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Public health medicine needs to be repaired. The hon. Member for Romsey (Sandra Gidley) was concerned about the decline in the number of public health doctors. The chief medical officer tells us that variation in senior public health staffing is unrelated to need and incompatible with Wanlesss fully engaged scenario. We cannot go back to the position in 1974, when public health doctors were directly employed by
local government. We can, however, encourage joint appointments between primary care trusts and local authorities. Directors of public health, however, must hold budgets and have functional accountability to the chief medical officer.
In public health medicine, what matters is what works. In contrast to Labours failure, the Conservative party has a proud tradition of effective public health. From Harold Macmillans home building programme of the 1950s, to our seatbelt legislation that has saved more than 60,000 lives, to the magisterial social marketing campaign of the 1980s that halted the advance of HIV/AIDS in its tracks, we have a pedigree in public health that gives us every right to table this motion.
The Parliamentary Under-Secretary of State for Health (Mr. Ivan Lewis): The Conservative party has no shame whatever. It abolished the word poverty from public policy, while allowing it to become a reality for one in three children. Too often, it has cried Nanny state when it should have offered responsible leadership. The Conservative Government left behind a battered and scarred society, in which public squalor and human misery were the reality for too many families and communities.
Increasingly, however, the Conservative party is caught out facing two ways. In response to the announcement by my hon. Friend the Minister with responsibility for public health of an expansion of activities programmes for inactive people, the hon. Member for Hemel Hempstead (Mike Penning) said in yesterdays newspaper that there is a financial crisis in the NHS, jobs are being lost and wards are lying empty, while money is being wasted on this gimmick. It is a disgrace, he said. However, the shadow Health Minister, the hon. Member for East Worthing and Shoreham (Tim Loughton), said that we have to consider imaginative solutions to get people active. He said that programmes such as Strictly Come Dancing have seized peoples imagination, and that such a good way of keeping fit could keep people healthy and out of hospital.
In The House Magazine, the organisation Forest recently had an advert saying, No thanks to the nanny state, which, it says, tells people not to eat, drink, smoke or think. It attacks politicians for having a dialogue with people about responsible approaches to their health. Big government, it says, is watching. It says, Eat, drink and smoke. At the Conservative party conference in Bournemouth, however, almost 400 people tried to get into Forests fringe meeting, and hospital staff were forced to turn people away, citing health and safety reasons.
The hon. Member for Westbury (Dr. Murrison) seems extremely annoyed about the Health Service Journal publication. He says that it is propaganda. I cannot work out whether it is the photograph of my hon. Friend the Minister with responsibility for public health that concerns him, or whether he is offended by the photograph of feet. The serious point is that using such publications to make the issue relevant and attractive to people is far more effective than boring guidance will ever be.
In contrast to the Conservative party, the Labour partys very raison dêtre is the belief that every individual, irrespective of race, religion or social class, has the right to fulfil their potential. My party has always believed that every child matters, that health care should be available free to all at the point of need, irrespective of ability to pay, and that successful individuals and strong communities march hand in hand in the good society. It is basic to those beliefs that without a healthy life peoples aspirations and potential are blighted, and our society and economy suffer.
We are committed to an enabling state, in which we lead, educate and legislate appropriately, responding to 21st century realities with 21st century solutions. In addition, there is personal and corporate responsibility, with individuals as citizens, parents and opinion formers taking responsibility for promoting healthy lifestyles, and with companies exercising responsibility in the legitimate pursuit of market share and profit margins. We have a proud record, although we always acknowledge that there is a lot more to do on that agenda.
Let me now address some of the important contributions to the debate from hon. Members on both sides of the House. I always admire the honesty of the hon. Member for Romsey (Sandra Gidley). In a recent debate in the House, she said that she regretted the fact that her party had misled older people and their families at the last election by saying that there was a possibility that they would receive free personal care. We will remember that when we see her partys manifesto at the next general election. She made some serious points about antenatal support and breast feeding. We are proud of our healthy start programme, but it is only a beginning. The Department is working on a new plan for maternity services in this country, which will offer choice to every parent and family in every part of the country. The nature of antenatal support and earliest interventions, such as on breast feeding, are a crucial part of that.
The hon. Lady launched a strange attack on the virtues of competitive sport. She said that she was worried about young people going back to playing football and hockey. In my experience, thousands of young people around the country play football and hockey and do so happily. I accept that her point about considering the motivation of every individual young person, and giving them the opportunity to be active, is an important one.
I am always careful about how I respond to myright hon. Friend the Member for Rother Valley (Mr. Barron). I have not yet appeared before the Select Committee of which he is Chairman. He drew attention to the historical scandal of the Conservative party paying scant regard to the question of health inequality. When the Conservatives were in government they actively talked out bans on advertising smoking and the idea of putting health warnings on cigarette packets. They removed nutritional standards from school meals. We all know about the reaction of the hon. Member for Henley (Mr. Johnson), who sits on
the Conservative Front Bench, to those parentspossibly constituents of my right hon. Friendwho stuffed hamburgers through school gates, saying that their children should be allowed to eat what they want. The hon. Gentleman said that he fully agreed with them. What kind of responsible action is that from someone who seeks to serve in a Government of this country? [Interruption.] I know that it is a funny prospect, but there we go.
My right hon. Friend was also right to point out the contribution made by the voluntary sector in local communities. It is often closer to those communities than the state ever can be in getting messages across and influencing the behaviour of individuals and people with whom it has a daily relationship. The Government sometimes have to be much better at learning how to engage with the voluntary sector to get our messages across to local communities.
The right hon. Member for Charnwood (Mr. Dorrell) is in denial about his time as Secretary of State. He was one of the people who refused to make the link between inequality and health, and he perpetuated that approach.
