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incompatible with their general well-being, and I am convinced these factors militate against their making properly considered decisions. In particular, the necessity for Ministers to come to the House at bizarre times of the night and early morning is indefensible."The Jopling Committee has also made a recommendation. It is interesting for the House to note the opinion of the 1959 Procedure Committee. I say this in the context of the numbers game that we had to play before last night's Division. The 1959 Procedure Committee stated :
"Members who are seriously ill should never again be required to attend to record their votes".
I very much hope that Madam Speaker will soon organise the conference to address that matter.
Perhaps an agreeable spin-off from the publication tomorrow of the Tomlinson report will be consultants taking redundancy and redeploying their skills in the development of preventive and occupational medicine. Those matters cannot be wholly funded by the NHS, and ample opportunities exist for co-operation between the NHS and the private sector. Only a few weeks ago I attended the opening of a magnetic resonance imaging screening unit in the grounds of Atkinson Morley's hospital in my constituency. That hospital pioneered CAT scanning about 20 years ago. The equipment for that is extremely expensive. It is owned by a private company which has a lease on the area, and Atkinson Morley's hospital provides the patients and the medical, surgical and, most important of all, radiological back-up.
Such sophisticated equipment obviously costs a great deal of money. Of the 90 units of MRI equipment in this country, about one third are privately owned, one third are owned by charities or by charities in combination with the NHS and one third are owned by the NHS itself. It is the most startling equipment and it will have an exciting future. I recommend that all my colleagues share the fascination of being able to look directly for the first time at organs and structures of the body. It is the most extraordinary thing to come on the scene since I qualified as a doctor, which I suppose marks my age rather than anything else.
On a more basic level, how will we ensure that vital--I mean "vital" in the proper sense of that word--preventive measures are carried out by GPs? The answer clearly lies in the new contract, which was very painfully negotiated, and the advent of the increasingly popular GP fund holders. The House will remember the outcry that we had to face from doctors who, having been trained in an NHS ethos and knowing no other, were initially horrified to have to take more administrative and commercial decisions in their practices. Opposition Members, on wholly outdated ideological grounds, also whipped up discontent and, more important, alarm in the general public about fund holding and NHS trusts. That was done under the entirely false argument that the trusts were "opting out" of the NHS. Only today I visited St. Helier's national health service trust which serves much of my constituency. It is enthusiastically planning targeting for the implementation of "The Health of the Nation" in next year's budget. I do not know whether it has sunk into Opposition Members' minds that another intellectual conversion has occurred in their party and, incidentally, within the British Medical Association, my trade union, which swayed from militancy to guarded warmness about the proposals, but which is still being mealy-mouthed about them. I wonder whether Opposition Members understand the changes that
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are taking place. I should not have thought so, judging by the speech of the hon. Member for Sheffield, Brightside (Mr. Blunkett). Only a month ago we read in The Times that the shadow Health Secretary, in the form of the hon. Member for Brightside, would abandon the Labour party's policy of abolishing NHS trusts and GP fund holding and drop the campaign to restore so-called underfunding in the NHS. I read the article in The Times and I heard the hon. Gentleman today. He owes it to the House to clarify his exact position and to say whether he carries the rest of his party with him. GPs running their own budgets will be able to achieve much more at the primary care level and thus take pressures off hospitals and give themselves more clinical satisfaction.All the admirable proposals in "The Health of the Nation" can be carried out without creating a nanny state. When I have a recalcitrant patient--
Dr. Goodson-Wickes : May I just finish my sentence?
Mr. Deputy Speaker : Order. I call Mrs. Gwyneth Dunwoody. 7.18 pm
Mrs. Gwyneth Dunwoody (Crewe and Nantwich) : Targets are all very well if they are realisable and sensible. The fairgrounds of my youth had vast numbers of machines that people were required to hit with an enormous hammer and a bullet then shot up and rang a bell. Very few people managed to do that because the machines were deliberately rigged. The similarities between the rigged bells and the targets of the White Paper seem very clear indeed.
