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Miss McIntosh: Is the right hon. Gentleman aware that the National Council for Voluntary Organisations conducted another survey that vindicates the Conservatives' view that lottery distribution bodies should operate free from Government interference and that the Treasury should pay for health, education and the environment? Only one in eight thought that they should be paid for by the new opportunities fund.

Mr. Caborn: We can bandy figures around because there is room for debate. All I am citing is the MORI poll—[Interruption.] The hon. Member for New Forest, West (Mr. Swayne) can laugh, but it does no justice to our discussion. The vast majority of hon. Members have made a constructive contribution.

The MORI poll, which was conducted on behalf of two major organisations, set out health, education and the environment as priorities. There has been a positive response to the money for coalfield communities, the new opportunities fund as it relates to schools and for school sports co-ordinators. I have seen projects throughout the

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country that have received investment as part of a major investment strategy by Sport England and know that they have been welcomed across the board. We could make party political capital out of that, but I do not think that it would do any good.

The argument about lottery money for Wembley stadium has been well rehearsed over the years. We hope that progress will be made on it. My right hon. Friend laid down clear criteria against which the decision will be made and we are awaiting the response of the Football Association.

I think that I have dealt with most of the points that were raised. The hon. Member for Upminster (Angela Watkinson) asked about a swimming complex in her constituency. I do not have the relevant details, but I have asked my officials to look into the matter and I shall write to her when I have that information.

This has been an extremely interesting debate, which Labour Members have approached constructively. We believe that the fair shares announcement was necessary and is a move in the right direction. It is part of the process of modernising the lottery and ensuring that it delivers what people want it to deliver. That process is not set in tablets of stone, and it needs to move on from time to time. My right hon. Friend the Secretary of State has set out a programme of consultation that includes the potential for change, and through it we want to take people with us in partnership.

It is totally untrue to say that we have politicised the new opportunities fund or any other aspect of the lottery. The Opposition never say how they would deal with funding demands if they came to power in the next 20 or 30 years. They have already committed themselves to reducing public expenditure to 35 per cent. of gross domestic product, which, in reality, would entail a cut of £60 billion. However, they cannot tell us what they would do with the new opportunities fund. All that they do is whinge and carp and make grandiose statements about cutting £60 billion from public expenditure—should they ever be returned to power. Would they politicise the new opportunities fund? I leave the British people to make their judgment.

Angela Smith (Basildon): I beg to ask leave to withdraw the motion.

Motion, by leave, withdrawn.

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Chest Disease

Motion made, and Question proposed, That this House do now adjourn.—[Angela Smith.]

1.32 pm

Dr. Jenny Tonge (Richmond Park): May I say what a pleasure it is to speak on a health issue for once?

The lack of treatment of respiratory diseases, which I shall also refer to as chest diseases, concerns me greatly. The British Thoracic Society ran a display in the Upper Lobby of the House—I hope that at least some hon. Members saw it—to try to highlight the issue of respiratory diseases. Such diseases kill one in four people in the UK and impose a huge burden on health and the economy. As heart disease cases have decreased, the burden of chest disease has actually increased. In 1999, 150,000 people died from respiratory diseases, 139,000 died from coronary heart disease, and 119,000 died from cancer, excluding lung cancer. In other words, respiratory diseases are the biggest cause of death in the United Kingdom.

Some 43 per cent. of those deaths are due to some form of pneumonia; 23 per cent. to cancer of the lung, nasal cavities, larynx or pleura; 20 per cent. to chronic obstructive lung diseases such as emphysema; and 16 per cent. to rarer diseases such as tuberculosis, cystic fibrosis, acute infection, pneumoconiosis and—believe it or not—choking. Having said that, TB is on the increase again, and choking is a quite common cause of death.

One in five deaths from cancer—one in five—are caused by lung cancer. It is not widely known among the general population that more women die of lung cancer than of breast cancer. Before I leave the subject of lung cancer—many of the issues that I am raising deserve a debate of their own—I understand that my noble Friend Lord Clement-Jones has got through the other place his Bill to ban tobacco advertising, which fell in the last Parliament. Will the Minister tell us what the situation is in respect of that Bill and when, after five years of Labour Government, we will see a ban on the advertising of tobacco, which greatly contributes to deaths from lung cancer?

Death rates from respiratory disease have fallen by a third since 1968, and over the same period deaths from coronary heart disease have fallen by 53 per cent. That is very welcome, but since 1984 the number of deaths from respiratory disease has stayed constant, while deaths from coronary heart disease have fallen by another third, which suggests that we are not doing enough to tackle respiratory disease. I am sorry to give the House even more statistics but it is important to get them on the record. Deaths from occupational lung diseases such as mesothelioma, the asbestos-related disease, have risen, with a 75 per cent. increase between 1988 and 1998. That is another disease that needs a debate all of its own because it is a huge issue.

