I beg to move,
That this House has considered the matter of preventive health services.
I welcome the opportunity to debate preventive medical services. We often debate issues involving the national health service and the treatment of ill health, and it is important for us to be able to focus also on the prevention of illness and the promotion of good health.
The NHS has been engaged in preventive health services since its inception in 1948, and some preventive health services even predate its establishment. Wartime posters reminded mothers not to forget babies’ cod liver oil and orange juice to prevent rickets and scurvy, and photographs of child health clinics with lines of children waiting to be vaccinated are emblematic of the early days of a service that is unique in its offer of health care free for all at the point of need, liberating all of us from fears of unaffordable treatment and untreatable illness: comprehensive health care, publicly funded by taxation.
The announcement made on Monday by my right hon. Friend the Prime Minister builds on that tradition by offering health checks where they will improve our ability to predict and prevent certain conditions in the people at greatest risk, including abdominal aortic aneurism in men over 65, which currently kills over 3,000 men a year. The screening programme is expected to halve that number. There will also be a mid-life test to identify vulnerability to vascular diseases that currently affect the lives of 6.2 million people, causing 200,000 deaths a year, and are responsible for a fifth of all hospital admissions. We announced last month that we would make available a vaccine to prevent the human papilloma virus, a major cause of cervical cancer. We have also made it clear that we support the implementation of further screening programmes when the National Screening Committee advises that the evidence base is sound.
Some of the greatest improvements in the health of the population have been secured through preventive programmes. As a result of vaccination, once-dreaded diseases like diphtheria and polio are extremely rare in this country, and smallpox has been eradicated worldwide. Those campaigns have been so successful that we can easily become complacent about their worth. There used to be 500,000 cases of measles in Britain each year, but they can now be measured in hundreds. In other countries, however, measles remains a major childhood killer. We have seen how dependent we are on prevention to keep it at bay in this country when, as a result of vaccine scares, immunisation rates have fallen, leading to needless infections, complications and death.
On children and the prevention of illness, will my right hon. Friend comment on the need for advice to be given to some of our communities who practise first-cousin marriages? That has a detrimental effect on any ensuing children in terms of genetically transmitted disorders, which cannot be prevented by vaccination or immunisation.
My hon. Friend touches on another important dimension of having a national health service that treats ill health, advises and supports, and ensures that information and evidence is clearly provided to individuals. That is the national health service at its very broadest. My hon. Friend has raised an important issue, but, given the shortness of the debate, my response must be brief. Her comments reveal the broad role of the national health service and its professionals as stewards of good information and advice for all individuals in this country.
That role is most applicable to tooth decay, which is almost entirely preventable. Does the right hon. Lady share my concern that there are not enough NHS dentists in constituencies such as Kettering? Does she also share my concern about the large number of young children who do not regularly visit an NHS dentist and receive the preventive health advice they need?
The hon. Gentleman is assiduous in his work in this Chamber, and I congratulate him on how he represents his constituents. I am sure he knows that we have some of the best standards of health care and healthy teeth in Europe, which is in large part due to fluoridation. The Government have invested a huge sum in dentistry, and the profession is expanding. Our training colleges are full, and our dentists are trained to the highest standards. I have no doubt that the hon. Gentleman will continue to make sure that his constituents get the very best of what they need from dentistry.
I thank the Minister for her generosity in giving way. Among the most significant preventable conditions are the neural tube defects, hydrocephalus and spina bifida. Is the Minister able to advise the House when a decision will finally be taken on the fortification of foodstuffs with folic acid to prevent those distressing conditions?
The Department has revisited that issue and we are now running a large campaign based on guidance, leaflets and advice to parents on folic acid. Rather than use up time now, I am more than happy to write to the hon. Gentleman detailing those developments, because he is right that it is an important issue.
To follow up on the point about NHS dentistry, is the Minister not concerned that the evidence suggests that the system of units of dental activity does not in practice incentivise NHS dentists to offer preventive dental health care to their patients, and also that, almost universally, dentists say that the system must be reformed to incentivise that preventive work?
As I am sure the hon. Gentleman knows, those are matters of great importance in the negotiations on the dentists’ contract, the terms of which are being revisited quite a long time after their inception. Dentistry is moving away from “extraction and fill” to a policy of prevention of tooth decay, but his comments will be looked at closely.
All the points that have already been raised make it clear that while we are, of course, concerned that we should have a national health service that is free at the point of need, treating people with illness, it also has a huge task to prevent ill health and to support individuals to have more control of their health in partnership with their clinicians. The NHS has discharged that role in the past 60 years, but it will need to do more in the coming years to empower people to monitor their own health. Screening programmes play a crucial role in that, such as the revolutionised child health care screening programmes, including hearing tests for new-born children, screening for sickle cell anaemia disorders, and the secured screening for cystic fibrosis, which will avoid lengthy diagnostic delays and minimise frequent hospital admissions for affected children. Those programmes play an important part in ensuring that people are able to stay healthy and fit and have a good quality of life, as well as treating them under the insurance policy that the NHS provides for all of us—the very best treatment when we need it.
I will be happy to do so after I have made a little progress.
Preventive health services are, of course, not the exclusive preserve of the NHS. An increasing range of commercial screening services are advertised, and there must be a degree of caution—the health service certainly has that—in considering the use of such programmes. Any screening service has the potential to harm people as well as to benefit them, because finding illness in a whole population who have no signs of illness is like looking for a needle in a haystack. Often, unnecessary concerns are raised, which can result in treatments that carry a higher risk of complications. Therefore, preventive health services in the NHS are designed to deliver the greatest benefit to both the individual patient and the population as a whole, and to ensure that the outcome of a screening programme is net benefit and not net harm. Those important issues need to be borne in mind. I have a feeling that the hon. Member for Wellingborough (Mr. Bone) wants to raise this matter, so I shall give way to him now.
I entirely agree with the Minister about screening being a good idea, but the initial costs must be extraordinarily high. First, the screening must be done, and then the illnesses are found and must be treated. Any screening programme will represent a huge additional cost. Has that been budgeted for?
If any screening process is recommended—I will discuss this later—consideration will be taken of the risks and the interventions and assessments, as I said a moment ago. Of course, such considerations are made all the time by the national health service in terms of screening and preventive interventions. That is why the outcome must be net benefit and not net harm. We must ensure that screening is effective and that it produces the greatest benefit for the health of the population. We must not conduct interventions that just reassure but actually offer no benefit.
Improvements in public health have been achieved by what the Nuffield bioethics report refers to as “quite interventionist public policies”. As we move forward in the 21st century, we cannot rely solely on that approach. No one person or policy will solve the complex issues in our modern-day society, such as childhood obesity or the need to stop binge-drinking and inform people of the associated risks.
I am very short of time and I would like to make some progress. I am sure that the hon. Gentlemen will make their points incredibly powerfully in the debate.
What I have said goes right to the heart of the issue: the balance that must be struck between state responsibility and individual choice—individual empowerment and responsibilities and the provision of services. As my right hon. Friend the Prime Minister said, the future of the health service must be about building partnerships between patients and the NHS, and ensuring that patients are empowered to monitor their own health and to exercise real choice. Crucial factors in that approach will be advice on diet and physical activity. Policy on smoking cessation has been crucial in making serious qualitative strides on high quality interventions to improve the health of the nation.
