Skip to main content

Commons Chamber

Volume 454: debated on Tuesday 5 December 2006

House of Commons

Tuesday 5 December 2006

The House met at half-past Two o’clock


[Mr. Speaker in the Chair]

Oral Answers to Questions

Foreign and Commonwealth Office

The Secretary of State was asked—

Middle East

1. What steps are being taken in pursuance of United Nations resolution 1701 to disarm Hezbollah and secure the release of Israeli soldiers held hostage. (107305)

The deployment of the Lebanese armed forces and UNIFIL—the United Nations Interim Force in Lebanon—in southern Lebanon in accordance with UN Security Council resolution 1701 has had a positive effect on security in the area and has helped to reaffirm the authority of the Government of Lebanon. That Government should be the only body able to authorise use of force in Lebanon.

My visit to Lebanon on 1 and 2 December was undertaken to show support for the constitutionally elected Government and for the full implementation of the UN resolution. We continue to call for the immediate release of captured Israeli soldiers and support efforts by the UN to broker their release.

Will the Foreign Secretary lobby further the UN and the International Committee of the Red Cross on the release of the two Israeli hostages? There have been no reports on either of them and their families have had no word on whether they are alive. I ask for that lobbying to take place immediately.

I can assure the hon. Gentleman that we keep in continual contact with all the many disparate individuals and groups endeavouring to obtain the release of the soldiers. Indeed, I met the wife of one of them in London a few days ago. I agree with the hon. Gentleman that it is particularly tragic that those holding the soldiers have so far not even been prepared to provide proof of life. That is very distressing for the families. Everyone is doing everything they can to procure the soldiers’ release.

Is my right hon. Friend aware that the UNIFIL commander, General Pellegrini, has stated that he is unable to prevent arms from Iran and Syria from being passed to Hezbollah? How seriously does she take that violation of the UN resolution?

As my hon. Friend probably knows, we take such issues very seriously and we continue to work with the Lebanese authorities—and to work through the European Union—to do everything that can be done to strengthen border security. There are obviously concerns about arms passing across the border. At present, there is a certain amount of dispute about whether, and to what degree, such transfer is taking place, but all such transfer is undesirable and we will try to halt it.

Will the Foreign Secretary join me in welcoming the Israeli Government’s decision not to take immediate retaliatory action if they suffer rocket attacks? Does she agree that that is a courageous decision that might help the middle east peace process, particularly if Hamas can play its part by restraining the Palestinians from launching such attacks?

I completely agree with what the hon. Gentleman says, and I think that most people would. There have been many previous attempts to pursue the peace process, and many of them havebeen bedevilled by one side or another reacting very swiftly to provocations that were clearly designed to undermine it. The step that he mentions is very welcome, and I share his hope that such restraint is shown on both sides.

Violations of resolution 1701 are obviously unacceptable from whichever side they come. Therefore, would my right hon. Friend also care to comment on the large number of Israeli overflights of Lebanon, which also violate resolution 1701? What representations is she making on that, bearing in mind that such overflights have been taking place since well before the events of this summer?

I can tell my hon. Friend that we have indeed made repeated representations to the Israeli Government on the issue of overflight, particularly since the events of the summer. I am sure he knows that this discussion goes straight back to the point raised by my hon. Friend the Member for Liverpool, Riverside (Mrs. Ellman) on whether arms continue to flow into Lebanon. Nevertheless, we accept that that tactic can bring considerable dangers in itself, and we have urged the Israeli Government to cease using it.

The Foreign Secretary said that she was recently in Lebanon giving support to the Lebanese Government. Is she convinced that they will be able to face down the extra-parliamentary demonstrations that are taking place, or is she concerned that they will result in the fall of the Lebanese Government and effectively lead to a Hezbollah regime that will be to the benefit of neither the Lebanese people nor Lebanon’s neighbours?

There can be no certainty about the situation in Lebanon, and I share the concern that the hon. Gentleman has expressed. Certainly, the step that is being taken, with the clearly expressed wish of bringing down the elected Government, is potentially very damaging and destabilising. When I was in Lebanon, among the points I made to my many interlocutors were, first, that the international community supports the Government—whom the people of Lebanon themselves elected—and secondly, that there are many pressing issues and problems on the plate of that Government and of the Lebanese people in reconstructing their country, and that that should surely be their top priority.

As the Israeli soldiers remain captive four months after a war that devastated large parts of Lebanon and killed huge numbers of Lebanese civilians—and Israeli civilians, too—does that not make the visit of my right hon. Friend the Prime Minister to Washington this week all the more important in terms of emphasising that none of these problems can be solved without an overall settlement in the middle east?

My right hon. Friend is entirely correct. We have repeatedly made the point—not only in Lebanon, but at the broader middle east conference in Jordan a couple of days beforehand—that although moves toward a peace process in Israel and Palestine are not sufficient to solve all the problems of the region, they are a necessary step, since none of the other problems of the region is likely to be resolved without them.