I have strong views on the prevention of ill health. It is something for which I have pleaded for a long time. It is utter hypocrisy to suggest that we need proper health targets and then refuse to make the direct connection between the provision of funds and the provision of services that would allow us to hit those targets. That has probably been the worst con trick that the Government have tried on the British public for many years. When talking about reducing smoking, one must understand that it is necessary to cut back advertising for smoking, particularly that aimed at young people. The length of time that people smoke is one of its most hazardous and appalling aspects. Some 1,149 people die every year in my constituency ; of those, 179 are the result of smoking-related diseases--one in six of the deaths in my constituency. But there is still no clear plan from the Government about what they intend to do. They simply promote a lot of generally cheerful ideas stating that it would be nice if we were to cut down on smoking. No matter which target in the document one examines in depth, one comes to the same conclusion : there are many pious hopes. The Government say that it would be wonderful if they could make it much easier for people to receive health education and could reduce the number of teenage pregnancies. However, there has been a consistent chopping of the provision of information to young girls on the need for proper health planning or the sort of service that they can easily receive. The results can be seen in every
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hon. Member's surgery when they are asked to provide houses for young people who are often homeless and pregnant. That connection is direct, not accidental.We can take that argument further. We are told that one of the main targets is the provision of good health care for the elderly. In my constituency we are constantly told that we are lucky and that the reorganisation of trusts has improved health care--it is important to keep repeating this claim. The money keeps running out and the number of beds keeps being cut, but according to the Government my constituents should realise that they are getting a better service. As if those changes are not enough, we even have an ambulance trust created specifically as an independent unit. It has considerable problems related not only to its equipment but to the provision of its services throughout Cheshire and other parts of Merseyside. We are moving towards what is lightly called community care. There is no better idea than community care, but it is not a cheap option. It must be provided not in the terms suggested by the present trusts-- reducing the number of geriatric beds and ring fencing small sums of money that are inadequate to provide alternatives in the community. It must be provided by highly skilled nurses and support in people's homes given by health professionals. That requires a good, constant supply of money, but it is clear that such sums will not be forthcoming.
I asked my local trust what would happen when two of the geriatric hospitals were closed down. I do not pretend that they were adequate, but they provided health care and protection for many of my elderly constituents. When I asked about the closures, I was told that other wards would be made available in the district general hospital--itself a trust. But the wards to be built in Leighton hospital will not replace the beds lost by the closure of the Barony hospital. It was never intended that the money from the sale of the Barony and Arclid hospitals should be diverted into development moneys for the psychiatric department. There has been a long-standing commitment to build and fund 16 functional mentally ill elderly beds from straightforward development moneys. It is clear that, far from the necessary money being provided, there is to be a severe shortfall in the provision of care for the elderly. There is to be only a partial replacement.
It is also important to understand that the creation of trusts is having a direct effect on the level of nursing care. I have been told by the trust that the quality of service when the elderly health care strategy is complete should not be affected. Almost all the staff being transferred to the newly built nursing homes are being downgraded, although at present they have an oral promise of the retention of existing commitments. That means that the skill mix in those new homes will be considerably less than that provided in the original hospital system.
We now know what happens when a new trust is created. We are told that it is a better way of providing health care, but the administration cost is increased by raising the wages of the tiny number of people at the top while the provision of health care for local people is reduced.
We should also discuss the damaging decisions that the Government are to announce tomorrow about the closure of teaching hospitals in London.
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The Minister for Health (Dr. Brian Mawhinney) : Before the hon. Lady leaves Crewe, will she express pleasure at the fact that patient activity in Crewe increased by 9 per cent. last year?
Mrs. Dunwoody : I see people being run in and out of the services at great speed. One hon. Member said earlier that his wife had stayed in hospital for a week after having her baby. That is almost unique within medicare services and I hope that it was not a sign that she was suffering from any complications.
The way that people are now wheeled in and out of hospital services like sausages should be enough to cause even this Government to pause. I do not want the Minister to tell me that I should be delighted that patients are going in and out of hospital like people in a revolving door. I care about the quality of care that they receive and how many of them have to return to hospital for further treatment after they have been sent home too soon. I also care very much about what they find when they get home and how much care they receive there. The Minister does not talk about that at all. In July last year I had what is termed a life-threatening illness and was taken into Barts hospital. I was there for some weeks and it became clear that the large ward on which I was being treated was entirely occupied by patients who came from Hackney, the City of London or the Barbican, where I have a home. Those in the ward were not patients who were not using their local health services. Whereas I once might have said that there was a good case for dispensing a greater amount of expertise from London into other constituencies, I know that when the present Government shut centres of excellence they are not replaced. The same level of care is not provided outside the capital. All that happens is that those within the London district are deprived of services that are essential to them.
If the wholesale slaughter of the teaching hospitals is allowed to go ahead, there will be no provision for many people in the London region. The Government will not provide equal amounts of cash for Manchester, Liverpool and constituencies such as mine. All that they will do is cheat the population of London. Even the Government should be ashamed of that.
7.27 pm
Mr. David Atkinson (Bournemouth, East) : I congratulate my hon. Friend the Member for Falmouth and Camborne (Mr. Coe) on his excellent maiden speech. I pay tribute to his continuing work in health promotion with the Sports Council and the Health Education Authority.
Yesterday I had the pleasure of attending the official opening by the Princess Royal of phase 2 of the new Royal Bournemouth hospital in my constituency. On behalf of my constituents, I wish to thank my right hon. Friend the Secretary of State and her predecessors for making that superb new hospital a reality. It was a casualty of the cuts in the hospital building programme during the last Labour Government and was, therefore, long overdue.
