What assessment they have made of the costs of obesity to the national health service. [153639]

The National Audit Office report, "Tackling Obesity in England", published in 2001, estimated that the direct cost to the NHS of treating obesity in 1998 was £9.5 million. Treating the consequences of obesity cost the NHS £469.9 million or 1.5 per cent. of the total NHS expenditure for that year.

I am grateful to the Minister for that answer. I pay tribute to the work of Cancer Research in bringing such an important issue to my attention. It estimates that obesity-related disease may cause 14 per cent. of cancer deaths in men and 20 per cent. in women. After giving up smoking, avoiding obesity and maintaining a healthy diet are the most important actions we can take to reduce the risk of cancer. On that basis, will she consider adopting a Portman-style approach to health education, encouraging those businesses involved in food manufacturing, production and retailing to get the message across—not only at the taxpayer's expense, but using their advertising skills as well as their financial resources to persuade people of the benefits of a healthy diet and lifestyle?

My hon. Friend is right to highlight the increased risks of cancer from obesity and to refer to the work of Cancer Research and other campaigns. I wish to point out, however, that the largest killer is coronary heart disease, to which obesity is a contributory factor. As for his suggestion, he will be aware that, during the past week, we announced a consultation exercise in connection with the White Paper on public health. It will seek answers to the questions that he asked about the role of the different stakeholders in helping people to live healthier lives. We accept that there is a role for the Government to play, as well as a role for individuals and for some key stakeholders. I shall bear his remarks in mind.

rose—

Order. I had hoped not to have to say it, but naturally I thought that questions and answers would be customarily brief. I do not want hon. Members or Ministers to get into bad habits that might spread to the other Chamber.

In the light of the huge costs to the NHS associated with obesity and unhealthy living, why did the Government allow the implementation of the food supplements directive, which by removing many safe and effective products from the shelves, will prevent thousands of people from maintaining their own health?

I appreciate that the hon. Gentleman takes a keen interest in this subject. He will know that I might judge his comments to be tendentious, but I accept that he genuinely holds those views. I do not agree with him. We are still in the process of negotiating many of the details about how the directive will be implemented. I look forward to continuing to work with the health supplements industry on securing the best possible deal based on what is safe and necessary for the consumer, and nothing further.

As my hon. Friend knows, I have a specific interest in promoting physical activity to tackle obesity. I am really grateful that we have this opportunity to discuss the subject. Three crucial Departments will have an input in the current consultation process for the White Paper. Can she reassure me that the Government will undertake genuine cross-cutting work on the issue and that the Department of Health, in particular, will not only promote physical activity and sport but use some of its finances to ensure that it supplements the work that is rightly being done in the Department for Education and Skills for schoolchildren and in the Department for Culture, Media and Sport for grass-roots and elite sport? Will the money follow the good words that we are now finally hearing from the Department of Health?

I can reassure my hon. Friend on that. My colleague the Minister for Sport and Tourism and I jointly chair the work that is done on physical activity. That is cross-Government work on a programme to stimulate more physical activity. We want to increase the number of physically active adults to 70 per cent. of the population by 2020. That shows the emphasis that we place on this matter.

Obesity affects the poorest the most, and opens up inequalities in health. That is not helped by the £5 to £6 surcharge that the common agricultural policy introduces into weekly grocery baskets. Given that the poor tend to be drawn towards unhealthy foods, what discussions has the Minister had with her colleagues at the Department for Environment, Food and Rural Affairs in advance of the statement today on CAP reform? There is very little evidence in what I have read this morning of cross-cutting or joined-up Government.

I can reassure the hon. Gentleman on that, too. Much cross-Government work is done with DEFRA. I am also a member of the sustainable food and farming group that meets, with DEFRA leadership, under Sir Don Curry, to examine sustainable food and farming.

I hope that the Minister has studied in depth the magisterial tome produced yesterday by the Royal College of Physicians, the Royal College of Paediatrics and Child Health and the Faculty of Public Health. What conclusions has she drawn from the fact that that lengthy document does not appear to contain any specific reference to the five-a-day healthy food programme? There might be a reason for that. Does she share the opinion of many organisations that that initiative, which has cost £540,000, has been ineffective? She might wish to reconsider its funding for the future.

On the contrary, we think that it is a successful initiative. One of the main authors of that report has been heavily involved in studying and improving diet in east London as part of his work on diabetes. The success of that work shows that if people can be persuaded to adopt a healthier diet, cases of type 2 diabetes can be reduced, as can those of cancer and coronary heart disease.