Time is short and I have been very generous in giving way, so I am afraid that the hon. Gentleman will have to speak in the debate.
Primary care has, of course, played a central role in the development and implementation of preventive health services, but the primary care team contains many different professions and expertise, all of which need to be utilised, from the house visitor to the practice nurse and pharmacist. In taking forward strategies to prevent ill health, the health service will need to rise to the challenge of ensuring not only the provision of a personalised service that supports the individual, but the appropriate use of all the skills that exist in our national health services.
Services work best when they are based on evidence and on expert guidance on the benefits to individuals and the whole population. We are fortunate to be guided by the National Screening Committee and the Joint Committee on Vaccination and Immunisation. I would like to take this opportunity to pay tribute to the work that those two committees, and others working in the field of preventive medicine in the NHS, have done.
As the NHS moves towards its 60th birthday, we are seeking to place even greater emphasis on the importance of preventive health services, which save and improve lives. That will be a key feature of the NHS next stage review, which is being led by Lord Darzi and is expected to report in the summer. We have much to be proud of from the first 60 years, and we intend to ensure that the next 60 years of the NHS builds on prevention and need, and celebrates everyone’s life and quality of life.
No one in this House or this country would deny the importance or significance of preventive health care, nor would they criticise the Government for, at last, shining a light on public and preventive health care. Conservative Members recognise the benefit of prevention and earlier detection, diagnosis and treatment in improving the overall health and well-being of the population, particularly as preventive health services are key to combating health inequalities.
Let us begin by discussing where we agree with the Prime Minister’s statement on Monday. We agree with devolved decision making and with greater emphasis on prevention. We want greater accountability, a more patient-focused NHS and greater individual empowerment, and a larger involvement for the charitable, voluntary and private sectors. We also want extended diagnostics in surgeries and greater access to screening, which all have the potential to save many lives. I am sure that the Minister will acknowledge that Conservative Members have called for all that repeatedly. However, the message delivered by the Prime Minister on Monday is in stark and direct contradiction to this Government’s track record. Over the past decade the NHS has been overseen by the Prime Minister, who has presided over a command-and-control, top-down, centralised and process-driven system, and certainly not over a patient-centred NHS based on outcomes.
The key to preventive health care is public health. Under this Government, our public health service is fragmented and there are few clear lines of accountability. Primary care trusts have no incentive to pay for public health interventions that will be costly in the short term as a result of additional demand. Public health budgets have been raided to bail out deficit-ridden trusts, and it is clear that, especially in London, there is an inverse relationship between socio-economic deprivation and public health expenditure.
Before the hon. Gentleman extols the virtues of his party on public health and preventive medicine, perhaps he would like to reflect back to the 1990 general practitioners contract, which contained 27 targets for GPs to meet on so-called preventive medicine, not one of which was evidence based and all of which fell quickly into disrepute because they were completely ineffective.
The hon. Gentleman will not be surprised to learn that I do not share his analysis. Let us consider what has happened since 1997. Rates of obesity, sexually transmitted diseases and substance abuse are all increasing, and progress on reducing smoking has stalled. Levels of infectious diseases, such as tuberculosis, are rising in the United Kingdom, and the UK has a higher prevalence of drug misuse than any other European country. That is not a record of which he should be proud.
I think that we all agree about preventive health, but the thing about this debate that worries me is the talk that we sometimes hear from Labour Members about denying treatment to people who happen to smoke or who eat junk food and are overweight. Will my hon. Friend confirm that the next Conservative Government will not deny people any treatment that they need because of their lifestyle choices? If we went down those lines, anyone who got pregnant would not be able to have an abortion on the NHS, because that would have been preventable too.
My hon. Friend makes a good point, and I can confirm from the Dispatch Box that that is not the policy of the party that I represent from the Front Bench, nor, to be fair, do I suspect it to be the policy of the Government.
Urgent action must be taken to prevent a public health crisis. On Monday, the Prime Minister promised everyone in the country a check-up for heart disease, strokes, diabetes and kidney disease. Of course, it is right that such checks are available to those who need them, yet instead of this being the initiative-seizing new start for the Prime Minister, the proposals have been criticised by the very people who are charged with implementing them.
Let us be clear that the Minister was right to mention and congratulate the National Screening Committee, but it has not recommended whole population screening, which was announced by the Government. Instead, it recommends a narrower programme of risk assessment that could include measurement of risk factors such as blood pressure, cholesterol and glucose, alongside assessment of the all-important family history. Will she detail the clinical evidence for such whole population screening, which could divert finite, financial resources away from deprived areas and ethnic communities, where it is vital to reduce health inequalities?
Before we get on to the detail, I think that my hon. Friend can help me with the mystery that all this involves. We are debating just one aspect of the speech that the Prime Minister gave on Monday, because the Government have chosen to select just one part of it. What confuses me about that speech is that it contained numerous messages about patient power, concern about a health service that was driven by the needs of providers rather than those of patients and the phrase “empowering patients”. That all sounds hollow in my constituency, where people see NHS services being closed down, taken away and reduced—they do not see how that reconciles with patient power. What does my hon. Friend understand the Prime Minister to mean when he talks about patient power? Does the fact that the only bit of the speech that the Government are focusing on today is a dissertation on preventive medicine mean that all the other things said by the Prime Minister were simply hot air?
My hon. Friend makes a very good point, which touches on the issue that I was trying to emphasise at the beginning of my remarks—one must look carefully at what this Government do, not what they say. Their record on the health service since they came to power in 1997 has been very much about central control and disempowering patients and those who use the NHS, rather than about empowering both individuals and groups. Conservatives want such empowerment to be a central part of the development of the NHS when we form the Government, as we hope to do after the next general election.
I want to make some additional points about what the Prime Minister said on Monday. There is no timetable for delivery of the screening. He said that it would occur at some point between April 2008 and 2011, but could not say at what point in the spending round the money would become available.
The House will also not be surprised to learn that some of the announcements made on Monday were not new. Conservatives have been calling for “triple A” screening for years, and the Government have promised to roll it out for at least a year. In the White Paper of January 2006, they recommended something called “life check”, which was supposed to include a mid-life health check, including checks on weight, blood pressure and cholesterol. That is remarkably similar to what was in Monday’s announcements.
Furthermore, no consultation on those proposals has taken place. Neither the National Screening Committee nor the British Medical Association were consulted on the screening plans. It is beyond belief that the Prime Minister did not consult the very groups set up to provide him with expert advice on screening, nor the doctors expected to implement those policies.
Does my hon. Friend agree that the Prime Minister has form in that area? Last September, he told the Labour party conference that every hospital in the country would be deep cleaned. Figures recently released show that a tiny minority of hospitals and trusts have been deep cleaned, and many have no plans for a deep clean in place with their strategic health authorities.
My hon. Friend is right to make that point, although that is not the specific area of debate for today. He is right to re-emphasise the point that, with this Government, one has to look carefully at their actions, not at what they say.
Not only have there been the criticisms that I have highlighted, but it is peculiar that the Prime Minister is announcing policy at the same time as a detailed policy review is being conducted by Lord Darzi. I suspect that it is because the Prime Minister is being reactive, rather that proactive.
The hon. Gentleman spoke with approval a moment ago about those who criticise whole population screening and prefer selective screening based on risk-factor selection. Does that mean that under a future Conservative Government, if people want to be screened but have not been selected by the bureaucracy on the basis of some risk factor, their only hope is to go to the private sector and pay?
