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Public Health (Bexley)

Volume 534: debated on Wednesday 26 October 2011

I am grateful for the opportunity to raise the important issue of public health and the situation in my borough of Bexley, which is of great concern to many of my constituents and, of course, to me.

Regrettably, there are vast health inequalities in Bexley and south-east London. The difference in life expectancy for two men living in different parts of Bexley could be as much as or more than seven years. The reasons for that situation, both locally and nationally, are complex and are affected not only by access to the NHS or social care services, but by diet, activity, education and employment. Public health is therefore a matter of fairness and social justice.

As well as causing serious long-term health issues, health inequalities have a wider impact. We all know that obesity can lead to problems with diabetes and heart failure, that smoking kills tens of thousands of people every year and that alcoholism can cause liver failure and increase a person’s susceptibility to other diseases. Those associated illnesses can cause productivity losses for business, reduce school attendance for children and lead to high treatment costs for the NHS. If those problems are not addressed, we could face greater problems in the future, as my hon. Friend the Minister will appreciate.

I am very worried about the increasing number of people who are being classed as obese. The long-term consequences for those individuals and their families can be catastrophic if they do not take action, because they may subsequently experience problems such as heart disease and diabetes. I am particularly concerned about the number of children who are alleged to be experiencing weight problems. According to the national child measurement programme, one in four reception age children in my borough of Bexley is considered to be obese or overweight. That is an incredible figure and, by the age of 11, it rises to one in three. I am sure that the Minister shares my concern about that problem.

There is also an issue among adults. Nationally, the number of obese people in England has doubled since 1993, and the number of obese women has risen by half. Locally, in Bexley, one in four adults is to be considered obese. With trends suggesting that most children who are considered to be obese will remain so well into their adult lives—particularly if their parents are obese, too—the consequences are of real concern to individuals, as well as to society.

I am pleased that my colleague the hon. Member for Erith and Thamesmead (Teresa Pearce) and my neighbour my hon. Friend the Member for Dartford (Gareth Johnson) are here today. The issue does not stay within borough boundaries, because it goes across our area.

I congratulate my hon. Friend on securing the debate. He cares passionately about health care in the borough of Bexley. He has mentioned that some of my constituents rely on services provided in Bexley and that, vice versa, some of his constituents rely on services in the Kent area. Does he therefore agree that it is essential to ensure that the relevant local authorities are aware of their obligations to each other, so that there can be some certainty about funding and budget setting for the councillors in the respective areas that we represent?

I totally agree with my hon. Friend. There is much cross-border health care traffic both from Bexley into Kent and from Kent into Bexley. That is the choice that people have and should have. Such a situation also reflects people’s needs, which should be met, so I endorse entirely what my hon. Friend has said.

Obesity is responsible for nearly half of all cases of diabetes, a quarter of heart problems and, in some circumstances, more than a third of cases of some cancers. The National Heart Forum estimates that those problems could get much worse and suggests that the number of people getting diabetes as a result of their weight could double by 2050. Financial considerations and costs must also be taken into account. It has been estimated that obesity directly costs the NHS around £4 billion a year. Of course, that does not take into account the cost of treatments and the care required for associated problems, which could and will be even more. In Bexley alone, diabetes costs the NHS £353 per person per year.

Last week, I attended a reception in the House of Commons for Silver Star, a charity campaigning for greater awareness of diabetes. I was pleased to meet Silver Star and learn about its work. I took one of its simple diabetes tests, and I am pleased to report that my glucose level result was 4.9, so I was deemed to be okay.

All the statistics highlight the challenge that we face and the number of people whom we need to assist. First, we must assess the problem’s cause, of which there are many—for example, poor choices, portion sizes, insufficient exercise, inappropriate advertising or a lack of culinary skills can all contribute to an individual’s problems. According to the Association of Public Health Observatories, just 30% of Bexley adults eat healthily, and the statistics on physically active adults in Bexley are significantly worse than the national average. Of course, every individual’s circumstances are different.

