The Deputy Prime Minister (Mr Nick Clegg): The coalition Government are sorting out the mess they inherited from the previous- [Interruption.] This always gets Opposition Members going from the beginning. The coalition Government are sorting out the mess they inherited from the previous Administration, including a woefully unreformed political system. That is why we are giving power back to Parliament by establishing five-year fixed-term Parliaments, why we are offering the public a choice, for the first time, on using a different and fairer electoral system, and why we will create fairer, more equal-sized constituencies in time for the next election.
"never take advice from those who have secured Government jobs because their self-interest clouds their judgment."
The Deputy Prime Minister: I think the hon. Gentleman asked, "Is he right?", but Lousewies van der Laan is a lady; I think we should get such facts right. As I have said, two parties have come together to repair the damage left by one; it is as simple as that.
Miss Anne McIntosh (Thirsk and Malton) (Con): Does my right hon. Friend agree that the coalition Government are breaking new ground along European lines? Might we send a message to the rest of Europe that actually we do believe in coalition Government in this country?
The Deputy Prime Minister: I certainly agree that in other democracies in Europe and elsewhere the idea of two parties compromising with each other in the national interest is considered to be a good thing. Only backward-looking Opposition Members regard every compromise as a betrayal.
Ms Harriet Harman (Camberwell and Peckham) (Lab): Speaking of which, is not the effectiveness of coalition Government a question of substance? On the substantive coalition policy of tuition fees, the House will want to know how the right hon. Gentleman, as Deputy Prime Minister, is going to vote. Is he going to vote for, is he going to abstain, or is he going to vote against it, as we are?
The Deputy Prime Minister: I am delighted that the right hon. and learned Lady is finally referring to substance. For weeks now Opposition Members have refused to tell the House, or the students demonstrating outside, what their policy is. Is it a blank sheet of paper? Is it a graduate tax or not? The fact is that the proposal we are putting forward-we have a plan; they have a blank sheet of paper-is fairer for students than the system we inherited from the Labour Government.
Ms Harman: We are clear: we are going to vote against the trebling of tuition fees, but the right hon. Gentleman will not tell us what he is going to do. This is about what he said he stood for when he was asking for people's votes. He said that as a matter of principle he wanted no tuition fees and that he would vote against any increase. People will judge him on this. If he votes against, that is the only principled position; if he abstains, it is a cop-out; if he votes for, it is a sell-out. Which is it?
The Deputy Prime Minister: Since the right hon. and learned Lady does not want to discuss her policy or policy in general, let me illustrate what this means in real terms. A care worker who has graduated from university, starting on £21,000 and earning more over time- [Interruption.] No, what people are interested in is what is going to happen to them in practice. Under our proposals, they will pay back £7 a month on average, compared with £81 a month on average under the scheme we have inherited from Labour, and £36 a month on average under the system of graduate taxes her right hon. Friend the leader of the Labour party wants to advocate. I hope that we will now be able to have a reasonable and reasoned discussion about what our proposal actually means for graduates in this country in future.
The Parliamentary Secretary, Cabinet Office (Mr Mark Harper): The Government have not made such an assessment, but the Electoral Commission found in its March 2010 report "The completeness and accuracy of electoral registers in Great Britain" that
"it is likely that the accuracy of the registers remains broadly similar to past decades".
It is clear, however, that more can be done to support accuracy. To that end, I have announced that the Government will speed up the implementation of individual voter registration from 2014, which will ensure that only those entitled to vote get on the register, bringing greater protection against electoral fraud.
Andrew Griffiths: I thank the Minister for that answer. We hear a great deal from Labour Members about the missing 3.5 million people. Can he explain what was done over the past 13 years to help them? What are our Government going to do to ensure that people entitled to vote can do so?
Mr Harper: I am grateful to my hon. Friend for that, and I congratulate him on being elected to the Select Committee on Political and Constitutional Reform, where he can pursue his interest in these matters. He will know that when in government the Labour party did, to be fair, try a number of things, but the things it tried were not successful. We are going to introduce individual electoral registration and we are going to trial data-matching next year, so that we can see whether there are more effective ways of allowing electoral administrators to get people on the register when they are entitled to be on it.
Andrew Bridgen: Does the Minister agree that some individuals deliberately keep themselves off the register because they are partaking in or are aiding and abetting benefit fraud? How does he think we should address that important issue?
Mr Harper: One of the things that we will do on individual registration is ensure that people will have to register with a signature and their date of birth and national insurance number details. Those will be checked against Department for Work and Pensions records to ensure that the voting record database is accurate. One of the things that we will be doing when we trial data-matching next year is looking to see what other benefits can be obtained from those public sector databases.
The Government do not have any current plans to do that, but we keep this area under review. In January, the Electoral Commission and the Association of Chief Police Officers will bring out their report on this year's general election. We will look at their conclusions
to see whether there is evidence of fraud taking place and whether we need to take any further steps to deal with it.
Mr William Bain (Glasgow North East) (Lab): Is the Minister aware of the great efforts made this year by Glasgow city council to increase voter registration? For example, it has worked with minority groups and carried out targeted canvassing. All that work is going to show a big increase in the level of electoral registration tomorrow. Why are his Government not joining good local authorities such as that in Glasgow to get the 3.5 million people not on the electoral register on to the voters roll as soon as possible? Why are they instead rushing to have a boundary review that benefits the coalition?
Mr Harper: I congratulate Glasgow city council, if what the hon. Gentleman says is accurate, because the work it has been doing is excellent. He will know that I wrote to the chief executive of every council in the country suggesting that they work with the Government on our data-matching pilots, to which I referred in a previous answer. We want to examine what steps can be taken to enable local government to look at those public sector databases in order to get more people who are eligible to vote on to the electoral register, as Glasgow city council has done.
Mr Harper: I have a great deal of respect for the hon. Lady, but that question really was not worthy of her. The completeness of the electoral register is as important as making sure it is accurate. It is perfectly reasonable to move towards fairer and more equal-sized constituencies, as this House has made a very clear decision to do, and their lordships will start debating the matter this very afternoon.
Mr Andrew Love (Edmonton) (Lab/Co-op): According to research, the level of registration will fall on the introduction of individual registration, and we need only look at the situation that occurred in Northern Ireland to back that up. This was recognised in the Political Parties and Elections Act 2009. Will the hon. Gentleman take into account the advice given by the Electoral Commission? If it decides that things are being done too quickly to improve the register, will he listen to it?
Mr Harper: I am pleased to say that I can do better than that. We have already considered the experience in Northern Ireland and the hon. Gentleman will know from my statement to the House that that is exactly why we will not remove anyone from the electoral register before the 2015 general election just because they have failed to register individually. We will leave them on the register to give them an extra chance and to avoid the situation that occurred in Northern Ireland, where there was a sudden drop in the number of voters on the register. I hope that that is helpful.
3. Mr Gary Streeter (South West Devon) (Con): Whether he plans to bring forward legislative proposals to amend the provisions of the Parliament Acts 1911 and 1949 as part of his proposals for House of Lords reform. 
The Deputy Prime Minister: I am chairing a cross-party committee to produce a draft Bill on House of Lords reform early next year. The Government believe that the basic relationship between the two Houses, as set out in the Parliament Acts 1911 and 1949, should continue when the House of Lords is reformed.
Mr Streeter: I am grateful to the Deputy Prime Minister for that response, but is it not in the nature of elected representatives to seek to acquire more power unto themselves, as has happened in Wales and Scotland and could well happen down the end of the corridor? Will that not bring an elected upper House into direct conflict with the provisions of the Parliament Acts? What does he propose to do about it if that should happen?
The Deputy Prime Minister: I certainly agree that it would be self-defeating if a reformed House of Lords tried in any way to mimic the House of Commons. Most bicameral systems around the world manage a clear division of labour between one Chamber and another. That is why the devil is in the detail-we must consider how long the terms are for any elected Members of a reformed House of Lords and in what manner they are elected in order to create a clear division of labour between the two Chambers.
Chris Bryant (Rhondda) (Lab): Will the right hon. Gentleman's proposals on Lords reform refer in any shape or form to the historic convention on collective responsibility? I note that the new ministerial code of conduct refers to collective responsibility in exactly the same words as the old ministerial code of conduct, namely by saying that all Ministers must adopt the same position in public, but now contains the extraordinary new phrase,
"save where it is expressly set aside".
