[Relevant document: the progress report, “Health Challenge England—next steps for Choosing Health”, published by the Department of Health in October 2006.]
Motion made, and Question proposed, That this House do now adjourn.—[Caroline Flint.]
It is a mark of the progress that this Government have made in safeguarding the nation’s health that possibly for the first time, public health has the opportunity to take its rightful place as one of the cornerstones of our health policy, moving the national health service towards being a prevention as well as treatment service. The programme of investment and health reform has transformed the NHS from a crisis service to one that is on the point of being able to deliver the health and well-being of every citizen, treating people as individuals, rather than as numbers on a waiting list. Clearly, in 2007 our NHS is more local than ever before. The service has been devolved. It is more transparent in its financial dealings, and its public health initiatives draw in partners across the public, private and voluntary sectors.
This Government established public health as one of the six key objectives in the NHS plan. In the past few years we have published a groundbreaking public health White Paper “Choosing Health: Making health choices easier”, completed 116 of the 210 commitments set out in it, and mapped the need and extent of the public health challenge in “Health Challenge England—next steps for Choosing Health”. In doing so, we have equipped those at the most local level to understand better the complex needs of their communities and neighbourhoods so that they can provide the best possible health service. In the face of the advice from the Conservative party not to legislate at all, this Government introduced comprehensive legislation for workplaces and enclosed public places to become smoke free by 1 July 2007—more extensive smoke-free provisions than any other country.
More than 100 years ago, enlightened reformers like John Snow did not look at the fashions of the affluent minority, with their love of spas, gyms and country retreats to convalesce after illness. Instead, Snow examined the conditions of the majority—the slums, the open sewers, the poor air and the dusty factories. He saw the connection between a lack of clean water and the spread of cholera. The modern sewerage systems and the fresh water that resulted from them were instrumental in reducing the impact of communicable diseases. After world war two, the mass vaccination programmes all but eliminated diseases such as polio. Today, our vaccination programmes are more far-reaching than ever and public information is more extensive than ever. However, although those are good things, they are insufficient. Life in the 21st century demands new approaches to public health. I hope that that will inform our debate.
I am grateful to the hon. Lady for giving way at this early stage. She referred to our apparent opposition to the “smoking” clauses in the Health Bill. Can she perhaps clarify that, because we have always made it clear that it would be our intention to have legislation covering smoking in enclosed public places? I would like her to clarify the misleading impression that she has given.
I will make a little more progress. I will be happy to give way at a later opportunity.
Today, individuals have greater choice and greater sources of information. Crucially, in many respects, much of the public are wealthier, better educated and living longer, with greater expectations of life and higher expectations of public services than ever before.
In relation to the intervention by the hon. Member for Westbury (Dr. Murrison), perhaps we should judge the Conservatives’ attitude to smoking in public places on the basis of the amendments that they tabled to the Health Bill, which were not for the comprehensive smoking ban that we will have on 1 July.
I agree totally with my right hon. Friend. In a number of areas—tobacco control, the ban on advertising, the world-class services in the NHS to support people to give up smoking, and the legislation that will come into force in England on 1 July—we need take no lessons from the Conservative party.
I am listening intently to the hon. Lady. Before she gets too rhapsodic in her oratory, perhaps she could answer two points. If the Government’s record is so good, why is it that the number of health service professionals working in public and community medicine focused on public health has been cut by a fifth since 2001, and why has there been a cumulative reduction of £300 million in expenditure on infectious diseases under her Government?
We have seen a growth in the number of people working in health improvement. That is not to say that there should not be more. As I develop my contribution, I hope that I will engage the hon. Gentleman in looking beyond what have sometimes been stifling demarcation lines between public health and other areas of the health service, and in looking at the opportunity for every health professional to be a public health advocate. Beyond the health service, in local government and in the public, private and voluntary sectors, we can put public health at the heart of many organisations. They should see it as an opportunity to deliver on their agenda, whether it is regeneration, educational attainment or, importantly, providing people with the health and well-being to get the most out of life.
I am grateful to my hon. Friend for giving way at this early stage. She has been generous with her time. Does she agree that one of the biggest public health problems is health inequality and that the Government are doing an enormous amount to reduce poverty and to ensure that people get back to work? Those things in themselves will make an enormous difference to the health of the nation. Therefore, they are very good public health measures in themselves.
I agree. We are the first Government to say plainly that health inequalities are a real problem and to set challenging targets. That is not to say that we have completed our journey, but one has to acknowledge the problem and set the targets to make a start in the right direction.
I will shortly. I have given way quite considerably in the last few minutes.
Today individuals have greater choice, but they want more. They demand access to services locally, at times that suit them, not at the convenience of the system. They want to walk in. They want easy access to information via the internet or advice via NHS Direct. They expect quick appointments. All of those were impossible in the Tory Britain of 10 years ago. Today, with a Labour NHS, they are almost taken for granted.
Placing public health at the centre of a modern health policy is essential. Government policy has to provide a comprehensive response to the vast changes in lifestyles and attitudes that, far from being unique to Britain, are features of many modern western societies. International travel and migration, affluence, over-consumption, sedentary lifestyles, shift working and convenience food are all aspects of modern, western society, but all contribute to new health challenges. Other changes, such as binge drinking and poor sexual health clearly have serious long-term consequences. A failure to face those challenges is not an option.
The maintenance of good public health involves a change in the relationship between Government and individual. It involves every adult, every parent, safeguarding their own health and that of their dependants—individuals becoming the guardians of their own health and well-being.
On that crucial issue, the public agree with Government. Recent surveys by the King’s Fund reveal that 89 per cent. of people agree that individuals are responsible for their own health. They also reveal that 93 per cent. of people agree that parents are more responsible than anyone else for their children’s health, and that 86 per cent. believe that the Government’s role is to prevent illness and to provide information and advice.
Does my hon. Friend the Minister recall a recent visit she made to Crawley, during which she looked at, among other things, public health measures, and specifically at a cooking class delivered through Sure Start to help parents to cook decent food for their children and thereby improve their health and performance at school? Is that not an example of the way in which we can truly get through to parents and help them look after their children better?
I agree wholeheartedly with my hon. Friend; not all parents need such classes, but some do. That is why there is not a one-size-fits-all approach to this issue. I also saw in Crawley the sport and leisure centre providing services for GPs to refer people with long-term conditions to exercise classes, and Crawley hospital being transformed in terms of supporting urgent care, and also physiotherapy for people with long-term conditions. I congratulate all the health professionals in Crawley—GPs, nurses and others—who are thinking about how they can make their hospital truly a community hospital, and a hub for the primary services not of today or yesterday, but of the future. I congratulate my hon. Friend on the part that she has played and for being brave enough to enter into that debate.
I thank the Minister for giving way; she is being generous in taking interventions. In answer to the question posed by the hon. Member for Dartford (Dr. Stoate) about the importance of health inequalities, can she explain why all the evidence—including the Government’s answers to certain questions—shows that health inequalities have widened under this Government?
I will attend to that issue later in my contribution, and I shall be happy to take an intervention from the hon. Gentleman at that point if he is not satisfied with what I say.
People have the freedom to make choices, but the Government have a role to play in helping them make more informed choices about their health, and it is important to understand that some people, families and communities might need more support than others. For example, 50 per cent. of adults say that they are trying to eat well, and the Government can help in that by encouraging simple front-of-pack labelling to assist people in judging whether food is high in salt, sugar and fat. By engaging with Netmums, an online forum for mothers—250,000 mothers are registered on it—we are involved in discussions about front-of-pack labelling, and also about advertisements aimed at children for high-fat, high-salt, high-sugar products. That is an example of how we are looking beyond the traditional ways of engaging with communities and the public, and how we are exploring how we might better listen to the current concerns of mothers.
By leading the debate, the Government can influence the actions of the private sector. Credit should go to the Sainsbury’s wheel of health initiative, the first simple food labelling device, which was informed by both Government and the Food Standards Agency advice, but which was devised by Sainsbury’s. Six million customers a week see its wheel of health labels. Independent research will determine exactly which labelling system is developed, and I acknowledge that other systems are being used by different retailers and food producers. What is clear—I think that this has been accepted by those from the food retailing and production sector who are involved in this debate—is that we will adopt whatever the consensus among consumers supports. I hope that that will happen.
Anyone who doubts the willingness of the private sector to promote the public interest should look at another project that we have engaged it with: Project Neptune, the food manufacturers’ commitment to reduce salt levels in food by 30 per cent. over a three-year period. I again congratulate the food producers who have engaged constructively in reducing the levels of salt, and also in promoting awareness of the dangers of salt in our diet if that exceeds the 6 g a day that the FSA recommends.
I know that there are good health reasons for the changes that are taking place within our food producing and retail sector. I also know that, realistically, for many companies in that sector it makes good business sense, too. I am pleased that in the last few years we have seen health become no longer a fad, but a trend. Those businesses that want to be associated with good health, and therefore to encourage consumers to choose their products, understand that business and health can come together, and the Government have a leading role to play in the debate on that.
The Minister highlighted consensus, and that is the most important thing. There must be consensus in the food industry, consensus in the voluntary sector and consensus across this House, because we are all involved in the debate to improve the health of our constituents and the entire country. [Interruption.] I do not want to take interventions from a sedentary position on my intervention. I am supporting what the Minister said about consensus, but that needs to go much wider than just the industry and the Government.
That is clearly so, and I can give the hon. Gentleman many examples of such consensus. I have not even begun to talk about the changes in our relationship with local authorities. From 1 April, for example, there will be a mandatory target regarding health inequalities. Legislation going through the House at the moment is forming the basis for statutory health and well-being partnerships, which will result in closer collaboration such as the joint commissioning of health services by local government and the health service. I could go on. There are plenty of such opportunities, and we are the Government who are seizing the moment and helping to make that happen.
Research also shows that 79 per cent. of parents accept responsibility for the quality of their own children’s diets. It is not the role of Government or of any other organisation to unseat the primary role of parents in influencing their children; they are rightly the most important influence on their children’s lives. However, where the Government have to be the parent by proxy—during school hours, for example—we can help not only the children but the families. We can help by guaranteeing the quality of school meals and bringing in nutritional standards that can make a real change to the food that our children eat in school every day; by providing fruit in school for 2 million children; by supporting breakfast clubs; and by discouraging fizzy drink vending machines and promoting water in schools. Not one of those four initiatives to support healthier diets for children was undertaken by the Conservatives during nearly two decades in power; all of them were undertaken in less than one decade by Labour. [Interruption.] As my right hon. Friend the Member for Redditch (Jacqui Smith) says from a sedentary position, the Conservative Government did away with nutritional standards.
I thank the Minister for giving way; she is being very generous in taking interventions. Conservatives would not disagree with anything that she has said, and we congratulate the Government in that respect. However, does she consider it the job of a responsible Government to ameliorate the impact of the abuse of alcohol, which it is said costs the Exchequer £20 billion a year—and is that assisted by introducing a 24-hour drinking regime?
Very few establishments have 24-hour drinking licences. It is interesting to note that Opposition Members are very partial in quoting aspects of the reform of drinking legislation. Before we introduced our legislation, it was very difficult for local authorities working with the police to revoke licensees’ licences. We had an archaic bureaucratic system involving magistrates, and trying to make any changes at all was like walking through treacle. Now, we have the powers to enable communities to be more involved, and to have a say when licences are issued. Where licences are provided, the ability exists to close down an establishment if it operates in such a way as to cause problems in the community. We have also increased the offences for disorderly behaviour and selling drink to under-age people, for example. Let us have a grown-up debate and acknowledge that, be it alcohol or food, the problems that are impacting today have developed over a number of generations. We must address the issue in a rounded, thoughtful and sustainable way.
In my area we have not 24-hour drinking but flexible hours, which have reduced town centre disorder by allowing clubs and pubs to close in a phased manner, thereby giving people a chance to leave the high street in an orderly fashion. However, the real problem with alcohol is that it has become cheaper in real terms in the past 20 years and more readily available, particularly through outlets that are open for many hours during the day. Some supermarkets use alcohol as a loss leader, selling it for as little as 40p a litre, for example, to entice young people in. That is one of the main problems associated with binge drinking. Will my hon. Friend look at that issue, which we need to examine?
My hon. Friend makes some pertinent points. Better management of, and timing of the hours of, licensed establishments can be a positive aspect of community management, particularly, but not exclusively, in our town centres. We have also engaged with the alcohol industry on the labelling of products, for example, and I hope that there will be an outcome to those discussions shortly.
We will also discuss the issue of promotions, not only in licensed establishments such as pubs and clubs, but in retail outlets. Indeed, more retail outlets have 24-hour licences than other establishments. At least, that is my perception of the situation from what I see in my local community.
Another issue is the education of our children and young people, and that is why the Department of Health is working with colleagues in the Department for Education and Skills to improve it. Some 80 per cent. of schools are now participating in our voluntary healthy schools programme—nobody is forcing them to take part—which covers the primary and secondary sectors. In order to be a healthy school, schools have to address not only eating, physical activity and emotional development, but substance misuse, sexual health and alcohol and cigarette use. I am encouraged by that programme. Schools have asked for it and we are trying to provide it. I hope that it will provide greater consistency in the information, advice and support that children and young people need to make informed choices. Parents also need to be engaged and we will do whatever we can to support parents to take that personal responsibility for themselves and their children.
Research tells us that the overwhelming majority of smokers accept that the habit is bad for their health, but reveals that they need support to kick it, which is why our world-leading NHS stop smoking services were established in 1999. Some 1.6 million fewer people smoke today compared with 1998 and I hope that the new smoking legislation coming into effect in July will see a further reduction in the numbers who smoke. We still face some challenges in that area.
I very much welcome the smoking ban, but does my hon. Friend share my concern that we will end up with lots of people standing outside buildings smoking and creating piles of cigarette ends on the pavement, which will be a public health risk? Will she work with local authorities to ensure that they take the appropriate action through the litter control tools that they possess so that we are not wading through dog-ends outside offices and other establishments?
I understand the point that my hon. Friend makes and, together with local authorities and environmental health officers, it is an issue that we are considering. We want to try to streamline the implementation of the legislation as much as possible. It is the biggest exercise of its kind anywhere in the world. I sometimes find that quite scary, but it is also very exciting and a real opportunity. The implementation is not the end of the story and we have to ensure that we engage people so that they do not just smoke outside instead, but seek to give up smoking full stop. Ideally, people should not start smoking in the first place. We certainly do not want to turn our communities into ashtrays because everyone is smoking outside.
From 1 October, we will raise to 18 the age at which people may purchase cigarettes, and I commend the campaign by my hon. Friend the Member for Barnsley, East and Mexborough (Jeff Ennis) on that issue.
Many young people understand the need to protect their sexual health, but they are often reluctant to visit specialist clinics. Those who do used to have long waits. We have more to do, but I am pleased to tell the House that today, two thirds of those attending such clinics are seen within 48 hours. Two years ago, that figure was only 38 per cent. Through an active partnership with Boots the Chemist, the Government can promote services to 20 million customers each week. Chlamydia testing kits have been issued to 31,000 customers, with 15,000 returned to date. In association with the Co-op’s 740 pharmacies, we were able to supplement the Government’s messages on condom use in the run up to Valentine’s day and I was pleased to be at the Co-op in Rossington to support its endeavours to encourage safe sex and condom use. I was asked a question on this issue at the last Health questions and it worried me then, as it should also worry Opposition Front-Bench Members, how many Conservative Back Benchers seemed to dissolve into laughter at the mention of the word “condoms”. I am not sure how that will help us to have a grown-up and less embarrassed debate about these issues.