In some respects, we are fortunate in Bexley, as we were one of the first boroughs to achieve national healthy schools status for all our schools. However, I am concerned that a minority of adults who eat badly may be setting a bad example for their children. The figures on physically active children in Bexley are also significantly worse than the national average. That is not helped by the fact that the number of children being driven to school has doubled over the past 20 years, which is a national issue that is not confined to Bexley.

Of course, physical activity alone is not enough to address the problem. We need to think more carefully about what we eat and what we feed our children. England’s chief medical officer, Professor Sally Davies, recently said:

“Most of us are eating or drinking more than we need to and are not active enough. Being overweight or obese is a direct consequence of eating more calories than we need. Increasing physical activity is a part of the equation, but reducing the amount of calories we consume is key.”

This is why the Change4Life campaign is important. It provides helpful tips on all the changes that we could make to improve our lifestyles, and it is already directing help to nearly 500,000 people. The campaign’s core ideas—encouraging physical activity, cutting portion sizes, swapping particular foods, discouraging snacking, drinking less alcohol and reducing fat intake—are all sensible and manageable. I hope that more people will take advantage of those resources and take action themselves. I urge my hon. Friend the Minister and the Government to prioritise that approach.

Another issue of health concern is the problems caused by smoking. Smoking rates have remained broadly the same during the past few years. Tobacco consumption remains the greatest single cause of preventable illness and early death, and it is also a big contributor to health inequalities. I am encouraged that, nationally, more people are using NHS stop smoking services. The number of people who registered a quit date has increased in the past year, with an increase in success rates, too. That shows that people are willing to take action to help themselves, which should be encouraged.

I put on the record my support for the award-winning Bexley stop smoking service, which has been doing some excellent work to help my constituents quit smoking and lead healthier lives. The Bexley stop smoking service is led by Jo Woodvine and helps hundreds of people quit smoking every year by using a variety of different methods. I commend the work that it is doing, because its efforts are having an impact. One in five Bexley residents smoke, which is slightly below the national average. However, I am concerned that 17% of women in Bexley smoke through pregnancy, which, worryingly, is above the average. Smoking during pregnancy increases the risk of complications such as stillbirth, miscarriage, premature birth and low birth weight.

There are also age-related problems with smoking. Tobacco consumption is still most prevalent among the under-50s. Every year, more than 300,000 under-16s try smoking for the first time. By the age of 15, some 15% of children in England are reported as being regular smokers, which is incredibly worrying. I accept that action has been taken on this issue. The minimum age at which one can purchase cigarettes has been increased to 18 and the sale of cigarettes from vending machines has been banned. The Government have introduced a tobacco control plan to help reduce smoking, which takes account of the problems that I have highlighted relating to the prevalence of smoking among adults, children and pregnant women. I agree that steps must be taken to reduce the promotion of tobacco and to improve regulation to ensure that children are not drawn into starting smoking. If more is done to highlight the diseases that can result from smoking, then adults may be persuaded to quit.

The substantial cost to society from smoking is estimated to be more than £13 billion a year, which includes NHS treatment, productivity losses and clear-up costs. However, only £11 billion is raised in taxes from tobacco. The Government are therefore right to consider ways of making smoking less affordable, as a disincentive. Most importantly, the Government need to ensure that NHS stop smoking services continue to be properly supported. The all-party parliamentary group on smoking and health has highlighted how cost-effective those services are, estimating that the Government benefit by as much as £1.7 billion a year through the prevention of serious and costly diseases.

Alcohol dependence is another area of great concern, and it is a major public health issue. Dependent drinkers are the drinkers at greatest risk of admission to hospital for a range of illnesses. There are an estimated 4,000 dependent drinkers in my borough of Bexley, and as many as one in seven people are putting their health at risk by binge drinking. While those figures are not as high as in some other areas of the country, they are symptomatic of the wider problems facing our nation. The latest alcohol statistics for England show that one in four men and one in five women are drinking more than the recommended number of units in an average week. On average, children—yes, children—consume 11.6 units a week.