There is an extraordinary rumour that the Deputy Prime Minister is thinking of not voting with the Government later today. Surely that cannot be right. Surely he is man enough to stand up and sign up to what he voted for in the general election-or at least to sign up to what he voted for in the coalition agreement. Otherwise, nobody will be able to trust a word he says again.
The Deputy Prime Minister: The hon. Gentleman always gets terrifically excitable, but none the less asks a question that is wholly irrelevant to the subject we are dealing with. That was absolutely nothing to do with House of Lords reform. I think-he was trying to be so clever that it is difficult to tell-he was referring to the coalition agreement and what it says about higher education policy, which is very clear.
The Deputy Prime Minister: As Deputy Prime Minister, I support the Prime Minister on the full range of Government policy and initiatives. Within Government, I take direct responsibility for the Government's programme of political and constitutional reform.
John Mann: A man tours the country telling people that if they vote for him he will abolish tuition fees. When he has the power, he increases tuition fees. What is the best description of the integrity of such a man?
The Deputy Prime Minister: This must be the same integrity that led the Labour party to introduce fees having said that it would not in 1997 and to introduce top-up fees when it said that it would not in its 2001 manifesto. Labour commissioned the Browne review, which Labour Members are now busily trashing. The facts are- [ Interruption. ] I know that the hon. Member for Bassetlaw (John Mann) and his colleagues do not want to hear the facts of our policy, but the facts are that our proposal will remove any up-front fees whatsoever, including for the 40% of part-time students at our universities. The fact is that all graduates will pay less per month than they do under the scheme we inherited from Labour. The fact is that at least one in four of the lowest paid graduates will pay less in total than they do now. That is a progressive package; Labour's was not.
T2.  Jason McCartney (Colne Valley) (Con): Does the Deputy Prime Minister feel that the integrity of voter registration would be aided if electoral registration officers could make inquiries about the validity of suspect applications?
The Deputy Prime Minister: Of course they have the power to do that now. Under the individual electoral registration scheme that we are seeking to introduce, we will ask voters to provide three proofs of identity and residence in order to verify the validity of their claims.
Sadiq Khan (Tooting) (Lab): It is good to see the Deputy Prime Minister at the Dispatch Box. I hope that before the end of these questions he might actually answer one. I am trying to get to the bottom of his and the Government's views on prisoners and voting. In an interview that he gave to The Guardian, when he had another job, he said he believed "the bulk of prisoners" should be given the vote. Is that his personal view or the Government's view? Can he reassure those of us who are concerned about violent offenders and those who have committed sexual offences being given the right to vote that he can today rule that out?
The Deputy Prime Minister: As the right hon. Gentleman well knows, the Government inherited a situation in which a 2005 court ruling had shown our current arrangements to be illegal and to fall foul of court rulings. The previous Government looked at the options for moving into line with the court rulings and there have been a succession of court rulings since then, most recently last week. We will provide our final response on how to make sure that our practices are in line with those rulings in the very near future.
The Deputy Prime Minister: A year ago, the previous Government announced that they would require- [ Interruption. ] It is worth listening to this as a contrast between inaction and action. They announced that they would require the banks to sign up to the code of practice on taxation. Last month, only four of the top 15 banks had signed up, which was in our view completely unacceptable. We want the banks to play not just by the letter of tax law but by its spirit. That is why the Chancellor instructed Her Majesty's Revenue and Customs in October to work with the banking sector to ensure that the remaining banks implemented the code by the end of this month, and I can today confirm that all the top 15 banks have now signed the code. That is an extra 11 banks in one month versus the four that signed previously. [ Interruption. ]
The Deputy Prime Minister: I would be for a system that provided a fair settlement for students. As I said before, unlike the system that we inherited from the hon. Gentleman's party, ours will remove all up-front fees paid by students and will only ask graduates- [ Interruption. ] I know that Opposition Members do not want to hear this because they do not want to talk about policy as they have a blank sheet for policy. We have a plan and they have a blank sheet-that speaks volumes.
T4.  Mr Dominic Raab (Esher and Walton) (Con): I welcome the Deputy Prime Minister's consultation on the freedom Bill. Is he aware that terrorism convictions have plummeted by 91% in the past four years, and will he continue to support the repeal of control orders and the ban on intercept evidence so that we can prosecute more terrorists and defend our freedoms?
The Deputy Prime Minister:
I strongly agree with the assumption and the assertion that the previous Government got the balance wrong between liberty and security. Indeed, I think that is now acknowledged even by that great liberal, the current Labour spokesperson on Home Affairs. That is why we are conducting a review of how
the anti-terrorism powers introduced by the previous Government are operating so that we can tilt the balance definitively in favour of liberty.
Mr David Winnick (Walsall North) (Lab): If the Deputy Prime Minister is so confident on tuition fees, why does he not go to speak to the students who are demonstrating outside now? They would be very interested in his broken election promises.
The Deputy Prime Minister: I heard the hon. Gentleman's leader on the radio the other day saying that he was tempted to speak to the students. When asked why he did not, he said that he had something in his diary-it must have been staring at a blank sheet, which takes an enormous amount of time, does it not?
T5.  Simon Hart (Carmarthen West and South Pembrokeshire) (Con): Could the Deputy Prime Minister update us on his plans for introducing a register of lobbyists? Does he expect the new chairman of Global Counsel, Lord Mandelson, to be on that register?
The Deputy Prime Minister: It must be a measure of Lord Mandelson's confidence in the leadership of the Labour party that he has decided to set up on his own to lobby the Government directly himself. We are indeed moving ahead next year to set up a statutory register of lobbyists.
John Cryer (Leyton and Wanstead) (Lab): A few months ago, the Deputy Prime Minister said, in a personal statement, that he thought the Iraq war was illegal. On that basis, for the benefit of the House could he set out what he sees as the limits of collective responsibility?
The Deputy Prime Minister: As I said before, collective responsibility operates, but this is also a coalition Government, whereby two parties with different views, different traditions and different perspectives have come together to govern in the national interest. That is why we are keen, on both sides of the coalition Government, to stick scrupulously to the open, public coalition agreement that we entered into with each other.
T6.  Priti Patel (Witham) (Con): Given that the Independent Parliamentary Standards Authority is one of the Deputy Prime Minister's policy responsibilities, what action will he take to ensure that IPSA stops spending hundreds of thousands of taxpayers' pounds on its own public relations and its ever-expanding bureaucracy?
The Deputy Prime Minister: I of course acknowledge that there is a great deal of unease on both sides of the House about how IPSA is operating in practice, which is why it is right that its working practices should be reviewed and, where possible, strengthened and improved. However, the fundamental principle that the administration of our expenses, pay and so on is independent remains exactly right in the wake of the terrible damage done to the House by the expenses scandals in the last Parliament.
Mr Angus Brendan MacNeil (Na h-Eileanan an Iar) (SNP): On Lords reform, does the Deputy Prime Minister think it right that those who give large donations to political parties find their way to the House of Lords?
The Deputy Prime Minister: I think we need reform of the funding arrangements for political parties, and we are keen to work on a cross-party basis with all parties in the House to restore public confidence in the way political parties are funded, while at the same time proceeding with reform of the other place, as I described earlier, by publishing a Bill on House of Lords reform early in the new year.
T7.  Greg Hands (Chelsea and Fulham) (Con): The Deputy Prime Minister will recall that last month I asked him about electoral registration fraud in Tower Hamlets. Will he agree to have a look at postal voter fraud, too? In Halifax in May, an astonishing 763 postal votes failed to match voter registration records. Does he agree that evidence is building of systematic electoral fraud in this country, which needs to be investigated?
The Deputy Prime Minister: As the hon. Gentleman knows, electoral registration officers already have the power to look into allegations of abuse, which are in some cases, as he has highlighted, very serious indeed, and where necessary and justified, refer them to the police. That is exactly what I would expect should happen.
The Deputy Prime Minister: I can tell the House what it is above and beyond everything else. It is a contrast with the big state. That was the governing ethos of the previous Government: every problem, every dilemma and every question, it was felt by the previous Government, should be sorted out by officials in Whitehall and politicians in Westminster. We believe- [ Interruption. ]
"intention to set up a commission on the long-standing knotty problem of the West Lothian question by the end of the year."-[ Official Report, 26 October 2010; Vol. 517, c. 154.]