Teenage pregnancies are at the lowest rate for 20 years. They have fallen by 11 per cent. for under-18s and 15 per cent. for under-16s since 1998. Along with my colleague in the Department for Education and Skills, the Minister for Children and Families, my right hon. Friend the Member for Stretford and Urmston (Beverley Hughes), we are working particularly to identify some of the areas that could do better and learn from best practice in some other parts of the country, where the success rate in reducing the number of pregnancies among young women in this age group is very good.
Will my hon. Friend join me in congratulating health authorities in Slough where teenage pregnancies have dropped from 121 in 1998 to 77 in 2005 and will she welcome the narrowing of health inequalities experienced between Slough, one of the poorest areas in Berkshire, and the constituencies around us? We now have fewer deaths from the big killers of heart disease and stroke.
I very much congratulate Slough on those efforts and I congratulate my hon. Friend on her championing of tackling health inequalities and dealing with some of these challenges so realistically. It is not easy. What I have been trying to do as public health Minister is to make the connections between strategies to tackle teenage pregnancy and strategies to tackle infant mortality. Statistics on infant mortality show that some 60 per cent. are related to teenage pregnancy, which is partly to do with issues about smoking in pregnancy, low-weight births and so forth. Again, we have to be smarter about connecting these different issues together in order to understand how best to tackle teenage pregnancy and, in doing so, how best to tackle infant mortality as well.
On sexual health, we know that Chlamydia is a major reason for infertility, which is one of the reasons why the Department is funding Infertility Network UK to survey primary care trusts on access to in vitro fertilisation treatment and also to ask questions about Chlamydia screening. If we had more Chlamydia screening and greater awareness of the need for it—not tomorrow or next year, but down the road—we could make a difference to the numbers of people presenting with infertility problems as a result of contracting Chlamydia at an early age.
I thank the Minister for giving way, but she has already spoken for 25 minutes. In further response to the question put by the hon. Member for Slough (Fiona Mactaggart), will she please explain why health inequalities have actually widened under this Government?
To be fair, I have taken a good number of interventions and I will come on to that issue shortly. I have already touched on some the issues around health inequalities.
I would like to draw attention to some of the issues often raised about the funding of public health. There are some, including Conservative Members, who have suggested, and continue to argue for, a strict ring-fencing of moneys for public health. I understand where they are coming from, but I think that it is misguided and short-sighted. We have moved from a situation whereby Whitehall prescribed everything from the centre to thinking much more about how to devolve resources and decision-making to the front line. That is not to say that we should not have resources at national level for the different aspects of public health, but we should be wary of the broader danger of ring-fencing, which could lead to public health being compartmentalised. It may provoke a narrowing of the public health effort.
Let me provide the House with an example. Either at the last Health questions or the one before that, I was pleased to point out that Plymouth took some “Choosing Health” money, but also some other money relating to “healthy communities”, which it packaged with other resources available for the regeneration of communities. Plymouth set a priority for healthier communities. When all that money was brought together, it far exceeded the “Choosing Health” money that was part of the formula allocation. Public health is important, and we have to have resources to make it happen. We also have to think more widely and in a more sophisticated way about how we can align different budgets to make better sense of the money that can be provided.
Having produced the “Health Profile of England”, and a profile for every local authority of the health outcomes for its community, we need to determine how we can better identify what is spent on prevention, so that accountability can be built in for the health outcomes and the money that is spent on dealing with them. In some areas, we might find that money is being spent but not delivering the outcomes that we want, while another area with less money might be adopting a different approach and forming different partnerships that might be proving more successful.
This is an important point of debate. Given the argument that the Minister is pursuing, why is the National Treatment Agency effectively ring-fencing money for one particular aspect of health care, namely, substance abuse of a particular kind? If money can be ring-fenced for that—and successfully so—should it not be ring-fenced in the wider public health arena?
As a Minister in the Home Office, I was responsible for the national drugs strategy. Now, at the Department of Health, I am responsible for drug treatment, and I am pleased that the hon. Gentleman acknowledges how successful our strategy has been in that regard. We are way beyond the target that we set ourselves for the number of drug misusers in treatment, and we have now set an even more effective challenge for retention in treatment. There is no point in people dipping in and out of treatment without achieving any success.
I have thought about this matter in a considered way. For the most part, we are talking about people who are addicted to heroin and other illegal substances. Let us face it, that is not the most popular area when it comes to providing resources. That is why, in this instance, we felt that we had to ring-fence the money. Comparisons may be drawn with public health, but I am trying to demonstrate that public health is a much wider area for engagement than drug treatment. People may disagree with that, but it is a view that I have come to. The bigger game in this area is that we should not compartmentalise public health. Every health professional—the cancer surgeon, the GP, the district nurse—must be an advocate for prevention and for good public health.
Public health goes beyond the health service and beyond the Government. It must be based firmly in the real world and address the circumstances in which people adopt particular habits or lifestyle choices. It must also encourage them to make changes. Fundamentally, public health must view people as individuals. It must look holistically at where they live, what kind of education they are getting, what kind of work they have access to, and how they will be able to continue to work if they suffer ill health. It needs to consider whether their community is safe. Is it an environment in which people will go out and walk and cycle and use the outdoor amenities? Or is it a community in which it is unsafe to do those things, and in which demotivation is likely to set in?
Public health is about viewing people not merely as Mrs. Patel the diabetic, Mr. Brown the coeliac or Ms Jones the breast cancer patient. It is about identifying people’s lifestyles and preferences, so as to reach the right people with the appropriate messages. The Department of Health is leading the way in utilising the tools of social marketing, in which we have been greatly assisted by the National Consumer Council and other organisations. This will help us better to understand what gets in the way of people improving their health, to identify how to get round the problem, and to provide the resources nationally that can be picked up by local government, employers, the local health service and community organisations to provide smarter, more targeted messages, rather than indiscriminate mass communication. It will also help us to support stronger commissioning to provide the right services—rather than a one-size-fits-all model—to reach into a community or an individual’s sense of well being to get some really different results.
The hon. Member for Billericay (Mr. Baron) raised the issue of health inequalities. I hope that everything that I have said so far is interwoven in some way with the challenge of health inequalities. One of the difficulties is that there is a moving target. The reality is that everybody is living longer. People might say that, in some respects, we have never been better off. However, people who are more affluent, more educated, live in better surroundings and have access to the internet—that probably includes many people in the House—are running forward faster than people who live in poorer communities, where housing is poorer, where the environment outside people’s front doors is hostile, where, through the generations, a style of eating or a habit of inactivity has set in, and where people do not feel that they have got the most out of the education system. Those challenges are daunting, but not insurmountable.
I have to tell Members on the Opposition Front Bench that we are credited throughout the European Union with being at the forefront of tackling the problem. We are looked to by other European Union countries, which, in many ways, are only just starting to tackle this difficult area. We are seeing some progress, although we want more. Three fifths of the spearhead areas—the local authority areas in our most deprived neighbourhoods—are on track to narrow the life expectancy gap for men or women, or both. The reduction in the average death rate from cardiovascular disease among the under-75s in spearhead areas has exceeded the national average reduction since the mid-1990s.
On infant mortality, we have seen a widening, and now a stabilisation. I am not complacent about that. One year’s figure is not good enough as a basis for a theory about how we are doing. However, in the last year and a bit, we have undertaken some national in-depth analysis of why some communities seem to be doing better than others on the target areas of life expectancy and infant mortality. That has allowed us to have far greater insight into the ways in which the partnerships at a local level should identify both the people most at risk and the options to effect change and close that gap faster than ever before. We know that, for infant mortality, the 43 highest rates are in 43 particular local authority areas. I know that there is the will and the commitment from those working in our health service, and in our local authorities and beyond, to bear down on this issue and make a difference.
We cannot do everything from the centre, but the Department of Health has a right to be able to do the things that cannot be done at local level: providing an overview and also national support, based on sharing best practice, to effect the quickest change. As I said before, one has to start by acknowledging health inequalities. Difficult though it may be, setting a target is one of the ways in which we can focus our attention. Clearly, we will be answerable in that respect in a way that the Conservative Governments of previous years were never answerable.
Although I agree with some of the points that the Minister makes, the simple fact is that the Government set themselves a target to reduce health inequalities and they have singularly failed to achieve that target—not by a narrow margin, but by quite a wide one. Does that not suggest to her that there have been failures in the Government’s public health policies?
It would be nice if every time there were a general election, we could start with a blank piece of paper and a situation in which what had gone before had no effect on the people of today. The fact is that, when we came to power in 1997, there were more children living in poverty and we did not have the sort of programmes that address health inequalities. I make no bones about the challenge of shifting the effects of not just 18 years of the Tories, but hundreds of years of health inequalities. We take responsibility for setting in motion the ways in which we can address that problem and we are making progress in a number of areas. That is not to say that there is not more to be done, but one has to start by understanding the problem and then trying to change society. That is what the Government are about. We are making progress and we will continue to do so.
My hon. Friend is right to recognise that some things can be done nationally, while others can be done locally. I can cite an example from Slough, where the Department of Health has sponsored a project on diabetes identification involving the Dr. Foster unit. The project has improved people’s awareness of diabetes, which is an important contributory factor to coronary heart disease. When I was first elected, I was shocked to discover that my constituency was in the top 10 towns in the country for early deaths from heart disease among males. As a result of that, we have a locally-determined clinic that 98 per cent. of diabetes patients are attending. The attendance was 50 per cent. at the old clinic, which just happened to be in Windsor, which does not have as much diabetes as Slough, but is better at arguing for facilities.
I commend Slough for its approach. That adds to what I have been saying. We know that there are often fewer GPs in our poorer neighbourhoods than in our most affluent neighbourhoods. We have thus had to take legislation through Parliament not only to free up opportunities for pharmacists, but to allow nurses to do some of the jobs that could previously be carried out only by doctors. Such a process cannot happen quickly—legislation does not happen quickly. However, it is necessary to identify problems, find solutions and take action to change the way in which health services are delivered. That is the path that we are on, and although the Conservative party has opposed it, we will ignore that and continue to do what is right and effective.
I am sure that my hon. Friend agrees that we need a grown-up debate on this issue, instead of just slinging statistics at each other across the House. One of the biggest problems involving health inequalities is the rising tide of obesity in this country. I know that my hon. Friend is doing a good deal of work on that extremely difficult and intractable problem. However, the fact remains that the population of this country is getting rapidly obese. We have to understand the causes of that and we will have do something fairly major to tackle the problem if we are to narrow the gap on health inequalities.
I absolutely agree. The situation has developed over at least the past 50 years. The problem cannot be resolved per se through political dogma. We need to identify the problem and do something about it. That is why awareness of five a day is important. The latest figures show that the consumption of fruit and vegetables increased by 7.7 per cent. in one year. The increase was something like 2 per cent. in the year before that, but the trend was in the opposite direction in the previous year. I was cheered by one of the biggest increases that we have seen in fruit and vegetable consumption in any one year. Although I am not against a bar of chocolate every now and again, I am pleased that confectionary sales are going in the opposite direction.
We are examining the way in which are weighing and measuring at children’s schools so that we can have the most comprehensive database in the world to allow us to plan better, to be more effective in helping parents to support their children and to identify where the problems really exist. Again, we must look beyond the here and now, which is why the foresight project is not only examining obesity now, but considering the situation five, 10 and 20 years down the road to determine what might be possible to tackle obesity, which is a problem not just in the UK, but worldwide. I read in the paper this week that the Italians are worried about obesity, even in the communities in which the Mediterranean diet is most dominant.
Research that came out yesterday suggested that we had the most obese women in Europe and almost the most obese men—we were beaten only by Malta. I am not saying that the Government are in any way to blame for the variation throughout Europe, but does the Minister have an explanation for it?
As I said, the Mediterranean diet that people have in certain parts of Europe, which is probably considerably healthier on the whole than the usual diet in our country, has perhaps protected people in many ways. We live in a society in which car use is perhaps greater than in others and in which some of the more physical jobs no longer exist—there is no reason to go back to those jobs because some of them were associated with health problems.
We are not on our own in having the problem either in Europe, or worldwide. When I attended the World Health Organisation Europe conference on obesity in Istanbul last year, I was reassured by how many countries were looking to us because we were ahead of them on trying to tackle the problem. Today, I have made it clear that the Government must arm the ordinary citizen to better look after their own health; to empower the parent to better maintain their child’s health; and to complement this with the services, often community based, to help people overcome barriers to good health. That gives people individual responsibility, but with the Government on their side.
There is no complacency from the Government about the challenges ahead and the cultural change that will be involved. New approaches to public health require a reformed NHS, with new partners and new ways of working—reforms that place more services in the community, closer to home, and reforms that improve transparency, such as providing insight into the pattern of services provided by GPs.
The new emphasis on public health is a policy direction whose time has come. The smoking ban has been widely welcomed; food labelling is now widely accepted; reducing salt, sugar and fat in food is not contested; five-a-day is part of the conversation with consumers; and building exercise into daily routines is regarded as common sense. All that illustrates that public health messages are becoming part of the nation’s vocabulary.
Public health is the forward looking, preventive face of the NHS, and Britain today is among the world leaders, treating people as individuals, meeting complex needs, addressing personal choices and tackling real inequalities. Public health will continue to be central to the work of a reformed, smarter, 21st-century health service. Public health demonstrates the Government’s ambitions for the nation’s health, ambitions shared by the British people. Only by working together can we make the difference, and that is what we will continue to do.
I wonder what our constituents will make of the complacency that is evident in the Minister’s remarks. The press today correctly reflects public anxiety over soaring obesity rates and reports that nearly a quarter of adults are now classed as clinically obese.
This morning, Ofcom announced its proposals on the advertising of HFSS foods—those high in fat, sugar and salt—to children, yet the Minister did not refer to that once. We broadly welcome those recommendations and we are particularly pleased that a decision has now been made. We are delighted that it will be reviewed in autumn 2008. Clearly that is an important announcement, and I should have thought that the Minister would start her remarks by referring to it , but on that subject she was silent.
If the hon. Gentleman reads Hansard he will see that I referred to the restriction on advertising to children. I am pleased to say that we made it clear in our manifesto that we would seek to restrict the advertising of HFSS foods to children. I wonder why it was not the subject of the Conservative party manifesto.
I am grateful to the Minister for her intervention. She has at least put that on the record, but I think that she will find, when she checks Hansard tomorrow, that she did not mention Ofcom, and I believe that she should have done so.
In “Health Challenge England”, we find that the Deputy Prime Minister has a key role in the fight for the national waistline. Apparently he leads a cross-cutting Cabinet Sub-Committee on health improvement. Indeed, obesity requires an interdepartmental response. However, last month the Public Accounts Committee took a look at that pillar of the “Choosing Health” White Paper and found that any cross-cutting on obesity has been characterised by “dither”, “confusion” and a lack of co-ordination.