2. What recent discussions she has had with the Government of Iraq and other Governments about war reparations. (107306)

I have met the Governments of key debt holders and urged them to consider the long-term benefits of reducing the burden of Saddam Hussein’s legacy, including the financial burden. As part of the Paris Club creditors’ agreement, the United Kingdom has agreed to forgive 80 per cent. of the Iraqi debt to the UK. Other countries have also slashed Iraqi debt, but some—especially among Iraq’s Arab neighbours—have declined to do so. We continue to encourage others to follow our lead in order to help significantly with the vital reconstruction of the Iraqi economy.

I welcome the tone of the Minister’s reply, but why have the Government acquiesced in an arrangement whereby $40 billion of Iraqi oil money that should have gone into reconstruction and development has been siphoned off for reparations, including very large payments to companies such as Bechtel, Halliburton and even Kentucky Fried Chicken for lost profit opportunities during the first Gulf war? Is that not obscene, as well as stupid?

I am not entirely sure that I go along with the adjectives that the hon. Gentleman has just used. I remind him and the House that reparations for losses incurred as a result of the Iraqi invasion of Kuwait have been dealt with by the United Nations Compensation Commission, which was set up by the United Nations Security Council in 1993. These have been paid out of the UNCC compensation fund, and payments to British recipients have now been completed.

I do agree with the hon. Gentleman, however, in that the vital need is to reconstruct Iraq. This situation does not help and is unsatisfactory, and I certainly agree that the new democratic Iraqi Government should not have to pay for the crimes of Saddam. However, thosewho loaned money to Iraq and who suffered under the Iraqi occupation of Kuwait have a right to expect recompense—a right that was recognised, as I said, by the United Nations.

Does my hon. Friend not agree that the UNCC regime must be brought to an end? It undermines the democratically elected Government of Iraq, because they are forced to levy their oil revenues to pay wealthy Kuwaitis and American big business. It is a regime imposed by the United Nations that was appropriate in its time, but its time is now over. Will the Government help to bring it to an end?

We have made it clear to the Paris Club creditors’ that this debt burden is a significant hindrance to the reconstruction of Iraq. However, I should point out that many honest businesses and countries suffered as a consequence of Saddam Hussein’s invasion of Kuwait—not least the Kuwaitis themselves. I am sure that in a perfect world we could bring this situation to early closure, and we have to convince those Governments and companies that that is the right thing to do. Believe me, some of those Governments and companies feel extremely bitter about the losses that occurred as a consequence of Saddam Hussein’s illegal action.

Does the Minister agree that a resolution of the reparations question must involve the regional powers, such as Syria and Iran, and that an allied withdrawal from Iraq would force those countries to face up to their responsibilities in the region? Rather than arming the militias in Iraq and fomenting the civil war there, they should start to build for stability. So in fact, an allied withdrawal might accelerate peace and stability in the region.

I certainly agree with the right hon. Gentleman that Syria and Iran—the two main countries that he is talking about—should take a much more positive role to try to bring stability and prosperity to Iraq. We have to talk not just to the Syrians and the Iranians, but, most importantly, tothe Iraqi Government—the democratically elected Government of Prime Minister al-Maliki. They have made it clear to us that they want a transfer of responsibility for security and for shaping the future of their own country. They very much hope that their neighbours will play a more positive role, and have been trying to achieve that in discussions with Syria and Iran.

I note that Syria, for example, is to open an embassy in Baghdad, which is a good move. However, I am not sure that a hasty retreat from Iraq would necessarily help that process. We have to undertake it in stages carefully and, most importantly, with the co-operation of the Iraqi Government.

My hon. Friend asks a pertinent question, as those issues hardly get any coverage in this country. I was in Basra last week and saw for myself how initiatives such as Operations Sinbad and Better Basra are achieving a great deal. I know that the right hon. Member for Richmond, Yorks (Mr. Hague), who speaks on foreign affairs for Her Majesty’s Opposition, has also been in Iraq recently.

I saw one project that alone involves the planting of 8,000 date palms, as part of Operation Sinbad, and employs 4,000 people in Basra. What Basra needs above all is for young men and women to get jobs and not to be prey to the militias that cynically use them to kill our troops. Many good things are happening in southern Iraq, and in the Basra area in particular, which is reflected in the urge of the provincial Government and other authorities in southern Iraq to take on more responsibility.

While we are talking about war reparations, will my hon. Friend look at the situation of the British people taken hostage in Kuwait when a British Airways plane landed there during the invasion of that country by Saddam Hussein? Many of those families were taken to Iraq as human shields and many are still suffering from the trauma of their ordeal. The Americans on the plane received compensation; the British never have. Will my hon. Friend look again at the matter?

I will be only too glad to do so. I know that my right hon. Friend feels strongly about what happened during the early days and weeks after the invasion of Kuwait. I believe that a comprehensive statement was issued by the previous Government, and I shall be glad to furnish her with a copy so that she and I between us might be able to discover what compensation might be paid out.