The Deputy Prime Minister: As my hon. Friend knows, reference is made in the coalition agreement to the issue and to the commission that we want to set up to look into it. I am glad to confirm that the Parliamentary Secretary, Cabinet Office, my hon. Friend the Member for Forest of Dean (Mr Harper), who is the Minister with responsibility for constitutional affairs, will be making a detailed announcement on the establishment of that commission before Christmas.
Meg Munn (Sheffield, Heeley) (Lab/Co-op): To prevent the voting problems that occurred in Sheffield and other places, the Electoral Commission recommended changes to administration, which I know the Deputy Prime Minister supports and which I support. The commission also recommended a change in the law. The right hon. Gentleman has stated that he does not believe the law should be changed. Can he tell us on what basis he made that decision and who he has consulted on it?
The Deputy Prime Minister: The hon. Lady has raised this matter before and it is indeed a serious issue. It is a question of trying to match the solution to the problem. Much of the evidence appears to suggest that the real problems were to do with the organisation by certain returning officers and the resources allocated to specific polling stations, not least the one that she and I know well in Ranmoor in Sheffield, where there were particularly long queues. I am open-minded about this but, in my view, simply changing the law without changing the resources provided to those polling stations will not improve the performance of the individual polling stations.
T10.  Nicky Morgan (Loughborough) (Con): What reassurances can the Deputy Prime Minister give to Shepshed town council and many other constituents that they will have the opportunity to give their views on proposed new constituency boundaries before those are finalised?
The Deputy Prime Minister: As my hon. Friend may know, we are tripling the period during which members of the public can provide written submissions as the boundary review is proceeding-up to 12 weeks. If the Boundary Commission comes up with a revised proposal, that trigger starts again and there is a further 12-week period, so in theory there is a six-month period during which members of the public can make their views known. That is a much better system than the party political rigged appeals that prevailed under the Opposition.
Fiona Mactaggart (Slough) (Lab): The Deputy Prime Minister has said that electoral registration officers and others can bring to book and to criminal court those who are charged with electoral fraud. Is he aware that a major barrier to doing that is the cost, and that the Labour party has just had to pay a £200,000 bill for the work it did to expose Conservative council candidates who fraudulently stole a seat in Slough two years ago?
The Deputy Prime Minister: I am afraid I cannot refer to the specific case. The hon. Lady makes her point of principle about the costs, which are important in themselves. Without knowing the details, I cannot comment on the costs of that case, but the ability of electoral registration officers to refer issues to the police and to allow the police and prosecuting authorities to take matters forward must always be protected.
The Attorney-General (Mr Dominic Grieve): The Crown Prosecution Service has an effective domestic violence prosecution policy, with a 29% increase in the number of prosecutions over the past four years and successful outcomes rising from 65% to 72%. In saying that, I recognise the work put in by my predecessors in this office in trying to raise the profile of that appalling crime. The CPS keeps its policy under review and in September 2010 it published guidance on prosecuting stalking and harassment. In January 2011 the CPS will introduce a new local assurance system to support the conduct of domestic violence prosecutions.
Ian Lavery: Given the 24% reduction in the Law Officers' Department's expenditure, will the Attorney-General confirm that he believes that the CPS has the resources that it requires to deliver effectively the violence against women strategy developed by the Labour Government?
Anna Soubry (Broxtowe) (Con): Women's refuges provide not only a safe place for women and their children, but a valuable service in the prosecution of men who have committed offences of violence against women. Will the Attorney-General do all he can to ensure that local authorities do not cut funding for women's refuges, given the service that they provide?
The Attorney-General: I certainly share my hon. Friend's concerns that that area should remain a priority for local authorities. In each case, they will have to adjust their expenditure to the financial constraints upon them, and I am sure that one of the most important things will be for people, such as my hon. Friend and other Members who are aware of the good work in that area, to make those representations quite clear to their local authorities as well as the importance that they attach to them.
2. Mrs Mary Glindon (North Tyneside) (Lab): What assessment he has made of the effects of the recent funding settlement for the Crown Prosecution Service on the provision of funding to witness care units. 
The Solicitor-General (Mr Edward Garnier): None specifically, but I have no doubt that the joint police and Crown Prosecution Service witness care units provide important support to victims and witnesses. In particular, such units have increased the number of effective trials by securing witnesses' attendance at court and improved the overall satisfaction of victims and witnesses with regard to the criminal justice system.
The CPS contributes £5.5 million per year and the police £6.5 million per year to funding those units, and the CPS provides a witness management system for use by police and CPS staff in WCUs. The CPS is committed to high-quality support for victims and witnesses, recognising its benefits to the criminal justice system.
Mrs Glindon: Northumbria witness care scheme has already streamlined its operations without compromising its service to witnesses and victims, and for that it should be commended. Can the Solicitor-General therefore confirm that that successful and efficient service will not be put in jeopardy as a result of the cuts to CPS funding?
3. Mr Jim Cunningham (Coventry South) (Lab): Whether he has had recent discussions with the Secretary of State for Foreign and Commonwealth Affairs on the application of international law in respect of Gaza. 
The Attorney-General: The Foreign Secretary deplored the loss of life during the interception of the Gaza flotilla. He also stressed the need to establish the facts about the incident, without which, if I may say so to the hon. Gentleman, it is impossible to ascertain what laws if any might have been breached and, especially, what was done during the operation to prevent deaths and injuries. My right hon. Friend therefore welcomed the United Nations Secretary-General's establishment of a panel of inquiry into the interception and both Israel's and Turkey's commitment to participate. It is also vital that existing national investigations proceed swiftly, transparently and rigorously to ensure accountability.
Simon Hughes (Bermondsey and Old Southwark) (LD): What discussions and activities does the Attorney-General engage in with either Foreign Office Ministers here or Law Officers in other countries to ensure that countries such as Israel comply with their international law obligations and with United Nations decisions?
The Attorney-General: I certainly consult, and discuss matters with, my right hon. Friend the Foreign Secretary as and when problems arise, and the hon. Gentleman will bear in mind also that my right hon. Friend has legal advisers in his Department who can help him with his work. The United Kingdom takes very seriously international law obligations and the maintenance of international standards of behaviour, and I can therefore reassure the hon. Gentleman that it is a matter with which the Government will continue to engage.
4. Paul Goggins (Wythenshawe and Sale East) (Lab): What assessment the Crown Prosecution Service has made of the likely effect on prosecution rates of the comprehensive spending review settlement for victim support services. 
The Solicitor-General: The Crown Prosecution Service's assessment is that there should be no impact on prosecution rates. May I take this opportunity to thank the right hon. Gentleman for his support for Trafford victim support?
Paul Goggins: I am grateful to the Solicitor-General for his answer, and I am sure he takes very seriously his obligations towards the victims of crime, whose evidence is often crucial. Given the cuts to his Department and to police budgets, however, can he confirm to the House that he will uphold the standards set out in the victims code, and in particular that enhanced services will still be available to intimidated and vulnerable victims and witnesses?
The Solicitor-General: As the right hon. Gentleman knows from his ministerial experience in England and Northern Ireland, and as I am sure he will agree, it is vital that victims are enabled to get their evidence into court. Special measures to protect vulnerable witnesses and intermediaries and other measures are therefore available, and from the work that his Government did and this Government will continue we intend to ensure that victims get their evidence into court-because without the evidence there are no prosecutions.
The Attorney-General: I have regular discussions with the Director of Public Prosecutions on a range of criminal matters. Rape is one of the most serious and damaging of all crimes. I support the work undertaken by the Crown Prosecution Service, with other agencies, to improve the way in which prosecutions are conducted and victims are treated in such cases.
Tom Blenkinsop: What impact does the Attorney-General believe that cuts in police numbers will have on the number of rape cases being investigated and the number of cases being referred to the CPS for prosecution?
Mr Robert Buckland (South Swindon) (Con): Does my right hon. and learned Friend agree that sometimes we lose focus by discussing the process of decision making about prosecution instead of focusing on deficiencies in the investigation of the crime? Particularly with reference to rape, that is a real problem that police forces are having to cope with.