The Minister has come here today, brazenly and despite all the evidence, to convince us of the brilliance of her Government’s stewardship of public health. Back on planet Earth, the Government’s own chief medical officer is a dissenting voice. He says:
“There is strong anecdotal evidence from within the NHS which tells a consistent story for public health of poor morale, declining numbers, inadequate recruitment and budgets being raided to solve financial deficits in the acute sector.”
Even the Government’s erstwhile health guru, Derek Wanless, is saying disobliging things about the Government’s approach to public health. However, we heard nothing about the crisis in the specialty of public health, or the raiding of public health budgets, from the Minister today.
I am not sure about anecdotal evidence. I will discuss evidence-based public health shortly, so if the hon. Lady will wait, perhaps we will talk a bit more about anecdote versus evidence, and I hope that my remarks will address her concerns. I understand that she has experience from her constituency, and the hon. Member for Slough (Fiona Mactaggart) mentioned evidence from her constituency, too. However, we have to consider public health across the country, and the evidence on that is clear.
The hon. Gentleman is generous in giving way, and I genuinely wish to have a grown-up debate on the issues. He raised the important subject of obesity; I chair the all-party group on obesity, and we spend a lot of time and effort working in a cross-party way to try to sort out the issue. Will he explain what he thinks the Government should do on obesity that they are not currently doing, as I am sure that that would inform our debate?
If the hon. Gentleman will allow me, I will come on to that. What he says about obesity is quite right. We have rightly spent a lot of time debating obesity this afternoon, and that is particularly timely, given today’s announcement from Ofcom. If he will bear with me, I will address his point in due course.
On 26 October, in a rare moment of candour, the Minister admitted that the gap in life expectancy and infant mortality has continued to widen since the target baseline was set. The life expectancy gap has increased by 1 per cent. for males and by 8 per cent. for females. The gap in infant mortality has increased from 13 to 19 per cent. In 1997, the Government pledged to vanquish social class health inequalities, but the fact is that they have got worse. Health inequalities are now the widest that they have been since the 19th century. They are positively Dickensian, and they are of the sort that Prime Minister Disraeli reflected on in his description of London’s rich and poor.
I feel for the Minister, because public health is a challenging brief, and there are few quick fixes, as the hon. Member for Crawley (Laura Moffatt), who is no longer in the Chamber, knows full well, as do the hon. Member for Dartford (Dr. Stoate) and I, as practitioners. We know how difficult it is to procure change, particularly when it comes to harmful life styles. Nevertheless, that challenge must be faced.
I am grateful to the hon. Gentleman for giving way a second time. The Government have changed the funding formula and the way in which they allocate money within the NHS to include an element based on health inequality. Why does the Conservative campaign pack describe that as unfair?
We would like funding to follow the burden of disease, because that is what the NHS is for—sorting out the burden of disease. I will come on to describe how we think public health funding should be ring-fenced, but the hon. Lady needs to know that, at present, money earmarked for public health is being siphoned off to pay for service elements. If we are serious about improving public health, which needs long-term investment, not quick fixes, the only way to do so is to protect it in some way. That is why I believe that the Minister, who was thoughtful on that point, will come round to the necessity of ring-fencing funding, if she is to achieve what she says that she wants to achieve.
We are genuinely having a good debate, and that is welcome. The problem with public health is that it goes far wider than one Department. It involves housing, poverty, unemployment, education, the pensions system, transport, and planning. Public health covers literally every Department, without exception. Will the hon. Gentleman tell me how it is possible to ring-fence a budget that covers every single Department?
We could perhaps start with smoking—we talked a bit about smoking, and we will talk about it more—and how that budget has been affected by deficits and the removal of money from the quit smoking campaign in order to sort out parts of the NHS deficit. I will talk about that and will give one or two other examples in my speech, so if the hon. Gentleman will be a little more patient, I might give him some examples that will support the case that I am trying to make.
I accept—the Minister was fairly candid on this point—that there is a judgment to be made on whether we continue to fund public health as we have done, or whether we protect it and ring-fence it in some way, just as the National Treatment Agency for Substance Misuse is protected. The Minister showed that she is under a slight misapprehension about what the agency does, which is a little alarming; it is not simply a Home Office responsibility, but covers a raft of health issues. A large part of that funding is for the treatment and prevention of substance abuse. It would be surprising if the Minister did not understand that.
Of course, I pretty much know what the National Treatment Agency does. It is responsible for supporting the development of drug treatment services, for improving the professionalism of drugs staff, and for prevention. I was trying to draw the hon. Gentleman’s attention to the fact that substance misuse occupies a different position in the NHS from public health. As I said, in future we may think differently about the treatment of drug misuse, but it is wrong to make a simple comparison between the work of the national treatment agency and that of drug action teams in the area of public health.
I am grateful to the Minister, and I shall come on to discuss the agency’s work on alcohol.
I should like to ask the Minister, who has some experience as public health Minister, whether she thinks that responsibility is correctly pegged at the level of Minister of State? A Conservative Secretary of State for Health would have responsibility for public health, too, because public health in all its ramifications has not been given the exposure or priority that it deserves. The fact that we are debating shortfalls—
I am not going to give way to the hon. Lady for a little while, although I promise to do so if I have time.
Given the great complexity of public health, it is a pity that the Government have sought to balkanise it and set responsibility for it at a relatively junior level. In December, the Minister rightly pointed out that the Black report of 1980 did not receive the attention it deserved, but she did not admit that in 1999 her Government ignored the Acheson report, which covered almost the same ground. That omission was not corrected today. This is the first time that we have debated public health in Government time for more than four years, although the Opposition have been extremely generous in using much of their own time to do so—we did so as recently as December—because we think that it is an important subject.
The Government, however, have been busy. They appointed a public health Minister and have proceeded to churn out publications of breathtaking vapidity, culminating in last October’s “Health Challenge England”. They launched their “Small change, big difference” public health campaign in April. Small change indeed! Will the Minister confirm that expenditure on that extravaganza totals £13,360?
I am reminded of that campaign only because “Small change, big difference” has been recycled as a catchy soundbite on the front of the document that we are discussing. “Health Challenge England” is big on anecdote disguised as case study, but two and a half years after the “Choosing Health” White Paper, we are entitled to expect an update with a clearer sense of direction. Indeed, the document is evidently so inconsequential that the Minister did not even bother to mention it in her 30-minute rant the last time that we debated public health on 5 December. Ministers cite reductions since 1997 in mortality from cancer and cardiovascular disease, but are we seriously expected to believe that they are responsible for those reductions? Deaths from those causes are happily in long-term decline, and current trends are simply extrapolations from the 1970s and 1980s.
I was not at the meeting, but a friend who was there tells me that Cancer Research UK disputes that. Clearly the issue needs to be looked into a little further, but I think it is generally accepted that the trends were established in the 1970s and 1980s and have continued pretty much in a straight line since then. We should celebrate that. It is excellent, and a tribute to the hard-working professionals in the field and the international research effort. However, it is extremely unedifying for Ministers to come here and quote figures, saying that their policies and their efforts have made all the difference. I do not believe that that is the case, and it is counter-intuitive.
I must make progress.
The Department of Health likes to cite 150,000 lives saved from coronary heart disease since 1996, but in November it was forced to admit that between 1978 and 1996 the equivalent figure was more than 500,000. Spurious claims from Ministers are simply not on. No wonder two thirds of doctors now trust the Opposition more than they trust the Government.
We know that over the past 10 years obesity, sexually transmitted disease, alcohol-related disease, teenage pregnancy, antique infections such as tuberculosis and syphilis, hepatitis and the consequences of drug abuse have become markedly worse in England, but how do we compare with our European neighbours? When we turn to the World Health Organisation for the information, we find that Britons are the fattest Europeans. Our children are getting fatter faster than children anywhere else in Europe, and the Office for National Statistics notes that they are becoming less active.
Will the hon. Gentleman give way?
He has only just come into the Chamber.
I am sorry, but I will not give way to the hon. Gentleman.
The rate of HIV infection here is 1.6 times the European average. Alcohol consumption has been flat-lining in the United Kingdom, but falling elsewhere. British people can expect more years of unhealthy life than people in most European countries. Our abortion and teenage pregnancy rates top the European league table. TB per head of population a stone’s throw from here exceeds the level found in several developing countries identified as TB hotspots.
The Minister likes to speak of encouraging best practice, but she has given no indication of what lessons she has learnt from our neighbours who are doing rather better than us. We have heard from the chief medical officer about the poor state of the specialty of public health. England has haemorrhaged directors of public health posts, and the reconfiguration of primary care trusts is leading to further reductions; yet on 3 October 2005, strategic health authority finance directors were told:
“the Department of Health is working to ensure that the overall numbers of public health posts are not reduced.”
Clearly it is not working hard enough, as the number of posts has fallen from 300 to 152.
In the local government reorganisation of 1974, public health doctors ceased to be medical officers of health employed by councils and they retreated to the NHS. I am delighted that the Government are now encouraging joint NHS-local government appointments, but what assessment has the Minister made of the catastrophic fall in the number of public health doctors, and what measures will she take to repair that broken specialty?
Yesterday I met representatives of Alcohol Concern. The organisation has received reports of significant cuts in alcohol services, which it ascribes to deficits. Eighteen months ago, £15 million was announced for alcohol services, but Alcohol Concern reckons that it has disappeared. I wonder whether the Minister can account for it. Alcohol Concern contrasts alcohol services with services related to other forms of substance abuse. Those are funded and regulated through the National Treatment Agency for Substance Misuse, which means that the money is ring-fenced. Three times as many people die from alcohol as succumb to the effects of drugs, and in public health terms the evidence would lead us to prioritise alcohol. So much for evidence-based policy-making.
The Minister rightly talks about smoking. It is captain of the men of death, but she did not compare the fall of 10 per cent. in smoking rates between 1980 and 1990 with the 3 per cent. fall on Labour’s watch. I hope the Health Act 2006 may save the 600 lives a year that are said to be lost to passive smoking. Indeed, I look forward to debating on Monday a raft of statutory instruments supplementary to the anti-smoking clauses of the 2006 Act, and I look forward to supporting, for example, a proposal to raise the age for sale of tobacco from 16 to 18. But what a horlicks the Government’s stewardship of those smoking clauses was. The Secretary of State campaigned for an exemption for private clubs in the morning, experienced a damascene conversion over lunch, and voted against the exemption in the afternoon.
Another, far less amusing U-turn was the withdrawal of the highly effective national quit smoking campaign last year to save cash. What was the result? Calls to the national helpline plummeted by 30 per cent. over the relevant quarter and there was a 10 per cent. fall in quitters after five successive years of increases. So much for evidence-based policy making, and a strong argument for ring-fenced public health funding.
An even stronger argument is the strange disappearance of funds destined for sexual health campaigns. In January last year we learned that £50 million was going on safe sex campaigns; £4 million materialised. When my noble Friend Earl Howe asked in November what had happened to the balance, Lord Warner replied:
“My Lords, it is stored carefully in the coffers of the NHS.”—[Official Report, House of Lords, 21 November 2006; Vol. 687, c. 236.]
A fat lot of good it will do in the coffers of the NHS. What is the money doing there? It is there as part of a slush fund to offset the Government’s NHS deficit and, of course, to shore up the job of the Secretary of State for Health, which depends upon it.
The problem with politicians is that they hold in insufficient esteem the evidence base that underpins evidence-based policy making. Celebrity-based policy making is an entirely different matter. Call me an old cynic, but I wonder whether Anita Roddick’s brave announcement—and it was a brave announcement—about her having hepatitis C has energised the Department of Health into launching what we understand will be a welcome publicity campaign for hepatitis. The Hepatitis C Trust, which I met on Tuesday, is understandably extremely miffed that it has not been consulted by the Minister. It points out that “Health Challenge England” ignores hepatitis C completely, as evidently do most PCTs, which have left the hepatitis C action plan, such as it is, on the shelf gathering dust.
Given the alarming increase in hepatitis C, the trust is understandably alarmed. I ask the Minister to speak to the trust, which feels upset about the way it has been treated. It is upset about what appears to be a knee-jerk reaction by the Department in response to recent media events. It is interesting that guru Wanless himself says:
“What we do not need is simply a list of frenetic and uncoordinated short-term activity, which can be stopped as easily and quickly as it began”,
by which he means—[Interruption.] The Minister says rubbish, but that is what her guru said.
The rubbish that I was referring to was the idea that we have just thought of our campaign on hepatitis C. We have been holding regional road shows throughout the country over the past year at least, in which we have looked at how we can deliver at local level, involving people who can raise awareness and those who provide services. I get feedback about how the road shows have been received. I understand that they have been very successful and more are planned.
We look forward to those that are planned. I am sure that Anita Roddick, who, as I say, has been extremely brave in her remarks to the press recently, will play a full and active part. It is a pity that it requires a celebrity to highlight such an issue for the Government—the Jamie Oliver effect. [Interruption.] I have to say to the Minister that it is all very well saying that things are rubbish and that I should move on, but I suspect that Wanless himself will continue to make disobliging comments about what she is doing in public health. He is quite clear that she is engaging in frenetic and unco-ordinated short-term activity—the sort of thing that can be stopped and started just like turning a tap on and off. Wanless is referring to the sort of activities that the Minister mentioned in her interventions regarding plans for hepatitis C.
I have had exchanges with the Minister through a number of parliamentary questions and answers. I asked about what she has done to anticipate the burden of disease that will arise as a result of hepatitis C infection. I have to say that what I have had back is a big “I don’t know.” The Government clearly have no idea about what this time bomb involves and have made no preparations to manage it. In public health terms, that is deeply and profoundly worrying.
Developing his characterisation of a Government thrashing about in public health, Wanless attacks what he calls
“loose proposals for personal trainers which do not seem well rooted in evidence or particularly clearly thought through”.
He goes on to suggest that these appendages of the “Choosing Health” White Paper are
“gimmicks that will discredit the public health function”.
For the price of eye-catching but unproven health trainers, we could have, for example, a national programme for screening abdominal aortic aneurysm. We know that that will save thousands of lives, because the pilots have been done and the evidence base is very strong. Every month the Minister delays, however, 200 elderly men die unnecessarily. Screening does not appear at all in the 34 pages of “Health Challenge England”. So much for evidence-based policy making.
I am grateful to the hon. Gentleman for giving way again. He knows that I share his worry about AAA; it is a very important issue on which I have done a fair amount of work. The problem is not the screening for abdominal aneurysm, which is a very simple ultrasound test, but putting in place the services that are needed—the vascular surgeons, follow-on care and intensive care beds. He is absolutely right that we could probably save 3,000 lives a year if we screened every man at the age of 60, but the problem is that it will take some time to train the vascular surgeons and put the facilities in place. I am fairly pleased that the Government are at least on the case, and I hope that they will introduce such an arrangement as soon as possible.
I am grateful to the hon. Gentleman for his intervention. He will be aware that a few days ago the surgeons who were involved in the pilot visited the Palace of Westminster, and we managed to screen about 30 parliamentarians from all parties, from the Lords and the Commons. The exercise was a huge success, and I know that the Minister received some parliamentary questions as a result of it. I am not sure whether the hon. Gentleman was one of those tested; perhaps not, as he is certainly too young to be in the target population. If he had attended the exercise, however, it would have been explained to him that the resources are in place. We are not talking about large resources in terms of surgeon or theatre time.