Cluster Munitions

3. What assessment she has made of progress towards banning cluster munitions; and if she will make a statement. (107307)

8. What assessment she has made of progress towards banning cluster munitions; and if she will make a statement. (107312)

The United Kingdom raised the question of cluster munitions at the recent review conference on the convention of certain conventional weapons, and we secured an agreement to hold urgent expert-level discussions on their humanitarian impact. My hon. Friend the Minister for the Middle East explained Government policy in a written ministerial statement issued yesterday.

In the 108 days since the ceasefire,177 people have been injured or killed by unexploded bomblets from cluster munitions in southern Lebanon. If casualties continue at the current rate, by 2007, when the Government’s proposed discussions are to take place, the figure will have risen to 500. Will the Minister make a commitment to hold truly urgent discussions with the Israeli Government regarding their violation of international law through their use of cluster bombs this summer?

The hon. Gentleman sets out clearly the nature of the problem. That is why the United Kingdom led the initiative at the recent CCW review conference for urgent discussions to take forward a comprehensive solution to the problem he describes so well. In addition, as my right hon. Friend the Foreign Secretary demonstrated on her recent visit to the area, the UK Government have provided financial assistance for the clearance of unexploded ordnance in southern Lebanon and we will continue to provide such assistance.

The Government have been trying to draw a clear distinction between smart and dumb cluster bombs—the latter of which they apparently disapprove of. Why then are they waiting until the middle of the next decade before ridding themselves of the large stockpile of dumb cluster munitions? Why not ditch them now?

I accept the implicit criticism in the hon. Gentleman’s observation about the distinction between smart and dumb weapons. However, the matter is not as clear cut as that. There is no internationally agreed definition. He has to face up to the fact that that weapons system, if used properly and in accordance with humanitarian law—that is, where there is no direct threat to the lives of civilians—is the most effective weapon for dealing with armour. He has to bear it in mind that, for example, if that weapons system was not available to British forces under threat from an armoured group, large amounts of high explosives would be required to deal with that threat, so there would be greater risk to the civilian population and greater risk of further damage to people in the area.

That is why it is appropriate to use this weapons system in accordance with humanitarian law, but at the same time to ensure that we take steps as best we can to reach an agreement internationally that, in particular, those weapons that cannot be properly targeted—those considered dumb, in the language that the hon. Gentleman uses—should not be used by any country.

Is my right hon. Friend aware that, according to the Mines Advisory Group and a cross-party group that was in Lebanon last month, some 32.7 million sq m of land are infected and contaminated by cluster munitions? According to the Mines Advisory Group, if the Israelis were to give it grid references for the 1.2 million bombs that were let loose in the last three days of action, instead of three children dying a day, as is the case, the number would, it hopes, be much less. Will he use his good offices to ensure that we put sufficient pressure on the Israeli Government to move forward on this important issue?

My hon. Friend is quite right. We have repeatedly urged the Israeli Government to provide the UN with detailed maps and other help in locating unexploded cluster munitions in the area that he describes. There is, however, a very determined effort under way to clear that area of unexploded weapons. As I have already indicated, we have given significant financial help to that effort.

Although I understand my right hon. Friend’s assessment of the military capability of thoseweapons, does he understand that the humanitarian consequences are so vast that there is a requirement to move as quickly as possible? What assessment has he made of the progress and what chance does he think there is of reaching an international solution in the way that we did for land mines?

That is why the United Kingdom has adopted the approach that I set out. What is important is that we secure an international agreement in precisely the way that we did in relation to land mines, as my hon. Friend indicated. It is important that all countries move together as part of international law on this question. However, I emphasise that the United Kingdom’s use of that particular weapons system is always governed by humanitarian law.

But should not equal priority be given to removing the causesof conflict, which lead to the use of destructive armaments such as these and, for that matter, the 4,000 missiles that were rained down on Israeli towns and cities at the beginning of this conflict and which have a pretty contaminating and non-humanitarian impact on those who are on the receiving end of them?

Will the Minister give equal priority to supporting all those in the middle east who seek a peaceful solution, including the President of the Palestinian Authority and the Prime Minister of Israel? Would not a good start be made if there was an initial settlement that led to the release of the two hostages, Ehud Goldwasser and Eldad Regev?

Of course, my right hon. Friends the Prime Minister and the Foreign Secretary, as I mentioned, were in the region very recently, as was my hon. Friend the Minister for the Middle East. So, a determined effort has been made by the Government, and will go on being made, to reduce the causes of conflict and to find a way back to a peace process.

I welcome what my right hon. Friend has to say and the written statement in particular. Does he agree that one thing that we could bring forth at the CCW conference in a year’s time would be a clear statement that we intend to publish details of our stocks of cluster munitions in the hope that all other countries do so? If that could be done, we would at least know the nature of the problem with which we are dealing.

I accept the point that my hon. Friend makes, but when trying to ensure that all countries respect international law, it is important that there is an international agreement. That is why we have taken the initiative, which I believe represents the best way forward. As other hon. and right hon. Members have said, the initiative is a route towards a comprehensive international ban.

In the past couple of weeks, we have begun a useful debate on this subject in Parliament, and I pay tribute to Landmine Action and others for the work that they do in this area.