It is absolutely right that the investigation of rape is one of the most difficult tasks for the police. That is for a whole range of reasons, including the difficulties of getting victims to come forward, the problems that the police face in having to look after them properly when they do, and the difficulties of ensuring that they will come to court to give evidence. There are also the problems that have been experienced with victims retracting their evidence. The Crown Prosecution Service, the police and I are very much
alive to all those factors, and we will continue to do all we can to improve the way in which this type of offence is handled.
Catherine McKinnell (Newcastle upon Tyne North) (Lab): The Law Officers will be aware of the case of Sarah, as covered in recent weeks by The Guardian newspaper. Sarah-not her real name-has recently been released on appeal from Styal prison having served 18 days of an eight-month sentence for falsely retracting rape allegations against her husband following alleged intimidation by him and his family. The case raises a number of very serious questions about approaches within the criminal justice system to supporting victims of rape and domestic violence, and there is a risk that it will deter victims from coming forward to report these terrible crimes. Will the Attorney-General meet the Director of Public Prosecutions and me to consider the CPS's approach to prosecuting women in such cases and to discuss ways that we can better support victims and witnesses of crime?
The Attorney-General: First, let me reassure the hon. Lady that the comments made by the Lord Chief Justice in the course of that appeal against sentence are being considered carefully by me and, I have no doubt, by the Director of Public Prosecutions, and I trust that lessons may be learned from the way in which that case was conducted. However, it is also worth bearing in mind, as I am sure that she would acknowledge, that individuals who bring allegations and then retract them pose particular problems within the criminal justice system, and those cannot necessarily just be ignored. The hon. Lady knows that if she wishes to have a meeting with me, I will always make myself available, and if she wishes to meet the Director of Public Prosecutions, the convention has always been that she should have access to him as well.
Robert Halfon: Given the ongoing problems with personal and private data protection, does my right hon. and learned Friend agree that because of the inadequacies of existing legislation, he should recommend to the Government the establishment of an internet Bill of rights so that individuals' ordinary rights are protected?
The Attorney-General: My hon. Friend raises an interesting possibility. At the moment, there is a framework of law which allows wrongful interference with internet privacy to be prosecuted. He will be aware that in July there was a call for evidence by the Government in order to look at this. In 2011, a new European Union protection framework is coming out which will also provide an opportunity to revisit this. Moreover, the Department for Business, Innovation and Skills is looking at the e-privacy directive, which will have to be implemented. There is no lack of consideration of this issue, and if my hon. Friend would like to provide input into that process, it would be gratefully received.
The Solicitor-General: All areas of prosecution policy are kept constantly under review. That said, the Crown Prosecution Service has comprehensive guidance for prosecutors to ensure that decisions in human trafficking cases are taken in line with the principles in the code for Crown prosecutors, taking account of the particular factors that are relevant in human trafficking cases.
Chi Onwurah: In the short time that I have been a Member of Parliament, I have already been approached by a number of women-girls, really-in my constituency who have been trafficked. Not one of them had seen a successful prosecution for their abusers in this country. Will the Attorney-General explain why his Government do not sign the EU directive so that we can do all that we can to ensure that those responsible for this trade are brought to justice?
The Solicitor-General: I will be corrected if I am wrong, but I rather think that we have signed that directive. The Government take issues relating to human trafficking extremely seriously. Indeed, I appeared in the Court of Appeal only the other day on an application to refer a sentence on the grounds of undue leniency and I await the reserved judgment.
Gemma Doyle (West Dunbartonshire) (Lab/Co-op): Earlier this year, the Trafficking Awareness Raising Alliance in Glasgow highlighted evidence that showed an increase in human trafficking during large sporting events. Is the Solicitor-General concerned that the Olympic games in London and the Commonwealth games in Glasgow will increase the threat of human trafficking in the UK? If so, does he agree that signing up to the proposed EU directive is important in the run-up to those events?
The Solicitor-General: I refer the hon. Lady to the answer that I gave to the hon. Member for Newcastle upon Tyne Central (Chi Onwurah). As a matter of general principle, any large event, sporting or otherwise, in this country-the hon. Member for West Dunbartonshire (Gemma Doyle) will appreciate that Scotland is a separate jurisdiction in such matters-that may lead to human trafficking or an increase in human trafficking commands our attention. We will bear down on it as best we can. It is often difficult for the victims of trafficking to have the courage or ability to give evidence, but it is essential that we encourage them to do so and provide them with the utmost protection when they attempt to do so.
As has been outlined in the House, departmental business plans, as launched on Monday 8 November 2010 are designed to provide key
milestones for the fundamental structural reforms being undertaken in a Department, as set out in the coalition programme for government. Where there are currently no plans to undertake major structural reforms, such as for the Law Officers' departments, no formal requirement has been made to create a business plan. Nevertheless, I am keen that the Law Officers' departments are transparent in their activities and that they present information about their priorities and performance in a manner that is understandable to the public. The Treasury Solicitor, Her Majesty's Crown Prosecution Service inspectorate and the National Fraud Authority have published business plans for the current year on their websites. The Crown Prosecution Service, the Serious Fraud Office and my office have internal business plans and consideration is being given to the most appropriate form of publication.
Andrew Gwynne: I am grateful to the Attorney-General for that answer, but given that the Law Officers' Department is in receipt of substantial amounts of public money, why should it not be subject to the same level of transparency as every other Department and have its business plans published on the No. 10 transparency website?
The Attorney-General: I think that the hon. Gentleman is conflating two issues. If he is concerned about transparency in expenditure, he can obtain such information without difficulty. However, I am prepared to consider publishing it in a new form. The business plan of my Department-that is those officials who work for me-has, in a sense, already been implemented. The Department's number of employees has reduced from 60 when the Government came to office to 42 today. It has therefore implemented its savings and streamlined its operations. On the other departments that I superintend, I think that the hon. Gentleman will be able to see their direction of travel on their websites. We will see what we can do to ensure that that is set out with greater clarity.
1. George Eustice (Camborne and Redruth) (Con): What discussions the Speaker's Committee on the Electoral Commission has had with the Electoral Commission on its monitoring of the conduct of the forthcoming referendum on the alternative vote. 
Mr Gary Streeter (South West Devon): The Speaker's Committee has had no such discussions. However, under section 5 of the Political Parties, Elections and Referendums Act 2000, the Electoral Commission must
"prepare and publish...a report on the administration of"
any UK-wide referendum. The findings of its report will be based on evidence collected from a variety of sources, including an analysis of referendum data, feedback from electoral administrators, designated organisations and permitted participants, and public opinion research.
George Eustice: One area where the Electoral Commission is a statutory consultee is the allocation of referendum campaign broadcasts to the designated yes and no campaigns. In a debate such as that on the alternative vote system, about which there are currently very low levels of public understanding, public engagement could be encouraged and increased by having a higher frequency of much shorter referendum broadcasts. What steps is my hon. Friend taking to ensure that the Electoral Commission takes its responsibilities seriously and moves to modernise our system of party broadcasts?
Mr Streeter: Under current law, the BBC and other broadcast organisations must have regard to the commission's views when deciding their policy and rules about any referendum campaign broadcasts. Discussions have already taken place, and the Electoral Commission supports the BBC's proposal to allocate broadcasts on the referendum only to those organisations designated by the commission, which will ensure a fair balance between the yes and no campaigns.
2. Fiona Mactaggart (Slough) (Lab): What discussions the Speaker's Committee on the Electoral Commission has had with the Local Government Boundary Commission for England on the likely effects on its future work programme of implementation of the provisions of the Parliamentary Voting and Constituencies Bill. 
Mr Streeter: The Speaker's Committee and the Local Government Boundary Commission for England have held no such discussions. The LGBCE advises me that parliamentary constituency boundaries are not a statutory or material consideration in its review work.
Fiona Mactaggart: But is the hon. Gentleman not worried, as I am, about the huge variation in ward boundaries in the most recent LGBCE assessments? In the last two, there has been up to a 30% difference between wards in Stoke and Cheshire in the number of voters per ward. Will that not make it much harder to ensure that wards will not be split in the new constituencies envisaged in the Bill? I think most Members would rather avoid that.
Mr Streeter: It is certainly the case that there are variations in the number of electors in certain wards, which is one reason why, in the hon. Lady's own constituency, the LGBCE is about to start work on reforming the wards in Slough borough council. Whether the Boundary Commission for England will take those variations into account is very much a matter for itself, not for the Electoral Commission.