That is not exactly what I said. The health service needs to take into account the clinical evidence base that supports the recommendations from the professionals. The Government need to look carefully at what the National Screening Committee recommends, which is not whole population screening. I understand that the Department of Health is starting to resile from what the Prime Minister said on Monday. I shall set out what we intend to do later in my remarks.
Not only have there been criticisms, but there are significant and glaring omissions. I just wish to give two brief, but representative, examples. First, despite what the Minister of State, Department of Health, the hon. Member for Exeter (Mr. Bradshaw), said inaccurately on “Newsnight” earlier in the week, pharmacists were not mentioned at all in the Prime Minister’s speech, despite their vital importance and the potentially significant contribution that they can make to preventive health care. The Government claimed that the new contract would lead to exactly these types of checks in the community, but only 1 per cent. of pharmacies have been commissioned by PCTs to do that screening.
We also critically require primary prevention to improve nutrition. The estimated overall cost to the NHS of failing to treat under-nutrition is £7.3 billion per year, but measures to alleviate this burden were not announced in the Prime Minister’s speech on preventive health care. Recent figures detail that the number of patients being admitted to hospital in an undernourished state has increased by a staggering 85 per cent. since 1997, to more than 130,000 last year. Failing to prevent under-nutrition in patients leads to longer hospital stays, delayed recovery, an increased risk of contracting health care-associated infections, and poor respiratory function. In some studies, undernourished patients are estimated to have a mortality rate up to eight times higher than well-nourished patients.
The Opposition believe that policies on such important issues as preventive health must be carefully and fully considered and appropriately resourced. We have consulted widely and made a number of proposals in that vital area of health policy.
We have pledged an independent ring-fenced budget for public health, allocated through a new public health structure, overseen by local directors of public health jointly appointed by PCTs and local authorities. We want to see a strengthened chief medical officer’s department, made more independent of Ministers. We will use the public health budget to enhance significantly the impact of health awareness campaigns, both for primary prevention, to convey an understanding of the impact of lifestyle especially on cancer risk, and for secondary prevention, promoting awareness of symptoms and encouraging early presentation. We would make greater use of the skills and expertise of health care professionals, such as pharmacists, who are close to their communities and well placed to provide information about medical conditions, lifestyle choices and medicine management.
Sadly, we have seen no such policy rigour from the Government, and the Prime Minister’s recent announcements have left health care professionals and patients confused over exactly what services will be provided, where the resources are coming from, and when the checks will begin.
I have a few brief questions for the Minister and I hope that she will respond when she winds up. Will the Minister confirm that it is the Government’s intention to fund fully any future recommendation from the National Screening Committee? Where are the resources coming from to fund the triple A announcement, which was first made in June 2004? What is the difference between the “life check” announced in January 2006 and what the Prime Minister announced on Monday? The Prime Minister said that everyone had the right to these check-ups
“when you want and need them, and where you need them.”
Is it the Government’s intention to apply that to screening and, if so, where is the clinical evidence and analysis of the importance of risk profiling? How can this be reconciled with the advice from the National Screening Committee, which does not recommend whole population screening? Could the Minister clarify whether the Prime Minister is really promising screening for everyone at any time?
The NHS is one of the country’s greatest assets, and the Conservative party’s No. 1 priority. Under a future Conservative Government, the NHS will have a greater patient focus; it will be based on outcomes, not centrally driven targets; it will be properly resourced; it will be free at the point of delivery; and, most importantly, it will focus on the key to our long-term health—better public and better preventive health care.
It is a pleasure to be able to speak in this debate on the subject of a more preventive health service. I apologise for my croaky voice, but I have a bit of a cold. Perhaps if I took more preventive health care decisions, I might not be suffering as I am today. [Laughter.] The topic is a worthy one and, of course, we would not have been discussing it without the new time made available for topical debates, which I warmly welcome.
I have lost track of the number of conversations I have had in my time as a Member of this House with health care professionals and constituents that have stressed the importance of taking a more preventive approach to health care in this country. I am sure that other hon. Members are no strangers to that topic either. The speech given by the Prime Minister earlier this week should be welcomed on both sides of the House as a step towards creating an NHS that is seen to be adapting to the new challenges and opportunities of the 21st century.
There has been an increasing focus in recent years on the impact of our lifestyles on our health. Lifestyle choices and the plethora of products available to support them are no longer a niche conversation or a niche market. The continued emergence of research that identifies risk factors associated with different diseases cannot be ignored. That is why a new focus on preventive health care is so timely. We now have the information available to support health professionals in seeking both to educate and protect our constituents. I am sure that I will not be the first or last Member today to utter the words “prevention is better than cure”, so I will get that one out of the way.
I would like to discuss briefly three aspects to the approach. It is necessary to raise the importance of both awareness and screening in increasing prevention of cancer and other killer diseases, and I would also like to ensure that Ministers are reminded of the continuing need to address health inequalities in the north-east. I would hope that long-term thinking and preventive health care will be able to make real inroads into health problems in Gateshead and Washington, and I will return to that issue.
The recent cancer reform strategy made clear the need for greater attention to be paid to raising awareness of rarer cancer symptoms and also began to set out improvements in screening that will continue to save lives throughout the country. If we are to see more preventive health care, we need better education of symptom awareness. Ovarian cancer is the fourth most common cancer in women, but all too often symptoms go unnoticed by GPs and patients alike. England and the UK were recently revealed to have among the lowest ovarian cancer survival rates in Europe, with just over 30 per cent. of women surviving for five years. The figure has not changed significantly in more than 20 years. Most women—75 per cent.—are diagnosed once the cancer has spread significantly, making successful treatment difficult. If our rates could match the best in Europe, an extra 800 women a year would survive beyond five years.
I welcome Professor Mike Richards’s statement that ovarian cancer will be included in the early awareness initiative that was announced as part of the cancer reform strategy. I welcome the active steps that are already being taken on better prevention through symptom awareness. The ongoing “TLC” campaign that encourages woman to “touch, look and check” their breasts for any signs of change also does valuable work in raising awareness of the risks of breast cancer. It is vital that Ministers continue to work with campaigners such as Breakthrough Breast Cancer to achieve the results that we all wish to see.
Alongside working to increase awareness, it is vital that access to screening continues to improve for those most at risk of developing cancers and other deadly diseases. I have been in touch with Cancer Research UK about that, because I know it takes screening seriously. The launch of the parliamentary phase of the “Screening Matters” campaign will be co-ordinated in partnership with other charities including Jo’s Trust and the Breast Cancer Campaign. The message is incredibly simple: screening matters because it saves lives. Hon. Members will have an important role in spreading the word and I encourage them to attend the launch event, which will be held in the House during February.
Breast cancer screening is estimated to save 1,400 lives a year. Bowel cancer screening for those at risk is also playing a role in detecting cancer early and increasing the chance of survival. The message that I continue to hear from organisations such as Bowel Cancer UK is that the steps being taken by the Government are hugely ambitious. Labour Members should share a sense of pride at having helped to support those changes.