Excessive drinking also has a significant impact on our health service. For example, since the introduction of the Licensing Act 2003, which allowed 24-hour drinking, the number of hospital admissions due to acute alcohol intoxication has doubled and the number of admissions wholly attributable to alcohol has increased by 70% locally, which is broadly in line with national trends. Between midnight and 5 am, the majority of hospital admissions are alcohol related. I was, and remain, opposed to the liberalisation of the drinking hours in the 2003 Act, which was a grave mistake.

Many long-term problems—alcoholic liver disease, hepatitis and cirrhosis—can be caused by excessive consumption over a long period of time, and they can lead to organ failure. Deaths from alcohol-related liver diseases have doubled in the past 20 years, with the overall cost of alcohol-related harm now standing at £2.7 billion a year. It is therefore vital to address the situation. There are simple steps that individuals can take, such as tracking alcohol intake, ordering smaller quantities or reduced-strength drinks, or swapping their drinks for alcohol-free versions. While retailers and drinks manufacturers promote the Drinkaware campaign, the industry needs to do more.

I am concerned about tuberculosis in London and about the current guidelines on prevention. A report published by London Health Programmes in June stated that, between 1999 and 2009, the number of TB cases in London rose by 50%. London now has the highest TB rate of any capital city in western Europe and accounts for 40% of all cases in the UK. Those trends are worrying. In Bexley, there are currently less than 20 cases of TB per 100,000 of population each year. However, during the same 10-year period, the Department of Health issued new guidelines to primary care trusts that recommended the withdrawal of the universal BCG vaccine. TB is an infectious disease that can affect any part of the body. It is curable, but detection is crucial. Early detection can mean relatively simple and cheap treatment. If left undetected or untreated, as in 12% of cases, the disease can become drug resistant, meaning more complex treatment at a hugely increased cost. The approach to prevention and treatment of TB therefore needs to change.

I am concerned that family travel is not given enough consideration. Many Bexley children are taken on holiday to the Indian subcontinent or to sub-Saharan Africa during school breaks, particularly in summer, and might be exposed to the disease. Consequently, there is a potential risk that, when the family returns to the UK, others might come into contact with the disease. I appreciate that prolonged exposure is required in order to transmit the disease, but this might happen and I am concerned.

As London Health Programmes has identified, targeting has been inconsistent. High risk groups, such as the homeless and those with lower immune responses caused by other problems such as drug taking or alcoholism, have not been given enough attention. The recommendations made in the draft London TB plan, which aims to improve the early detection of TB and the effectiveness of treatment as well as to reduce the risk of transmission, must be carefully considered. In particular, the Government should seek to implement the proposal that all newborn children should be vaccinated within six weeks of birth to protect them from TB. This welcome suggestion could be an effective measure to prevent cases of the disease. However, it would not address the problem for children in my borough, who have still not received the BCG vaccine because the Department of Health felt that we did not have enough cases per 100,000 of population. I would like to see a limited programme in the next few years for children in London boroughs who have not received the vaccination.

Bexley is a very good place to live and work. I do not want to say that it is all negative, because it is not. There is a huge amount going on in Bexley that is to be commended, and I put that on the record. The vast majority of people in our borough are really good people—moderate, reasonable people—and educating, helping and advising them is the way forward. However, Bexley is not immune to increasing health issues. I hope that the Minister and the Department will support— I know this is not her brief, but I cannot resist the temptation to include this in my remarks—plans for a health and well-being campus to be established at Queen Mary’s hospital in Sidcup. If approved, this could begin in 2014 and provide vital services, such as primary and community care, GP services and hospital services, all on one site. As part of the plans, Bird college, a dance, music and theatre performance centre, hopes to be on the site as well, which could provide real benefits for public health. The strategic outline case has been submitted, and I hope that that important project can progress.