Sarah Newton (Truro and Falmouth) (Con): What recent representations and discussions has the Electoral Commission had with the Deputy Prime Minister regarding the real problems associated with second home voter registration?
Mr Streeter: I am not aware of any recent discussions about that very important matter, which perhaps afflicts hon. Members from the west country more than those from other regions, but I will take my hon. Friend's representations to the Electoral Commission and see whether such dialogue can now take place.
Clive Efford (Eltham) (Lab): Until now, local government boundaries have formed the building blocks on which constituencies are made up. It is important that local communities are understood so that electoral boundaries are easily and clearly understood by people who live within them. May I stress to the hon. Gentleman the need to make the case that local communities must take precedence in all decision making on future and current boundary reviews, which will affect parliamentary boundaries in future?
The Second Church Estates Commissioner (Tony Baldry): Last month the Archbishops of Canterbury and York appointed the Bishop of Carlisle, the Right Rev. James Newcome, as the lead bishop for health care, including the support of hospital chaplains. The Church of England works extensively with workplace chaplains, especially in hospitals, and is keen wherever possible to develop interfaith chaplaincy co-operation. We believe that chaplains of all faiths play a vital role in the support of patients, families and staff in hospitals.
Tony Baldry: Chaplaincy services are central to meeting the spiritual needs of patients, families and staff, and I am glad to note that the Under-Secretary of State for Health, the noble Earl Howe, has recently stressed to hospital trusts the importance of chaplaincy services. We will continue to reinforce that message at every level, because we are all too keenly aware of the importance of chaplaincy services to those who are sick, the dying, their families and the bereaved.
4. Duncan Hames (Chippenham) (LD):
What discussions the Electoral Commission has had with the Deputy Prime Minister on the effect on the electoral
system of accepting young people onto the electoral roll at the point at which they are issued with a national insurance number. 
Mr Gary Streeter (South West Devon): The Electoral Commission has had no such specific discussions. However, it has had discussions with the Deputy Prime Minister about how national data sources can be used to improve registration, including among young people, as part of the Government's proposals for implementing individual electoral registration in Great Britain.
Duncan Hames: Even though the franchise begins at age 18, will the hon. Gentleman acknowledge the benefits to young voter engagement of allowing them on to the register at age 16, when they are issued with a national insurance number, rather than waiting until the year in which they turn 18?
8. Sir Alan Beith (Berwick-upon-Tweed) (LD): What consultation the Church Commissioners have undertaken with organisations in the north-east on the future of the paintings of Jacob and the Patriarchs in Auckland castle. 
The Second Church Estates Commissioner (Tony Baldry): I was grateful for the meeting yesterday that was chaired by the Bishop of Jarrow, which the hon. Lady helped to organise. As a consequence of those discussions, it was agreed that the lord lieutenant of Durham will chair a working party to consider over the next three months whether it is possible for the Zurbaráns to remain at Auckland castle.
Helen Goodman: I am grateful to the hon. Gentleman for that answer and I agree that we had a fruitful if rather cold meeting yesterday. In taking future decisions, will the Church Commissioners take account of the Christian mission in its widest sense because, as he knows, the castle is in a town with some of the poorest and most deprived wards in England?
The hon. Lady highlights the challenge for the Church Commissioners. I was grateful to her for taking me to visit Woodhouse Close church community centre and the Woodhouse Close church, which is in one of the poorest wards in the country. That demonstrates the Church Commissioners' need to raise money to allocate to clergy in such parishes. However, we will
consider carefully and seriously any suggestions that the local community makes that enable us to retain the Zurbaráns at Auckland castle. She must appreciate, however, that they are a drain on, and not an asset to, Church Commissioner funds.
Sir Alan Beith: I welcome my hon. Friend's decision to initiate some new discussions with bodies that are interested in a sustainable future for Auckland castle and the paintings, but will he recognise that the paintings are a precious cultural asset of the north-east region? In their time and to this day, they make a strong statement about the emancipation of the Jewish community in the UK?
The Church Commissioners, by and large, do not possess pictures-we tend to own land and property-but I am in absolutely no doubt of the importance and identity of those pictures, which is why the working party that I mentioned, which will be chaired by the lord lieutenant of Durham, will consider ways in which the Zurbaráns can stay at Auckland castle, but I say that without prejudice to the wider statutory and charitable responsibilities and obligations of the Church Commissioners.
Pat Glass (North West Durham) (Lab): I am not sure that the Church Commissioners fully understand the strength of feeling throughout the north-east about those paintings. I welcome the statement on the working party, but will the hon. Gentleman ensure that it includes representatives from the whole region?
Tony Baldry: The hon. Lady can rest assured that the hon. Member for Bishop Auckland (Helen Goodman) and others left me in absolutely no doubt, in the four hours that we were stuck together in the snow yesterday, as to the strength of feeling about the pictures in Bishop Auckland. We fully understand that feeling, but may I explain? If the pictures were sold, they would generate something like £500,000 a year in perpetuity, which could be applied to funding clergy in deprived areas, not least in the north-east. There is a difficult balance to strike, but we understand the importance of the pictures to the north-east. We will listen, which is why I am glad that the working party, which will be chaired by the lord lieutenant, has been set up.
6. Greg Hands (Chelsea and Fulham) (Con): What discussions the Electoral Commission has had with the Foreign and Commonwealth Office on allowing UK citizens resident abroad to vote at UK embassies and consulates. 
Mr Gary Streeter (South West Devon): The Electoral Commission discussed that issue as part of a round table event with Foreign and Commonwealth Office and Ministry of Defence officials in 2008, but the then Government failed to introduce the comprehensive strategy that the commission sought. The commission, however, has recently repeated its recommendations that the UK Government should introduce proposals for a comprehensive electoral modernisation strategy, including to address how it intends to improve voting opportunities for overseas electors.
Greg Hands: I am sure that overseas electors will be delighted to hear that progress is being made. My hon. Friend will recall that I asked him a similar question last time round, after which I was inundated with e-mails from British ex-pats. One said:
"I have been abroad for 10 years now (ironically, working for the British Government) and have not once received our ballot papers in time to vote".
"As a result of poor planning on the Electoral Commission's part, I was denied my vote."
Mr Streeter: My hon. Friend is a tireless campaigner on behalf of overseas voters. There is no question but that the cumbersome nature of registration requirements and the tight time scales for getting postal votes to and from overseas voters are part of the reason why so few register and vote overseas. As I mentioned earlier, the Electoral Commission has made radical recommendations to the Government about streamlining the procedures, and it is very much to be hoped that the Government will take those on board.
"in the interests of the nation"
The CCT is supporting some 340 church buildings, all of which are of considerable historic or architectural interest. We are grateful for the co-sponsoring by the Department for Communities and Local Government and the Department for Culture, Media and Sport, on a 30:70 basis. This is an issue that is
bigger than just the Church. Some 45% of all grade 1 listed buildings are churches, and those buildings represent an important part of the social history of our nation.
Tony Baldry: My hon. Friend raises an important point about the use of church buildings. The cathedral and church buildings division of the archbishops' council has been working for the last five years to help congregations do everything that they can to work with communities to identify how church buildings can be used creatively to serve the widest community use. We now see extended use of church buildings, including as post offices, shops, libraries, internet cafes, benefit advice centres and citizens advice centres. Wherever possible, we want to see churches as living buildings where as much community activity as possible takes place, and the Church Commissioners will always support such activity.
Tony Baldry: All Church of England clergy seek to give support and personal attention to those getting married, at the time of their wedding. My hon. Friend is to be commended for his work with the South Bedfordshire Community Family Trust, which seeks to provide relationship education and support in partnership with churches-a good example of initiatives taken locally to strengthen and support marriage.
Tony Baldry: This is an issue that we take extremely seriously. The House of Bishops will consider next month what further advice needs to be issued to clergy and to diocesan chancellors to reduce the risk of sham marriages being conducted in our churches. The Bishop of Ripon and Leeds and I will meet shortly with the Minister for Immigration to ensure that we work closely with the Border and Immigration Agency to see that the Church's systems for preventing sham marriages are robust.
The Secretary of State for Health (Mr Andrew Lansley): With permission, Mr Speaker, I would like to make a statement on public health. Today, the Government have published a public health White Paper with two clear aims: first, to protect and improve the health of the nation; and secondly, to reduce health inequalities by improving the health of the poorest fastest.