The maternity unit in phase two anticipated the recommendation contained in the Select Committee report on maternity service in pioneering the establishment of a midwife-led facility for low-risk women. This has been a satisfactory outcome of the health authority's original intention to centralise all obstetric services at Poole hospital, which might have been convenient for the consultants, but was certainly not convenient for my
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constituents or for those of my hon. Friend the Member for Christchurch (Mr. Adley). I record our appreciation of our right hon. Friend the Member for Bristol, West (Mr. Waldegrave), who, as Secretary of State, ordered a re-think last year in response to our appeal to him. That has resulted in an acceptable compromise. I congratulate the Government on pressing forward with their determination to make ours a healthier nation. Having implemented our strategy for a more efficient national health service, we are right to concentrate more than ever before on how we can avoid the need for health care in the first place. As my right hon. Friend the Secretary of State has said, tremendous progress has been made in recent years. Although it is right that the Opposition should point out where Britain lags behind, let us also give credit for the fact that we are leading the field in eliminating some of the seemingly incurable diseases of the past. Research is the key, and resources for it must remain adequate.In the White Paper my right hon. Friend has selected five key areas for targeting ; heart disease, cancer, mental illness, AIDS and accidents. These are the five horsemen of the modern apocalypse. Terrible as they all are, they have two things in common--they are mostly avoidable and they are mainly self-imposed. The Government must now build on that message.
A couple of years ago East Dorset community health council undertook "Survey 10,000" to discover consumers' views of health services and health promotion. It concluded that less than half of them were taking steps to improve their health. That is disappointing. The survey also concluded that of those who do seek advice, the majority will act on it. That is more encouraging. Is there not more that can be done to encourage people to be more aware of their state of health by means of personal monitoring? I believe that there is. In July, a number of colleagues in the House responded to an invitation from IBM to become better aware of the use of information technology in our lives. Among the exhibits was a community based, touch-screen, public-access, health information system known as HealthPoint. It encourages the public to find out more about their state of health in a hundred different ways--diet, alcohol intake, smoking, AIDS, drug misuse and stress. For example, it can be placed in the waiting areas of hospitals and clinics, libraries, shopping centres, chemists and the workplace. If the Minister for Health is not aware of HealthPoint, I hope that he will make himself aware of it. It was developed by the university of Glasgow for his colleagues in the Scottish Office.
As the White Paper makes plain, heart disease followed by cancer present the greatest threat of premature death in Britain, not to mention ill health and disability for thousands. As my right hon. Friend said, we can do a great deal about both diseases and their avoidance. She rightly emphasised improved diet, and the growing emphasis on the risks of foodstuffs with lethal additives, sugars, salts and fats, is at last producing a consumer demand for more healthy alternatives, even in junk food like pizzas, burgers and potato crisps. This trend must be encouraged by education in schools, exhortation in campaigns and by clearer and compulsory labelling on foods. I hope that my right hon. Friend will keep up the pressure on our major food producers to find healthy alternatives to the more dangerous preservatives in food--emulsifiers in ice
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creams, for instance. I hope that they will respond even more positively to the clear, established link between saturated fats and heart disease.Public attitudes and awareness of the need to take better care of one's health have improved in response to campaigns such as "Look after your heart". A recent Allied Dunbar survey showed that even more needs to be done to improve our fitness and to avoid heart disease. I was delighted by my right hon. Friend's initiative this week to promote health at work. The annual absenteeism cost of £5 billion suggests that a properly planned health promotion programme for staff would be incredibly cost-effective.
Many of us will be aware of the excellent organisation Fitness for Industry, run by our hon. Friend the Member for Dorset, West (Sir J. Spicer), who is also responsible for establishing the Westminster gymnasium. Looking around the House this evening I do not see too many colleagues who use the gym, and sad to say there are still many companies not even contemplating how they can convert some under-used or redundant corner of their premises into a fitness area where their employees can work out at lunch time and before and after work. The investment need not be great ; a home multigym can cost only £300, a sum which unfortunately cannot be offset against company tax. I ask the Minister to urge the Treasury to make it allowable against tax. He should also urge the Health and Safety Executive to issue guidelines to employers on health at work.
Smoking remains the greatest single preventable cause of premature death in this country. The recent manifesto for action on smoking issued by the Health Education Authority has already been mentioned. Among my constituents, 13.7 per cent., or one in seven, die from smoking ; 500 a year are admitted to hospital because of smoking, using 14 beds a day, at an annual cost of £664,000. I am encouraged, however, by the fact that these statistics are the fifth lowest in the country.
I welcome the strategy in the White Paper, especially its emphasis on no- smoking areas in public to combat the effects of passive smoking. Surely Roy Castle's successful treatment for lung cancer will bring home the dangers of smoky pubs and clubs. I remain convinced that the answer still lies in education, not in penal taxation, which does little to discourage the hardened smoking addict, who will make other sacrifices, usually at his family's expense. It would be helpful, however, if my right hon. Friend would confirm once and for all that there is absolute and conclusive evidence that smoking leads to lung cancer, which in turn leads to an agonising and premature death. Health warnings on cigarette packets should state that clearly.
Now that doctors can put smoking as a cause of death on death certificates without having to refer to a coroner, I hope that GPs will not hesitate to use this opportunity to improve the accuracy of statistics on tobacco- related deaths.