The Prime Minister’s announcement of a new vascular screening programme has been warmly welcomed by many, including health charities such as HEART UK, the Primary Care Cardiovascular Society, the National Obesity Forum and the British Heart Foundation. However, we must ensure that that ambitious programme is properly supported. We need to stick to well-founded examples of best practice, such as those established for vascular screening. We will not succeed unless we have appropriate treatments and expertise available for those who are identified through screening as suffering from a potentially terminal illness.
There is huge potential in the increased screening programme and it will make a real difference for many in my constituency. The introduction of the smoking ban, the success of the “five a day” campaign and improvements in the quality of school meals all add up to show the Government’s strong and continuing commitment to public health in Britain. We now have more than 32,000 more doctors and 85,000 more nurses. Waiting times for operations are shorter than ever and screening projects are becoming more and more effective.
I do not believe that we would have seen anything like the same degree of financial support or policy commitment under a Conservative Government. All the local authorities in Tyne and Wear are in the top two fifths of the most deprived areas of the UK. Gateshead and Sunderland, which cover my constituency, are both in the top fifth. I know from talking to staff at Gateshead Queen Elizabeth hospital and at Sunderland royal hospital that they are doing all they can to address the health inequalities that affect my constituency so badly.
Those inequalities are prevalent despite the excellent care that my constituents receive at those hospitals and across the wider north-east from skilled and dedicated staff. In the Sunderland metropolitan area, life expectancy is 18 months below the national average. Death rates from smoking, heart disease, strokes and cancer are all above the national average. The mortality rate for cancer is 136 per 100,000 compared with a national average of 119. Almost a third of children are dependent on means-tested benefits. That can be compared with a wealthy London Borough such as Kensington and Chelsea, where the cancer mortality rate is only 81 per 100,000.
In Gateshead, life expectancy is almost two years below the national average. Again, deaths from smoking, heart disease, strokes and cancer are all above the national average. In fact, mortality rates for heart disease and strokes are at 110 per 100,000 compared with a national average of 90. The statistics create a compelling argument that cannot be ignored. It is a common-sense recognition that the more we can prevent killer diseases through medical progress and lifestyle change, the more savings we can make on health budgets.
Progress will be achieved only if primary care trusts and social care services work closely together to educate the public. Therefore, it is even more vital that we do not push the two services into a battle for funding so that gains for one only lead to losses for the other. That is why I am delighted about the recent provisional funding announcement, which will go some way to ending the problems that have been caused by the double damping of funding.
In constituencies such as mine, health services need extra support to tackle ingrained public health problems. Many of us know the old sayings such as “an apple a day” and “go to work on an egg”, but in the current environment there is a risk that such simple messages can get lost in the myriad information and warnings about the impact of our chosen lifestyles.
I hope that ministers will acknowledge the issues facing constituencies such as mine in the north-east and will endeavour to address them as a priority when moving towards more preventive health care.
It is pleasure to follow the hon. Member for Gateshead, East and Washington, West (Mrs. Hodgson). I immediately had a sense of affinity with her when she made her comments about her rough throat. I failed to take the preventive measure of a flu jab for the first time in 10 years, and the result was a miserable Christmas. I have a great deal of sympathy for her.
The debate concerns an issue for which there is no doubt universal support. No one objects to or resists the idea of preventive health care. It is in every citizen’s interest that the NHS should focus on that. It is also in the NHS’s interest. As Derek Wanless said when he advised the Government on NHS funding, unless we help people to care better for themselves, we will bankrupt the NHS; it is simply unsustainable.
The real debate is about whether the Government have delivered on preventive health measures and are likely to do so in future, as well as about the real meaning of the Prime Minister’s speech on Monday. Like the Conservative spokesman, I was left with a degree of suspicion. It seems extraordinary that the announcement could have been made without discussion with the National Screening Committee or the involvement of clinicians or the British Medical Association. One is inevitably left with the sense that it is part of the big political battle over health and the Prime Minister’s determination to recover lost ground on the health service.
In a spirit of new year generosity, I will acknowledge that the Government have made some progress. For example, QOF—the quality and outcomes framework—introduced the idea of incentives to encourage primary care to engage in preventive measures. As the hon. Member for Gateshead, East and Washington, West said, the screening programmes for breast cancer and bowel cancer have made progress. That should be acknowledged. I absolutely support the introduction of ultrasound screening for triple A, or abdominal aortic aneurysm, provided that it happens and is properly funded. As we have heard, the announcement was originally made some time ago and we are still waiting.
The decision on vaccinations against cervical cancer was also absolutely right, and it will save lives. The debate is now about whether the programme can and should be extended to cover older age groups within the licence. It is licensed for those up to the age of 26, and yet women in the older age bracket will not get vaccinations under the programme. Will the Minister undertake to look into that?
The problem is that the rhetoric, overall, has not been matched by delivery. The biggest challenge is public health priorities in disadvantaged communities—lifestyle ill-health. The hon. Member for Gateshead, East and Washington, West was absolutely right to draw attention to the enormous health inequalities in this country, which are growing under the Government. The key issue is access to health services and reaching those hard-to-reach individuals who are not benefiting from the screening that has been introduced for others across the country.
It is extraordinary that remuneration for GPs continues to discriminate against those who work in disadvantaged communities. The NHS Confederation has argued that the minimum income guarantee, which hits GP practices in disadvantaged communities, should be reformed, along with QOF. At the moment, QOF pays out less money to GPs in disadvantaged communities than it does to those in the leafy suburbs.
Why are public health budgets cut whenever financial constraints are imposed? Why is it being proposed that work in London on HIV prevention for gay men should be cut by 36 per cent.? The common thread is that all the financial incentives for PCTs around the country under budget pressure are that they should put money towards meeting treatment targets, rather than into prevention. That problem will remain until those incentives are changed.
My slot in the debate is very limited, so my final remarks have to do with preventing fractures. The national hip fracture database is a fantastic initiative to drive up standards and quality of care, and it focuses on preventing fractures. In the UK, 310,000 patients suffer fractures every year. The treatment of osteoporosis is key: 3 million people suffer from the disease, and the social and hospital care costs of their fractures amount to some £2 billion a year. Proper treatment for all osteoporosis suffers could cut the fracture rate by 50 per cent., yet the Government have excluded osteoporosis treatment from the QOF arrangements in the negotiations that are under way. That is a big mistake. Osteoporosis was not mentioned in Monday’s announcement, and the Government should think again.
This year, the NHS will have been in existence for 60 years. When I was preparing for this debate, the sobering thought occurred to me that I have been qualified for slightly more than half that time. I want to begin by paying a huge tribute to the 1.3 million people who work in the NHS, as they have created what I still believe is one of the best health services in the world, if not the very best. I hasten to add that that is not in any very large measure due to my efforts, although I hope that I have contributed at least a small amount.
There have been huge changes in the NHS since its inception, but a big disappointment has been that it has been unable to become a prevention service. Over the decades it has concentrated on being a treatment service, and my memories of my early days in the NHS make it easy to see why.
When I started in general practice, five of us shared a small Victorian building. Patients had to climb a steep flight of stone steps to the front door, which meant that disabled people simply could not get in. We had no practice nurse, no computers and no proper medical records apart from the ordinary GP notes that, of course, could not be searched. That meant that it was almost impossible to set up anything approaching a screening or properly preventive service.
We did what we could, of course. We immunised children and, when people came to see us, we took the opportunity to check their blood pressure and so on. However, we could not systematically screen patients, as we had no way to recall them or to call them in for checks. We certainly had no system to follow up everyone whose cholesterol was outside the normal range or whose blood pressure was over the top.