The need for this White Paper is beyond question. Britain currently has among the highest rates of obesity and sexually transmitted infections in Europe. Smoking still claims 80,000 lives a year. Alcohol-related admissions to hospital have doubled in the last seven years. In recent years, inequalities in health have widened, rather than narrowed.
"dramatic health inequalities are still a dominant feature of health...across all regions."
There is a seven-year gap in life expectancy between the richest and poorest neighbourhoods, but a gap of nearly 17 years for disability-free life expectancy. About a third of all cases of circulatory disease, half of all cases of vascular dementia and many cancers could be avoided by reducing smoking, improving diet and increasing physical activity.
We need to do better, and we will not make progress if public health continues to be seen just in terms of NHS provision and state interventions. Two thirds of our potential impact on life expectancy depends on issues outside health care. Factors such as employment, education, environment and equality are all determinants of health. They are, as Michael Marmot put it,
"the causes of the causes"-
the underlying factors leading to poorer health. Unhealthy behaviours, such as drinking too much, smoking or taking drugs, are part of a complex chain of individual circumstances and social causes, typically rooted in poor aspiration, adverse peer pressure and low self-esteem.
The human cost of poor health is obvious, and so too is the financial one. Alcohol abuse costs an extra £2.7 billion and obesity an extra £4.2 billion each year to the NHS alone. Although there are things we can do to help, we cannot resolve all the difficult issues from Whitehall. Hence the White Paper has one clear message above all others: it is time for politicians to stop telling people to make healthy choices, and start helping them to do it. There will be a profound shift in tone, attitude and outlook. Rather than nannying people, we will nudge them by working with industry to make healthy lifestyles easier; rather than lecturing people about their habits, we will give them the support they need to make their own choices; and rather than dictating policies from the centre, we will support leadership from communities, by giving local authorities more power to develop the right approaches for their communities.
The White Paper is a genuine cross-Government strategy. Through the Cabinet Sub-Committee on Public Health, we will put good health and well-being at the heart of all our policies. To do so, we will recognise that we need to provide support at key times in people's lives. We will not only measure general well-being; we will seek to
achieve it. For instance, because we know a mother's health is key to a child's health and development, we are investing in 4,200 more health visitors working with Sure Start children's centres to give families the support they need; because we know those who are unemployed for long periods are more likely to be admitted to hospital and more likely to die prematurely, we are transforming the welfare system, ending the benefits trap and making sure that work always pays, through a single universal credit; and because we know more people would cycle to work or school more often if there were safer routes for them to use, the Government are investing £560 million in sustainable transport.
Subject to parliamentary approval, there will be a new dedicated public health service-Public Health England-which will provide the resources, the ideas, the evidence and the funding to support local strategies. Public Health England will bring together, within the Department of Health, expertise from a range of public health bodies, including the Health Protection Agency, the National Treatment Agency for Substance Misuse and the chief medical officer's department. It will work with industry and other Government Departments to shape the wider environment as it affects our health. It will also develop health protection plans and screening programmes to protect people from health risks.
The foundations of good health are rooted in the community, often at a neighbourhood level, so we must strengthen and renew local leadership to ensure that these efforts reach deeply into communities and match their unique circumstances. Under the White Paper, the lead responsibility for improving health will pass to local government for the first time in 40 years. We intend to give local authorities new powers to plan, co-ordinate and deliver local strategies with the NHS and other partners, and to embed the foundations of good health in ways that fit local circumstances. Directors of public health will provide strong and consistent leadership within local councils. We also intend to establish the new local statutory health and well-being boards as a way of bringing together the NHS and local government.
Whereas before, public health budgets were constantly raided by other parts of the NHS, we will prioritise public health spending through a new ring-fenced budget. We will look to the highest standards of evidence and evaluation to ensure this money is spent wisely. The new outcomes framework for public health, on which we will consult shortly, will provide consistent measures to judge progress on key elements across all parts of the system-national and local. The framework will emphasise the need to reduce health inequalities, and will be supported by a new health premium, incentivising councils that demonstrate progress in improving the health of their populations and so reducing health inequalities.
We have learned over the last decade that state interventions alone cannot achieve success. We need a new sense of collective endeavour-a partnership between communities, businesses and individuals that transforms not only the way we deliver public health, but the way we think about it. Through the public health responsibility deal, the Government will work with industry to help people make informed decisions about their diet and lifestyle, to improve the environment for health, and to make healthy choices easier. Through greater use of voluntary and community organisations, we will reach
out to families and individuals, and develop new ways to target the foundations of good health. Reflecting the framework in the ladder of interventions developed by the Nuffield Council on Bioethics, we will adopt voluntary and less intrusive approaches, so that we can make more progress more quickly and resort to regulation only where we cannot make progress in partnership.
This is a time when the NHS and social care are under intense pressure from an ageing population and higher costs-a time when we must therefore put as much emphasis on preventing illness as we do on treating it. In the past, public health has been a fragmented and forgotten branch of the health service. This White Paper will make it a central part of everything that we do, and we will bring forward legislation in the new year to enact these changes. By empowering local authorities, strengthening our knowledge of what works, and establishing the right incentives to drive better outcomes, this White Paper will deliver the strategy and support needed to reduce health inequalities and improve the nation's health. I commend this statement to the House.
John Healey (Wentworth and Dearne) (Lab): I thank the Secretary of State for advance sight of his oral statement. I am sure that the House will also thank him for the advance copies of the White Paper, which were available before he made his statement.
"take a radical new approach to public health".
Today he has published the White Paper, and it falls far short of his hype. He has had six years in opposition and six months in government to prepare for this White Paper, but it will disappoint many of those who are most committed to better public health in this country and most concerned that we still have a great deal further to go. For the most part, this White Paper is not new. It is not clear how it will help to improve public health, and it is not a guarantee that the big gains made in the last decade-in cancer screening, healthy food in schools, stopping smoking and free flu vaccines, as well as the big cut in deaths from heart disease-will be continued.
However, in the spirit of responsible opposition, let me tell the Health Secretary that we can offer general support for his aims, which are very similar to those that we set out in our White Paper in 2004. I can promise him close scrutiny of his actions and those of his Government, because as the White Paper says, good public health depends on much more than what the NHS does. As he said in his statement, education, employment, environment and equality are the causes of the causes of poor health. However, the Government's wider policies, which will lead to higher unemployment, poorer housing, greater poverty and an end to the Sport for All programme in schools, will do more damage to public health than his White Paper will do good, and more to increase health inequalities than his plan will do to reduce them.
So what did the Health Secretary say to the Chancellor about policies that will see a third of a million public sector staff on the dole? How hard has he argued against the Education Secretary's plan to axe the school sports partnerships, which have seen three times as many children playing competitive sport than six years ago, and nine out of 10 children playing more than two
hours of sport each week? Why is it that everyone else in the Government is set to make announcements affecting public health-on alcohol taxation or pricing, for example -except the Health Secretary? Far from being, as he said, a genuine cross-Government strategy, the White Paper-like his last one, on NHS reform-shows that this a Health Secretary working alone and operating largely in isolation from the rest of Government.
There is nothing new in "nudge", except the soundbite and how hard the Secretary of State is pushing it. We set out the importance of individual decisions and incentives, alongside the need for support services and Government action, in our White Paper on public health in 2004. The test for the Health Secretary is whether the Government will act when they can and when they are needed, especially to protect children. The legislation is in place to end point-of-sale displays of cigarettes. The evidence is there and the experts are clear. Cancer Research UK says that
"we need to put tobacco out of sight and out of mind to protect all young people. The Government has the opportunity to act with conviction and reduce the devastating impact that tobacco has on so many lives."
There is little new in this White Paper, and little is clear about how its plans will improve health and reduce health inequalities. It is 96 pages long but short on detail. We welcome in principle the lead responsibility for improving health being passed to local government, but can the Secretary of State guarantee the powers and the funds that it will need to do the job? Will he confirm that public health outcomes will also be part of the operating frameworks for the NHS and social care, because it would be a disaster if the NHS were now to decide that public health was not its job?
We are concerned about the Secretary of State's responsibility deals. What exactly does he mean by that? What influence will industry have over future health policy? What does he say to the Liverpool health expert and Tory adviser, Professor Simon Capewell, who said that health experts on the public health commission
"were outnumbered and outvoted by people from Tesco, Diageo, and other food and drink manufacturers-and the Commission went with what the industry wanted...which is a scandal"?