The White Paper describes HIV and AIDS as the greatest new threat to health this century. There is no alternative but to continue to promote ever safer sex and to emphasise more strongly than ever that it is anal intercourse that is largely responsible for AIDS. With neither vaccine nor cure in sight, prevention remains the
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essential message, and the governing bodies of schools have a heavy responsibility when deciding what additional sex education to provide under the national curriculum for 12 to 14-year-olds. Such education must be appropriate to the schools and must encourage young people--indeed, all of us--to talk more easily about the subject. I conclude with one of the broader lessons that can be learnt from the alarming report earlier this year about the HIV-positive Birmingham man who infected at least three women and was blamed for having infected a fourth. There are certain conclusions to be drawn from the fact that those reports exposed a lifestyle which he and his friends pursued in their inner urban area--a lifestyle revolving around alcohol, football, videos and sex.7.38 pm
Miss Joan Lestor (Eccles) : I apologise for my voice. It would be wrong to blame it entirely on the fact that I am a victim of passive smoking in the Tea Room, a problem caused by those who are in turn the victims the tobacco advertising, but my hoarse voice is certainly linked to the smoke there. When one has a cold or a throat infection, the atmosphere in the Tea Room is bad for one's health. I just hope that my voice will last out this speech.
I want to concentrate on child health. Although that is referred to in the White Paper, children have been largely overlooked in the promotion of good eating habits and of health in general. The target of reducing the number of children smoking has been mentioned, but from reading the report it is unclear how the Government will achieve that target without controlling the advertising of cigarettes. Other important issues, however, such as child nutrition, poverty and deprivation have hardly been tackled. We could all read out our qualifications which entitle us to comment on such matters, as the Secretary of State did, but if we ignore the connection between child health and poverty and between bad housing and child health, we have learnt very little. One in five of our children now live in poverty. That means that they are subject to great deprivation, as are their parents. Many of them live in bed-and-breakfast accommodation or in poor housing. Ministers' refusal to acknowledge the obvious link between child poverty and poor health is irresponsible and totally unacceptable. It is self-evident that sub-standard housing leads to ill health. Similarly, families living in poverty will, of necessity, consume the sort of fat and sugar-loaded diet that easily staves off the pangs of hunger, but does nothing to build a healthy body. Anyone who has visited bed-and-breakfast accommodation knows that they offer no facilities for promoting a healthy diet.
The White Paper specifies targets for reducing adult obesity, which I welcome, but it says nothing about that problem in children. The seeds of obesity are sown in childhood. Anyone who has tried to change the pattern of eating established in childhood knows how difficult that is. People brought up in the 1930s filled a blank space with suet puddings, dumplings, cocoa and the like. They now suffer illnesses directly related to that diet.
We know better now, but, as my hon. Friend the Member for Halifax (Mrs. Mahon) has said, it is important to reinstate the nutritional standard of school meals. Many children no longer have a hot lunch and they
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have replaced it with sandwiches, sugary snacks or crisps. The school lunch is often the only hot meal available to children and they are now suffering nutritional deprivation they will suffer illness throughout their adult lives as a result of that. In the 1950s, graphs were kept of the comparative growth of rich and poor children. In those days children received free orange juice, school milk and proper school meals and the gap between the development of those children narrowed ; now it is widening. For years the medical schools of Guy's and St. Thomas's--I hope that they will not be closed down--have carried out a joint study of the height and growth of children, which are strong indicators of health in childhood. The height differences between children in different social groups narrowed in the 1970s, but it grew wider in the 1980s. Only last month Professor Walter Holland, one of this country's leading experts on community medicine, warned that British children were getting fatter and that a time bomb of obesity and disease was ticking away under them. He pointed out that the increase in children's weight, particularly among girls and children from the poorer economic groups, had not been commensurate with their increase in height. That weight gain is an important indicator of the likely health of those children when they grow up, especially in terms of the greater frequency with which they will suffer from arthritis, diabetes, heart disease and high blood pressure. As the hon. Member for Falmouth and Camborne (Mr. Coe) said in his maiden speech, we need to tackle the need for exercise in childhood. Too many children now go everywhere by car. I do not believe that the White Paper has addressed those warnings.The Government also have a responsibility to protect children from the advertising of products that are damaging to their health. Earlier this year we debated the issue of tobacco advertising and I drew attention to the Benson and Hedges advert that featured a puffin--a symbol clearly identified by children because of Puffin books. Whatever the tobacco giants may claim, I am firmly convinced that they target under-age smokers. Indeed, they do so in order to replace the 300 addicted smokers who die from smoking-related diseases every day.
More than 450 youngsters start smoking in the United Kingdom every day and five out of six of them are under the age of 16. The Secretary of State rightly pointed out that the parents of many children who take up smoking are smokers. She implied that if adults stopped smoking, children would do likewise. That is why it is so important that we tackle the advertising of cigarettes, because children whose parents smoke see the attitude in their homes reinforced through advertising. If that were not so, those children would be less likely to smoke. Perceived attitudes have never been challenged and that is why the role of advertising is so important. I am appalled that the former Prime Minister is now promoting tobacco in the third world. That is absolutely disgraceful and she should know better.