Things have changed radically. Now, I work in a large, purpose-built surgery with 11 consulting rooms, eight partners and three full-time nurses. We have a professional team of managers to help us make sure that people are called in when necessary, and an enormous array of ancillary staff and health professionals are attached to the practice who offer a range of services that was simply unknown when I began as a GP. That has made a massive difference.
On top of that, we have access to community services such as heart failure clinics and nurses dedicated to looking after people with Parkinson’s disease or continence problems—the list is very long. Modern computerised systems and almost paper-free records mean that in a few seconds I can find out exactly how many people’s cholesterol is above the recommended level, or how many people with diabetes have not had regular check-ups or the retinal screening that they need. The fact that GPs can do all that almost instantaneously means that we can contact people, call them in, remind them when they are due for health checks, and so on. That has made a massive difference to how people are treated, and makes screening and prevention a real possibility.
I recognise the changes for the better that have been introduced, but the hon. Gentleman will have seen the impact on public health budgets around the country and in his area of London. Does he accept that the combination of treatment targets that put intense pressure on PCTs and payment by results has ensured that the incentive is to link payments to treatment rather then prevention?
I listened to the hon. Gentleman very carefully, but I do not recognise the problem that he describes. The QOF system set up under the new GP contract is almost completely evidence based. It is reviewed every year by the British Medical Association and the Department of Heath to ensure that it reflects best practice. Everything that GPs do has a dedicated outcome and a proper scientific base, which means that we know that what we are doing is worthwhile medicine and that it genuinely improves patient care.
A few years ago, if a patient with suspected cancer came to see me I had to beg, borrow and steal an urgent out-patient appointment. If I was very lucky, and ready to call on the old boys’ network, I might have been able to get one in a month or two. Now, I can guarantee such a patient an appointment with a cancer specialist within two weeks, and probably a lot sooner.
We are now able to do things that were simply not possible in the old days. I can get open-access MRI scans and endoscopies, and I can investigate people far more rigorously inside the practice. That means that I am more likely to reach the correct diagnosis far sooner than would have been possible in the days when I had to wait for a consultant to confirm my fears.
My hon. Friend is making an extremely good and effective speech, but he just mentioned that he can now get patients presenting with cancer or other serious symptoms a consultant-level appointment referral within two weeks. That is a fantastic improvement on the two or three months that it used to take. Does he agree that that would not have been conceivable without targets? Has he noticed that the Conservative party proposes to abolish the targets on which that performance is based?
My hon. Friend makes a valuable point, and it is deeply regrettable that the Opposition seem hell bent on getting rid of targets. He is right to say that targets have driven up standards in the NHS hugely and that they have massively improved patient outcomes. We are now able to measure the number of people with particular conditions. We can check that they are properly managed, recall those who need further treatment, and ensure that they are on the best drugs available. That is the way to go.
Although the history of prevention has not been very good, I have tried to make it clear that we are now at the point when we can take advantage of modern techniques to ensure that preventive medicine is used properly, but there are risks. As I noted in an earlier intervention, the previous Government appeared to want to improve patient outcomes and health but did not ensure that treatment was evidence based. The checks that doctors were required to carry out under the 1990 GP contract quickly led to disillusionment, because they were not based on anything that could be recognised as good patient care.
The National Screening Committee has made it clear that it will recommend treatments to the Government only when there is evidence to prove their effectiveness. That is very important. There used to be the so-called “stands to reason” test among GPs: doctors would say that it stood to reason that measuring a person’s blood pressure or cholesterol would do them some good. Yet that is not so, because there must be evidence that proves that interventions in those circumstance will change outcomes.
Getting such evidence is difficult, and that is why it has taken longer than I had hoped for the National Screening Committee to recommend triple A screening. It has now made that recommendation, because the evidence that that screening is worth spending on is now sufficiently solid. It has been shown that triple A screening can save around 1,600 lives a year among those men over 60 who are most prone to the diseases that it can detect.
I should like to take this opportunity to pay tribute to the Men’s Health Forum. Along with Ministers and the all-party group on men’s health, I have worked very closely with that organisation to ensure that interventions shown to be worth while and to provide value for money are adopted. As a result of all our hard work, the Prime Minister has announced that the programme that we have been advocating would be taken up. That is a great improvement over relying on interventions that might not have been so effective and might have wasted public money.
The NHS has a rosy future. New money is still being put in every year, and I am also pleased that the Prime Minister is not afraid to promise continuing reform. Unless we continue to reform the NHS and to reconfigure services, we will have no way to ensure that patients get access to the most modern treatments, in the most suitable setting and with the most appropriate staff mix. It is important that we continue our programme of reform, to ensure that all patients have access to what they need.
Choice is also topical. In his latest speech, the Prime Minister said to us that he wants to make sure that patients are at the centre of choice. Patients now have a choice of where they are treated, to a large extent when they are treated, and to an increasing extent by whom they are treated. That is important, because if we are to expect people to take more responsibility for themselves and for their own health care, they have to have access to the information they need, and they have to feel that they, not the Government and not necessarily their doctor, are in charge of their condition. It is their condition, their body and their future; they must be central to making decisions on what happens. I believe that if we give patients that right, they will rise to the occasion and take the responsibility to improve their own health outcome, which will be important to improving their long-term condition.
I have mentioned how welcome it is that the Government are to introduce triple A screening. Some of the other measures the Prime Minister mentioned, such as screening at-risk groups for heart disease, kidney disease and diabetes, are also important.
The hon. Gentleman has just beaten me to it—I was about to mention osteoporosis and pay tribute to him for his comments in that respect. I entirely agree with him that osteoporosis is a worthwhile subject, certainly in terms of secondary screening and prevention. Someone who has had a low-impact fracture—one resulting from a fall rather than a strike by a moving object—should be screened for osteoporosis. People who fracture a joint or a bone in a fall should have a DEXA scan to ensure that they do not have osteoporosis; and if they do have the condition, they can be given appropriate treatment.
Like the hon. Gentleman, I have been calling for osteoporosis to be introduced into the QOF. In fact, only a few weeks ago, I spoke to Laurence Buckman of the BMA and tried to persuade him to ensure that it was put on the agenda for future QOF discussions. We will have to watch this space. Again, however, we will have to ensure that the evidence is there before we rush to decide whether it is a good idea or a bad one. I think that it is a good idea, and I hope that the screening committee will come to share that view in due course.
It appears from the discussion between the BMA and the Government that the Government have given priority to introducing incentives to extend hours rather than to measures such as osteoporosis screening. Does the hon. Gentleman share the concern of many people that to focus on extended hours to the exclusion of such preventive measures is to miss a massive opportunity?
I do not think that the two aims are mutually exclusive. One of the points I wanted to discuss is capacity in the NHS. The Government’s current policy, which I entirely support, is to ensure that people are treated in the most appropriate place, preferably near their own home, if that is possible. That entails moving more facilities into the community. As I said, that is already happening in my area. More clinics and services are available within communities; people have more things done in the local surgery and they can attend clinics in their local town. However, there is a big issue of capacity in the NHS. We have to decide how the extra work can best and most appropriately be distributed to the health professionals we have available. In general practice, as I said, I now have three full-time nurses, whereas previously I had none. However, we need more: we need health care assistants, so that the nurses can pass on some of the more routine work to them and get on with the clinical management of patients.