May I press the Minister on his answer to my hon. Friend the Member for Dunfermline and West Fife (Willie Rennie)? The right hon. Gentleman did not tell us why, if it is a matter of principle to get rid of dumb cluster munitions, it will take until the middle of the next decade for the British to do that. More generally, does not the Government’s distinction between dumb and smart cluster munitions ignore the reality that the smart bombs can have an unacceptably high failure rate of 10 per cent? Surely the bottom line is that we should be getting rid of all cluster munitions.

I am not going to give the hon. Gentleman and the House a lecture on the distinctions between dumb and smart weapons. One problem is that the word “smart” is generally used to refer to a guided weapon. Unfortunately, in this context, “smart” is also used to refer to the ability of this particular weapon to self-destruct if it has not exploded after a period of time.

A smart cluster bomb ought to be guided and should self-destruct after a period of time. However, I accept that the definitions are sometimes used imprecisely. I also accept that it is important that we move together with other countries to try to find a comprehensive way to resolve the problem. I do not wish to repeat all the points that I have made about the use of the weapons system, but I assure the House that the United Kingdom Government have only ever used such weapons fully in accordance with international law.

Has the Minister read research by Handicap International that demonstrates quite clearly that 98 per cent. of casualties from cluster munitions are civilians and that a third are children? Can he justify to the House how it is right that civilians should be allowed to go back to homes and fields that are clustered with explosive debris? Will he work with the International Committee of the Red Cross to try to overcome intransigence—especially on the part of the United States of America and Russia—over getting a ban on such munitions?

I am not even going to try to justifywhat my hon. Friend describes. It is appalling that children—or anyone—are damaged by such weapons when they fail to explode, because that is an indication that they have been used in circumstances in whichthe United Kingdom would not use them. It is important to emphasise that great care is taken by our commanders in the field to ensure that the provisions of humanitarian law are recognised and respected. By implication, my hon. Friend made clear the importance of getting a comprehensive international agreement on these weapons, which I emphasise.

In an effort not to be dumb, may I put one simple point to the Minister? As part of the Government’s efforts to achieve an international ban on cluster bombs, would it not assist if the UK gave them up first, thus taking the moral high ground? I remind him that while unilateral disarmament might not be the flavour of the month among those on the Treasury Bench at present, it might be a good idea during the negotiations.

As my hon. Friend the Minister for the Middle East did in yesterday’s written ministerial statement, I have made it clear that the Government’s intention is to phase out a certain kind of these systems—I say that without repeating the word used by the hon. Gentleman. I agree with him to the extent that it is important that we lead the way on that. However, equally, it is vital that we use the existing framework that is available to all countries that own and use those systems, and that there is a comprehensive agreement. Kofi Annan has made it clear that the parties should use the existing CCW framework, and that is the approach on which the United Kingdom Government have led the way.


4. When she next expects to meet her European Union counterparts to discuss the effectiveness of current sanctions against Zimbabwe. (107308)

My right hon. Friend the Foreign Secretary discussed Zimbabwe with her EU counterparts in October. I have also had discussions on that country, including with my Portuguese counterpart. There will be further discussion of the EU’s targeted measures against Zimbabwe early next year, before their expiry in February. We believe that the measures, which target the regime members and not ordinary Zimbabweans, are effective and should be continued.

The Minister will be aware ofthe total collapse of Zimbabwe’s infrastructure and the rampant hyperinflation, with the cost of water in Harare last week increasing from 8 to 130 Zimbabwean dollars per unit. Is he also aware of the horrific human rights abuses, including the recent police attacks on the trade union vice-president Lucia Matibenga, which resulted in a broken arm? Surely the time has come for our Government and Europe to tighten smart sanctions and travel bans, which do not affect Zimbabwe’s hard-pressed citizens, but are aimed at Mugabe and his evil henchmen?

May I make it clear that the UK condemns the most recent assaults on ordinary Zimbabweans? The organisation Women of Zimbabwe Arise shuns any form of violent demonstration and has a history of peaceful protest; there can be no excuse for the attacks that its members have suffered. The beating of women and children only two months after the abuse of the trade union leadership is further evidence of Zimbabwe’s terrible human rights record, which Robert Mugabe tries to argue is a figment of the west’s imagination.

I agree with the hon. Gentleman that it is vital that we continue to isolate the regime, but, as his opening observations made clear, we have no quarrel with the people of Zimbabwe and no reason to cause further harm to a population who are already suffering as a result of the appalling decisions of their leaders. That is why we draw the distinction between sanctions that are aimed at the regime and other measures that might further damage the people of Zimbabwe.

Although I welcome the talks on Zimbabwe with our EU partners, should not more effort be spent in talking to Zimbabwe’s neighbours, whose actions might have more effect, and to countries such as China, which continue to invest in Zimbabwe?

I agree that all parts of the international community, and in particular Zimbabwe’s near neighbours, could do more. It is important to continue to isolate the regime, and it is vital to world opinion that the countries of southern Africa take united and effective action to isolate Zimbabwe. I strongly agree with my hon. Friend’s comments.