We welcome the health inclusion board and the new national public health service, although we thought that this Government were committed to cutting, not creating, quangos. But is not the fact that the inclusion board will tackle the health needs of groups such as homeless people, drug users, alcoholics and sex workers an admission that GPs on their own do not know, and will not commission, what they need for the future?
Is not this one of the first in a series of bodges that will be needed to make the Secretary of State's massive reorganisation plans for the NHS actually work? Whatever he says, we and the public will judge him on what he does. Will he ensure that his £3 billion internal reorganisation of the NHS does not damage public health? Will he take tough decisions about Government action on tobacco? Will he make and win the big arguments in government about the damage to health that comes from no work, poor housing and bad education? In government, it is deeds that count, not words.
Mr Lansley: I am grateful to the right hon. Gentleman for his support for the strategy that is set out in the White Paper. However, he then proceeded to aim off in every other direction. He said that I was in opposition for six and a half years, and, indeed, I made it very clear six years ago that when we came back into government, we intended to ring-fence the public health budget, to create directors of public health who were accountable to the NHS and to local authorities, and to establish a public health service that was more independent and more effective. His Government could have adopted those proposals six years ago, but they simply did not do so.
What was the record of the right hon. Gentleman's Administration? Obesity rates in this country are way above average; in fact, they are among the highest in Europe. Alcohol-related admissions to hospital have doubled in seven years. Sexually transmitted infections are up by more than two thirds in the last decade. Even smoking rates have not changed. Parliament approved a smoking ban in public places, but in the most recent years, there has been persistent prevalence of smoking. It has not gone down in the past year. One in five of the population are experiencing mental ill health at any given time. Those are the records of the Labour Government on public health. Inequalities have widened. In life expectancy, the gap has widened. In infant mortality, the gap has widened. On their own measures, the Labour Government failed in public health, and we are going to put in place a strategy that is truly effective.
Some of the leading international experts, including Sir Michael Marmot, have welcomed what is in the public health White Paper today. The public health profession also welcomes it, because it knows that we are committed to addressing the wider determinants of health. My colleagues across Government are direct participants in the Cabinet Sub-Committee that is delivering this strategy, which is the starting point for public health delivery. Not all the details are in here. We are going to move on to a tobacco control strategy, a physical activity plan, an obesity strategy, alcohol strategies and a range of other responses to the public health threats that we face, and we are going to do that across Government. Only today, my right hon. Friend the Chancellor of the Exchequer announced that we would do what we said we would do, and increase duty on the strongest beers while reducing it on some of the weaker ones, thus beginning the process of incentivising and nudging.
The right hon. Gentleman asked about the responsibility deal. Let me give him an example. In 2004, the last Labour Government said that they would introduce front-of-pack food labelling. They wanted to introduce a single traffic-light system. All that fell apart in utter confusion. There was never a consistent front-of-pack food labelling system. The last Government never worked with industry; they worked against industry, and what was the result? A variety of different systems, and nothing consistent for the public to look at.
Only by working together on a voluntary approach will we start to make progress more quickly, whether it is on labelling, reformulation or activity with employers in the workplace. We will make progress, we will do it more quickly, and we will regulate only when necessary, rather than resorting to regulation and, as the Labour Government did, failing to make any progress and failing to regulate. That is not a basis on which we can deliver the public health improvements that we need.
This is a starting point for a public health strategy that will deliver the improvements in public health that the country requires. We are a Government who are committed to those improvements. They are central to improving well-being, and our strategy will deliver them.
Mr Stephen Dorrell (Charnwood) (Con): I congratulate my right hon. Friend the Secretary of State on a White Paper that redeems his pre-election pledge to raise public health to a higher level of priority than was accorded to it not merely by the last Labour Government, but by the Conservative Government in which I held my right hon. Friend's responsibilities. I congratulate him on delivering the first step towards that commitment, and particularly on the transfer of public health responsibility to local government. The White Paper proposals will fulfil the promise to make public health a cross-Government responsibility, and will deliver what has been described as the "fully engaged scenario". That is the only way in which we can deliver our broader public health objectives.
Mr Lansley: I am grateful to my right hon. Friend for his comments. Derek Wanless said that we needed an "engaged" scenario back in 2002, but it simply did not happen. I know that many in public health feel that the transfer giving local government the lead responsibility on public health-which is radical and new-will, in many respects, bring public health back home. It allies the public health initiative and resources to the responsibilities of local government on economic development, the environment, planning, housing and education in precisely the ways that will influence the wider determinants of health.
Frank Dobson (Holborn and St Pancras) (Lab): I welcome the Secretary of State's proposal to return public health to local authorities, from which a Tory Government took it away, but why did he not mention housing in his statement? It is widely accepted that homelessness, poor-quality housing, overcrowding and insecurity of tenure are major causes of both mental and physical ill health, and a major cause of inequalities in health.
Mr Lansley: I am grateful to the right hon. Gentleman for his support. In fact, I did mention housing. However, I have also established in the Department a health inclusion unit-derided by those on the Labour Front Bench as a quango, although it is not one-whose purpose will be to focus specifically on some of the most excluded communities, such as the homeless and Traveller groups. Life expectancy in some of those groups can be in the 40s, and the gap in life expectancy and the health inequalities are a scandal. I have appointed Professor Steve Field, formerly of the Royal College of General Practitioners, to lead it, and I think that he will do a fantastic job in ensuring that the NHS, as well as local authorities, reaches out to deliver the health improvement that is needed.
Stephen Williams (Bristol West) (LD): I welcome the White Paper in general, and particularly welcome the commitment to rigorous and evidence-based policy-making. I commend to the Secretary of State the latest report of the all-party group on smoking and health, which I chair, entitled "Inquiry into the effectiveness and cost-effectiveness of tobacco control". May I give the Secretary of State and his ministerial colleagues a strong nudge to implement as soon as possible the orders on control of the display of tobacco that were passed in the last Parliament?
Mr Lansley: I am grateful to my hon. Friend for his comments. As in a number of other areas I have mentioned, we will publish a strategy in due course, and a tobacco control strategy will be published in the new year. Parliament voted for the display regulations and we are looking into that, but we have to balance the evidence on health improvements with the impact of such a measure, particularly the burdens on small retailers. We are also currently examining the option of plain packaging of cigarettes, which the last Government did not do. That might in itself be an important measure to reduce both the visibility of cigarettes and the initiation into smoking of young people in particular.
Mr David Blunkett (Sheffield, Brightside and Hillsborough) (Lab): Not so much nudge as fudge on this issue. Why will the Secretary of State not accept that giving those displaying tobacco and cigarettes time to adjust by allowing them to implement the regulation this time next year is good common sense? Is it not the case that the Government's refusal to acknowledge the implementation of this regulation passed by Parliament can only be explained by there being an ideological objection to protecting young people in particular from the incitement to buy?
Mr Lansley: I am afraid the right hon. Gentleman is simply wrong about that: we have made no announcement, and I have said we are considering it. More to the point, I have said we are also considering the question of plain packaging of cigarettes, which is being pursued by a Labour Administration in Australia, and which his Administration did not pursue.
Nadine Dorries (Mid Bedfordshire) (Con): The White Paper states that we are going to provide easy access to confidential non-judgmental sexual health services. Will that include better counselling for women seeking an abortion, and will that counselling include the information that has so far been withheld from women seeking a termination?
Mr Lansley: The support for women seeking the termination of a pregnancy should include the fullest possible information about the nature of that procedure and its consequences. Consent should always be fully informed.
Mr Kevin Barron (Rother Valley) (Lab): There is much merit in what the Secretary of State has announced. Will the new outcomes framework, which will provide consistent measures to judge progress on key elements, include smoking cessation figures? As he well knows, 50% of our health inequalities in this country are created by tobacco use.
Mr Lansley: We will publish a consultation on the outcomes framework soon, but smoking cessation and the absence of initiation into smoking are clearly very important. Smoking is still the single largest avoidable cause of early mortality, and we must try to reduce further the prevalence of smoking. It has not been reduced in the last couple of years, and we need to reduce it.