Indeed, all that work has been done, and the national screening committee has looked at it. I have been in correspondence with the Minister on the matter, however, and there appears for some reason to be a reluctance to get the process started. I am sure that she will eventually get it started, but, as I said, it is a pity that there is such a delay. The hon. Gentleman said that 3,000 lives a year could be saved, which is perhaps a bit optimistic, but a conservative estimate of 200 people a month is reasonable. It is a pity that we are losing those people unnecessarily when the evidence suggests that we should be using such an arrangement. That is the important point: the evidence suggests that we should be doing this, and it perhaps does not suggest that we should be engaging in some of the other interventions about which the Minister seems so enthusiastic.
On evidence-based policy making, I would like to refer to a parliamentary answer that my hon. Friend the Member for South Cambridgeshire (Mr. Lansley) has received from the Minister of State, Department of Health, the right hon. Member for Doncaster, Central (Ms Winterton), who has recently arrived. The question was:
“To ask the Secretary of State for Health what the evidential basis is for the statement on page 10 of the National Director For Heart Disease and Stroke’s report entitled “Mending Hearts and Brains”, published on 5 December 2006, that 5 per cent. of patients used to die while waiting up to two years for heart operations.”
The answer was:
“‘Mending hearts and brains’”, the document in which the figure of 5 per cent. features, is a personal report from the National Clinical Director for Heart Disease and Stroke. This figure of 5 per cent. reflects a judgement based on expert professional knowledge and experience rather than research evidence, of which there is little”.
The Minister was therefore being sold anecdote as evidence until my scrupulously evidence-based hon. Friend prompted her to be more inquisitive.
It is extremely important that we are clear that public health should be rigorously evidence based. My hon. Friend, at any rate, would be very much an evidence-based Secretary of State for Health. We would not engage in some of the more dubious interventions of this Government, who have been going down rabbit holes left, right and centre. That simply is not helpful, and it brings public health into a degree of disrepute.
A pattern is emerging characterised by loose adherence to the concept of evidence-based policy making and a willingness to sort out the deficits of the acute service by siphoning funds from more elective areas: notably, training and public health. Let us be clear: all politicians have a horizon that rarely extends beyond four or five years. That is the problem for public health: for as long as funds are not protected, it will always be first in line to be tapped when times are tough. To succeed, as Derek Wanless has said, we need a long-term commitment to public health. Given the raid on funding identified by the CMO, that means ring-fencing; there is simply no other way. I am sure that the Minister will come to realise that in the fullness of time.
Will the hon. Gentleman give way?
No, I will not give way to the hon. Gentleman; he arrived late, and he did not hear the Minister’s opening remarks.
The Government have at least set up the Public Health Interventions Advisory Committee. We thank the Minister, as we will certainly use the new structure to generate public health policy that is rooted more firmly in the evidence.
Let me finish with the wise words of the chief medical officer. In last year’s annual report, Sir Liam said that the lack of progress on public health is more compatible
“with the Wanless ‘slow uptake’ scenario than with the ‘fully engaged’ scenario”.
How does that candid admission of failure square with the Minister’s upbeat assessment today?
In answer to the hon. Member for Westbury (Dr. Murrison), I hope that his Front-Bench colleagues will be a bit more responsible in their comments about Anita Roddick’s celebrity launch earlier this week for hepatitis C than they were about Jamie Oliver’s celebrity launch in relation to healthier eating choices in schools. At a school quite close to my constituency, a group of parents tried to defeat the introduction of healthier meals, and the hon. Member for Henley (Mr. Johnson) said that there was nothing wrong with them pushing pies through school railings—probably a habit that he picked up in the Bullingdon club when he was up at Oxford.
With regard to public health, the issue of smoking has been mentioned, and the hon. Member for Westbury referred to some European countries. I do not know whether other Members saw in The Sunday Times this week the extraordinary article, which I assume was accurate—perhaps I am naïve—under the headline “MEPs’ cigarette ban goes up in smoke”. By all accounts, it appears that the European Parliament had decided to introduce a smoking ban within its confines on 1 January this year, but withdrew it after a few days.
The article went on to say:
“A 12-member committee of MEPs, which included some smokers, decided that the ban, which had been in place in the parliament’s premises in Brussels and Strasbourg since the start of last month, was ‘unenforceable’”
and had been withdrawn. According to the article, a UK Independence party member, Nigel Farage, said:
“‘I have been ignoring it since January 1…and I have smoked in more places than before.’”
[Interruption.] The hon. Member for Hemel Hempstead (Mike Penning) says that it is no business of the EU where people smoke. I hope that we get a more responsible approach from 1 July when it comes to smoking in public places.
I do not know whether the right hon. Gentleman noticed that when we voted on the smoking ban—and I joined him in the Lobby—the Conservatives had a free vote, instead of being whipped like Labour. Decisions were made by individuals.
Labour MPs had a free vote. Indeed, the hon. Gentleman and other Opposition Members put their names to an amendment that I tabled against the Government motion. There were free votes all round, and a sensible decision came from that. Hopefully, we will see a more responsible attitude here on 1 July than we are seeing from legislators in the European Parliament.
I welcome the opportunity to debate the events that have moved us on from the “Choosing Health” White Paper. Irrespective of what is said about which Government have been good or bad over the years in public health terms, such a White Paper has not been introduced by any Government before, and it took a while for this Government to do it.
I want to consider some of the major issues. It is not so much a case of how far we have come, but what public health challenges all of us face in the 21st century. The basis of the White Paper is that in 2004 one in five people were obese, and as a result, in less than 20 years there is likely to be a 5 per cent. rise in strokes, an 18 per cent. rise in heart attacks and a 54 per cent. rise in type 2 diabetes. It is hardly surprising that the World Health Organisation estimates that if we could eliminate the major risk factors—smoking, obesity and physical inactivity—the great majority of cases of heart disease, stroke and type 2 diabetes would be prevented. Worldwide, that would be an extraordinary achievement and one of the biggest moves we could ever make towards improving the health not just of the British public, but of the public throughout the world.
We all have to recognise that the threats to public health in this century are different from those in centuries past. Public health is no longer about clean drinking water, better housing and better sanitation, but about individual lifestyles and habits. It is not easy to deal with those. We cannot increase physical activity simply by building new infrastructure, welcome as that is. Two major sports and swimming centres are being built in the next few years in my constituency, and they will be a landmark in terms of giving people the opportunity to take part in physical activity.
We cannot stop people smoking either. A great effort has been made to deal with that, and that effort continues. Smoking cessation has been targeted by the Government for the first time, and a major improvement in public health will come of it in years to come. Nor can we stop people binge drinking or taking part in risky sexual behaviour just by passing laws. We must accept that it is not as easy for legislators to have an effect on the health of the public as it was in centuries gone by. We cannot end obesity with a vaccination programme—although I have no doubt that the pharmaceutical industry is looking into that. Indeed, some quacks advertise now, normally on the web, saying that if people buy their pills and take just a couple a day, they will lose weight. That is quackery, and weight loss does not work like that. We shall have to wait and see whether the pharmaceutical industry finds a cure in the years to come, but it has not done yet, so other factors need to interact.
The right hon. Gentleman says that it is difficult for Government to bring about behavioural change. However, does he agree that in one area, sexual health, Government action and campaigning have made a difference? Therefore, does he share the disappointment of Conservative Members and people throughout the country involved in that area that funding for sexual health campaigns has been cut from £50 million to just £4 million?
I do not know about sexual health campaigns, but more investment certainly needs to be put into sexual health clinics. My own PCT has not been able to bring in chlamydia screening. It would have done had it not been for the top-slicing this year because of the irresponsibility and overspending in other parts of the national health service. I do not blame that so much on the Government. The PCT’s intention was to bring in better sexual health services. The inappropriate and irresponsible actions of other people working elsewhere in the health service meant that we were unable to do that this year. I wait with great interest to see if we will do it when we get back the money that has been top-sliced. I will be on my feet if we do not; let me put it no more strongly than that at this stage.
In every case, Government action must be designed to enable people to make healthier choices for themselves and for their families. We know that individual choices play an increasingly important role in determining health outcomes, and that it is far harder for people to make healthier choices if they are struggling with unemployment or disability, trying to bring up a family on low income, live in a damp and overcrowded home or in a neighbourhood blighted by crime and antisocial behaviour. We know that for far too many people, the cards are stacked against them before they are even born.
I say that despite the fact that this Government have greatly improved many of the factors behind the existence of greater health inequalities in some communities than in others. I say that despite the fact unemployment in my constituency has reduced dramatically, and employment has increased dramatically, under this Labour Government. That does not mean that everything is rosy in terms of health inequalities. It is not, and the Government recognise that. I am pleased that they do.
We also know that things do not have to be like this. That is why, after decades, the Government have decided to do something about health inequality. To use the phrase that the hon. Member for Westbury (Dr. Murrison) used to describe health inequalities is nonsense. I will go on to the issue of widening health inequality; I will not duck it, but to say that it is Dickensian is nonsense.
Well, let us look not at Dickens but—the hon. Gentleman will love this—at Frederick Engels, who looked at the condition of the working classes in Manchester in the 1850s. What was the average age at which males in Manchester in the 1850s died? It was 47. The idea that statistically we can compare public health, or the health of the public, now to what was happening in Victorian times is nonsense. I say that honestly to the hon. Gentleman. Next time we have a debate on public health—I hope that the Opposition will use a bit of their time for that—we will look in greater detail at how public health and the health of the public have improved not just since 1850, but even in the past 10 years. That is well documented.
The Government want and are working towards a fairer society. That has meant that there has been fairer funding in the NHS, and more funding per head has been allocated to constituencies such as mine, because of health inequalities. The disease burden is quite high. The formula bandied about by Opposition Front Benchers a few months ago would mean that we got even more money. I would be more than happy if we were to move on to a “disease burden” system of funding health need, but other issues need to be taken into account.
Over the past 10 years, the Government have been making health services better in communities that have more health inequalities. Twelve years ago now, my constituency—or Rotherham metropolitan borough council I should say, as that was the geographical area on which this was measured—had the highest ratio of patients to general practitioners in England and Wales. We do not have that now. That is not down to doctors. The vast majority of them are private, independent business people, and although they work for the national health service they set up their own businesses according to where they want to live and raise their families. Clearly, under the system that has been in place, Rotherham has for 40 years or more been one of the places where they would not want to set up in business and raise their families. One of the reasons for that might be health inequalities—the disease burden that exists there, and therefore the high work loads in constituencies such as mine.
I have nothing but praise for GPs, but those ratios have for years and years been far too high—they have been the highest in England and Wales. The national health service is an organisation that I support, but it did, or could do, nothing about that until this Government landed on the Government Front Bench. They changed the local contracts so that primary care trusts themselves could employ doctors to work in such areas—so it was not up to doctors to think that they wanted to set up in business there. Instead, the PCT could put doctors into single-handed practices; they still had high patient ratios and work loads, but it could help and assist them. Those matters should have been on the national health service agenda decades ago, but they never were. However, under this Government they are. This Government have been able to do that, and over time that will improve the situation in this country.
The hon. Member for Billericay (Mr. Baron) made several interventions about what has been happening in the past few years. The White Paper “Choosing Health: Making healthy choices easier” clearly outlined a fundamental strategic shift towards public health, health prevention and moving care closer to people in their own communities. Other White Papers have followed it in terms of moving care and taking pressure off the acute sector by moving treatment out into the primary sector. The danger—it has always existed, and could have happily been solved—is that the new emphasis on health promotion and healthier choices leads to an increase, rather than a decrease, in health inequalities. They have not returned to the levels of Dickensian days or Victorian days, but when more choice is made available to people, the better off—the people who have always made better choices, such as the better educated—swiftly take on board messages about diet, smoking, drinking and exercise. Historically, that is what they have done; the more such choices are put into the public domain, the more of them will act on such messages, so it appears that there is a widening of health inequalities.
I am not saying that the position at the bottom end is perfect. However, although inequalities might be widening—the middle classes and the better educated might nowadays be taking better decisions than they have done—that does not mean that the health of the people at the bottom is not also increasing; on the contrary, it is. Therefore, when we address the question of widening health inequalities, let us get it into perspective. There is a widening of health inequalities, but the health of the people at the bottom, who have always been disadvantaged for whatever reason, is improving. Their lifestyles are improving as well; they are not Dickensian, Victorian, Edwardian or anything else. That is an important issue, and if the Opposition have not thought it through, they ought to.
I am grateful to my right hon. Friend for giving way, and I am glad that he is not quite as anxious as the hon. Member for Westbury (Dr. Murrison) about my intervening on him. Does not the point that my right hon. Friend is making about health inequalities powerfully reinforce the case for integrating all public services at local level? That is happening in Swindon, in terms of the local area agreement and the integration of the PCT, social services and the borough council. Will not such steps help to tackle the kind of inequalities that my right hon. Friend is talking about?
In health terms, the low paid and the public in general have been better off in the past decade than they were in the previous one. [Interruption.] Opposition Members can mess about all they like, but I am telling them the hard realities. These issues existed under Conservative Governments, who did not even debate them. They never wanted to do anything about health inequalities.
They are widening now because there are greater opportunities. Those who are able, and have always have been able, to make better choices for themselves and their families are doing so more frequently because they have the opportunity. That does not mean, however, that the health of everybody is not improving. I do not deny that we need to look at what is happening to the less well-off, and this Government are doing so. I am not saying that we do not need to do anything more.
Does my right hon. Friend not agree that it is very difficult to have a grown-up debate on these issues when we hear nothing but complaints from Opposition Members about how bad things are? I have yet to hear from them a single suggestion—apart from screening for double aneurisms—on how to put right any part of the huge cacophony of disaster that they have been describing.
My hon. Friend, sadly, is absolutely right; however, he needs to take that issue up with the Opposition later in the debate.
My hon. Friend the Member for North Swindon (Mr. Wills) is absolutely right—this is not just a national health service issue. The health service should be, and is being, required to work more closely with local government not just on adult social services, but on education, the environment, leisure and transport. That is happening in my constituency and in many others. We must use local area agreements to bring together all the partners who can transform people’s lives—not just local government and the NHS, but local residents themselves, the police, public agencies, the voluntary sector, faith groups and the social enterprise sector. There are now three area assemblies in my constituency, based on eight local authority wards. People from the local chambers of commerce, the health sector and the various community groups meet monthly to discuss their communities’ lifestyles and the help that they need to improve public health. These are the actions that we need to take.
I say—the Opposition will like my saying this—that it is crucial to have more joint appointments of directors of public health. I am not saying that public health should go back to being wholly the responsibility of local government. Not that long ago—certainly in my lifetime—local government had that responsibility. We took our eye off the ball decades ago, and I am pleased that the Government are addressing that issue.
Yes, my hon. Friend is absolutely right. Before the latest—let me call it the last—reorganisation of PCTs, 48 per cent. of PCTs and local government bodies had directly coterminous responsibility for social services; now, the figure is indeed 70 per cent. Getting that shape is important if we are to invest in the future. I discovered from a recent press release that the head of social services for Rotherham borough council, John Gomersall, had recently been appointed as a non-executive director of the PCT. I wish him well. We will see more such examples, which will enable us to continue to improve the health of the public.
All parts of the House need to be a lot more responsible than the European Parliament on the question of smoking inside buildings, for example. We need to find and build consensus where we can. This issue matters in everybody’s constituency. The disease burden and health inequality are high in my constituency for all sorts of reasons, but every hon. Member has constituents with health problems that have been going on for years. Those people need our attention and we must ensure that no matter who forms the Government, we work to get rid of the health inequalities that have been around for far too long.