Janet Sackman was a young and healthy teenager who was chosen especially years ago to advertise Lucky Strike cigarettes--behind a waterfall, I think. By the age of 17, having been encouraged to smoke, she was hooked on tobacco and she has since developed lung and throat cancer. Who was that advertisement directed at? Not at hon. Members, but at teenagers like Janet. My hon. Friend the Member for Crewe and Nantwich (Mrs. Dunwoody)
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and I have a high percentage of constituents who are now dying from smoking-related diseases and we know that they were affected by that advertisement. One could cite many other such advertisements. We must recognise the problem caused by tobacco advertising.Voluntary codes have been mentioned and the Secretary of State said that one cannot force people to do certain things. However, it is important to take issue with another problem connected with advertising--the inadequate controls over misleading advertisements of sugar-loaded foods and confectionery. Those products are often described as energy giving to young children and their parents. If the truth were told, they would be more accurately described as tooth rotting. It is important that the Government take a long, hard look at that issue against the backdrop of reduced dental care for children.
Local authorities are making cuts in school health programmes because of Government restrictions on spending. Our children are deluged with advertising that is often linked with unfortunate preconceptions. They believe that if they eat a particular food they will be able to perform to a particular standard in sports. That is an absolute disgrace.
The school nurse programme is underfunded and under threat. It has been brought to my notice that, in Gloucestershire, parents have received letters giving notice of the discontinuation of annual school dental check- ups. The reason for that decision was improvements in child dental health, but what brought about that improvement? It was the annual dental check-up. Children will now receive four check-ups throughout their school lives between the ages of four and 18. With national health service dentists to become as scarce as coal mines if the Government have their way, more families will find themselves unable to afford private treatment. If adults do not regularly visit the dentist, it is unlikely that their children will get into that habit. School dental check-ups are a vital safety net against the background of disintegrating public health care for our children.
How some of the targets relating to children in the White Paper, welcome though they are, will be reached is a mystery. The commitment to reduce pregnancies among under-16s by at least 50 per cent. by the year 2000 is welcome, but how can that be achieved without taking practical steps to prevent conception in the first place? Special attention must be given to that matter if we are to avoid more teenage pregnancies. The Birth Control Trust, for example, should be given more funding and support if we are to reduce the number of teenage pregnancies.
7.48 pm
Mr. Simon Coombs (Swindon) : I join my colleagues in congratulating my hon. Friend the Member for Falmouth and Camborne (Mr. Coe) on his excellent maiden speech. I also congratulate the hon. Member for Eccles (Miss Lestor) on surviving her 10 minutes. I thought that her voice became stronger as she went on, which shows that practice does help. That is an awful warning to all of us, is it not?
The White Paper is a move forward in health promotion, but I want to issue one or two warnings about it. I also disagreed with a couple of things that my right hon. Friend the Secretary of State said. I welcome the White Paper and all that went before it because they have created the framework for health promotion. It is right to
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pay tribute to the progress that has been made in relation to GP contracts and the improvement in targets in such things as cervical smears and child immunisation. Those are welcome steps in the right direction, but we still have serious problems in this country. The first problem is coronary heart disease. This week I put a question to a Minister at the Welsh Office, and received the information that in Wales the number of deaths from coronary heart disease had fallen from 345 to 331 per 100,000 in the past 11 years. That is progress, but it is slow, and it is not speedy enough to satisfy those hon. Members who feel strongly about such issues. In almost 10 years since the publication of the Committee on Medical Aspects of Food Policy report there has been little progress in reducing our population's intake of saturated fats. There has also been too little progress on increasing the amount of fibre in the diet through eating fruit and vegetables. I do not join Opposition Members in saying that it is simply a matter of social class or is due to whether people are richer or poorer : it is up to people to make choices, and they can make them irrespective of their income or that of their families.Another problem is plasma cholesterol. That is often a genetic feature, but we can all do something about it. A 10 per cent. reduction in plasma cholesterol could lead to a 20 per cent. reduction in premature coronary heart disease. There are ways in which cholesterol can be reduced, even by people who may have a genetic tendency towards it. That is of crucial importance. I hope that my hon. Friend will tell us at the end of the debate when the Government intend to respond to the Standing Medical Advisory Committee's proposals on cholesterol testing. The House will be interested to know when we can expect progress in that direction. Like every other Member who has spoken, I must mention smoking. I am one Conservative Member who feels that we must insist that the European Community does something about the scandalous subsidising of tobacco crops throughout the Community, which is costing its taxpayers £1 billion per year. We must also consider the vexed question of tobacco advertising. Having lost a parent from lung cancer, I feel that we must take any step that will reduce people's tendency to smoke and to reduce the number of passive and active smokers.
Clearly the Government have set a challenging target. Why lose any opportunity to reach that target? When the Smee report is published next week, I am sure that it will show that in countries which have banned all advertising--not merely television advertisements--that has helped to reduce smoking. Let us follow suit and not be too worried by arguments about freedom. It will still be up to people to decide whether they smoke. For heaven's sake, why do we want to encourage them in any way?