The biggest untapped area of capacity in the NHS is pharmacy. I am pleased that my right hon. Friend the Minister of State mentioned pharmacy in her opening speech. We need to maximise the use of all parts of the NHS, and pharmacy is an important part. Almost every community has a pharmacy at its centre; almost all high streets have a pharmacy. Pharmacies are already open for the extended hours that the Government want primary care to be available, and they already provide out-of-hours services. Pharmacists are well motivated and highly trained professionals who, to a large extent, know their patients. I believe that, with the right negotiations with the Royal Pharmaceutical Society, the Pharmaceutical Services Negotiating Committee and others, a good deal could be reached to ensure that pharmacists’ expertise and capacity are fully utilised for the benefit of patients.
I envisage pharmacists becoming far more involved in screening. They can take blood pressure and cholesterol measurements, recall people for follow-up as necessary, and work with local GPs and others to ensure that that capacity is best used. As part of the launch of the pharmacy White Paper, I urge my right hon. Friend to include pharmacy as much as possible in the new screening programme.
It is a great pleasure to follow the hon. Member for Dartford (Dr. Stoate), whose colleague I am on the Select Committee on Health. I also welcome the Minister of State’s presence here today, because she has been most helpful in the past.
If my understanding is correct, preventive health services are right, first, because they improve people’s lives—earlier interventions ensure that they do not develop a serious condition, so their quality of life is enhanced. Secondly, preventive measures save money, because treating someone early saves the NHS from having to spend lots of money later on treating them as an acute patient. All right hon. and hon. Members are in favour of preventive health services, such as screening. The job of the Opposition is to prod the Government and to keep prodding. We have to try to make the legislation that the Government produce more effective.
Today, I shall talk about something that affects people in every constituency in the country, but that has been a fairly acute problem in my area: the treatment of wet-eye age-related macular degeneration. Each year, the condition affects about 40 people in every constituency in the country, and it is the most common cause of blindness. The condition is treatable through a simple series of injections, which either stops the loss of sight that would end in blindness, or restores sight that has been lost. Several drugs are licensed for the purpose; the two most commonly used are Lucentis and Macugen.
It is fairly easy for a patient to recognise the symptoms—they are losing their sight—so they go to their GP, who immediately refers them to a consultant. The consultant sees the patient, then tells him, “You have wet-eye AMD. You could go blind within three months. The good news is that a simple series of injections will stop you going blind. The bad news is that you cannot have it on the NHS—but come and see me two miles down the road, and I’ll treat you at £800 per injection.” The NHS is saying to people that they can go blind, or they can go private and pay for treatment.
Suppose that someone had a bad knee, such that in several years’ time they would need a joint replacement. That would be bad enough. Obviously, it would not be cost-effective to wait; preventive treatment will ensure that that person can keep walking. However, we are talking about someone who will go blind within three months if immediate action is not taken, and the drugs are available. Something is wrong.
The Government have been extremely helpful, and there has been a cross-party campaign to get the problem sorted out. The Minister replied to my speech in my Westminster Hall debate on the issue, and was most helpful.
The Prime Minister has been extremely helpful, too. At Prime Minister’s questions, he rightly said—I paraphrase—that the situation was not right, but that it was a matter for NICE. Surprisingly, just two weeks after he said that, NICE came up with some guidance. The Royal National Institute of Blind People issued a press release immediately afterwards, entitled “NICE delivers early Christmas present to thousands at risk of going blind”. NICE said that primary care trusts should treat people who have wet age-related macular degeneration immediately with the new, approved drugs, Lucentis and Macugen. It put that guidance out to consultation.
NICE does not have a particularly good history on the issue. It introduced guidance last year that said, “We’ll only treat someone once they’ve gone blind in one eye,” which was wholly inappropriate. It generated the biggest response to any consultation by NICE; there was outrage. NICE took that on board, and the Government urged it to look again at the matter. As a result, it came out with the new guideline, which is wholly welcome.
I would probably not be giving this speech if that guideline was being implemented. My PCT, Northamptonshire Teaching primary care trust, knows about the problem because of the campaign that I have run, which my excellent local newspaper, The Evening Telegraph, has supported, and because the BBC’s “Politics Show” highlighted one of the cases. However, the PCT sent me two letters—just to make sure that I got the message—and, obviously because I am not a very sensible MP, they put a sentence in bold and in capitals, so that I did not miss it. It says:
“NICE has not yet issued final guidance to the NHS on these drugs”.
The rest of the letter says that the PCT will not take any action, and will continue to let people in my constituency in Northamptonshire go blind until NICE eventually issues its final guidance. That is outrageous and there is no moral justification for it. We are talking about spending a few hundred pounds on action that will prevent people from going blind.
The amount that the NHS would have to pay for treatment for someone who goes blind is enormous. Also, what about all the social consequences? I have a constituent, Mrs. Doreen Marshall, a lovely lady in her 80s. She is the carer for her husband, who is in his 90s, and who has some disability problems. They live separately, and they are not a burden to the state. She is going blind in both eyes. If she had not paid to have the treatment privately, the state would have had to pay out millions of pounds over the next few years. It is preventive health services of that kind that the Government are keen for PCTs to take note of. Luckily for Mrs. Marshall, a private company paid her treatment bills. When the Minister winds up, I ask her to reiterate what the Prime Minister said on the subject: PCTs should take notice of what NICE has just said, and should, as a matter of urgency, start to treat people who would otherwise go blind.
It is a pleasure to follow the hon. Member for Wellingborough (Mr. Bone). I know that he takes preventive health seriously, because we have been in the gym at the same time twice this week, so I congratulate him on the efforts that he makes. I will focus on one small, specific issue to do with preventive health services, so as to allow other Members their full time allocation.
The debate is topical because of the structural changes to Sport England. One might wonder why on earth that was a matter for a topical debate on the health service. The Department for Culture, Media and Sport is rightly making Sport England concentrate on sport. That means that a vast amount of work is being done—work that is increasingly important to all of us who have campaigned on sports and physical activity issues over the past decade. We recognise that the Department of Health, through the PCTs working with agencies such as local government, will be vital to increasing participation in physical activity and sport. That is needed if we are to prevent problems arising from what is probably the most important issue facing the country—the levels of obesity that are likely in future.
The Foresight report demonstrated that by 2050, if no action is taken, or even if current levels of action are maintained, it is likely that up to 65 per cent. of men and 50 per cent. of women will be clinically obese. That means that 40 per cent. of the national health service budget will be taken up by that issue. If there is a ticking time bomb, it is obesity.
My hon. Friend the Member for Dartford (Dr. Stoate) has been at the forefront of campaigning on the matter for a decade, and I follow. I am glad that he spoke on another topic today. If he had spoken about obesity, he would be the expert on it. We have talked anecdotally about the impact of obesity, but the Foresight report and some of the work that has been done by NICE, which is a well kept secret and does not seem to be in the public domain, has demonstrated that tackling physical activity levels and building in lifestyle changes to deal with obesity is one of the most cost-effective steps that we can take.