What guidance the Government give local education authorities and schools on the nutritional standards of school meals; and if the Government will take steps to raise those standards. [153640]

How many schools have joined the national school fruit scheme and what estimate has been made of how many children eat the fruit provided. [153641]

The Department's guidance on healthy school lunches provides advice on implementing the standards. The findings of the Department for Education and Skills and Food Standards Agency exercise examining school lunches in 80 secondary schools will inform future policy decisions on this issue.

I recognise that exercise and diet go together. I have a question about diet. Does my hon. Friend not agree that school meals provide a great way to ensure that we reach every young person? We could offer a very attractive nutritional meal once a day to every young person. Does he not think that that is worth the effort? Physically, we can provide good quality food, and educationally we can give young people a message that they take with them through the rest of their lives and that they take back to the rest of their families. Is it not worth a universal effort across Government to get that done?

Indeed. There are enormous benefits in terms of health, education and physical well-being. I have seen some great examples of schools that are way ahead of the field in this respect. We can share best practice. The purpose of the research to which I referred is to see whether there is in the system sufficiently strong advice and guidance to schools. We will evaluate that and reconsider the existing advice in the light of that research on 80 schools.

I am delighted with the national school fruit scheme. It is a real pleasure for those of us who have visited schools—I am sure that all hon. Members have done so—to see the children enjoying their fruit. That sends a strong message as they grow up.

I am delighted to congratulate Staffordshire and its schools that are taking part. The fruit scheme is beneficial. I pay tribute to colleagues in the Department of Health who led on and will be funding that programme as it moves forward. It is a great example of joined-up government. The more it can be integrated with other aspects of the healthy schools standard in the way that my hon. Friend describes, the greater the impact will be.

I, too, congratulate the hon. Gentleman on the national school fruit scheme. Has any research been done to maximise the take-up of fruit in schools and to find out whether any fruit is less or more popular? Are there any plans to extend the scheme to some of the more popular raw vegetables?

Perhaps I could answer the hon. Gentleman. Although the fruit that children like to eat varies from child to child, many vegetables are proving popular—and some quite surprising vegetables, too. Vegetables have been tried in some schools as part of the programme. We will consider supplying some vegetables as part of the national roll-out for the remaining areas. Carrots, for example, are proving popular with young children.

Is my hon. Friend aware that Ilford Jewish primary school is so keen on the national school fruit scheme that it is campaigning to extend it to key stage 2? Will he congratulate that school on its campaign and say whether the key stage 2 extension could be considered?

I certainly was aware of that. I met one of the teachers from the school at the weekend. He told me that it intends to present a petition to No. 10 Downing street to that effect. I am not in a position today to make a dramatic announcement, saying that we are going to spend some more Department of Health money on extending the programme from key stage 1 to key stage 2, even though it is always tempting to spend other people's money. The success of the scheme in key stage 1 is demonstrable. Over the next two years it will cover the whole of the country. It will be appropriate at that point to review whether we can take it further into key stage 2 in our junior schools.

Is the Minister aware that nearly 750,000 schoolchildren who are eligible to take up school meals currently do not do so? Although the steps that the Government have taken to improve the nutritional value of school meals is welcome, if not overdue, does he agree that their efforts would be futile if children and parents did not take up their rights because of a fear of embarrassment? What steps are being taken to overcome that problem?

I very much agree with the hon. Lady that there is a serious issue in many parts of our country with the stigma attached to taking up free school meals. Every effort has to be made nationally, and most importantly at the school and local level, to ensure that parents are aware of the eligibility criteria—because there have been changes in recent years, and that is part of the picture—and that the stigma is overcome, so all our young people can benefit from those programmes, and others, such as breakfast clubs. I am happy to look further into what we as a Government can do about that and write to the hon. Lady setting out our plans.

I wonder whether when my hon. Friend reviews school meals he will look carefully at whether we really need to adhere to the current food-based standards, bearing in mind that they allow items to be served that contain little meat, fish or cheese and are highly processed, and consider again the recommendation of the Education and Skills Committee that we adopt nutrient-based standards for school meals. That would go a long way to improving the content.

I pay tribute to my hon. Friend for her doughty campaigning on this issue, both in Parliament and beyond. She secured a debate on the subject in this Chamber only last week.

Further to that answer, I ask the Minister to liaise with his colleagues from the Department of Health on the issue of food colourings and additives, which often have an adverse affect on the behaviour of children and young people. Will he see what can be done to eliminate those from school diets and make people more aware of the side effects? They can so often lead to disruptive behaviour in the classroom.