On health education, we must deal with nutrition education in schools. That has not been mentioned in the debate so far. I am not happy that the nutritional advice made available through home economics within the national curriculum is sufficient to encourage young people into healthy eating and cooking when they become responsible for families. We must ask the Minister to talk to Ministers at the Department for Education--not merely through a Cabinet Committee--to impress on them the
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need to ensure that health economics teaching includes advice on diet and nutrition. I hope that my hon. Friend the Minister will feel able to respond to that at the end of the debate.I welcome the healthy schools project, and I hope that it will include some of the suggestions from the school meals campaign. It is not good enough that while some counties, such as mine, make every effort to encourage healthy eating in schools, in others the pizza generation has taken over, almost to the exclusion of everything else. The pizza van waits outside the school gates every lunchtime for its ready victims to come forth. We have to insist on national standards in something as important as school meals.
I hope that my hon. Friend the Minister will tell the House when we can expect the Government to propose full nutritional labelling. There has been much consideration and involvement with the European Community on that subject : now we need action. A great deal of progress is being made. It is true to say that industry is now more aware of its responsibilities for the diet of the nation. The Food and Health Forum--the all-party group in the House which I have the honour to chair--has received presentations from organisations as diverse as the National Farmers Union and the Food and Drink Federation and they all accept that they have responsibilities to improve the nation's diet. That is important and should be encouraged by Members on both sides of the House. Finally, the targets in the report may not look tough to some hon. Members but they will be hard to achieve because, human nature being what it is, people will resist blandishments, encouragement, education and incentives. There will always be those who say, "We know best" and "My grandmother lived to be 90 and she smoked 40 a day, so I can do it too." They may be right, but that does not alter the fact that everyone who smokes has a greater chance of dying a premature and agonising death. That fact is incontrovertible. We must tell people who have a sweet tooth and who enjoy a rich fatty diet that they are taking risks with their health and that they could avoid those risks if they chose to do so. However, we all know that many of them will choose to ignore whatever advice is given. We must press on, and we must tell the Government that it will not be easy to reach those targets. Too many people will say, "We are immortal--it will never happen to us."
Education will be important. Whether it is provided by the health education authority or by health education units within the health authorities, it is expensive and it will have to be paid for. My hon. Friend will have to deal with the problem of where that money is to come from. We can improve the lifestyle of all the people in this country, if we are prepared to do so, but let us not pretend that the White Paper is anything more than one step along a road which will be difficult and challenging, and which will require sacrifices by everyone in the country, whether they are smokers or those who indulge in the various dietary inadequacies which disfigure our population to far too great an extent.
7.58 pm
Mr. John Hutton (Barrow and Furness) : Many Labour Members, including my hon. Friends the Members for Sheffield, Brightside (Mr. Blunkett) and for Eccles (Miss
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Lestor), have expressed our reservations about a health promotion strategy that fails to give proper attention to significant factors such as unemployment, economic deprivation and poor housing conditions.While the Secretary of State for Health has sought to develop a strategy to improve the health of the nation, other policies are being developed by different Government Departments which are having the opposite effect on that strategy. I am thinking of the Government's economic and industrial policies, which are creating an inexorable rise in unemployment, of the Government's employment policies, which are encouraging low and poverty pay, and of their housing policies, which are creating ever-increasing tension and stress in the housing stock, especially in public sector housing. I do not intend to dwell on that aspect of our reservations about the Government's health strategy, although I must say a little about what is happening in my constituency. In two years Barrow and Furness has lost 8,000 jobs. Every week, when I hold my advice surgeries, I see growing signs of increasing economic deprivation. More and more of my constituents are being forced on to income support and benefit, and I am deeply concerned about what is happening to the health of my constituents. I know that in the coming years there will be many other constituencies throughout the country where the Government's policies will have an effect on the health of many thousands of people.
I wish to concentrate on three issues that arise from the White Paper which bear on the Government's policies on accident prevention, reducing the incidence rate of cancer and dealing with mental illness.
I ask the Government to consider the role of home safety committees within their strategy on accident prevention. I read the White Paper and I could not find one reference to the committees. I assume that that is an oversight by the Government and not the result of their pathological aversion to anything and everything that is provided by local authorities.
Home safety committees are administered by local councils. They bring together local NHS agencies, emergency services, voluntary organisations and trading standard officers. They do an excellent job and the Government should examine their work carefully with a view to putting it on a statutory basis. In taking that course there would be resource implications for the Government, and perhaps that is why there is no reference to the committees in the White Paper. Perhaps the Government, and especially the Minister for Health, will have to consult Ministers in other Departments. I hope that the Minister will be able to give us an assurance that he will at least consider my suggestion. Home safety committees, and especially the one in my constituency, are doing an excellent job.