Order. Hon. Members do not seem to have taken any account of the fact that there is very little time left in this debate. We have had only three contributions so far, and I am about to call the Liberal Democrat Front-Bench spokesman. Seven hon. Members have been in their places from the start hoping to make a speech in this debate. I hope that a sense of proportion will prevail so that that can be accomplished.
I shall be relatively brief and I also hope to be a little more reflective and consensual than some of the other contributions have been so far.
Good public health is the holy grail of modern politics. It has massive implications, and it could be argued that this is the most important debate that we will have this week. Parliament has a track record of underplaying the issue. In the 19th century our predecessors only took seriously the harm and diseases caused by the drains of London and the befouled Thames when the smell actually reached this Chamber. Now we face a different pressure. Longevity is increasing, thanks to better medicine, therapies and drugs, but we have not seen the same increase in the period of good health enjoyed by people in their lifetime, which is increasing more slowly. The period of decline and dependency is growing. There is more immobility, dementia and bone and muscle wastage. As a result, there has been an increase in the chronic diseases of old age, which is coupled with a falling birth rate and huge medical costs. Those factors have been well illustrated by the Wanless report and the King’s Fund. It is a serious problem and there is no realistic way at present that we can continue to fund it.
The only acceptable solution for a civilised society is to aim for a longer, but healthier old age. The ideal scenario for health economists would be a world in which people lived happily and healthily to 90 and then fell off their bicycle or died while out jogging. One change alone could transform matters and our calculations, and that is a successful means of preventing the onset and development of dementia and Alzheimer’s. Research in that area is crucial, because if predictions in that area change, the public health scenario also changes.
It is clear that something must be done, and it is also clear that something can be done. If we consider the variations in health outcomes between inner cities and the suburbs—the fact that somebody born in Blackpool lives eight years less than somebody born in Kensington—we see a serious problem that needs addressing. We must be clear that more chronic diseases are the result of the use and abuse of the body during a lifetime. Over time, a bad lifestyle has deleterious effects. Obesity, for example, plays a part in the development of diabetes, heart disease and some cancers. That is a drab picture, but we must acknowledge that some significant progress has been made by several Governments. First, progress has been made in addressing occupational diseases. We no longer get the dreadful litany of asbestos, coal and chemical related complaints that we used to have. They are still around, but they have a date stamp on them. We have also had serious improvements in health and safety at work and elsewhere, although too many people still die in accidents on building sites and too many are run over on our roads. We have been extraordinarily successful in counteracting infant mortality and the diseases of childhood, through better antenatal and post-natal care and programmes of education and immunisation. Those also have their place in the adult world, and we look forward to better screening for diseases such as bowel cancer, better immunisation and greater awareness.
Enormous gains are to be had in public health. Recently a vote was held on the most successful public health breakthrough in the past 200 years. The winner was not penicillin or any other therapy or medical technology, but Chadwick’s institution of drains. Second on the list was the invention of the contraceptive pill, so neither of those were medical technologies as such.
There are appreciable problems in public health, which I want briefly to deal with. Gains that are made in public health are generally long term and not immediately evident. If we do something about childhood obesity, its effects will not be immediate. We will not see better health outcomes straight away: we may see the difference in the children, but the long-term effects will kick in much later.
Will the hon. Gentleman therefore comment on a proposal in my constituency of Hull? To deal with childhood obesity, we introduced free healthy school meals in all our primary and special schools, which is having a dramatic effect on educational achievement. I think that it will also have an effect on the long-term health of those children. After a very successful three-year pilot, the Lib Dem council is now going to scrap it, so how does that fit in with the hon. Gentleman’s proposals on obesity?
I cannot comment as I have no direct knowledge of that, but I will deal with the issue of school meals later.
Progress in public health is actually quite hard to monitor. If a drugs education programme works or if there are benefits from healthy eating or physical exercise, it is not easy to see them in a straightforward way—unlike with the administration of a medicine to a patient. Another factor is that much of what can be done turns out to be totemic and slightly cosmetic. I have certainly sat in school dining rooms where there are pictures of big green apples—and watched the children tuck into pizza and chips.
Progress is also complicated because it requires a fair degree of partnership. In order for it work, we have to work with leisure services, schools and the adult world of the workplace. A realistic problem touched on here is that funding can be quite erratic and intermittent in the world of public health. I warm to some extent to the Conservative suggestion that we need clearly earmarked funds, but I also respond positively to the Minister’s suggestion that we need to target funds very effectively. I agree that what we do in public health is not simply a matter of health spending.
Another problem in public health—we have to be fair and acknowledge it—is that we are sometimes working against other very strong and powerful social forces: commercial advertising, for example, and media influences. Young people pay more attention to Heat magazine than to directives from the Department of Health, and we should acknowledge that there can be a positive side to that. A lot of very good health messages come out via the media. There are both good and bad aspects of the media, but one of the principal and most basic problems is that all the Government can do in connection with public health is advise, facilitate, enable and encourage. They cannot actually coerce or proscribe. Essentially, the Government are trying to carry out the very difficult job of influencing lifestyle. They can present the public with an idea of the good life or the healthy life, but in a pluralistic society, that will always be debatable. That is relevant to debates on drugs, sexual behaviour and alcohol use, where some of the unhealthy options are seen as a legitimate choice.
The Government can be accused, if they weigh in heavily, of being bossy or of being a nanny state. Even if they do not insist on a Korean-type national exercise scheme, they still come in for a certain amount of criticism. Plato, for example, favoured a very Spartan regime, coupled with no medical care whatever, but that is not the sort of approach that any Government these days—or for the foreseeable future—could recommend.
I have no problem with the suggestion that good health is a precondition of a good life, and everybody knows broadly what good health amounts to. That is a fairly evident conclusion that the whole House would share. I have absolutely no problem either with the state removing hindrances to good health. I firmly supported the smoking ban in public places, not simply because it got rid of—or will get rid of—passive smoking, but because it removes hindrances in the way of people who want to give up smoking. It helps to minimise the social occasions when people light up, although they are trying very hard to give up a habit that is doing them no good. We should be fairly unrepentant about that.
My mother is a twin. Her sister died 20 years ago, whereas my mother is alive, well and not troubling the NHS to any great extent. What is the difference between the two? One smoked; the other did not. Given that stark fact, one would think that there was every incentive for a Government to persuade people not to smoke at all, as well as not to blow smoke in other directions.
Notwithstanding the enormous benefits that will come with the smoking ban, the reality is that we still have to take the public with us. Public health works if we take the public with us. Messages therefore have to be attractive as well as cautionary. Healthy eating programmes in schools have sometimes led to a dip in school meal consumption, with children simply getting their food elsewhere. It is possible, however, to over-stress the contribution of school meals to childhood obesity. I cannot recall a time when school meals were anything other than pretty fattening, from an adult point of view.
Taking people with us is especially important in recognising that good public health requires good mental health. That means combating over-stressed lifestyles and unnecessary emotional trauma. Good mental health supports good physical health, and vice versa, but it is far harder for any Government to create the conditions for the latter, or to find agreement on what the latter actually amounts to. It is often said that the national health service should live up to its name rather than being a national sickness service, but there is more to it than simply putting up posters about eating oranges. That simplifies the objectives of public health, which include full physical and mental well-being.
Public health needs all the friends that it can get. It needs a whole-Government approach, a local government approach, a local community approach and a family approach. It also needs a commitment to a good, sustainable and wisely structured society.
I was really disappointed in the comments made by the hon. Member for Westbury (Dr. Murrison). They struck me as very old-fashioned in their approach to public health, and demonstrated a narrowness of approach and a failure to acknowledge that public health embraces most of what goes on in our society. We need to take a much more holistic approach to public health, rather than concentrating on narrow clinical indicators, which many of today’s contributions seem to have done. The hon. Gentleman also failed to deal with some of the underlying issues affecting public health in the United Kingdom today, including school food. I shall talk in a moment about some of the good work being done in Hull from which the rest of the country could learn.
I was pleased to hear the contribution of my right hon. Friend the Member for Rother Valley (Mr. Barron), who took a much broader approach to the public health debate, which is the proper and most sensible approach. I was also intrigued to hear the comments of the hon. Member for Southport (Dr. Pugh), who talked about public health needing all the friends that it could get. In my experience, the Lib Dems are certainly not the friends of public health in my constituency.
I should like to add to the broader comments of my right hon. Friend. Enormous strides have been made in recent years, and we should congratulate the Government on making public health a key target for the well-being of the United Kingdom, as well as its economic well-being. Having healthy citizens will be key to our success.
Public health is a broad issue, and all public sector bodies and authorities should include improving the public health of their communities among their key targets. I was a local authority councillor for eight years, and I have been a non-executive director on a primary care trust and on an acute district general hospital trust. I have seen that we can really make a different when the NHS, local government and the voluntary and community sectors work together. Leaving public health to the NHS alone, however, is not going to solve the problem.
Investing in and improving public health has enormous implications for the regeneration of areas such as my constituency. Communities that are blighted by poor health often have low educational achievement, poor housing and poverty of ambition. Those communities are often fractured. As a country, we cannot afford to waste the talents and abilities of people living in our communities. We, as elected politicians, cannot stand by and refuse to accept our responsibility to improve public health.
I want to make a couple of comments about yesterday’s debate on the acute sector and the reconfiguration in the NHS. The acute sector swallows up huge amounts of the NHS budget. I was interested in the comments made yesterday by my hon. Friend the Member for Dartford (Dr. Stoate), who said that the vast majority of hospital admissions should be seen as a failure of health policy. I agree wholeheartedly with that analysis. We need to front-load the public health budget in the NHS now to reap the reward in the years to come. If we do so, we will see a reduction in admissions to hospitals and a reduction in the number of people with conditions such as diabetes, coronary heart disease and strokes, and we will improve the life chances and opportunities of people all around the country, who will live longer, in better health. The acute sector has always been the focus of the NHS, but that focus is now shifting—rightly—to improving community facilities and investing in the wider preventive public health agenda.
I wonder whether the hon. Lady could lend her support to the campaign of people in the East Riding against the closure of all NHS beds at Withernsea cottage hospital and at Hornsea and Beverley. Those closures will have an impact on the services provided in Hull and public health throughout the area, and her support would be welcome.
With the greatest respect, the hon. Gentleman misunderstands my point. Also, I am concerned that my primary care trust, which was in balance in the last financial year, had to bail out his PCT in the East Riding, which massively overspent. There are higher health inequalities among my constituents than among those in the East Riding, so I am not going to take any lectures from the hon. Gentleman. I am concerned that yesterday a lot of Opposition Members spoke about wanting additional funding for their constituencies and constituents. They failed to grasp the bigger picture in relation to public health. All that Conservative Members seem to be interested in is keeping money going into the acute sector. They do not seem to be able to grasp that, if we put money into the preventive public health agenda now, that will save money in the long run. It is a shame that there still seems to be a disappointing, old-fashioned view among Opposition Members.
I want to turn to a few of the interesting and exciting initiatives that are happening in Hull, which, as I have said, has poor health standards. We have high levels of coronary heart disease and teenage pregnancy, but we are starting to address and turn around some of those issues. That does not happen overnight. A generational commitment has to be made. We already have a joint director of public health, Dr. Wendy Richardson, who is jointly appointed with the PCT and the local authority. She is doing an excellent job.
That leads me on to a piece of work that has been jointly commissioned. The local authority and the PCT are on board. The scheme is about free healthy school meals in all our primary and special schools in the city and it is the only initiative of its type in the United Kingdom. It focuses on the nutritional and educational benefits of getting children to eat well while they are at school. It is called the eat well, do well scheme and the children all get a free breakfast, free fruit throughout primary school, and free lunches and after-school refreshments, all of which are healthy.
I point out to the hon. Member for Southport, in particular, that take-up has increased. In some of our schools in the city centre, take-up of free healthy school meals is more than 90 per cent. The pilot, which has been going on for about two and a half years, is being evaluated by Hull university. Professor Colquhoun is providing interim reports, which all show that the policy is having a dramatic effect on the well-being of children in our primary schools. We might not see the savings from the scheme for 20, 30 or 40 years, when the children will have grown up and might otherwise have developed problems such as coronary heart disease, cancer and diabetes. However, we are making the investment now, and that fits in well with investing now to save for the future.
The scheme is making a real difference to educational achievement in the city, but the public health angle is the key reason why it should continue. It is disappointing that the Liberal Democrat council has an old-fashioned view—a silo mentality—of what local authorities should provide and what health services should provide. I am keen on examining ways of pooling budgets so that joint work can be carried out, given that such projects can provide positive outcomes.
I am not suggesting for one moment that such a scheme should be implemented throughout the whole country. I am interested in what works locally. We have talked a lot about local initiatives for local problems. The scheme seems to be working in Kingston upon Hull, but I am not sure that it is needed somewhere like Kingston upon Thames. There is great public support for the scheme. A poll that was held between 27 and 31 January by the Hull Daily Mail, my local paper, showed that 76.6 per cent. of respondents supported continuing the scheme as free for all children in primary and special schools. That shows that there is a real commitment to the scheme in the local community. It is depressing that there is such an old-fashioned silo mentality about what local authorities should and should not provide. We all have a duty to improve the public health of our communities. I will take up what the hon. Gentleman said about public health needing all the friends that it can get. He is absolutely right; it is just a great shame that the Lib Dems are not friends of public health.
Teenage pregnancy has been an ongoing problem for the city of Hull for many years, but the Labour Government have put resources into trying to tackle it. They have given resources to provide education about the means to avoid teenage pregnancy. They are tackling the underlying circumstances that motivate young people to get pregnant, and they are supporting young parents to get back into education and training and to access health services so that they can make positive choices about future conceptions. The latest figures show that the trend is going down again, which is welcome, but there is still some way to go.
I want to focus on two projects that show best practice involving boys and young men. There is a sexual health project in Hull for those people that is run by Cornerhouse, which undertakes one-to-one support and group work and trains staff working with young people around the city. Additionally, work that is going on with young fathers has been highlighted as a model of best practice. However, there is still a funding problem with that. Unfortunately, the Lib Dem council seems to fail to understand that it has a duty to this mainstream scheme. The primary care trust is providing 50 per cent. of the funding and the local authority should be providing 50 per cent. There seems to have been a problem involving the Liberal Democrat council accepting its responsibility. It is a great shame that the council is not a friend of public health.
The doula project in Hull is unique to the city because it is the only project in the country that uses volunteer doulas who are trained to get alongside and befriend pregnant women and to provide extra support to mothers in the early weeks and months after birth. The excellent project helps to provide a focus on public health by working with young families, especially mothers. It is funded through Newland and Avenues Sure Start, which highlights the commitment to improving public health across the piece.
We need to consider pooling budgets and to examine local area agreements and strengthening the role of local strategic partnerships. We need to make sure that public health is at the centre of local policies and the decisions that are taken locally. At the moment, we are still acting as if we are in silos and do not all have a responsibility for public health, but we all do.