Is it not a fact that there are no practical consequences that the Minister can name that have affected the leaders of Zimbabwe as a result of the sanctions? To follow up the suggestion made by the hon. Member for Tamworth (Mr. Jenkins), is it not necessary to do more and not only talk to Zimbabwe’s neighbours, but pin them down to practical measures that they can impose and we cannot?

I have made it clear that we would likethe international community, including Zimbabwe’s southern African neighbours, to do more, but I do not accept that there are no practical consequences. If that were so, the regime in Zimbabwe would not protest so loud and so long about the impact that the sanctions have. The fact is that its leaders do protest, which means that the sanctions are having some effect on them.


The human rights situation in Burma remains dire. Serious human rights abuses are being committed, particularly in areas of armed conflict. The Burmese people do not enjoy the most basic human rights—including the right of freedom of speech and association—democracy and good governance, and the rule of law.

The Burmese Government have recently orderedthe International Committee of the Red Cross to close its field offices. The Under-Secretary of State for International Development and I have issued strong statements condemning that action, which I have placed in the Library of the House.

I discussed the human rights situation in Burmawith UN Under-Secretary-General Gambari on15 November. I have also invited Juan Mendez, UN special adviser for the prevention of genocide, tobrief Members of both Houses of Parliament on14 December.

I thank the Minister for that full answer. It has been the policy of this country for many years to discourage UK companies from investing in and trading with Burma, but despite that the human rights situation in that country has worsened, as hehas just described. What consideration have the Government given to shifting from a policy of discouragement to one of prohibition? Does he accept that if we did that, we would have a great deal more moral authority when we were trying to discourage other countries in the region from trading with and investing in Burma?

I thank the hon. Gentleman for his question and for the way he worded it. It reflects the common approach across the House and shows how effective that can be. There is a common European Union position on the matter, which includes an arms embargo, a ban on defence links, a ban on high level Government visits to Burma and a ban on the supply of equipment. As a result of our discouragement, British companies have been disinvesting in Burma to the point that there is little or no UK investment in Burma or its overseas territories. I assure the hon. Gentleman that the best chance we have of imposing embargos is through the EU. If we do so unilaterally, we will open the door to some countries in Europe which may not want to join in the strength of the common position. It is critical that the 25 countries maintain the same line and ensure that commitments given are carried through.

My right hon. Friend will be aware that the Chinese Government have extensive economic and political relations with Burma. What representations has he made to the Chinese authorities about these matters? Is he optimistic that China will eventually move into line with the body of international opinion?

I have not only raised the matter with my counterpart in China and with the ambassador on numerous occasions, but in recent days I have taken the opportunity to speak to my counterpart in India, and yesterday I met the representatives of countries in the Association of South East Asian Nations to talk through with them a more proactive approach by the ASEAN countries. Last evening I met the Foreign Minister of Brunei, who is chair of the ASEAN group, to discuss with him a more practical approach by ASEAN, along with India and China, to try and resolve the issues on behalf of the people of Burma.

Following the pretty bleak reply that the Minister gave on the Burmese regime, does he agree that it is one of the most evil regimes in the world in terms of its human rights record? Recent reports say that Burma has the highest recruitment of child soldiers, and routine rape and torture of women and young girls. That is unacceptable. What further action is the Minister taking within the European Union so that certain countries do not block a UN resolution? Does he agree that tougher action needs to be taken by China and Russia so that together the international community can bring forth a real and workable UN resolution to stop the regime committing such human rights abuses?

I thank the hon. Gentleman. First, I have spoken directly with the Burmese ambassador on numerous occasions, with a range of allegations backed up by firm evidence. To date the response has been negative. No responsibility is accepted, including for rape by army officers and army personnel. Secondly, I have had personal and detailed discussions with all the countries that the hon. Gentleman mentions, except Russia. As I said to Mr. Gambari when we met recently, our commitment is to support a UN resolution. All our efforts among our European colleagues and colleagues in the ASEAN group are important to get maximum support for any further Security Council resolution. That is why I have invited a UN representative to come here on 14 December and give a report to Members of both Houses. It is important that hon. Members of both Houses have the opportunity to meet a UN representative and to discuss with him in person the role of the UN working with us as a Government. Not everyone can fly to Geneva or New York, so we are bringing Geneva and New York here. The hon. Gentleman and the hon. Member for Orkney and Shetland (Mr. Carmichael) are welcome to attend the meeting, which is a genuine effort by me to open up the dialogue and give others the chance to put the case for the Burmese people.


Iraqi leaders have reaffirmed their commitment to national unity. The national reconciliation initiative is being pursued and the constitutional review committee has now been formed. On security, two provinces have already been handed over to Iraqi control and four more will follow this month. Agreement has also been reached to transfer four of the 10 Iraqi army divisions from the multinational force to Iraqi command and control this year. Political progress is, though, still being hampered by high levels of sectarian violence specifically aimed at undermining the Government’s efforts to improve security. We will continue to support the Iraqi Government in their work.