It is important that action is taken across a range of areas to tackle the incidence of cancer. Many of my hon. Friends--I am glad that there are Conservative Members who support the view--believe that the Government cannot continue to avoid taking further measures to prevent tobacco companies advertising their products. Despite what is often said by these companies, their advertising is clearly and blatantly aimed at young people and at recruiting new smokers. That is a disgrace.
I regret that the White Paper takes a rather disingenuous approach to tobacco advertising. As a result, the Government's targets for reducing the incidence of
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lung cancer and other smoking-related illnesses appear to be hopelessly optimistic. A ban on advertising should be at the top of the Government's agenda and not wrapped up in the weasel words that are all that we see in the White Paper.In the treatment of cancer, excellent work is being done by the hospice movement in providing palliative care for those who are dying from the disease. I mention especially the work of St. Mary's hospice in Ulverston in my constituency. It is a small hospice--there are only six beds--but it provides a vital home care service and a drop-in support service. Demand for the services that it provides constantly outstrips availability. The hospice has to rely heavily on voluntary contributions. Its budget is about £500,000, about 83 per cent. of which comes from its own fund-raising efforts. That is a remarkable tribute to the people of Furness and of the south lakes area. The hospice receives no direct funding from the South Cumbria district health authority, but I am glad to say that it benefits from the Government's allocation to regional health authorities. Of course, that funding is not guaranteed beyond this year. I hope that the Government will extend their support to the hospice movement in general and keep under constant review the mechanisms through which health authority funding is distributed to the hospices.
I would like to have seen greater emphasis in another area of the Government's proposals, and that is on a recognition of the value and role of proper bereavement services in promoting the health of the nation. Those who, like myself, have experienced the immense grief that is caused by the death of a child will know how debilitating the sense of loss can be. There can be a real threat to the physical and mental health of those who are mourning the loss of a loved one. I shall never forget when my second son, Jonathan, died 10 years ago. I was told by caring professionals in the NHS that I was young and that my family and I could look forward to having more children. I was told that, in effect, there was nothing to worry about. That was not the result of callous indifference on the part of the profession. I believe that it was the result of a lack of efficient and proper training. I want the Minister and the Government to recognise that this is an area in which the expertise of the hospice movement can and should be central to developing a national response and strategy. I hope that the Minister will be able this evening to say something about the Government's view of bereavement services as part of their target of improving the mental health of the nation. As I have said, I hope that the Government will be able to respond to what I have said about the role of home safety committees and bereavement services. I have reason to believe that I should be less than optimistic that they will begin to address the problem of tobacco advertising. Unless they do so, however, their credentials in promoting the health of the nation will be seriously compromised. 8.7 pm
Dr. Liam Fox (Woodspring) : I begin by congratulating the Government on bringing forward for the first time a real health strategy. For too long debates in the House have focused on funding mechanisms and developing the correct mechanisms to achieve better value for money. At last we have started to measure output in our health care
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system. For too long also we have measured the quality of health provision by what we put into the system. That is rather like the shopper who measures a good day's shopping by the amount of money that has been spent rather than on what has been brought home. The White Paper goes some way at least towards setting real targets in trying to achieve good value for money and the correct outcome in terms of health care.We must congratulate the Government where credit is due on having the lowest infant mortality rate of all time, the lowest post neo-natal mortality rate, on having brought in the new haemophilus influenza B vaccine and the new typhoid vaccine and, I hope, increasing the take-up of them. These are real improvements in our health care. I wish that sometimes the Labour party would give us, the Government, a little credit when we bring forward real improvements. Constant sniping--pretending that nothing good is happening in the health service--is bad for the entire debate and makes the climate for debate all the more difficult.
I have a particular interest in the primary care sector, because I was a general practitioner until the general election. Most of my hospital training was in the east end--the poorer part of Glasgow. For a short time I worked in Harlesden, in Brent. I was appalled there at the inequality within primary care services. In inner-city London, there were general practitioners with no appointment service and no proper system of record keeping. In some instances, there was no running hot water. At the same time and in the same system, but in another part of the United Kingdom, there were general practitioners who, with the same funding system, were providing plush waiting rooms, an excellent appointment system, health care clinics and preventive measures. Surely that is unacceptable in a publicly funded service. What do we do? The Government responded by bringing in the general practitioner contract to try, for the first time, to establish a minimum acceptable standard of care. What did we get? The Labour party was up in arms. It told the people that the health service was about to fall apart. The British Medical Association told us that it would not be able to carry out the preventive measures that it had been undertaking until that moment.
I ask the House to look at the record. We have seen a tremendous increase in the take-up of immunisation. Preventive measures have been taken in the form of hypertension, diabetic and asthmatic clinics. These have been provided within the health service, but perhaps there have not been enough of them.
The carrot has worked rather well. It has brought forward many more services. It worries me, however, that general practitioners, especially when there is a high patient turnover, can still make a good and happy living without having to bring in some of the services that are detailed in the contract.
I would be happier if the Government considered carrying something of a stick. Perhaps we could have a general practitioner inspectorate to focus especially on inner-city practices. We have made tremendous advances, but there are still some places and areas that leave something to be desired.