I also urge the Minister to consider the role that community pharmacies can play in helping to reduce health inequalities and public health problems. At the heart of the local communities that they serve, they are uniquely placed to offer advice to significant numbers of people. They can sometimes be more accessible than GP services, and they can be found in retail settings.

In conclusion, I congratulate my hon. Friend the Minister on all the tremendous work that she is doing on public health. The Government are right to prioritise public health and to ring-fence finance. I support strongly the transfer of increased responsibilities to local councils on public health issues. Fundamentally, I believe that education and awareness are vital. If public health problems are to be properly addressed, we need to ensure that everyone plays their part—schools, parents, businesses, charities, and local and national government—otherwise we could be storing up huge problems in our country, including Bexley. I am grateful for the opportunity to make these few points today, because it is very important to address public health issues for the future.

It is a pleasure to serve under you this morning, Ms Osborne. I do not believe that we have met in Westminster Hall before.

I congratulate my hon. Friend the Member for Bexleyheath and Crayford (Mr Evennett) on securing the debate. He does not miss an opportunity to raise issues of public health in his constituency. As my hon. Friend and all of us do, I want to see a public health system worthy of its name, set up with the sole purpose of protecting and improving the health of everyone in this country. The public health White Paper outlines how we intend to achieve that, with ring-fenced funding, health and well-being boards and joint strategic needs assessment all playing a big role. Every element is designed with local needs in mind, so communities and local organisations in his constituency will be able to play a bigger role than ever in improving the public’s health. On the whole, the residents of Bexley are healthier than the national average, but that does not mean for one second that a great deal of work is not still to be done. People living in the most deprived areas of Bexley can expect to live up to seven years less than those living in the wealthiest areas, which is a staggering figure.

It was a pleasure to be joined by my hon. Friend the Member for Dartford (Gareth Johnson) and the hon. Member for Erith and Thamesmead (Teresa Pearce). My hon. Friend rightly mentioned the importance of cross-authority working. In particular, as we move into the new systems, I stress the need for public health leadership. People in Bexley will need a strong and visionary public health system with expert leadership. I am sure that the council and the local primary care trust are considering carefully how to provide such leadership after April 2013, when the breadth and importance of the local council’s responsibilities will increase enormously. Those are big challenges, but they also represent a fantastic opportunity, and Bexley is well placed to capitalise.

My hon. Friend the Member for Bexleyheath and Crayford discussed his grave concern about obesity and gave us some figures, such as that 20% of year 6 children are obese, which is 2% higher than the national average. That is a shame, and the problem is not unique to some areas of the country, because England has among the highest rates of obesity in the developed world. Recent figures show that levels of childhood obesity are stabilising and that adult obesity rates may be levelling out, but the overall rates remain extraordinarily high.

We published a document, which my hon. Friend referred to, “Healthy Lives, Healthy People: A call to action on obesity in England”, on 13 October to set out our approach. Through projects such as the healthy child programme, the national child measurement programme and the responsibility deal, we want to give clear and consistent messages on what the healthiest choices are and how people can make them. People need information and to recognise the harm that they do to their health by ignoring such choices. As I have said, local authorities will be at the forefront, and they will have that ring-fenced public health budget to use in ways that suit local people, doing far more good than a uniform approach that descends from on high in Whitehall.

The local NHS is taking steps to fight obesity and to encourage physical activity, in particular in children. The Bexley healthy schools project is working with every single one of Bexley’s schools and children’s centres, teaching children about the importance of healthy eating and physical activity. The parents’ education and children’s health project educates parents and carers about healthy and economical cooking. School food policies are also being reviewed with parents, pupils and staff, to ensure that children receive nutritionally balanced packed lunches that they will actually eat—there is no point in putting healthy food in front of children, if they then fail to eat it.