What can the Foreign Secretary say to disprove the withering verdict of the US State Department official, Kendall Myers, that Washington has systematically ignored British advice over Iraq? Can she give a single concrete example of any piece of advice given by her or the Prime Minister that was accepted by Washington and without which the catastrophe in Iraq would have been even worse?

I could certainly give the hon. Gentleman many examples of advice that we have given that has been accepted by Washington. As regards Kendall Myers, I had never heard of him before and I do not suppose that I shall ever hear of him again—[Interruption.] The example with America goes back as far as Winston Churchill, a point of view that the hon. Gentleman might not wholly share.

Does the Foreign Secretary agree with the view of the Secretary-General of the United Nations that Iraq is now in a state of civil war? A simple yes or no answer would be very helpful.

No. Furthermore, I would say to the right hon. and learned Gentleman, who is very experienced in politics as well as in some of these issues, that it might have occurred to him, because it has certainly occurred to me, that it was not the Secretary-General who said that—not for the first time, the words were put into his mouth by a journalist.

Should there not be total condemnation from everyone in this House, whichever line they took at the time of the war, of the mass murder that is being carried out on a daily basis against completely innocent people by terrorists who have, needless to say, not the slightest interest in democracy? Since it is clear that the occupation troops can in no way stop what is happening, does my right hon. Friend accept that the continued reduction of British troops is to be welcomed? I hope that that will continue throughout next year.

My hon. Friend is entirely right that everybody must, and does, condemn the terrible levels of violence and the nature of the violence—wanton violence—in Iraq, which seems to be aimed at nothing more than destroying the hope and the prospect of peace. It is confined to fewer areas than one is sometimes given the impression is the case from coverage in this country, but it is nevertheless quite appalling.

My hon. Friend is also right to say that it is important that we continue with the process of handing over security responsibility to the Iraqi police and armed forces as they become able to take it on. Like him, I strongly hope that that process will continue.

As it would appear that the presence of forces responsible for the invasion is merely fuelling the insurgency,what discussions have taken place with the Iraqi Government about the desirability of handing over some of the responsibility to United Nations forces?

Lots of discussions have taken place with the Iraqi Government about a transfer of responsibility, but I have detected no interest in the Iraqi Government in finding a new international force. Perhaps I could remind my hon. Friend, as she seems to have forgotten, that the multinational forces that are there are under the authority of the United Nations. The Iraqi Government are not interested in getting in a fresh set of international troops, but there is certainly interest in taking over control of security themselves—that is a view that we strongly share.

Let me add that it is not the case that the presence of multinational forces is fuelling conflict in every part of Iraq—there are some areas where it may not be assisting and may even be adding to difficulties, but that is not so across Iraq. That is why the Iraqi Government are not asking for those forces simply to decamp.

Given the pace of the policy reassessment going on in Washington, does the Foreign Secretary agree that it would be highly desirable for the Government to come to the House before the Christmas recess with a statement of policy on Iraq and on the prospects for our operations there? Will she describe the shape currently taken by any policy review going on in the Foreign Office, the Ministry of Defence or Downing street in parallel with the two reviews taking place in Washington? With or without that, what can she tell the House about the advice that the Prime Minister will give to President Bush when he travels to Washington tomorrow?

The advice that the Prime Minister will give to President Bush is exactly the advice that he has shared with the House and, indeed, the country, on many occasions. It is on the need to give attention to supporting the Iraqi Government’s efforts to improve services and infrastructure, and to improve and take greater responsibility for security, as they can. Obviously, it is not entirely up to me how matters are reported to the House, but I certainly give the right hon. Gentleman an undertaking that if there is a change that seems to require fresh information to be given to the House, I will be happy to give it, in one way or another.

I am grateful for that answer, and of course I will pursue the matter. In the meantime, it is evident that military force alone will not resolve the current situation, and I know that the Foreign Secretary will agree that a broader political reconciliation in Iraq is indispensable to its future, but what does she think are the chances of arriving at such a situation in the next few months? Does she think that it is a good idea to establish an international contact group of countries that wish to help in such matters, and that have the influence to do so? Such a group could begin to provide the international framework to buttress any such agreement in the future.

First, may I say that I strongly share the right hon. Gentleman’s view—a view thatwe have been expressing continually to the Iraqi Government—that political reconciliation is imperative in Iraq? We have encouraged and supported that Government in that work. I can tell him and the House that, two or three days ago, I had a long and very fruitful conversation with the Iraqi Foreign Minister, who told me how much better those efforts are proceeding, and how encouraged he is that people there are seeing some improvement in the situation. I very much hope that the next few months will bring the kind of improvements that he, and we, seek. On the issue of an international contact group, I can tell the right hon. Gentleman that for some time we have urged Iraq’s neighbours and its colleagues elsewhere—for example, in the Gulf and among the Arab states—both to join the international compact to support Iraq, and to be prepared to be engaged in a wider group helping to support and assist the Government of Iraq in their endeavours. We continue to make such representations, and I think that they are increasingly being taken seriously. Whether there will be a formal contact group is another matter, but support for the international compact will, I think, have the kind of effect that the right hon. Gentleman seeks.