We shall also have to consider the role of medical education, especially in view of the community care
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programme. For example, general practitioners do not have much training in dealing with mentally handicapped people or mental illness. I had six months' training in psychiatry as part of my general practice training, but that was not compulsory.It is possible to be a general practitioner in Britain with no experience in psychiatry apart from a couple of weeks' training as an undergraduate. We must consider that if we are serious about obtaining the proper treatment for mental illness in order to attain our targets. If we are to deal adequately with potential suicides, we must know how to spot them. If we are to deal adequately with post-natal depression, we must know which patients are vulnerable, and that requires good medical skill.
The most attractive feature of the White Paper is the Government's clear commitment to a multi-departmental approach. It is far too simplistic to say that poverty causes this and homelessness causes that. Public health is multi-factorial. We know that asthma is worsened by too many vehicle emissions. All the evidence points to that. But that is the consequence not of a poor society but of an affluent society with too many motor cars on the roads. Much heart disease is due to people having too sedentary a life style because there is too much transport so that they do not do enough walking. Again, that is a problem of affluence. All I ask is that the House does not take too simplistic a view in dealing with such matters. Of course poverty is a factor. All epidemiological evidence suggests that there is something in that, but all we hear from the Opposition is poverty, poverty, poverty--la, la, la, always on the one note, never accepting the complexity of the issues. Not once did the Opposition mention that. They are always hitting on the one strand. That does not advance the debate one little bit. It is just boring for Conservative Members.
There is one other problem in how we are to move forward. We know that we will have to work within public spending constraints and we know that medical science will continue to demand ever more. Therefore, irrespective of national wealth, there will be a genuine gap between what we can afford to buy and what medical science can provide. I ask my hon. Friend the Minister tonight to question some of our priorities.
For example, is it ethically justifiable to spend £3,000 a time reversing vasectomies that patients have chosen to have on the NHS when we have a shortage of coronary care beds? Should we spend millions of pounds removing tattoos when we have other priorities in the health service? Those are genuine questions which will have to be addressed.
I am sorry that, largely because Opposition Members take such a simplistic view, those issues have not been aired as they should have been today. I hope that my hon. Friend will consider all of them. The Government are to be commended for a courageous White Paper. It is a welcome start.
8.12 pm
Ms. Angela Eagle (Wallasey) : I crave the indulgence of the House at the beginning of my speech as I am suffering from an affliction similar to that of my hon. Friend the Member for Eccles (Miss Lestor). I only hope that my voice lasts as long as hers did. I was particularly moved by what my hon. Friend the Member for Barrow and Furness (Mr. Hutton) had to say
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about bereavement. Having suffered the loss of a parent, I too believe that there are large gaps in the services currently offered in that area, which need addressing urgently.It is just possible to believe that we have a Government who care about the nation's health. I commend the Government for having a strategy, however inadequate, and for finally deciding to introduce health targets. Any target, even the wrong one, is better than no target at all. That is the faint praise that the Government will get from me tonight.
Leaving aside the alarming omissions of analysis in the White Paper which render its prescriptions flawed and problematical, and leaving aside the Government's obsession with individualism and their refusal to admit that good health relies on far more than a responsible attitude to one's own health, important though it is, and even forgetting the Government's obsession with market forces as a panacea for all problems--we heard a great deal earlier about the so-called centrally planned socialist method of delivering health care in Britain, which served us well for many years-- what we have not heard about is the fundamental problems in delivering health care services according to a market ethos.
They are there in theory, in that the market fails for health care because of externalities, imperfect information and supplier-induced demand. The market fails in neo-classical economic theory and it fails in experience. We need only look at the parlous state of the American health care system, which is the most privatised and market-oriented in the world, to prove the truth of that contention. Even with those gaps, we might suspend disbelief and give the Government the benefit of the doubt, but the omission of the issue of social inequalities, which has rightly been much commented upon by my hon. Friends, finds them out. There can be no realistic or serious preventive health care strategy without an analysis of social inequality, poverty and its ill effects, unemployment and its ill effects, bad housing and its ill effects and--this will be an increasing issue as the market- oriented reforms come through--access to health care for all and increases in charges which deny access and the ill effects that that can have in a preventive health care setting.
It is not my intention to show any disrespect for the often important work that is being done in that area by the regional health authorities, the family practitioner committees, associations, district health authorities and general practitioners, but they cannot be expected to make a good case and fight ill health with one hand tied behind their back.
How can we take seriously any attempt to improve the nation's health which makes no mention, in 125 extremely glossy pages, of poverty and of the proven links between unemployment and ill health and between bad housing and ill health?
If the World Health Organisation's report was an inspiration to the White Paper, why on earth did it take the Government more than 10 years to get around to introducing the first health targets? The WHO initiative was launched in 1978, and it was not until 1988 that the Secretary of State for Wales introduced the first targets in Britain.
Why, if the WHO was such an inspiration to the White Paper, have the Government ignored the first target of that initiative, which aims to reduce inequalities both within
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