Mr. Dorrell: The Minister makes an assertion that is demonstrably untrue from the record. I was frequently asked whether I acknowledged a link between social deprivation and ill health, and frequently said, Yes,of course I do, and it is one of the functions of the national health service to target resources at eliminating those inequalities. The charge against the Government is that they have not done that effectively.
Mr. Lewis: The right hon. Gentleman was happy to serve in a Cabinet that believed that there was no such thing as society because we are simply a collection of individuals. He was also a pro-European until he sought to be leader of his party. He went to Chequers and gave a press conference, pretending that he had become a Eurosceptic overnight. That is his record.
My hon. Friend the Member for Dartford(Dr. Stoate) has an impressive track record on public health. He is right to say that the Government have taken a power to raise the minimum age for purchasing tobacco. We have just completed a consultation exercise on that and will respond in due course on how we intend to put that power into practice. He and my hon. Friend the Member for Barnsley, East and Mexborough (Jeff Ennis) have done particularly good work on that.
My hon. Friend the Member for Dartford also raised the question of alcohol, a modern menace in society. We all accept that we need to take alcohol, and in particular drinking among young people, far more seriously. We are addressing a number of issues relating to that, such as working with the industry on sensible drinking messages and labelling, our know your limits campaign, and screening and brief interventions. We are also working with the Portman Group to appoint a chair and board of trustees of the Drinkaware Trust, which is a voluntary body.
The hon. Member for Mid-Bedfordshire (Mrs. Dorries) raised several issues, but in none of her contributions has she acknowledged that under-age conception is at its lowest level since the mid-1980s. I would imagine that she would welcome that. I agree
with her about the over-sexualisation of children as a result of gaining access to certain materials. I think we would all accept that the media and other opinion formers in society should take a far more responsible attitude to the way in which sex and sexuality are presented.
The hon. Lady should recognise the achievements and the progress that has been made, as my hon. Friend the Member for North-East Derbyshire (Natascha Engel) did. Last week we announced an additional£1 million to strengthen work on our sustained investment in targeted HIV health promotion for groups most at risk. There has been a large drop in the number of AIDS cases diagnosed and a 70 per cent. drop in AIDS deaths because of the uptake of antiretroviral therapies since the late 1990s.
My hon. Friend said that public health was a hard-core Labour policy. I would not have used that term myself, but I know exactly what she meant. She made a valid point about the work that the Minister with responsibility for public health does every day across government, ensuring that there is a joined-up approach to tackling public health. All too often, that is presented as a sole responsibility of the national health service and the social care system. We need policies across government to tackle social exclusion, and I pay tribute to her work in providing leadership inside the Government and outside in terms of the messages that we give to the general public. My hon. Friend the Member for North-East Derbyshire was also right to raise questions about health education in the school system.
The hon. Member for South-West Surrey (Mr. Hunt) wants a lot more money to be invested, as he would, but he also wantslet us be clear about thisthe measure of health inequality as determining the nature of NHS funding to be removed. That sums up thetrue level of commitment to public health on the Conservative Benches. They want to remove any regard for health inequality as we make decisions about the way in which NHS funding is distributed.
My hon. Friend the Member for Bassetlaw (John Mann) asked me to look at the healthy living centre in his constituency, and the desire to bring sport and education together. He also mentioned the work of the Do it 4 Real organisation. I am more than willing to consider those issues. He asked questions of the Opposition Front Bench, to which he got no answers.
The hon. Member for Wellingborough (Mr. Bone) lectured us on the founding principles of the national health servicefounding principles that the Conservatives opposed at the time and which they have done everything possible to corrode and undermine when in government. Again, he never says that we are bringing up the levels of primary care trust funding, which historically have been below complement. He complained about historical underfunding. He isright: hon. Members should be concerned aboutthe cumulative effect of 18 years of Conservative Government that led to that underfunding.
My hon. Friend the Member for Crawley (Laura Moffatt), who has a great track record of having worked day in, day out in the national health service, talked about the importance of local strategic partnerships, recognising that at a local level we need a partnership between local government, the national health service, the voluntary sector and ordinary peoplefamily membersto tackle the problems and raise our game in terms of public health. She made the point that that cannot be the responsibility of one Department, one organisation or one part of society; it has to be a partnership between the state, the citizen, the family and the voluntary sector if we are to achieve our objectives in this important area.
The Conservatives cannot advocate operational independence for the NHS and no targets, and then claim that they support ring-fenced funding and targets for public health. They cannot portray every reconfiguration as a cut, and then claim to believe in prevention. They cannot adopt economic policies that would mean savage cuts for the NHS and public services, and then claim to be the guardians of public health. They cannot surely keep a straight face in the context of this debate when they propose to scrap health inequality as a key factor in determining NHS funding.
Public health is as much as anything a generational challenge. We are the party of Sure Start and childrens centres; of universal nursery provision; of enhanced maternity and paternity provision; and of parenting support. We are the party of extended and healthy schools; of Every Child Matters and every family matters; of the new deal, welfare to work and affordable housing; and of the minimum income guarantee and the winter fuel allowance. We are the party that has transformed heart and cancer care and the party that has banned smoking in public places. We are the Government who brick by brick are rebuilding society, based on a new settlement between an enabling state and responsible citizens. The Conservative party may be led by a man who smiles a lot, but the British people are not stupid. They know that leadership requires a combination of sound values and practical action. A healthy future is built not on a nice smile, but on a commitment to sustained public investment and a long-term attack on social exclusion and inequality. Public squalor is the Tory legacy; public health is an expression of Labours core values.
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