The Foreign Secretary must be right to emphasise the importance of Iraq’s neighbours, who must be part of the solution, as regards the politics of Iraq. When my right hon. Friend the Prime Minister is in Washington, will he tell the United States Administration unequivocally that we must now talk, however reluctantly, to the Syrians and the Iranians? They must be part of any solution; if not, they will be part of the problem.

Those countries are part of the problem now. I am sure that my right hon. Friend the Prime Minister will discuss with the President a whole range of matters, which will encompass the points rightly raised by my hon. Friend. It has long been clear—and, of late, we have made it explicitly clear—to, for example, the Syrians that people are prepared to talk to them, and that it is in their interests, and in the interests of Iran, and all of Iraq’s other neighbours, that there should be a stable Iraq in the future. They might think about that a little more fully than they seem to do at the moment. Of course, although people are prepared to engage in dialogue—I am pleased, for example, that the Syrians are opening an embassy in Baghdad—the degree and the nature of that dialogue will depend on whether or not action is taken by both Syria and Iran that shows good will, as opposed to ill will.

Middle East

7. What discussions have taken place with the Israeli Government on the use of rubber bullets by the Israeli military against Palestinian protestors. (107311)

A report in 2002 by a group of Israeli researchers, including the then chief physician of the Israeli police force, recommended that rubber bullets

“should…not be considered a safe method of crowd control.”

Despite that, on 4 August this year, my constituent, Margaret Pacetta, was shot in the back with a rubber bullet during a peaceful protest in the disputed village of Bilin, leaving her bruised and badly shaken. Will the Minister raise that issue again with the Israeli Government and ask them to follow the advice of the 2002 report?

The hon. Lady is rightly concerned about what happened to her constituent, but she will acknowledge that rubber bullets are a hell of a lot better than ordinary metal ammunition, which tends to kill people or blow their arms off. There is not a general prohibition on the use of rubber bullets under international law—she will recall that the United Kingdom used them regularly in Northern Ireland. We expect the Israelis to use them only when necessary with proper control because, as she said, they are sometimes lethal. Our embassy in Tel Aviv raised that particular case with the Israeli authorities on 13 June, and our ambassador wrote on 15 June. The embassy pursued the case with the Israeli Ministry of Foreign Affairs on 30 August, and it asked the Israeli Government to clarify whether plastic or rubber bullets were fired at demonstrators and whether the crowd was beaten with batons. If so, it asked them to explain why such force was necessary, but it is still awaiting a response.

Mr. Liberman, who is a Member of the Knesset, believes that all Palestinians should be cleared out, not only from the occupied territories but from Israel. What chance is there of establishing a Palestinian state when a Knesset Member with racist views is holding the coalition Government together in Israel?

I agree with my hon. Friend that it is an absurd situation, as that man holds views that are akin to those that prevailed under apartheid. He wants Palestinians to be driven out of Israel, but I am sure that that view is not held by most Israelis—it certainly is not held by most Palestinians. We should work wherever possible in our negotiations with the Israeli Government and generally in diplomacy to counteract such arguments.

Will the Minister raise the issue of glass fibre shells, which have allegedly been used in Gaza, with the Israeli Government because, as doctors in the House will know, they leave small fragments that cannot be detected by X-ray?

I will certainly make inquiries, but it is the first that I have heard about such munitions being used. If that is the case, we would certainly deplore their use.

Ceasefire (Gaza)

We welcome the mutual ceasefire in Gaza between the Palestinians and Israel. Like everyone else, we were concerned that in the early part of the ceasefire Qassam rockets were fired from Gaza into Israel, but we welcome the public commitments of Prime Minister Olmert and President Abbas to make it work. All sides need to use this opportunity to take measures to restore confidence and return to the road map. A great deal of energy, commitment and continued effort is required from the international community to help to facilitate that.

I thank my hon. Friend for his answer, but does he not think that it is time that pressure was put on the American Government to make a concerted effort to sort out the middle east question, particularly the road map to peace?

My right hon. Friend the Prime Minister visited the region from 9 to 11 September and met key leaders. He believed that it was important to visit the region to exchange ideas and to start to identify a way forward for the parties, as that can lead to genuine dialogue through negotiations and a way back to the road map. I do not doubt that he will urge our American allies to devote more energy to that re-engagement in his impending visit to Washington.

My right hon. Friend the Member for Torfaen (Mr. Murphy) recently visited Sri Lanka, and he put his finger on an important issue in peace building and efforts to reinvigorate the procedure. He noted that it is not enough for the parties to be brought together once every six months in Geneva—it is something that must be worked at day and night, as was the case under Prime Minister Major. People must construct back channels, and explore ways to bring the sides together. It is about peace building, and those are not easy techniques to evolve. We should not assume that it is enough to hold the occasional grand meeting at which the great and the good are brought together and various resolutions are arrived at. We have to do much more, as it is about building peace from the bottom up.

