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—

They are a quality team.

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.

rose—

Does the hon. Gentleman want to try to explain that?

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.

Will the hon. Gentleman give way?

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?

We did not vote against it on Third Reading.

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.

Will the hon. Gentleman give way?

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.

Will the hon. Gentleman give way?

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.

Will the hon. Gentleman give way?

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.

rose—

I give way to the hon. Gentleman.

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.

rose—

Perhaps the hon. Lady can tell us of similar examples in her own area.

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.

rose—

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.

Will the hon. Gentleman give way?

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—

Will my hon. Friend give way?

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.

Will the Minister give way?

No.

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.

It is in the motion.

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.

rose—

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.]

Order. Let the hon. Lady speak.

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.

Not for children.

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.

rose—

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.

rose—

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.