend the Minister with responsibility for public health that concerns him, or whether he is offended by the photograph of feet. The serious point is that using such publications to make the issue relevant and attractive to people is far more effective than boring guidance will ever be.

In contrast to the Conservative party, the Labour party’s very raison d’être is the belief that every individual, irrespective of race, religion or social class, has the right to fulfil their potential. My party has always believed that every child matters, that health care should be available free to all at the point of need, irrespective of ability to pay, and that successful individuals and strong communities march hand in hand in the good society. It is basic to those beliefs that without a healthy life people’s aspirations and potential are blighted, and our society and economy suffer.

We are committed to an enabling state, in which we lead, educate and legislate appropriately, responding to 21st century realities with 21st century solutions. In addition, there is personal and corporate responsibility, with individuals as citizens, parents and opinion formers taking responsibility for promoting healthy lifestyles, and with companies exercising responsibility in the legitimate pursuit of market share and profit margins. We have a proud record, although we always acknowledge that there is a lot more to do on that agenda.

Let me now address some of the important contributions to the debate from hon. Members on both sides of the House. I always admire the honesty of the hon. Member for Romsey (Sandra Gidley). In a recent debate in the House, she said that she regretted the fact that her party had misled older people and their families at the last election by saying that there was a possibility that they would receive free personal care. We will remember that when we see her party’s manifesto at the next general election. She made some serious points about antenatal support and breast feeding. We are proud of our healthy start programme, but it is only a beginning. The Department is working on a new plan for maternity services in this country, which will offer choice to every parent and family in every part of the country. The nature of antenatal support and earliest interventions, such as on breast feeding, are a crucial part of that.

The hon. Lady launched a strange attack on the virtues of competitive sport. She said that she was worried about young people going back to playing football and hockey. In my experience, thousands of young people around the country play football and hockey and do so happily. I accept that her point about considering the motivation of every individual young person, and giving them the opportunity to be active, is an important one.


I am always careful about how I respond to myright hon. Friend the Member for Rother Valley (Mr. Barron). I have not yet appeared before the Select Committee of which he is Chairman. He drew attention to the historical scandal of the Conservative party paying scant regard to the question of health inequality. When the Conservatives were in government they actively talked out bans on advertising smoking and the idea of putting health warnings on cigarette packets. They removed nutritional standards from school meals. We all know about the reaction of the hon. Member for Henley (Mr. Johnson), who sits on the Conservative Front Bench, to those parents—possibly constituents of my right hon. Friend—who stuffed hamburgers through school gates, saying that their children should be allowed to eat what they want. The hon. Gentleman said that he fully agreed with them. What kind of responsible action is that from someone who seeks to serve in a Government of this country? [Interruption.] I know that it is a funny prospect, but there we go.

My right hon. Friend was also right to point out the contribution made by the voluntary sector in local communities. It is often closer to those communities than the state ever can be in getting messages across and influencing the behaviour of individuals and people with whom it has a daily relationship. The Government sometimes have to be much better at learning how to engage with the voluntary sector to get our messages across to local communities.

The right hon. Member for Charnwood (Mr. Dorrell) is in denial about his time as Secretary of State. He was one of the people who refused to make the link between inequality and health, and he perpetuated that approach.

The Minister makes an assertion that is demonstrably untrue from the record. I was frequently asked whether I acknowledged a link between social deprivation and ill health, and frequently said, “Yes,of course I do, and it is one of the functions of the national health service to target resources at eliminating those inequalities.” The charge against the Government is that they have not done that effectively.

The right hon. Gentleman was happy to serve in a Cabinet that believed that there was no such thing as society because we are simply a collection of individuals. He was also a pro-European until he sought to be leader of his party. He went to Chequers and gave a press conference, pretending that he had become a Eurosceptic overnight. That is his record.

My hon. Friend the Member for Dartford(Dr. Stoate) has an impressive track record on public health. He is right to say that the Government have taken a power to raise the minimum age for purchasing tobacco. We have just completed a consultation exercise on that and will respond in due course on how we intend to put that power into practice. He and my hon. Friend the Member for Barnsley, East and Mexborough (Jeff Ennis) have done particularly good work on that.

My hon. Friend the Member for Dartford also raised the question of alcohol, a modern menace in society. We all accept that we need to take alcohol, and in particular drinking among young people, far more seriously. We are addressing a number of issues relating to that, such as working with the industry on sensible drinking messages and labelling, our know your limits campaign, and screening and brief interventions. We are also working with the Portman Group to appoint a chair and board of trustees of the Drinkaware Trust, which is a voluntary body.

The hon. Member for Mid-Bedfordshire (Mrs. Dorries) raised several issues, but in none of her contributions has she acknowledged that under-age conception is at its lowest level since the mid-1980s. I would imagine that she would welcome that. I agree with her about the over-sexualisation of children as a result of gaining access to certain materials. I think we would all accept that the media and other opinion formers in society should take a far more responsible attitude to the way in which sex and sexuality are presented.