I suppose that any debate on public health will be wide-ranging, and this one certainly has been. Increasingly, debates on health follow a familiar pattern: the Government claim that the health service is performing splendidly and are very critical of how it was under Conservative Governments. Indeed, the Government say that life in Britain is wonderful and that it was awful under Conservative Governments. Listening to the Prime Minister being interviewed by John Humphrys this morning, I realised that he is suffering from a health problem—he is deluded—and the problem is catching. I listened very carefully to what the Minister with responsibility for public health had to say. I have always said that I think her very genuine in her commitment to public health, but I was concerned about her overall strategy. We have these debates—I do not suppose that we listen to each other—and nothing changes. However, I want to touch on three subjects, hoping, in an optimistic frame of mind, to make an impact.
Health outcomes have improved dramatically; 150 years ago men lived, on average, to age 40 and women to 41, but today men live to 77 and women to 81. More extraordinary is the infant death rate, because it has fallen from more than 100 deaths for every 1,000 births in 1905 to five deaths for every 1,000 in 2004. Those results are wonderful, and the Minister is right to nod. Throughout the world all those outcomes are improving. The worry that my colleagues and I have is that on those two points our outcomes are not as good as those of any number of other countries. In a debate on public health the House might consider why that is.
My hon. Friend the Member for Westbury (Dr. Murrison) was entirely right to refer to the chief medical officer’s report. I would not describe the chief medical officer as a Conservative party lackey. In his annual report on public health, he devoted a whole chapter to public health budgets, which he entitled, “Raiding public health budgets can kill”. He went on to state that he had talked extensively to public health professionals throughout the NHS over the past two years and the following points consistently emerged from their accounts.
The first was that an
“Expressed commitment to public health by many health bodies is not matched by concerted action.”
That must be a worry for the Government. The second point was that
“Public health budgets are regularly raided to find funding to reduce hospital financial deficits or to meet productivity targets in clinical services…losing funding and the skills that had been acquired over time.”
Those are two points that have been made by the chief medical officer, not Conservative Members, and I ask the Minister, who I dare say will not have a great deal of time to wind up the debate, if she will comment on them.
The second issue that I want to raise is the Health Committee’s report on obesity, which was ground-breaking and has had enormous effect. I know that the Minister with responsibility for public health took it very seriously. In praising industry and enterprise, I want to praise Sainsbury’s—I do not have shares in Sainsbury’s, but I might be offered some—which this week launched the most comprehensive alcohol labelling system to date. It is an excellent strategy and it is certainly what the Health Committee asked for.
I cannot believe that the Minister is content with the childhood obesity situation. In 1999 the Government abandoned the targets in the Conservative Government’s first ever public health White Paper, which aimed to reduce rates of obesity in the general population to 6 per cent. among men and 8 per cent. among women. Current projections are that by 2010 the figures will have risen, and 33 per cent. of men and 28 per cent. of women will be obese. In addition, the National Audit Office has criticised the Government’s progress towards meeting the obesity public service agreement targets.
As for childhood obesity, in 1995, 9.9 per cent. of children aged between two and 10 were obese, and that figure has steadily risen to 13.4 per cent. The Minister is only too well aware of the arguments on why that is, but what we would welcome are solutions. I welcome Ofcom’s decision to ban advertisements for unhealthy food. I remember when three Ministers gave evidence to the Health Committee on the subject—in fact, I think that the Under-Secretary of State for Health, the hon. Member for Bury, South (Mr. Lewis) was on the Committee—and there was an argument about the banning of advertisements for unhealthy food, so it is good that a ban has been introduced.
I am concerned about the Public Accounts Committee report. It made eight recommendations that any hon. Member may read, and its conclusions were very worrying. For instance, it says:
“Important messages on diet and lifestyle have yet to get through to parents and children as clearly or as effectively as required.
To date, there has been little comprehensive, published research on the effectiveness of prevention and treatment strategies for child obesity and, consequently, the Departments have…done little to intervene directly with individual children who are obese or at risk of becoming so or their parents.”
I have two other, quick points to mention; I know that four other colleagues wish to speak, and I do not believe in being greedy with the time.
My hon. Friend mentioned hepatitis C, and I happen to be the chairman of the all-party hepatology group. This week, Dame Anita Roddick attended our reception, and I am delighted to say that I awarded her an Oscar, ahead of Sunday’s Oscars, in which I hope Dame Helen Mirren, a Leigh-on-Sea girl who went to St. Bernard’s high school in my constituency, will get an award. I was delighted to give Dame Anita Roddick an Oscar because she has been brave in putting her head above the parapet; I understand what my hon. Friend was getting at when he mentioned the subject. She spoke to us in a direct fashion, and although she was not overtly critical of the Government, I pass on to the Minister the fact that the grant of £70,000 to the Hepatitis C Trust is not overly generous. These days, we all have so little time to listen to each other, but the Hepatitis C Trust does listen to people. It tries to reassure them and deal with their anxieties, so when budgets are being considered, it would be nice if the trust were given more money.
The other concern that I wanted to raise was about the advertising campaign. I know that the Minister and my hon. Friend the Member for Westbury locked horns on the issue, and I will not get too involved in that, but I point out that the Hepatitis C Trust is concerned about the groups targeted. Let us consider all the dangers that we face today, what with the number of people getting tattoos. Groups felt concern about the way in which the advertising campaign was run. Dare I suggest that the Government would do well to turn to Saatchi & Saatchi, and other advertising agencies?
I was going to say that I will end with sex, but instead I shall say that I will end with a point about sexual health. The Minister is probably fed up with my endless questions about abortion, but I will not shut up about the matter. Only this week, a little baby whom one could hold in the palm of one’s hand—she weighed 10 oz, and measured 9 in—survived when she was born at under 23 weeks, so the issue is not going to go away. Before the general election, the three party leaders were firm in their belief that something had to be done because of advances in medical science, but nothing has happened. Every year in Britain, 300 babies are born aged between 22 and 23 weeks—babies born at 23 weeks have a 17 per cent. chance of survival—so the House must do something about the issue.
The Health Committee produced a report on the sexual health of the nation. The facilities we saw were pretty awful, and are not at all good compared with those overseas. Will the Minister say something about Chlamydia? The annual screening target is 945,000 16 to 24-year-olds, but so far we have screened 63,000 people, which is 6.7 per cent. of the target. As a result of that failure, many 16 to 24-year-olds will suffer and become infertile.
I am delighted that we have had this debate. If we are honest—and we are probably not entirely honest with one other in the Chamber at the moment—we know what the problems are, but it is the solutions that are the challenge. Until the British people are given the opportunity to decide at an election whether or not the Government are, as I mentioned earlier, suffering from delusions, we must work with the Labour Government, so I urge the Minister to see whether she can come up with some solutions.
I am grateful for the opportunity to speak. I will keep my comments brief, as I know other colleagues wish to contribute.
I am grateful to the hon. Member for Southend, West (Mr. Amess) for saying that there will be an opportunity for the country to decide at the next election what kind of Government they want. I have waited all afternoon to hear what the Conservative policy is on public health. I intervened on the hon. Member for Westbury (Dr. Murrison) to ask what it is, and he wants to introduce screening for abdominal aneurisms. I entirely agree, and I hope that he is successful in persuading the Minister to introduce that screening. He wants ring fencing, too, for the public health budget, but, as I tried to explain in another intervention, that is almost impossible, as public health is the responsibility of all Government Departments. It would therefore be difficult to ring-fence that budget. Personally, I would very much like a Cabinet-level public health Minister who could range across all Departments.
It is interesting that it should be me who draws out Tory policy, because Opposition Members did not mention it in their speeches. [Interruption.] Perhaps I did not hear the hon. Member for Westbury say so.
The hon. Gentleman said that it was a pity that the Black report did not receive wider coverage. As I recall, it was suppressed by Baroness Thatcher because it was far too inflammatory, and it was almost impossible to obtain a copy. It was not until Peter Townsend published it in a Penguin book that the public were allowed to see it, and it was hardly looked at by the Conservative Government.
That is a point for debate. As I recall, there was no public health Minister in the Conservative Government at that time.
As time is short, I do not wish to make too many points, as some of them have been touched on by colleagues. However, there are one or two things that I would like to raise. I chair the all-party pharmacy group, and I believe that pharmacists have an enormous role to play in promoting public health. They could do much more, and more public health measures could become an essential part of the pharmacy contract, so that they become universally available at all pharmacies and thus make an enormous contribution to public health. Will the Minister look at the GP contract and the way in which QOF—quality and outcomes framework—points work? We could achieve far more improvements in primary care if public health became an essential part of QOF. In particular, if a significant number of points were attached to the management of obesity, I am sure GPs would devote more time and effort to tackling that serious issue. The problem of advertising for kids has already been mentioned, and I am glad that that is now to be dealt with.
I am very concerned about the traffic light food labelling scheme, which certain retailers, for reasons of their own, refuse to accept. I fear that that will cause enormous confusion among consumers. The scheme will only work if all retailers adopt an accepted norm. The Food Standards Agency has done important work on the scheme, and I deeply regret that the largest retailer in the land refuses to accept it. I am pleased that the Minister has reported reductions in the salt content of processed foods, but we need to go a great deal further, because salt is a major issue.
I will not detain the House further, as many other Members wish to speak. I shall merely say that if we dealt with some of the issues that I have raised, we could make significant further improvements in public health that would benefit us all.
I am pleased to follow my neighbour, the hon. Member for Dartford (Dr. Stoate). Although I do not often agree with him, he made several important points today. However, I was disappointed that he had not listened to the speech of my hon. Friend the Member for Westbury (Dr. Murrison), who said that he wanted to ring-fence funds and that there should be a Cabinet Minister to deal with public health. Both are policies that we should consider for the future, with—I hope—increasing support from Labour Members.
I am pleased to be able to speak in this debate. Health debates tend to be about hospitals, primary care, cuts and so forth, rather than about public health.
I am sorry that the Minister finds everything so amusing, but I am afraid that cuts are being made in primary care trusts. It is a problem that we are experiencing in Bexley. But we must not go down that path; today we are discussing public health, not primary care trusts.
Preventive health care, health education and making healthy choices are important issues. For my constituents, they are vital issues. I was disappointed by the Minister of State’s speech, because I have a good deal of time for her—unfortunately, she is not in the Chamber at the moment—but today she was combative, aggressive and very party-political. I do not think that that helps when we are discussing an issue such as this. The hon. Member for Kingston upon Hull, North (Ms Johnson) was also party-political when commenting on the Liberal Democrats, but I shall not go down that path either.
We ought to be working together to establish how we can improve public health. To listen to the Minister, one would think that there were no problems for the public health of our country, but I cannot agree that that is the case. The issues that I want briefly to discuss are smoking, alcohol, obesity and healthy eating. In my part of south-east London, problems are increasing in respect of all those issues.
I fundamentally opposed the extension of licensing hours to allow more drinking time. My neighbour, the hon. Member for Dartford, said that everything in Dartford was fine, but in our borough the extension has increased binge drinking and the consequences of antisocial behaviour. I was appalled to learn that about one in 26 NHS bed days could be ascribed to alcohol-related diseases, and that 40 per cent. of accident and emergency admissions were alcohol related. Those are real problems in today’s society. The increase in the rate of deaths from alcoholism among women and in the number of women drinking to excess is worrying. We should be thinking about how we can stop binge drinking and the increase in alcohol abuse. The Government made a mistake in increasing licensing hours and opening times, and the figures that we are seeing are cause for concern.
In my patch, I have been involved with Welling Alcohol Service Provision, or WASP, a voluntary organisation based in Welling. Working on the ancient principle that actions speak louder than words, a small group of former alcoholics arranged a meeting and subsequently set up an organisation at a drop-in centre—a pop-in service that would be available 365 days a year for ex-alcoholics who needed a place to meet and socialise. They are doing a wonderful job and I pay tribute to them. Regrettably, funding is a problem. The Government should consider making more funding available for such organisations so that they can do good work in the community to help people who have problems overcoming their alcoholism.
The second aspect that concerns me greatly is the problem of obesity and healthy eating issues. I was appalled to see that in my borough, Bexley, 11 per cent. of children are obese when they enter primary school, according to the children and young people’s plan for our borough for 2006-09. That is an extremely worrying trend. I welcome the efforts by Sainsbury to improve food labelling, the efforts by Jamie Oliver to encourage healthy eating and so on, but that is not enough to improve the health of our young people. Too many of them are still going for fast food and still eating all the wrong things, which will have long-term consequences for their health.
Education is of course the key—education at home, with the family, and education at school. More publicity and more media attention are vital, or we are storing up public health problems for the future. I am not convinced that the Government have got it right. They cannot do it alone. As I tried to suggest to the Minister in an intervention, it is no good her saying that the Government are doing this or that. There must be a broader-brush approach, with all of us involved, including voluntary and community organisations and parents groups. The Government should take the lead, but that is not enough. It is a matter that we should discuss constructively across the Chamber. That is why I was a little disappointed with the brush-off that I got from the Minister, which was party political.
The Government have taken positive steps—on smoking, for example. I voted for the smoking ban. I think it is a good thing—[Interruption.] I am sorry that my hon. Friend the Member for Beverley and Holderness (Mr. Stuart) does not agree. I have never smoked and I am worried about the youngsters in my borough who smoke. They are ruining their lives and potentially causing damage for the future. We are grateful that the House had the opportunity to vote as it did, and we look forward to the summer, when the ban will be introduced and people will no longer be subjected to passive smoking.
I am concerned by the lack of physical activity among our young people. The Olympics will be a tremendous opportunity, which we welcome, although there are other associated issues, such as the problems that we will have in Bexley as a result of paying for the Olympics, and whether the facilities will be completed on time. However, the principle is good and we should be extolling the virtues of sport and physical activity.
According to the Office for National Statistics time use survey in 2005, the three main activities of people in Britain were sleeping, working in their main job, and watching TV and videos or listening to music. Although all those are important, one would like to think that, if we aim to encourage people to pursue a healthier lifestyle and if public health is at the top of our agenda, people would also engage in physical activity and sport.
The percentage of time spent on sport and outdoor activities has fallen during the Government’s time in office, from 15 per cent. in 2000 to only 10 per cent. in 2005. If we are serious about improving public health, the Government must get people to do more physical activity, especially youngsters, so that their lifestyle includes sport and recreation.
This has been a very good debate, albeit that it has been too partisan for those of us who believe that public health is a bigger issue than one for party political knockabout. Education has to be the key target to change people’s lifestyles and ensure that they learn about the consequences of their actions. The Government can do much, but it is limited.
Finance is always the key, so what my hon. Friend the Member for Westbury said about ring-fencing needs to be looked at again. I know that primary care trusts in south London are raiding the budgets of the public health sector to meet their shortfalls. In the long term, the consequences will be disastrous. If we had ring-fencing, it would help to keep the public health sector afloat. I hope that the Minister will agree to look again at the proposition made from the Opposition Benches.
We need a more co-ordinated approach under local directors of public health, with the local authorities and PCTs working much more closely together. It is a joined-up approach that we need if we are to tackle this growing problem. There is a great opportunity, and I hope that the Government will take that on board.
It is a pleasure to follow the hon. Member for Bexleyheath and Crayford (Mr. Evennett). Many years ago, I spent 10 years teaching in his constituency. When I go back now, I can see that people there are much healthier today than they were back then.