My hon. Friend mentioned Silver Star, and I am pleased that he got a tick for his own health, but he is absolutely right that type 2 diabetes is of considerable concern. I understand that the Bexley community diabetes project has had contact with nearly all diabetic patients in the borough. That project is centred on empowering patients and putting them at the heart of managing their condition while calling on health care professionals, when necessary. It is about personal responsibility, ownership and understanding that if people feel they have some control over their lives they do very much better. He also mentioned physical activity, and I thank him for specific mention of “Change for Life”—one of its successes is that it does not look like a Government-run programme—which has had a big impact. He might be interested to know that the brand will be used for action on alcohol in the new year.

We will be publishing an alcohol strategy in which communities and local government will again play a big part, because they will be able to take action based on what they think will work. Local councils are already involved with some of the social harms of alcohol—certainly anti-social behaviour and crime is of considerable concern—and with licensing. Local schemes and projects have contributed to Bexley having a lower than average rate of alcohol-related harm. For instance, the Bexley business support unit offers counselling, group work and medical help to people with alcohol problems. However, a great deal remains to be done. In April, an outreach service was commissioned to help people in the borough who had not used the services before or who find it difficult to access treatment. Data from the first six months of that service show that it has been successful.

On London as a whole, the Secretary of State for Health has backed a statutory London health improvement board, chaired by the Mayor of London. It is already drawing up plans for priority areas such as alcohol and childhood obesity and looking into promoting the use of existing licensing powers, helping accident and emergency departments share data on violence resulting from alcohol misuse and getting early interventions in place so people who misuse alcohol can get quick and effective advice, which is so important.

Smoking kills 80,000 people a year, and yet a persistent minority, which includes a significant number of people, continues to smoke. Each year, an estimated 320,000 children try smoking for the first time. The tobacco control plan to which my hon. Friend referred outlines our ambition to cut smoking rates in adults down to 18.5%, in 15-year-olds down to 12% and in pregnant women down to 11%. Many of us still feel that those figures are too high. Again, we need to give people information, but people also need support to quit. The plan demonstrates how we aim to achieve that. At the beginning of the month, tobacco sales from vending machines became illegal, which is a big start because such machines were a source of tobacco for children, and large, brightly coloured tobacco displays will soon be joining them in the ashtray of history. Displays will end on 6 April 2012 in large shops and three years later in small shops and other businesses in England.

My hon. Friend referred to Bexley’s stop smoking team, which helped 1,611 people give up last year, exceeding its target for the third year running. It has won awards, and he goes to great efforts on its behalf—this is not the first occasion on which he has mentioned it. Many people criticise local services, but it is right to acknowledge the tremendous job that they are doing. I hope that the Bexley team can spread that good practice around the areas in the vicinity. Anyone living or working in Bexley can access the service for free via a GP or participating pharmacy and, if that is not convenient, the team regularly provides services in more convenient locations such as libraries, children’s centres or a special bus outside a local supermarket.

My hon. Friend mentioned TB, and he rightly stated the specific problems for London. We always keep the evidence under review, and we are guided at all times by the Joint Committee on Vaccination and Immunisation. He is right that the issue is complex, but there is no doubt that London has more than its fair share of the problem. As I have said, strong public health leadership in such fields will be extremely important. I assure my hon. Friend and the other two hon. Members present in the Chamber today that the Department of Health and the London strategic health authority support the Mayor of London’s health inequalities strategy. Inequalities simply have no place in modern society, and everything that we can do to lessen them is worth pursuing. I want to see local councils arguing across the council chamber about how it is no longer fair for their residents to live less long that those of another council in the same area.

I thank my hon. Friend for giving me the opportunity to raise yet again the need for the public to improve their health. It matters to stop illness, disability and premature death, but it also matters as we live longer, because staying well as we live longer is becoming increasingly important to us all.

Sitting suspended.