I spoke recently at the Westminster diet and health forum, and the issue was raised with me there. In conjunction with my colleagues in the Department of Health, I undertook to look into the matter. I will write to the hon. Gentleman setting out what we discover from that, and any plans that follow from it. Logically, it makes sense to consider that in the context of the broader work that I have been describing. I am happy to do as he has asked.

I am grateful for that constructive answer. The Minister will also be aware that many children do not eat school meals, and buy their lunches instead from food vending machines. Is he aware that many schools want to get rid of the vending machines that sell fizzy drinks, snacks and unhealthy junk food, but cannot replace them with a so-called green machine selling healthier food because they cannot afford the loss of income that would ensue? Will he see what help schools can be given to address the issue, so that we can prevent schools that try to encourage healthy eating from being financially penalised for doing so?

I am certainly aware of the concern that has been expressed by a number of schools. I want to use my position in the Department to encourage school heads and governors to take up the healthy vending options, and to replace the fizzy drinks and crisps with an alternative. I understand that in those schools where the alternative is provided, many of the children opt for the fruit or water—the healthy options. The Department is in discussion with some of the providers of those healthy alternatives, and I want to send out a strong signal to schools to encourage them to consider those options when making their decisions.

If they will make a statement on steps to improve social housing provision to protect the health of the mentally ill. [153642]

The "supporting people" programme, launched on 1 April 2003, will deliver high-quality and strategically planned housing-related support to complement existing care services and improve levels of social inclusion for the vulnerable, including those with a mental illness.

Does the Minister recognise the problem, which I see locally, of growing numbers of people with mental illness being housed very inappropriately? Often, there are young men on medication among elderly people, to the detriment of the health and welfare of both groups. Will she work with other Departments, including the Office of the Deputy Prime Minister and the Home Office, to ensure that there is stronger guidance for social housing agencies, and better provision of proper, and in particular supervised and sheltered, accommodation?

Indeed. I am grateful to the hon. Gentleman for his remarks. Certainly, the Department of Health and the ODPM are working together to carry out the further analyses recommended by the independent review to ensure that the scheme continues on a sustainable basis. That will include looking into the provision of housing, too.

What action they are taking to promote (a) walking and (b) cycling to schools. [153643]

The Department for Education and Skills and the Department for Transport have signalled our joint commitment via the document "Travelling to School: an Action Plan", which was launched last September. It outlines how schools and local authorities can increase the number of pupils walking and cycling to school. The Government are funding a network of travel advisers and capital grants for schools to promote cycling and walking to school over the next two years. That is a total investment of £50 million.

The percentage of children driven to school in cars continues to rise. Is the Minister aware that the City of York council is on track to meet its target to double the number of cycle journeys taken by nine to 14-year-olds over a five-year period, from 1999 to 2004? While schools in York are glad to receive capital grants from his Department, they also need revenue funding for cycling and pedestrian safety training and school crossing patrols when they produce new travel plans. Will he consider ways of countering the national shortage of lollipop men and women? Without them, walking to school and other pedestrian journeys become much less attractive.

No, I was not aware of that remarkable progress in York, and I congratulate York council and the schools and young people of York on it. I am happy to look into the revenue aspects. I understand the concern about lollipop ladies and men. I am aware of recruitment difficulties in my constituency. I will look at that matter further in response to my hon. Friend's question.

If the Government will make a statement on the role of exercise in preventive medicine. [153645]

Inactivity is inextricably linked to obesity-related diseases, and to psychological illness. A key objective of the Government's investment in sport and physical activity is improved public health in those areas. The activity co-ordination team is producing a 17-year national activity strategy across nine Departments to increase activity levels.

Can the Minister confirm that the level of activity that used to take place among young people—particularly in schools—has fallen dramatically between 1997 and 2004? Does he agree that obese children have a tendency to grow up into obese adults? What proposals do the Government have to tackle the growing level of obesity that is due in no small part to lack of exercise?

The reference period 1997–2004 is probably driven more by political considerations than by the reality of obesity. A child 30 years ago had 70 per cent. more physical activity than a child today. That is the structural weakness that we have in the system for all sorts of reasons, one of which could be the built environment.

The Minister will recall that at departmental questions I raised the issue of the increasing burden that the Government are placing on local authorities, and especially in relation to sports facilities. I refer in particular to coaching levels. Each and every one of us can point to a sports project that is affected in that way. For example, in my constituency there are the playing fields in Poppleton and a bid for an all-year-round tennis court in Bedale, and there are many other projects within the Vale of York.