We know that throughout history the greatest advances in human health have occurred not because of doctors, hospitals or even medicines, but because of improvements in public health, including clean drinking water, improved sanitation, better shelter and housing, enabling people in countries such as this to keep warm, and proper nutrition. There was a point in the second half of the 20th century in this country at which, with poverty falling and all the factors that I have just mentioned moving in the right direction, along with the onset of medicines for the epidemic diseases and increasing longevity, we looked forward to a time when we would have almost perfect health. Something else was happening at that time, however. With that increasing prosperity and consequent lifestyle changes, we were getting fatter. We are still getting fatter, and our children are getting fatter than ever. It is on that problem—obesity—that I wish to focus today.
In 1976, in a consultation document on public health produced by the then Department of Health and Social Security, obesity was barely mentioned. It was considered a minor risk factor for coronary heart disease. By 2004, however, the Wanless report, “Securing good health for the whole population”, said that obesity
“has the potential to be of equal importance to smoking as a determinant of future health.”
Since then, we have seen even greater changes regarding obesity. The key facts are that obesity reduces life expectancy by an average of nine years and is responsible for 9,000 premature deaths a year. The prevalence of obesity has trebled since the 1980s. Some 22 per cent. of men and 23.5 per cent. of women are now obese, and well over half all adults are either overweight or obese; that is 24 million people.
Overweightness and obesity are also increasing among children. Almost 28 per cent. of children under 11 are overweight or obese, and 14 per cent. are obese. If we do not do anything about that, the number of affected children will continue to rise, and they will have a shorter life expectancy than their parents. If current trends continue, at least one third of adults, one fifth of boys and one third of girls will be obese by 2020.
I declare two interests in this debate. First, my wife works in public health for the Great Yarmouth and Waveney primary care trust. Secondly, a few years ago, I lost a lot of weight. I therefore feel that I can speak with some personal authority this evening, not because of the former—my wife’s job—but because of the latter. Some hon. Members will remember how I used to heave myself around the place, and one of our friends in the Press Gallery once wrote in a diary column that when I stood up I looked as if I had just eaten somebody for breakfast. I do not know how heavy I was back then, because bathroom scales stop at 20 stone—I was probably closer to 21 than 20 stone.
By 2001, after I had got myself re-elected, I had had enough—I was fed up of spilling food at mealtimes on my tie, fed up of the difficulty of threading my way through crowded receptions. People have asked me how I lost the weight. The lesson is very simple. First, one should eat less. Secondly, one should think about what one eats, avoid fat and sugar—if one does not want to be fat, one should not eat fat, or not a lot of it—and try not to eat between meals. People have said to me, “Why don’t you write a book called, ‘The Politician’s Diet’. It might sell a few copies among the others.” It is no good going on a diet: if one does, when one comes off it, the weight goes back on. The point is to change one’s approach to food.
I congratulate the hon. Gentleman on his achievement. It is nice to know that we agree on that anyway.
I wonder what the reaction of other people has been to the hon. Gentleman’s weight loss. People did not come up to me and say, “Well done. Great.” They gave me a funny look and said, “Are you all right?” They thought I was ill with a wasting disease or something. Everyone wants to lose weight, but when somebody does, people think that the person is ill. It is strange. I have shown that I was not ill, and I am not ill now. I am so much more active, and I hope that the hon. Gentleman feels the same. I am fitter, and I do not have the tiredness and aches and pains that I used to have. I have been able to pursue my hobby of walking up mountains and managed to reach the highest peak in north Africa. In the summer, I finally achieved my goal of getting to a 20,000 ft peak in the Andes. I put the picture of myself standing on Mount Toubkal on my last election address to show my electorate that I was fit and not dying.
People talk about exercise, but I just walk. I always walk up escalators. If we want to see the problem in the country, we need only look at the people who stand on escalators when they could walk up them, or who use lifts instead of stairs. Exercise is good, but I am told that to burn off a cheeseburger, fries and a shake one must walk 9 miles. I was lucky: I had someone who helped me to focus on my aim to lose weight; not everyone is that lucky.
Today, I want to focus on the food that we eat. We need to change the food that we eat and the amount that we eat. The food industry and retailers have a huge role to play. They are not doing enough, and I question the commitment of some of them to helping us solve the obesity problem. Why do I say that? Every year, for many years, I have gone along to Tesco’s computers for schools presentations. Last year, it occurred to me that collecting computers for schools tokens was an incentive to buy more food, so I suggested to Tesco that perhaps it should build in an additional incentive by giving extra vouchers if people bought fruit and vegetables. I also put the idea to the Minister of State, Department of Health, my hon. Friend the Member for Don Valley (Caroline Flint) in a parliamentary question.
There was a little publicity, and Tesco’s initial response was that it did not believe in straitjacketing its customers, which was not very helpful. When I eventually received Sir Terry Leahy’s response in a letter, it was full of what I call healthy food-speak waffle; it did not say anything at all. Tesco refused to take up that sensible and reasonable idea. In the meantime, I received a letter from Sainsbury’s saying that it operated precisely such a scheme for its sports equipment vouchers. I therefore congratulate Sainsbury’s, and say, “Shame on Tesco” in that respect.
I began to suspect whether some companies were serious about tackling obesity. My suspicions have increased since the recent debacle over food labelling. It is important to be able to see the label on food. I used to look at the percentage of fat per 100 g. That helped me, but the information is not prominent; it is in small print and not easy to follow. I was delighted when the Food Standards Agency brought out the traffic light system. It sends a simple, clear and strong message because it gives fat, sugar and salt the red light, and we need to do that if we are to change what we eat, which we must do. One can go into small convenience stores on the way home in the evening and find that all they have are things such as crisps and Munchies. There is no fresh food. The people in them say, “That’s what our customers want,” but customers will react to the red traffic lights and want different things.
On the same day as the traffic light system was launched, the Food and Drink Federation launched its guideline daily amounts. It is a recipe for confusion. Sadly, I think that it was deliberately planned by certain food companies and food retailers as an attempt to undermine the Food Standards Agency scheme. The GDA boxes require quite a high level of intelligence to understand. Having been a teacher, I have a good idea of what can generally be understood and it takes very good mental arithmetic to keep a tally of all the percentages of fat, salt and sugar. It probably needs a calculator and one would have to write it down in a book. That will not achieve anything. In addition, there are different guideline daily amounts for men and women and different types of people.
When people from the Food and Drink Federation came to the House, they made a slick and hard-selling presentation. They held up a bottle of ketchup and said that the problem with the red traffic light system is that it is all based on percentage per 100 g, but people never put 100 g of ketchup on their food, so it is rubbish. But people do eventually eat 100 g of ketchup; it does not matter whether they put it on all at once or over a week. That is where the federation is wrong. It brought its range of produce along with it. We need to change that produce. If people see red traffic lights and change what they ask for, customers will give food manufacturers a different message and we will end up with better food in our shops.
Thank you, Madam Deputy Speaker, for calling me to wrap up the Back-Bench contributions in this extremely good debate. I have very much enjoyed sitting through it.
The press lobby called me amiable and chubby. I cannot do much about being amiable, but I decided to do something about being chubby. I went on a diet and now hope that I can keep the weight off. However, I shall not bore the House with my eating habits. I want to stay within the boundaries of a public health debate. If I do not, Madam Deputy Speaker, I am sure that you will rule me out of order. I want to link my comments to the cuts in the Hertfordshire health economy. The £50 million savings that we are being asked to make over the next two years will have a fundamental impact on public health provision across the county and in my constituency.
We cannot fail to mention per head funding. In Hertfordshire it is £900 per head; in the constituency of the Secretary of State for Health it is £1,300 per head, and in parts of Scotland it can be as high as £1,800 per head. There may be very good reasons for those discrepancies, and this is not the place to argue the pros and cons. However, at a time when our acute services and public health services are being cut, the discrepancies are causing my constituents and the residents of Hertfordshire a great deal of concern.
I am grateful to my hon. Friend, who has a short allowance of time, for giving way. Those cuts in local primary care in Hertfordshire are devastating. A recent letter leaked to me from the PCT indicated that £1 million of extra savings had to be made locally in primary care, which means that district nurses are going to be made redundant, as well as the acute nurses whom we will lose.
My hon. Friend makes a good point.
A paper published this month, entitled “The future of health visiting in Bedfordshire and Hertfordshire”, by the Bedfordshire and Hertfordshire Local Medical Committee Ltd quotes a report by Amicus, which is a fantastic union, as I am a member of it. The Amicus “Who cares?” campaign reported that the number of whole-time equivalent health visitor jobs slumped to a 12-year low for England in 2005. That seems to conflict with the Minister’s comment in her opening speech that they were at an all-time high.
The report was written jointly with health visitors. It went on:
“The meeting recognised that it is now necessary for Health Visitors to concentrate their sparse resources on the under 5s; Health Visitors reluctantly feeling that they have no alternative but to reduce their input into older children and the rest of the family, unless absolutely necessary, and the elderly. GPs are already aware of the loss of specific health promotion activities formerly carried out by Health Visitors since the move to a geographical basis rather than being practice allocated, naming specifically the loss of obesity clinics and smoking cessation activities.”
The current funding crisis within our PCT is causing a lot of concern to our general practitioners and to health visitors. The impact of those cuts is being felt by local service users.
We have been told that reductions in acute services will be offset by placing more services within local communities. That in itself may not be a bad thing. However, the experience of the Hertfordshire Partnership NHS Trust, our mental health trust, was that it lost beds while at the same time having to reduce services within the community. Specific services reduced include alcohol-related services. The issue of alcohol abuse, and treating those who are prone to such abuse, are as important, if not more important, than drug addiction, bearing in mind that alcohol is far more widely used and more widely abused.
Among the other services that have been cut within local communities are some that I would regard as public health services, including helping people suffering from depression or early-stage mental health illnesses. Often if we catch these illnesses at the beginning, when people start to be troubled by them, we can avoid significant costs and treatments further downstream.
Those are all areas of concern. Of course if we are not treating early-stage depression in the community, we eventually get greater pressure on GP services—GPs are already stressed and dealing with a large number of people—and then we get over-prescription of expensive medicines. Funding in our PCT is of huge concern, and paying back the deficit over the next two years is having an impact on local services.
I wonder whether I may, through my hon. Friend, put a point to the Minister. There are large, increasing numbers of people living in holiday homes and static caravans for much of the year—10 or 11 months of the year. A 65-year-old man living in a static caravan in a coastal area such as mine will bring only one 20th of the health funding of a permanent resident. That is an increasing issue in coastal and rural areas. I wonder whether he would like to comment. I hope that the Minister might touch on it later.
I do not represent a rural community, but I imagine that that would be of huge concern to those communities where it happens, because they bear the majority of the cost of looking after that person, although they are not in receipt of 95 per cent. of the normal funding.
May I talk briefly to Ministers about drugs? We have a number of excellent local support service providers within Hertfordshire. They are very small niche providers, but they understand the communities that they serve perfectly, and they provide a variety of services. One of the great joys of being a Member of Parliament is meeting truly fantastic people who for no financial reward, and with very little recognition beyond their peer group, work immensely long hours with extremely difficult and troubled people.
I am concerned that local groups such as those that I have referred to might be squeezed out by the imposition, or the promotion, of national or large regional contracts—admittedly the large organisations to which they are awarded are charities, but charities that operate on a far wider scale, and do not have many of the attributes of locally based organisations. I would urge the Minister to take my concerns seriously—but I shall not do so, because I know that she will indeed take them seriously. I also urge my own council to listen to the concerns of local service users about the type of services that they are accessing, because small and local solutions are often best suited to address the problems that we as a community are trying to resolve.
We in Broxbourne have all the problems that are prevalent in other constituencies. Broxbourne has a Conservative Member of Parliament, but in Waltham Cross, for example, there are many of the problems associated with inner cities. It is not a particularly wealthy town; it has a high incidence of sexually transmitted diseases, high levels of addiction, and high levels of mental health problems.
I congratulate the Government on the Sure Start programme. It has been hugely welcome and successful, but recently we had to fight hard to ensure that we could get continued funding. I hope that that is the last time that we have to fight for that, because the service provided is of such outstanding quality and excellence, and its benefit to the community is so high, that I hope that in future it will be taken as a given that people in Waltham Cross will be able to access that high quality of service.
Public health is a massively important issue, and I am glad that we have had such a sensible debate. I am also glad that there is such a committed slimmer on the Labour Benches as the hon. Member for Waveney (Mr. Blizzard). I have not quite reached his degree of thinness, but I will work on that over the next few months.
The debate has been interesting, although perhaps a little too party political in certain respects. However, there have been some worthwhile contributions.
The speech of the right hon. Member for Rother Valley (Mr. Barron) was passionately felt, although perhaps a little partisan for a Health Committee Chairman. He criticised our talk of widening health inequalities. Our central point, which seemed to escape him, is that health inequalities have widened under this Government. There is no point in talking about absolutes when it can be very well argued—certainly the evidence supports this—that in relative terms, the Government’s public health policy has not helped the lower-paid; in fact, it has failed them. That cannot be denied if we look at the figures, or the Government’s own target.
The hon. Member for Southport (Dr. Pugh) rightly stressed the importance of recognising how health policy affects the elderly, and I agree with him. It is important to recognise that Government targets sometimes focus too much on acute services, to the neglect of those suffering from long-term medical conditions, even to the point where those with such conditions often consider themselves to be second-class citizens in the NHS. That is a valid point, and the balance needs to be addressed.
The hon. Member for Kingston upon Hull, North (Ms Johnson) criticised our approach to public health but failed to mention, or recognise, any of the failures of the Government. That was a shame, because it did not make for much balance in her speech.
My hon. Friend the Member for Southend, West (Mr. Amess) rightly talked about the Government being deluded in believing that their health policy was working, and he expressed the concern that all the evidence suggests that public health budgets are being raided, and he referred to the chief medical officer’s most recent report.
The hon. Member for Dartford (Dr. Stoate) did not listen to my hon. Friend the Member for Westbury (Dr. Murrison) when he said that public health should be a Cabinet responsibility; that was clearly stated by my hon. Friend. My hon. Friend the Member for Bexleyheath and Crayford (Mr. Evennett) rightly pointed out that 24-hour drinking has increased the level of binge drinking in his constituency, and he expressed great concern about that. He reminded the House that according to the National Institute for Health and Clinical Excellence, alcohol-related disease accounts for some one in 26 NHS bed days, and more than one third of all accident and emergency attendance. He also rightly stressed the importance of the all-embracing approach to public health that is required—it cannot be left just to the Government—and the important role of education.
May I congratulate the hon. Member for Waveney (Mr. Blizzard) on being probably one of few examples of the success of the Government’s public health policy? He rightly stressed the importance of a healthy diet, and I congratulate him on that, too. My hon. Friend the Member for Broxbourne (Mr. Walker) rightly mentioned his concern about cuts in Hertfordshire’s public health budget, and he linked them to cuts that are taking place elsewhere in the local health service because of deficits. That is bound to impact on local patients.
To remain viable in the long run and for the good of our health, the NHS must change its emphasis from being a national sickness service that treats disease to a national health service that focuses on preventing it. By not addressing public health with a concerted effort now and in recent years, we are storing up problems that will have to be addressed through secondary care in future, resulting in worse outcomes for patients—a point that was made in all parts of the House. Indeed, the chief medical officer has argued that we are in what Derek Wanless called the “slow uptake” scenario in public health. That could mean extra costs in real terms to the NHS of £30 billion by 2022-23, and a difference in life expectancy of some three years for men and two and a half years for women.