I have some figures. NICE works on the basis that it would recommend a drug up to a cost limit of £20,000 per life year. By contrast, the work that it has done on physical activity in the workplace and obesity, and the work that it is doing on physical activity and the environment, indicate a cost of just £1,000 per life year for the introduction of physical activity. So as most speakers have said, prevention is better than cure. If we spend £1,000 now, the likelihood is that we are helping to avoid the prospect of 40 per cent. of the health service budget in 2050 being devoted solely to tackling the problems of obesity.
I am one of those who has been going around saying that obesity will kill the present generation and our life chances will be reduced. We could be the first generation to see a reduction in our life expectancy. Foresight and some of the work carried out by NICE suggest that that is a myth. The reality and the problem is that obesity is an inefficient killer. That is not much consolation. Obesity makes us ill for a long time. It reduces our life chances eventually, but in the meantime we are an enormous burden on the national health service. More importantly for the individual, it is an enormous burden on their lifestyle. We need to make sure that obesity is at the top of the health agenda.
In this crucial period during which the future direction of Sport England is decided, the Department should make it clear that it is willing to work with PCTs in local partnerships including county sports partnerships and local authorities, to encourage physical activity and bring about lifestyle changes. The Department cannot shirk that responsibility.
Now that the importance of school sports is recognised, about 30 per cent. of those leaving school will take part in activities that we recognise as sport—team games and organised sporting activity. About 50 per cent., hopefully, will want to have a fairly active lifestyle and engage in other activities that reduce our chances of becoming obese. But 10 to 20 per cent. will require interventions, and that is where more work is needed—for example, among young girls aged 13 or 14, where there is a significant drop-off in participation rates, among young Asian women, who have cultural issues, and among those with disability and special needs, who are still missing out on sporting activity in schools. Those who are involved in school sport and even the Youth Sport Trust, in discussions this week, recognise that progress has been made elsewhere, but admit that it is lacking for those with disabilities and special needs at school.
Over the coming weeks and months, while Sport England is developing a strategy, it is crucial that the Department of Health offers guidance and support to PCTs to ensure that sport is delivered at a local level. Local partnerships exist already. I chair my own county sports partnerships. We are fortunate that the director of public health in Leicestershire is a triathlete. He is part-funded by the PCT and part-funded by the local authority. That situation represents a win-win, but it does not necessarily replicate itself around the country. In schools a decade ago, if there was a good head who was interested in sports, sport happened at the school. I want to make sure that for sport, there is no postcode lottery.
Some PCTs have demonstrated the good practice of GP referral schemes, physical activity co-ordinators, creating the built environment and workplace activity. We should recognise that people’s lifestyles are changing dramatically, particularly from a sports perspective. By 2010, 65 per cent. of people will be working an atypical working week, so working 9 to 5 or a 3 o’clock kick-off for a football or rugby game will no longer be the norm. Sport, physical activity and recreation must take account of that shift in balance. That is why the workplace will be increasingly important. Governing bodies of sport and others need to try and work out what form sport and physical activity will take in the next 10 to 20 years. It will be very different. Everyone knows how difficult it is after a long day at work to come home and motivate oneself to go back out to do something physical.
We know that 20 per cent. of people will always be keen to do sport and physical activity and another 20 per cent. can be encouraged, but the couch potatoes and others in the middle should not be put off or frightened by the prospect of having to take up a sport or to do something really dramatic such as joining a gym, because we can build a lot of activity into our daily lives. The World Health Organisation target of five times 30 minutes of moderate activity a week needs to be explained to people. We may be at the slightly difficult level of talking about active hoovering, but moderate exercise such as gardening and walking is enough to meet the WHO definition.
We need to ensure that in our social marketing, which will probably be one of the most important things that we do, we sell the idea of building physical activity into our daily lives. I do not envy the Government because I have seen the Parliamentary Office of Science and Technology paper on changing behaviour, which says that that is one of the hardest things to do. The problem is that everyone recognises the need to change their behaviour in order to reduce the potential for obesity, but as with new year resolutions, we may do well until the end of January but come February all resolve goes out of the window. We must change the whole way in which we lead our lives.
I know that my right hon. Friend the Minister met the premier rugby clubs recently who have been working on behalf of the Department on the five-a-day campaign. I visited Saracens rugby club to see its community programme and went to some of the schools with the players. The motivation that results from being told by a leading sports star to eat five portions of fruit or vegetables a day is far greater than when a politician, someone in a white coat, or even—with all due respect—a doctor says so. I saw the motivation created as a result of the programme being delivered by sportspeople throughout the country, and I would urge that there should be a connection between sport and more moderate levels of physical activity.
This is a topical debate because the next few weeks, or possibly the next couple of months, will be crucial to delivering what most of us in sport have wanted for a decade or so, and that is for the Department for Health to take a real interest in increasing physical activity and changing lifestyles to tackle the obesity time bomb that is heading our way.
I thank those hon. Members who have spoken recently for accelerating to give me nearly my full time. I understand that the Minister will also be very generous and has said that she can manage with four minutes. I shall try to give her a little longer, but I am grateful for this opportunity.
I always enjoy following my friend on the Health Committee, the hon. Member for Dartford (Dr. Stoate), the only other doctor. I can cap his years in the NHS by quite some time, and I remember the terrible things that we used to do. We carried around hatpins with red knobs to test visual fields, and the sharp end we used to test for sensation from patient to patient to patient. Can you imagine it? Things have moved on tremendously.
I shall be slightly pedantic and separate prevention from screening, because they are quite different and I do not want us to lose sight of the well-established preventive techniques that are essential because we are rushing to screening, which may not be so evidence-based. I do not need to mention stopping smoking because obviously the effect of not smoking in public places is already showing benefits in the reduction in heart attacks. That is absolutely incredible.
Tackling obesity, as the hon. Member for Loughborough (Mr. Reed) said, is crucial. I am sure the Minister is aware that one of the recommendations in the Health Committee report in 2004 on obesity was that there should be a specific Cabinet public health committee, chaired by the Secretary of State for Health, but bringing together Ministers with responsibility for health, education, sport, transport, trade and industry, environment, food and rural affairs and work and pensions—the whole shooting match. When the Government responded to the report they said that such a Committee had been set up and I should like to know whether it is still active and what it has achieved, because that was important.
I have just one quick point to raise on inoculation. The absolute value of inoculation is dramatically demonstrated when we hear about the greatest cause of death among children on the African continent—it is not HIV, malaria or tuberculosis, but the pneumococcus. We have virtually eradicated that here.
Prevention of sexually transmitted infections is vital. In the Health Committee report on that, we recognised the huge importance of sexual and relationship education, or SRE, at schools and recommended that it should become a core part of the national curriculum. The Government response, just three months later, stated that SRE was a statutory requirement; I was never clear about whether it had been all the time or we had achieved it. The Government also said that they had asked Ofsted to report specifically on the progress of SRE teaching. Is that being done?
The Parliamentary Office of Science and Technology drew attention to the other alarming thing about HIV/AIDS in its recent note about the condition in the UK. People are less scared of HIV/AIDS than initially because it is now controllable, but the salutary warning is that the fastest increase in HIV/AIDS is happening among men who have sex with men. They are white men, who in the vast majority of cases acquire the disease in this country. The horrifying figure is that about one in 20 men between the ages of 15 and 44 who have sex with men are HIV-positive. The problem is huge; as we rush to screening, we must not forget the well proven bits of health prevention.