I recently asked a parliamentary question to find out the cost to the health service of treating respiratory disease, and I received the response that the Department did not have precise details of the cost, but

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The British Thoracic Society has given a figure of £2.576 billion of expenditure in 2000. I do not know what that figure represents as a proportion, but it sounds as if it is rather higher than the percentage given in the response to my parliamentary question. Perhaps the Minister can clarify that.

There are clear socio-economic factors affecting respiratory disease. Men between the ages of 20 and 64 in unskilled manual jobs are much more likely to die from obstructive respiratory disease such as emphysema or tuberculosis, and there are other marked class differentials. They are 40 times more likely than professional people to die from emphysema or chronic bronchitis and nine times more likely to die from tuberculosis. That has implications for our policy on housing and the alleviation of poverty. In the 1990s, 29,000 working years were lost due to respiratory disease in those doing unskilled and manual labour. I find it difficult to get my head around such statistics, but they sound very impressive.

I am also very worried by the rise in the number of cases of pulmonary tuberculosis. There was a 22 per cent. increase in the 1990s, which is horrendous when one considers that when I was a junior hospital doctor we thought the disease was dying out. It was also very disturbing to find out a couple of years ago that we had run out of vaccine. As the House probably knows, that became a saga because only one manufacturer made TB vaccine and it has taken some time to put the situation right. There are questions to be asked about that, including whether all those who should be vaccinated against TB have indeed received the vaccine. I am particularly concerned about 11 to 14-year-old schoolchildren, many of whom must have missed out when no vaccine was available.

World comparisons of respiratory disease rates reveal that the UK has twice as many cases as the European average. Only Kyrgyzstan, Kazakhstan, Turkmenistan, Uzbekistan and Ireland have higher death rates from respiratory disease rates than the UK. That is according to the British Thoracic Society. I find those statistics very depressing.

Another debate could be had on asthma in children. I will not go into great detail, but I am sure that everyone either has someone with asthma in their family, or has a close friend or relative who has a child with asthma. It is a serious problem in this country today. It is thought to be because of traffic fume pollution, but whatever its cause, asthma is the biggest cause of childhood illness.

I could go on quoting statistics damning our neglect of respiratory disease. The extent of the burden of lung disease is largely unrecognised and we need a huge investment in services. The introduction of national service frameworks—NSFs—for other diseases and making health authorities and trusts target other diseases, such as cancer and coronary heart disease, might sound good, exciting and right, but the result is that trusts and health authorities tend to neglect less glamorous diseases that are not the subject of Government targets.

I object to the notion that we are targeting cancer—what does that mean? Cancer varies from a serious or catastrophic illness that kills within weeks or months, to a mild, easily treated illness. What do Ministers mean when they say that they are targeting cancer? Does it not mean that other diseases are excluded from the spotlight?

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I suspect that that has happened to respiratory diseases. Someone with boring old emphysema has little chance of being targeted by anyone, even in the absence of a ban on tobacco advertising.

My local hospital has 1.2 whole-time equivalent—I love that sort of statistic—and excellent consultant physicians to deal with respiratory disease, but the population served by that hospital numbers 330,000. According to the Royal College of Physicians, the British Thoracic Society and the British Medical Association, we should have one specialist per 80,000 people. My local area should have four consultant chest physicians, not 1.2, however excellent the 1.2 are. On 22 January, I tabled a parliamentary question asking the Secretary of State

The answer was:

with either organisation about that subject. Apparently, it is not a big issue in the Department of Health.

My area also has insufficient respiratory nurse specialists to cope, especially in view of the large number of children with asthma; and for 15 per cent. of the year, because of holidays and study leave, we have no chest physicians practising in the area. The majority of patients with chest diseases are not seen by a specialist; they are dealt with by people who have other expertise. Waiting lists for respiratory function tests are increasing, and a significant proportion of lung cancer patients—one of the targeted diseases—are not seen within the two-week national target period because of the lack of consultant manpower. There is no specified acute lung unit or respiratory specialist cover for patients in the intensive care unit.

My constituents and those in other constituencies around our local hospital are extremely badly served in respect of respiratory disease. The only way to improve matters is to get more doctors and nurse specialists. I fully understand why we do not have enough specialists, but we cannot debate the subject without saying what a disgrace and a scandal it was that the previous Government allowed the number of doctors in training—and nurses as well—to fall to such an extent. I could introduce hon. Members to young people in my constituency who have the right A-levels to go to medical school but who could not get a place anywhere because so many medical school places had been cut. That was one of the great national scandals of the last 20 years.

Please will the Minister find us some chest physicians from somewhere, just as the Government are finding surgeons to do joint replacements? Perhaps other countries would oblige and send surgeons here and save our people from the biggest killer in the UK today, respiratory disease. I look forward to the Minister's reply.

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