Despite all the claims by Ministers, there is a worsening picture of public health across the country. Sexually transmitted infections are rising. For example, cases of syphilis have increased by 1,600 per cent. since 1997. Cases of gonorrhoea have increased by 44 per cent, cases of chlamydia by 150 per cent., and cases of HIV have more than doubled—all since 1997. Meanwhile, the number of alcohol-related deaths has more than doubled during the last 10 years, and cases of tuberculosis have gone up by 10 per cent. in the last year alone.
Moving on—if further evidence of failure is required—according to a report published by the Health Protection Agency in December 2006, the number of people newly diagnosed with hepatitis went up nearly fourfold between 1996 and 2005. As for obesity and diabetes, according to the Department of Health’s own figures, on current trends the proportion of girls who are overweight or obese is predicted to be 40 per cent. higher by 2010 than in 1997, and three in every four men and three in every five women will be overweight or obese. These are worrying figures—and they are the Department of Health’s own.
Those figures clearly show a worsening public health situation across the country, and that, whatever Ministers may say or claim by way of success, the results prove otherwise. Indeed, the results are so bad that if they applied to an organisation outside politics, those responsible would probably be fired. I suppose that we have had the equivalent of that with the civil servants’ own survey within the Department of Health, which clearly demonstrated a lack of confidence in the Secretary of State. There comes a time when the Government must take responsibility for their actions, and after 10 years in government, that time is now. These growing public health problems are home-grown; they are of the Government’s own making.
I suggest that to find the reasons for this poor public health record, we need look no further than the chief medical officer’s latest annual report, published last July. He points to the fact that the Government’s constant reorganisation of the NHS has hit public health particularly hard. He claims that reorganisation after reorganisation has caused considerable disruption to the provision of public health services and undermined staff morale. He has been very clear about that. The CMO also shares the concerns of many others that not only has public health been neglected, but the number of senior public health staff in England—including directors, consultants and specialists, but excluding academics—has been almost static since 1997.
Perhaps most importantly, as hon. Members have pointed out—especially my hon. Friend the Member for Southend, West—Professor Sir Liam Donaldson devotes a whole chapter in his latest report to public health budgets. It is entitled “Raiding public health budgets can kill”: his point could not be clearer. In that chapter, the CMO makes the point that in talking extensively to public health professionals throughout the NHS over the past two years—something that I would recommend Ministers to start doing—it emerges that public health budgets are regularly raided to find funding to reduce hospital financial deficits or to meet productivity targets in clinical services, losing funding and skills that have been acquired over time.
As my hon. Friend has described, there has been an explosion in sexual infections across the country, including in the East Riding of Yorkshire, my local area. Does he agree that one positive outcome of today’s debate may be that the Minister of State with responsibility for public health will reinstate the expenditure on sexual health campaigning, so that we can send the message out and reverse the deplorable increase in those conditions under this Labour Government?
I agree with my hon. Friend. I hope that we shall hear some positive noises from the Minister about expenditure on sexual health education, because it has been deplorable. The figures speak for themselves.
Many criticisms have been made suggesting that we have not produced any policies in this area, which is totally untrue. Our point is that if we are trying to plan for public health in the longer term—and if we are serious about getting to grips with this growing problem, nothing but a long-term strategy will do—ring-fenced funds are essential.
The CMO concludes his report with the comment:
“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.”
That has got to be the wrong way to go about things. How can we get to grips with worsening trends if budgets are continually raided to correct short-term financial difficulties at PCT level? I appreciate the Minister’s honesty in saying that she has given the issue serious thought, but I ask her to reconsider her position. Without ring-fenced budgets, things can only get worse.
On the issue of funding for sexual health, in November 2004 the then Secretary of State for Health announced £300 million of funding for sexual health services. However, in August 2006 the Department’s independent advisory group on sexual health and HIV reported that too little of the extra money had reached front-line services. It said that funds were not getting through because local health care providers were using the money in other areas. That is not Conservative Front Benchers speaking, but the Department’s own independent advisory group.
In 2004, the then Secretary of State also announced £50 million for a sexual health campaign, but that shrank to £4 million when it was announced by the present Minister. Where is the remaining £46 million, and why has it not been used? According to an answer given in the other place, it is simply sitting in NHS coffers. It will not do much good there. The low priority accorded to sexual health is again reflected in the fact that the hon. Lady had to admit last year that the Government do not even collect data on the number of tests for sexually transmitted infections, rendering meaningless their promise in the 2001 sexual health strategy that by the end of 2007, 60 per cent. of genito-urinary medicine clinic attendees would have an HIV test.
Of course, in the case of cancer and other conditions, early identification of signs and symptoms is a vital weapon in our armoury against disease. That is why screening programmes are so essential to the future health of the nation, and to the NHS. Once again, the Government’s record is poor. Despite furious lobbying by the relevant charities, they were three months late in launching the new bowel cancer screening programme. The scheme had the potential to screen 500,000 by the end of its first year, but by November the number of people screened had reached only 100,000.
Meanwhile, recently published research by the cancer screening programme shows that the number of young women who attended for cervical screening last year was down to 69 per cent., compared with 79 per cent. 10 years ago. Charities such as Breakthrough Breast Cancer continue to express their concerns about the accessibility of breast screening. The Government failed last year to meet their own target for 80 per cent. of people with diabetes to receive retinopathy screening.
On abdominal aortic aneurysms, we support the introduction of AAA screening for men aged 65 and over, which is predicted to save perhaps 2,000 to 3,000 lives a year at a cost of around £25 million. The Government have been dragging their heels on this issue for far too long, and should now establish a number of centres around the country where understanding of the programme can be dispersed.
Finally, on obesity—another area where the Department of Health has proved unfit for purpose—the Treasury set a public service agreement target in July 2004 to halt the year-on-year rise in obesity among children under 11 by 2010. However, up to 15 per cent. of children in the UK are currently overweight or obese. It is estimated that by 2010 there will be more than a million obese children.
Of course, the Government have failed to give a clear and straightforward lead on the question of food labelling, investing £2 million in the traffic light system, while the food industry is developing an alternative model. We have consistently argued that traffic lights on their own are too simplistic and do not help consumers and parents to plan healthy living for themselves and their families.
Meanwhile in just five years from 2000, the proportion of adults spending some of their time on sport and outdoor activities dropped from 15 per cent. of the population to only 10 per cent. in 2005. That may cause little surprise when one considers the fact that the share of national lottery funding going to sport has fallen from 20 per cent. in 1998 to only 16 per cent. now.
Where has that left public health in this country? We come back, I am afraid—much as the right hon. Member for Rother Valley will not like it—to the fact that health inequalities have widened under this Government. They have missed their public service agreement target of reducing inequalities in health outcomes by 10 per cent. by 2010, and health inequalities are now at their widest for a very long time indeed.
The goal of our public health policy must be to deliver messages about healthy lifestyles in a way that engages with the public and changes attitudes, but there is also a vital second level of public health—secondary prevention, awareness of symptoms and early diagnosis. In each of those key areas, Labour’s record has been very poor. I now look forward to hearing from the Minister exactly what the Government are going to do to put it right.
We have had a wide-ranging debate, which demonstrates the breadth and scale of the challenges we face—new challenges that I suggest need new solutions. If we do the same old things in the same old ways, we will get the same old results. As I have made clear and as the public knows, it is not all down to the Government to meet the public health challenges of lifestyle. There are things that we can and must do—smoking legislation, for example—when people cannot do it for themselves. There are things that we can support people in doing and things that only they can do for themselves and their families. It is a complex area. All that is not about me passing the buck, but about having a realistic debate on the challenges that we face at the beginning of this new century.
It has been a good debate, in which I took 17 interventions in my opening remarks and we have heard seven Back-Bench speeches as well. I hope that everyone who has taken part feels that they had a good opportunity to air their concerns.
In the time that remains, I shall try to deal with some of the points that have been raised. The hon. Member for Westbury (Dr. Murrison) argued that the reductions in mortality rates were simply due to trends during the 1970s and 1980s. Other hon. Members made the point, however, that we cannot assume that such reductions will continue even at the same rate, let alone at an accelerated rate, without additional measures and policies. This is true in a number of areas. I do not deny that smoking rates have gone down during Administrations other than Labour Administrations. However, when we consider some of the core, hard-to-reach communities, the task becomes more challenging, and that is where we are today. That is why the issue of health inequalities is so important. They raise particular challenges that would be left unchecked without Government intervention and support.
The hon. Gentleman and others asked what we were doing to replace the specialists in public health who had gone. Department of Health data do not verify the suggestion that there has been a significant reduction in capacity in public health. There were 718 specialists in 2000, 634 in 2002, and 788 in 2004. The data for 2005 have yet to be established. We are working with various public health organisations to track what has happened post-PCT reorganisation. The welcome development of more jointly appointed public health directors is a sign of how we can sustain the public health role in a way that is different from the approach that we have adopted in the past, which involved a purely health perspective.
There have been Government debates on public health in the past four years. We had a Government debate on health inequalities just a year ago, and there have been other opportunities as well. I am always open to participating in Adjournment debates; in fact, if anyone is interested, I shall be here for the one that is taking place after this debate.
The question of our sexual health campaign and the £50 million was raised. We have not spent only £4 million on the campaign; that was what we spent on our “Condom essential wear” campaign. In the run-up to Valentine’s day, we targeted our campaign through the radio stations that young people listen to, and the magazines that they read. We have been looking at more targeted ways than simply using big adverts to reach into those communities.
It is also important to recognise, whether in regard to sexual health, smoking or obesity, the way in which we have engaged other organisations to be the front face of some of our communication campaigns. That is an important part of the way in which the Government are making a difference. Sometimes, with the best will in the world, when the Government say something, they do not get listened to. That is why getting the British Heart Foundation, Cancer Research UK and other organisations to help us with these campaigns has been very positive. We fund those organisations in numerous different ways.
We should be proud of our record on tobacco cessation services. Tobacco Atlas, which is run by the World Health Organisation, says that the UK will see the greatest decline in tobacco use in the world between 1998 and 2008. We were second only to New Zealand in April 2006. Over a period of three years we have had more than 800,000 remaining as quitters. So, yes, there is more to be done, but I think that we can be pretty proud of the Government’s record on this.
Several hon. Members have mentioned the Public Accounts Committee report, to which we will respond shortly. I suggest that some of the evidence on which the Committee based its case has been attended to in the interim, since it first started on its report. I acknowledge, however, that tackling obesity is a complex issue that requires commitment across government and outside government in a more joined-up way. Part of that involves putting in the foundations to make a difference, and our weighing and measuring exercise will establish the largest database of its kind in the world. It is important that we get that right. An excellent example can be seen in Westminster, where parents have been engaged and best practice has been applied. I am looking forward to the roll-out of that exercise later this year.
I am very pleased about the Ofcom announcement. We said in our last general election manifesto that we would seek to restrict the advertising of high-salt, high-fat and high-sugar foods to children. Ofcom has announced its intentions on that today, which is welcome. We shall monitor the impact of those measures closely, to determine whether we need to look at giving the Government a further role in changing the balance of the promotion and nature of food advertising, particularly to children.
On food labelling, our leadership—without the heavy hand of regulation—has made an impact. My hon. Friend the Member for Waveney (Mr. Blizzard) and others have raised the question of which system works best. I think that the colour-coded, or traffic lights, system seems to be working well. That certainly seems to be the case from what I have seen and heard from the public. An important aspect of the labelling system is whether it leads to food manufacturers reformulating their foods to get more of them into the amber and green categories. My focus was particularly on foods that were used as meals, such as sandwiches and soups. If the industry wants to label tomato ketchup, that is fine, but we were conscious of the meal replacements or products that are used as meals, such as cereals and so forth. They cause the most problems for mums and dads shopping for their families. That was our approach. If the industry wants to widen that further, that is its choice. It is not something that I pressed on the industry.
When it comes to public health being evidence-based, we are trying to achieve a more robust attitude. That is why the National Institute for Health and Clinical Excellence produces guidance on the promotion of good health and the prevention of ill health. However, we need to look at achieving a balance, so that we can try to improve the evidence base without allowing certain ways in which we work to paralyse us when it comes to doing anything. We were conscious of the good GP referrals scheme in relation to physical activity, which has flourished in the last 10 years. We did not want that to be stopped inadvertently because people felt that there had to be a huge clinical trial to justify its existence. However, it is in the interests of public health to try as much as possible to make sure that we can have the same sort of authority as other parts of the health service.
The Government have done a lot to improve screening. I understand that the national screening committee has advised that screening for men aged 65 can be recommended in principle. It did not recommend screening for women. That is in relation to abdominal aortic aneurysms, which were mentioned earlier. We have noted that and asked for further detail. Issues such as screening and vaccinations come up all the time. The new pneumococcal meningitis vaccine for children has been introduced in the last six months and I understand that that has gone well.
All these issues raise important points for the Government in terms of what we can afford and provide for, and their impact. There has been a lot of talk this afternoon about what we should be doing. There is a price tag attached to everything. The Opposition refused to vote for the increase in funding for the NHS and—in relation to some of the other points that have been made—are refusing to change the NHS in a way that will make it fit for the future and allow space for public health to flourish.
The hon. Member for Southport (Dr. Pugh) seemed to have a reasonable approach. I did not hear much about what the Liberal Democrats would do that would be different from what the Government are doing, but we welcome him on board.
My right hon. Friend the Member for Rother Valley (Mr. Barron) talked about the challenges of the 21st century. Physical activity is not just about facilities; it is about engaging people so that they use those facilities. We cannot just say that we will build facilities and people should come to them. We have to think about what sort of activities young people want to be involved in. For example, what gets in the way of Muslim women using swimming pools? The issue is usually that they want to be able to swim without the presence of male lifeguards. Some areas, such as Brent, have tackled that and the rate of women and girls from the Muslim community who go swimming has gone up enormously. The issue is about listening to people when it comes to the ways in which we can break down barriers. My hon. Friend also made an important point about GPs. When it comes to health inequalities, some of our poorest communities have not had the services that they deserve. Giving PCTs the power to challenge that is important.
On the speech made by my hon. Friend the Member for Kingston upon Hull, North (Ms Johnson), I have visited Hull and seen the importance of the school meal programme. I attended an international conference where that was leading the way. The people of Hull will have to judge for themselves whether the Liberal Democrats in Hull have got their best interests at heart.
The issue of hepatitis C is vital. I am pleased to say that the European Liver Patients Association has recently commented:
“The UK, often portrayed as lagging behind the rest of Europe in terms of hepatitis C management, has dramatically increased the number of new cases identified in 2004 and 2005 compared with previous years.”
So, we are making some progress. As the hon. Member for Southend, West (Mr. Amess) knows, I am always willing to listen to members of the all-party hepatology group.
Regarding the budgets of the NHS, there will not be the space for public health, and the point raised quite rightly by the chief medical officer about the raiding of public health budgets is not new. We need a better balance in the NHS to ensure that hospitals and secondary care have their place and that, rightly, public health and primary care in communities have a fair slice of the cake. That is why I am looking at—[Interruption.] No, not ring-fencing, because that does not offer a solution—
It being Six o’clock, the motion for the Adjournment of the House lapsed, without Question put.