It is very simple. We are investing well in excess of —500 million in the local education authorities. There is also likely to be some new thinking about sports facilities. Although open spaces and playing fields are very important, the generation of tomorrow demands a little more than that. The private sector is showing the way. If one looks at how JJB Sports has developed indoor five-a-side, or one goes to Trafford, where 24 indoor pitches are booked a year in advance, one sees that the demand for such facilities is considerable.

On the role of exercise in preventive medicine, in a previous incarnation I was an advocate and a practitioner of exercise on prescription and GP referrals on the leisure side. However, GPs had difficulty in persuading people that exercise rather than a prescription at the local chemist was the solution; another obstacle was the difficulty of keeping people on such schemes. Will the Minister or one of his colleagues advise us on what the state of play on exercise and prescription is, and on how we can take that very beneficial scheme forward?

Perhaps we can have a double answer to that. I want to deal with what has just been said on coaching. It is very important to get that into context. We would like to see multi-skilled coaches, obviously specialising in sport and exercise, but trained to go into a doctor's surgery and help on questions of obesity and related issues. They would be able to work with the National Association for the Care and Resettlement of Offenders and the probation service or be able to help develop and deliver sport in primary schools. We will expect the new coaches to be multi-skilled in a number of areas, one of which will be health. My colleague the Health Minister has also been active in this area. She may want to say a word.

Exercise referral is an important tool available to GPs, and is increasingly used by them. I was in Manchester a week or so ago, where a big scheme is running that involves a lot of exercise-referral prescription. I agree with my hon. Friend that sometimes it may be difficult to persuade patients. We hope that the debate about the role of physical activity and diet for the public health White Paper will help to convince people.

I think that I heard the Minister for Sport and Tourism saying that 10 per cent. of exercise in schools came from sport. What is the other 90 per cent. made up of?

I think that the hon. Gentleman misunderstood. I said that between 8 and 10 per cent. of the nation's activity comes through sport. The rest comes from gardening, DIY or walking to work rather than going by car, for example. That is where the bulk of the nation's activity is. A third of the nation is physically active, according to the World Health Organisation definition, and another third could probably be persuaded to be that active, but it would be pretty difficult to persuade the final third.

According to the national food survey, we consume less energy per household now than in the 1970s. That would suggest that the principal cause of rising levels of obesity is changes in energy expenditure rather than an increase in energy intake. Does the Minister agree? If so, does he accept that his Department should lead in tackling the problem of obesity, which, as the Joint Committee report published this week suggested, is a growing problem?

There is no lead Department as such; one of the problems has probably been that we have not been thinking the issue through in a holistic way. From the media reports yesterday, anybody would think that obesity has come about in the last couple of weeks. It has not. A National Audit Office report published 18 months to two years ago clearly showed that that was the trend. I agree that physical activity is a major part of the problem. For the first time, life expectancy in the US and UK is decreasing. The cost of obesity to the economy will rise to about £3.5 billion by 2010. It is a serious issue that must be tackled across Departments.

I want to add to my right hon. Friend's comments and remark that, although he is broadly right about the intake of food in the house, there is a question about how much food intake there is outside the home, and that contributes to the problem. Physical activity and diet are both aspects of the problem. It is wrong to emphasise one at the expense of the other. We must decrease the food intake and considerably increase the physical activity.

The Minister for Sport and Tourism accepted that his Department has an important role, if not the lead role, to play. Why then has it presided over a decline in the amount of time spent on sport and physical activity by five to 16-year-olds since 1999? That has been a continuing decline, as the recent report by Sport England confirmed. Furthermore, why has his Department reduced the commitment, first announced in October 2002, that all five to 16-year-olds will have access to at least two hours of high quality PE and school sport by 2006? That was reduced in the most recent public service agreement to only 75 per cent.

That is a bit rich coming from a Conservative Member on the subject of facilities for physical activity.

Is it true or not?

No, it is not true, because we have given a commitment to provide two hours of quality physical activity or sport for every child from the age of five to 16. We have had to invest, because the lack of investment over the previous 15 to 20 years left us in a difficult position. We are now investing more than £500 million through local education authorities to achieve that objective and to arrest the serious problem that 75 per cent. of young people do not continue active sport on leaving school. Therefore, a precondition of the investment through the local education authorities is that facilities will be open to the community.

What plans the Government have to introduce legislation to protect people at work from the effects of passive smoking. [153646]

We currently have no plans to introduce such legislation. Employers have a duty under the Health and Safety at Work etc. Act 1974 to protect the health, safety and welfare of their employees, including risks from passive smoking. The Health and Safety Executive has published guidance to employers on effective smoking policies at work.