I cannot.

The hon. Lady should recognise the achievements and the progress that has been made, as my hon. Friend the Member for North-East Derbyshire (Natascha Engel) did. Last week we announced an additional£1 million to strengthen work on our sustained investment in targeted HIV health promotion for groups most at risk. There has been a large drop in the number of AIDS cases diagnosed and a 70 per cent. drop in AIDS deaths because of the uptake of antiretroviral therapies since the late 1990s.

My hon. Friend said that public health was a hard-core Labour policy. I would not have used that term myself, but I know exactly what she meant. She made a valid point about the work that the Minister with responsibility for public health does every day across government, ensuring that there is a joined-up approach to tackling public health. All too often, that is presented as a sole responsibility of the national health service and the social care system. We need policies across government to tackle social exclusion, and I pay tribute to her work in providing leadership inside the Government and outside in terms of the messages that we give to the general public. My hon. Friend the Member for North-East Derbyshire was also right to raise questions about health education in the school system.

The hon. Member for South-West Surrey (Mr. Hunt) wants a lot more money to be invested, as he would, but he also wants—let us be clear about this—the measure of health inequality as determining the nature of NHS funding to be removed. That sums up thetrue level of commitment to public health on the Conservative Benches. They want to remove any regard for health inequality as we make decisions about the way in which NHS funding is distributed.

My hon. Friend the Member for Bassetlaw (John Mann) asked me to look at the healthy living centre in his constituency, and the desire to bring sport and education together. He also mentioned the work of the Do it 4 Real organisation. I am more than willing to consider those issues. He asked questions of the Opposition Front Bench, to which he got no answers.

The hon. Member for Wellingborough (Mr. Bone) lectured us on the founding principles of the national health service—founding principles that the Conservatives opposed at the time and which they have done everything possible to corrode and undermine when in government. Again, he never says that we are bringing up the levels of primary care trust funding, which historically have been below complement. He complained about historical underfunding. He isright: hon. Members should be concerned aboutthe cumulative effect of 18 years of Conservative Government that led to that underfunding.

My hon. Friend the Member for Crawley (Laura Moffatt), who has a great track record of having worked day in, day out in the national health service, talked about the importance of local strategic partnerships, recognising that at a local level we need a partnership between local government, the national health service, the voluntary sector and ordinary people—family members—to tackle the problems and raise our game in terms of public health. She made the point that that cannot be the responsibility of one Department, one organisation or one part of society; it has to be a partnership between the state, the citizen, the family and the voluntary sector if we are to achieve our objectives in this important area.

The Conservatives cannot advocate operational independence for the NHS and no targets, and then claim that they support ring-fenced funding and targets for public health. They cannot portray every reconfiguration as a cut, and then claim to believe in prevention. They cannot adopt economic policies that would mean savage cuts for the NHS and public services, and then claim to be the guardians of public health. They cannot surely keep a straight face in the context of this debate when they propose to scrap health inequality as a key factor in determining NHS funding.

Public health is as much as anything a generational challenge. We are the party of Sure Start and children’s centres; of universal nursery provision; of enhanced maternity and paternity provision; and of parenting support. We are the party of extended and healthy schools; of “Every Child Matters” and every family matters; of the new deal, welfare to work and affordable housing; and of the minimum income guarantee and the winter fuel allowance. We are the party that has transformed heart and cancer care and the party that has banned smoking in public places. We are the Government who brick by brick are rebuilding society, based on a new settlement between an enabling state and responsible citizens. The Conservative party may be led by a man who smiles a lot, but the British people are not stupid. They know that leadership requires a combination of sound values and practical action. A healthy future is built not on a nice smile, but on a commitment to sustained public investment and a long-term attack on social exclusion and inequality. Public squalor is the Tory legacy; public health is an expression of Labour’s core values.

Question put, That the original words stand part of the Question:—

Question, That the proposed words be there added, put forthwith, pursuant to Standing Order No. 31 (Questions on amendments), and agreed to.

Mr. Deputy Speaker forthwith declared the main Question, as amended, to be agreed to.


That this House welcomes the Government’s trebling of investment in the NHS by 2008 which is crucial to improving public health and tackling health inequalities; notes that this extra investment has enabled a huge expansion in preventive services including extending breast cancer screening to women aged 65-70 which has helped increase the number of breast cancers detected by 40 per cent. since 2001 and the first ever national bowel cancer screening programme which will detect around 3,000 bowel cancers a year when fully rolled out; acknowledges that this Government has done more than any previous government to help people give up smoking, including banning smoking in all workplaces and public places from1st July 2007; further welcomes the help and support being given to people to live healthier lives including two million 4 to 6 year olds now receiving a free piece of fruit or portion of vegetable, new healthier standards for school meals, clearer food labelling, new health trainers and NHS life checks; and recognises the unprecedented action this Government has taken to tackle the root causes of ill health and health inequalities including helping more people find work, lifting a significant number of children out of relative poverty and taking action to tackle poor housing.’.