I was delighted that the Minister mentioned the National Screening Committee because when I heard the Prime Minister’s comments I wondered whether he had taken that into account. Certainly, aspects of cancer screening and screening for sexually transmitted infections are well established. However, as many hon. Members have said, blanket and not necessarily targeted screening for a wide range of conditions has not yet proved worth while.
I turn to screening for abdominal aortic aneurisms. My search on the website is obviously a few months out of date because I did not know that the National Screening Committee had got to the stage of recommending it. I found its draft studies on the issue and was horrified by the extent of the problem—the number of people who would have to be screened and of staff who would have to be trained to do the screening. After that, there would have to be many people in vascular surgery departments to mend the aneurisms that had gone beyond certain limits. Once an aneurism is above a certain size, it has to be followed regularly, which involves more scans. I would love to know from the Minister that all that has been taken into account.
I shall end by quoting something from that bible for doctors, the Merck manual. It emphasises some of what the Minister has already said:
“The premises of screening are that early detection of disease can improve outcomes in patients with occult disease and that the false-positive results that often occur during screening do not create a burden that exceeds the benefit of early detection.”
The paragraph concludes:
“If 12 different tests for 12 different diseases were done, the chance of at least one false-positive result is 46 per cent.! This underscores the need for caution when deciding on a panel of screening tests and interpreting the results.”
With the leave of the House, Mr. Deputy Speaker. I am delighted briefly to respond to the debate. I thank all hon. Members for their thoughtful contributions on this subject. I strongly support the remarks by my hon. Friend the Member for Dartford (Dr. Stoate) and others about the excellent work that is going on throughout the national health service and the debt of gratitude that we owe to the dedication of the staff in delivering these services. I am sure that we would all want to reinforce that point.
My hon. Friend the Member for Gateshead, East and Washington, West (Mrs. Hodgson) made an excellent speech in which she made two points. First, she drew attention to health inequalities and the importance of the role of prevention and strategies linked with public health policies to ensure that we reach out to hard-to-reach groups. As my hon. Friend the Member for Loughborough (Mr. Reed) noted in his important contribution, that must go much wider than just the health services themselves. The most important aspect of public health policy is the combination of understanding the risks and the causes and bringing together the public services, the voluntary and community sector and organisations such as Sport England to bear down on the particular issues that we need to address.
My hon. Friend the Member for Gateshead, East and Washington, West is absolutely right as regards her second point on the importance of symptom awareness and early detection leading to treatment. As she and the hon. Member for Wyre Forest (Dr. Taylor) said, screening matters. We must understand clearly the distinction between prevention strategies for ill health and all the various strategies that we can deploy, and use screening when necessary, when proven and when it gives the required outcome, quickly followed by the appropriate treatment.
The hon. Member for North Norfolk (Norman Lamb) talked about human papilloma virus and vaccinations up to the age of 26. We are following the advice that has been given to us by the scientific bodies about where it is best to use such vaccination. This is about prevention, not treatment; that has been a theme throughout the debate. He also made an important point about financial incentives in the health service and how we can ensure that they are not skewed only to ill-health treatment. I assure him that the operating and outcomes framework issued to the national health service this December has many public health objectives within it and seeks to address exactly the point that he raised.
My hon. Friend the Member for Dartford, eloquently using his experience, as ever, talked about the transformation in the health service and the enormous possibilities that exist to intervene speedily in cancers and other areas given early diagnosis and the crucial importance of screening, with a balance across all the fields. I entirely agree with him about pharmacies. They are a great untapped resource which will expand access in the NHS and ensure that we all get the appropriate treatment at the right time, and that we are able to be involved in and control our own health and well-being and to understand much more about the causes of ill health and therefore how we, as individuals, have a role to play in preventing it.
I was sorry to hear the comments of the hon. Member for Wellingborough (Mr. Bone) about wet-eye macular degeneration. He, with others, has been a great advocate in that regard in this House. We are talking specifically about a certain treatment. Although the National Institute for Health and Clinical Excellence has not made a final determination, I have been clear in this House and in correspondence that until that happens the primary care trust should not refuse treatment in this area for any other reason than on a clinical basis—that is the clear guidance given to PCTs. I am happy to consider the matter further and pursue it for him if he will send me the correspondence.
My hon. Friend the Member for Loughborough has been a fantastic advocate in this House in ensuring that people understand the complexities of issues such as obesity and the importance of using all the available opportunities and levers to tackle them and to understand the roles played by the built environment, transport, activity and food, as well as health care. I absolutely agree with him about the fantastic scheme that the Saracens are running, and about the importance of a comprehensive approach. On the question of a partnership, under the operating and outcomes frameworks issued to the NHS we require primary care trusts to work with local authorities, organisations such as Sport England and the voluntary and community sector, through local area agreements, to bring to bear all the policy opportunities to tackle the problem.
I defer to the enormous experience of the hon. Member for Wyre Forest, and to his knowledge of this area. I am glad, however, that he did not have his pin with the red head on him, so that he was not able to stick it into everyone in the Chamber. He is right: we have to be clear about the difference between prevention and screening, and about when it is appropriate to deploy measures relating to either.
This has been an excellent debate and our proposals to expand a preventive health service, linked, crucially, with screening programmes where appropriate, mean that we intend to ensure that, as we look forward to the 60th anniversary of the national health service this year and the celebration of that huge achievement, we go forward with confidence to improve the range and quality of services, both for treatment and—
It being one and a half hours after the commencement of proceedings, the motion lapsed, without Question put, pursuant to Temporary Standing Order (Topical debates).
On a point of order, Mr. Deputy Speaker. Earlier, I announced the business of the House for the next two weeks. I overlooked to announce the business that will take place in Westminster Hall. I sincerely apologise to the Leader of the House—[Interruption.] I am sorry; I apologise to the shadow Leader of the House for the fact that she has had to return to the Chamber unexpectedly.
I would like to inform the House that the business in Westminster Hall for 17 and 24 January will be:
Thursday 17 January—A debate on extending participation in sport.
Thursday 24 January—A debate on the report from the Foreign Affairs Committee on “Global Security: The Middle East”.
Further to that point of order, Mr. Deputy Speaker. In relation to matters raised at business questions today, I wonder whether I might seek your guidance as to how I can ensure that the record is put straight. There was an exchange at business questions about—
Order. I do not want to interrupt the right hon. Lady too soon, but all she can comment on is the matter that has been raised by the change of business.
It must be related to the point of order that the Leader of the House made on the business for next week, and nothing else.
I seek your guidance, Mr. Deputy Speaker. I apologise if I attempted to relate my point of order on business questions to the point of order from the Leader of the House, but it is about business questions. I have a point of order about business questions this morning. Is it not possible for me to raise it as a separate point of order?
Yes. [Laughter.] Briefly.
An issue was raised in business questions as to whether the Leader of the Opposition had received the Senior Salaries Review Body report on MPs’ pay, and the Leader of the House indicated that it had been sent to him on Monday. I understand that it was received in his office yesterday, but he did not receive volume 1, which related to the report on Members’ pay. He received only volume 2, which contains the appendices. I wanted your guidance, Mr. Deputy Speaker, as to how I could ensure that the record was put straight on that matter.
Clearly, all documents that are necessary in order that Members of this House can carry out their business should be made available in the correct way as quickly as possible. The right hon. Lady has made her point, it is now clearly on the record and perhaps we ought to move on to the next business.