May I reinforce what the Minister has just said about peace building? It is essential that both sides get rapid benefit. In the absence of rapid benefit, there is never support for the process.

I agree entirely with the right hon. and learned Gentleman. As he knows as well as any of us, it should not be rocket science. I have met people who said that Egyptian contractors could be used to build 200,000 new houses in Gaza. Imagine what that would do for employment in the area. There are plenty of people with good intentions. There is no shortage of resources, but there is a shortage of political leadership and will to get on with it—and to get on with it quickly.

Cluster Munitions

10. Whether the UK will be represented at the conference on cluster munitions in Oslo in February 2007; and if she will make a statement. (107314)

Invitations to the conference on cluster munitions in Oslo in February have not yet been issued. We will carefully consider any such invitation, if and when it is received.

Given that Kofi Annan has, among other things, called for a freeze pending the ban, and given that the expert-led urgent discussions will not report back to the review for a whole year, I urge the Government not only to attend the Oslo conference, but to take a lead part in discussions on a possible moratorium and, ultimately, a ban on these utterly abhorrent weapons.

I am grateful for my hon. Friend’s suggestion, but I answered her question as I did because we have not yet received any invitation, so we are not in a position to say whether we can attend or not. I agree with my hon. Friend that it is important to take forward a process, which is why we have taken the initiative and appointed a group of experts to look into the problem through the conference of the convention on certain conventional weapons in order to bring about the possibility of an international ban. I hope that my hon. Friend strongly supports that, which is precisely the process that Kofi Annan advocated.

Carbon Emissions

11. What recent discussions she has had with the Secretary of State for Environment, Food and Rural Affairs on international mechanisms to enforce the reduction of carbon emissions. (107315)

I am in regular contact with the Secretary of State for Environment Food and Rural Affairs on how best to deliver the UK’s climate objectives. I have made the joint pursuit of climate and energy security a strategic international priority for the UK. It is vital to our security and therefore a major focus of our diplomacy to achieve a rapid transition to a low-carbon global economy.

The Secretary of State for Environment Food and Rural Affairs is committed to UK and EU cuts in carbon emissions, but only the United Nations has the authority to take a global view of this issue, so will the Foreign Secretary press the UN to make climate change a central purpose—naming and shaming recalcitrant countries, if necessary—rather than the peripheral concern that it is now?

I think that the hon. Gentleman is being unfair to the UN in saying that it is a peripheral concern. Indeed, at the recent United Nations framework convention on climate change conference in Nairobi, the Secretary-General made a very strong statement about the importance of this issue. I certainly share the hon. Gentleman’s view that the matter should have even more prominence in UN discussions, which is something that we are urging on the new Secretary-General.

The Secretary of State knows that we share her strong commitment to international co-operation to achieve carbon emission reductions. Does she share our view—and the view expressed by the Minister for Europe on 26 October—that it can be achieved without any additional EU powers?

We are rather a long way from the international agreement that we all seek in the longer term. In the shorter term, we certainly believe that one of the main instruments that can be used to make progress is the EU emissions trading scheme and extensions to it. As the hon. Gentleman knows, this country is, I believe, the only one to have had its national allocation plan proposals for the new scheme accepted. That does not, at present, require any new powers.

North Korea

Immediately following North Korea’s nuclear test in October, the Foreign Secretary had telephone conversations with her counterparts, including Chinese Foreign Minister Li. I also called the Democratic People’s Republic of Korea ambassador in London to the Foreign Office to make our views clear. On a previous visit to the region in July, I discussed the issues with interlocutors from China, as well as Japan and South Korea, and my right hon. Friend the Deputy Prime Minister had further talks during his visit in October. We remain in direct and regular contact with the Chinese Government on the issue, including through our ambassador in Beijing and via other high-level ministerial and official contacts. China has an instrumental role to play in the resumption of the six-party talks and in ensuring that North Korea complies with UN Security Council resolution 1718.

I thank the Minister for that answer. A few weeks ago, the Deputy Prime Minister told the House that he had had three hours of talks with the Chinese special envoy to North Korea at the end of October. Will the Minister tell us a little more about the content of those talks?

I do not want to be awkward and say, “No, because I wasn’t in the room when the discussions took place.” I can tell the hon. Gentleman, however, that if the Deputy Prime Minister spoke to the special envoy in the same way that I did, it will have been a very productive discussion.

Does the Minister accept that the situation in North Korea is a perfect illustration of why it is vital that we renew our nuclear deterrent? Does he agree that the argument that we are unlikely to use such a deterrent is not only wrong but dangerous when we are faced with an opponent such as North Korea, which accepts only one principle, namely, that might is right?

I take on board entirely what the hon. Gentleman says, and I thank him for his support of the Government’s position. It is also really important that we get the six-party talks going again. It is critical that we resume those discussions. We already have talks about the talks under negotiation, and several points remain under discussion to be agreed between the United States and China. I hope that the talks will resume soon.

Opposition Day

[1st Allotted Day]

Public Health

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.