I am sad to hear the Minister's answer. She knows as well as I do that our great party came into existence to protect workers' rights, and their health and safety must be part of those rights. There are many people whose health is under daily attack from passive smoking. The health of people working in restaurants, bars and clubs comes under great pressure and deteriorates. Much research, including this week's report, shows that smoking is linked to infertility in men and women. Can she reassure me about the story on the front page of The Times today? The Secretary of State for Health has ruled out any vote on the issue, but I warn the Minister that we, as the party of Government, have had some recent lessons about Ministers being out of touch with Back Benchers and opinion in the country.

I know that my hon. Friend feels passionately about this subject, and the Secretary of State and I share that passion. We have consistently said that smoke-free indoor public places are the ideal way of protecting people from the health dangers of secondhand smoke, which we fully recognise. There will be an opportunity for further debate on the subject, and an examination of how to take it forward, as part of the consultation leading up to the White Paper. Last week, my right hon. Friend the Secretary of State for Culture, Media and Sport and I had a meeting on the subject with the hospitality sector, and we are trying to make progress there. Some 50 per cent. of workplaces are now free from tobacco smoke, up from 40 per cent. in 1996. In addition, about another 36 per cent. of workplaces limit smoking to specific areas. There is a particular issue in the hospitality sector, and we are holding discussions to make progress, to which the Secretary of State for Culture, Media and Sport and I are committed.

Can the Minister specify what the issue is in the hospitality sector?

I believe that my hon. Friend the Member for Huddersfield (Mr. Sheerman) specified clearly what the issue is: customers can choose whether they want to be in a smoking environment, but it is more difficult for workers employed in the sector to choose a smoke-free environment.

Our Government have a remarkable record in the area of public health: we had the first Public Health Minister, my hon. Friend the Member for Pontefract and Castleford (Yvette Cooper). However, this is an area of acute disappointment, as my hon. Friend the Member for Huddersfield said. The presidents of the royal colleges were united in calling for legislation, and the Government's chief medical officer agreed. However, the Secretary of State for Health said that the chief medical officer was "an outrider" on the issue. Can the Minister please come to the meeting of the all-party group on smoking and health, which I have the privilege and pleasure of chairing, on a date of her choosing, to explain the Government's rationale? It defeats many of us who are active campaigners in the field. The evidence on health mounts up, as does that on economic benefits. How much longer must we wait? Sometimes, the talking and the consultation must stop, and action must begin.

I reassure my hon. Friend that action has begun and much progress is being made. I should be delighted to come, at an appropriate time diarywise, to meet the all-party group, and I look forward to receiving an invitation to do so.

What collaboration is taking place between Departments to maximise the health benefits of specialist sports colleges. [153647]

Specialist sports colleges already contribute to better health and awareness of healthy lifestyles. The wider PE, school sport and club links programme is led jointly by the Department for Culture, Media and Sport and the Department for Education and Skills, which remain in close touch on the implementation of the sports colleges, work strand. Other Departments are also consulted through a number of arrangements, latterly through the activity co-ordination team. We are all working towards that aim.

I thank the Minister for his response. I have two excellent sports colleges in my constituency: Priesthorpe high school in Pudsey and St. Mary's comprehensive school in Menston, which was visited by my right hon. Friend the Secretary of State for Education and Skills just two days ago.

My hon. Friend raises the point of communication and making the whole system much more sustainable than it used to be. One big problem in sport has always been that when we run initiatives, there is honestly nowhere for the kids to get coaching. Every year during Wimbledon we see all the kids picking up a tennis racket and wanting to play tennis, but having nowhere to play.

I welcome the Minister's comments. In stark contrast to what the Opposition said earlier about where we are now, we actually have a structure that can start to deliver the level of activity that we want.

We are making progress, slow as it may be. We are convincing people that we are serious about the issue, probably for the first time. As I said, many well-meaning developments in sport have not been as sustainable as they should have been, so it has been important to get the structures in place. The governing bodies and those who are involved in sport, such as Sport England and UK Sport, are now working in partnership. That was probably not the case previously.

I am not sure that the Minister could, or did answer my question about the involvement of local primary care trusts. Sports colleges are a good basis for local collaboration, and I wonder whether the Minister from the Department of Health could comment on what steps might be taken to involve local health providers and commissioners.

My hon. Friend makes a valuable point. It is not only the primary care trusts and their boards that have a role to play in this. but GPs through exercise referral schemes. The opportunities are there. Indeed, I met representatives from the Register of Exercise Professionals fairly recently. They are interested in making people aware of who exercise professionals are at primary care level so that more linkups can be made between those who can help people with professional exercise and primary care trusts in just the sort of way that my hon. Friend envisages.