Mr Lansley: All councils will be supported to develop health improvement strategies. When we come to publish the consultation on the funding of the public health budget, that will set out how, in addition to the resources used nationally, there will be significant resources in a ring-fenced budget for local authorities. Because of the nature of the health premium, that budget will be significantly weighted towards areas of greatest disadvantage and poorest health outcomes.
Joan Walley (Stoke-on-Trent North) (Lab): Whatever Government were in power, I would welcome an enhanced role for environmental health officers in improving public health policy. Given the depth of the coming cuts to local authority budgets, however, there is real concern, regardless of the ring-fencing statement we have had, as to whether there will be sufficient resources and capacity for environmental health officers. Does the Secretary of State intend to have an environmental health officer at chief officer level inside the Department of Health?
Mr Lansley: I have had discussions with environmental health officers and they are enthusiastic about the opportunity for much greater synergy between their work and public health responsibilities. They see their role as integral to the achievement of public health. Indeed, some of the greatest public health improvements of the past were initiated in local government and through responsibilities that are currently within environmental health legislation, so I am looking to the health and well-being boards to bring these responsibilities together more effectively.
Dr Sarah Wollaston (Totnes) (Con): Is my right hon. Friend aware that about 30,000 people a year in this country die as a result of alcohol, and that Department of Health modelling has shown that if we were to increase the minimum price per unit to 50p we would save over 2,000 lives a year? Will he look at the proposals published in the British Medical Journal to have variable rates of VAT so we can increase the price without penalising the on-licence trade?
My hon. Friend will know that the Chancellor of the Exchequer made an announcement today about the level of duty on beers, in particular. We have made it clear, in the coalition agreement and since, that we will act to ban the below-cost selling of alcohol. I think that that will make a significant difference. We will also in due course publish an alcohol strategy, through which we will examine a range of ways in which we can not only enforce the current legislation more effectively, but create an environment in which we
progressively reduce the abuse of alcohol. It is very important for us to understand that we must distinguish between our relationship with tobacco, whose use we want to minimise-we want to encourage people never to use tobacco-and our relationship with alcohol, where we are seeking its responsible use, rather than seeking to penalise people who engage in responsible drinking.
Mr Lansley: The health visitor programme is not funded by cutting anything else; it comes from within the NHS budget, because we regard providing support to families when babies first come home and offering a universal health visiting service that signposts other resources to help families as absolutely integral to the improvement of health in the future. That is funded from within what was an historic commitment from this Government to protect the NHS budget and to increase it in real terms over the next four years. We are going to fund this from within the NHS resources.
Paul Maynard (Blackpool North and Cleveleys) (Con): Males in the Blackpool part of my constituency have only a 56% probability of reaching the age of 75. Can the Secretary of State tell me what measures in the White Paper will help to promote the act of ageing and allow more of my constituents to reach a milestone that many of us take for granted?
Mr Lansley: I am grateful to my hon. Friend for his question. Many aspects of the White Paper and subsequent strategies relate to these issues. In the long run, his constituents will find that the measures that have an impact early in life or which work through early intervention will make the biggest difference, as was made clear in Sir Michael Marmot's review, in which he talked of a universal proportionality. Such measures include, for example, our universal health visiting service and family nurse partnerships, which are intervening at that stage. If we have not succeeded through early intervention, however, or many people have chronic ill health, we will continue to ensure through our screening programmes and local health improvement plans that people are identified early and opportunities are created for them to make lifestyle decisions that will improve their chances of disability-free life expectancy thereafter.
David Cairns (Inverclyde) (Lab): I welcome the acknowledgement in the White Paper that about 25% of HIV cases in this country are currently undiagnosed. Will the Secretary of State therefore lend his support to the "Halve It" campaign, which is being launched tonight by the all-party group on HIV and AIDS, which I chair, with the Terrence Higgins Trust and others? The campaign aims to halve that number by 2015. That will mean fewer early deaths, fewer cases of HIV being spread and, ultimately, significant savings for the NHS.
I agree with the hon. Gentleman. Almost 22,000 people with HIV are unaware of their condition. We need to ensure, through the sexual health services,
that people have consistent access to HIV testing and are encouraged opportunistically to ensure that they are HIV tested so that we can deliver the services they need. What he describes is one of the opportunities that we can examine when considering how the outcomes framework will measure the performance of local health improvement plans.
Mr Charles Walker (Broxbourne) (Con): I have just learned that for the past year Hertfordshire primary care trust has been plotting to close the enormously successful urgent care centre in Cheshunt. If that happens, can the local authority step in, if its finances allow, to run the urgent care centre?
Mr Lansley: I was not aware of what my hon. Friend describes, and strictly speaking it does not relate to the White Paper. None the less, it will remain the case that local authorities, through current overview and scrutiny arrangements or future scrutiny arrangements, have the ability to ensure that major service changes of that kind are subject to scrutiny. If such changes are not justified in the interests of local people, they can be referred to me and I can seek the independent reconfiguration panel's advice.
Emma Reynolds (Wolverhampton North East) (Lab): The Health Secretary rightly underlined in his statement the importance of tackling obesity. Is there any truth in the suggestion that he has expressed concerns that plans to dismantle the school sport partnerships will exacerbate the problem of tackling childhood obesity and has he discussed those concerns with the Education Secretary?
Mr Lansley: No; the hon. Lady should not believe what she reads in newspapers. The Education Secretary is not scrapping the school sport partnerships; he is providing the resources directly to schools so that they can make the decisions on how they promote sport. From my point of view, I have always made it clear-this has been the burden of my conversation with my colleagues-that we are already supporting school sports clubs in secondary schools through Change4Life. We intend to maintain that and to expand the role of Change4Life, linking in to primary schools so that we stimulate activity and exercise for young people overall. That is entirely complementary to how schools, using their own resources, stimulate sport. With regard to competitive sport, they will be assisted additionally through infrastructure funding for the new school Olympics.
Dr John Pugh (Southport) (LD): I congratulate the Secretary of State on his long-standing and personal commitment to public health as the best way of dealing with health inequalities. How do we stop GPs operating in silos and prescribing pills where they might prescribe exercise? How do we join up the pieces?
I am grateful for that question. The answer has two parts. First, the general practice-led commissioning consortiums will be members of the new health and well-being boards in local authorities to which I referred. They will participate in the joint strategic needs assessments and strategies through the commissioning framework, the outcomes framework and the quality and outcomes framework, which applies
directly to general practice. The less we focus on processes, and the more we focus on outcomes for patients, the more general practice will be focused on preventive solutions, because they will deliver good outcomes at relatively low cost. To that extent, the preventive agenda in general practice and community health services will be incentivised through a focus on outcomes.
Mr Lansley: I must disappoint the hon. Gentleman. We will publish shortly-I hope before Christmas-the consultation on the funding arrangements. We started by establishing the baseline spend for public health, which was never identified under the last Government. It has taken months even to get to the point where we can establish what it looks like- [ Interruption. ] The hon. Member for Leicester West (Liz Kendall) mentions Julian Le Grand from a sedentary position. He did good work, but it included the whole of maternity services as a public health service. Julian Le Grand and Health England's work arrived at the figure of £4 billion. In fact, the baseline is in excess of £4 billion, but its composition is completely different. We will set out shortly the structure and proposals for funding local authorities' public health activity.
Mike Weatherley (Hove) (Con): Given my right hon. Friend's voting record in the last Parliament, and indeed that of most Government Members, will he advise the House what specifically he is looking to achieve through the tobacco display ban analysis?
Mr Lansley: Through our tobacco control strategy, I am looking to achieve, as we will set out, a continuing reduction in smoking prevalence. In particular, I want to identify how we can substantially reduce the initiation into smoking among young people.
Kate Green (Stretford and Urmston) (Lab): I genuinely welcome the Secretary of State's recognition of the importance of a cross-Government approach to tackling health inequalities. He will be aware that Sir Michael Marmot identified income as one of the most important determinants of health. Will the Secretary of State make representations to his colleagues the Chancellor and the Secretary of State for Work and Pensions to ensure that everyone can have an adequate income, from those reliant on out-of-work benefits to those who are in employment?
I understand the hon. Lady's point. Sir Michael Marmot has generously welcomed the White Paper's proposals and its thrust. He made a specific proposal about a specific standard of living related to health-effectively a basic income proposal. That is not the Government's proposal, but we intend to act on the other five domains in his report, the effect of which, among other things, will be to ensure that the welfare to work programme-the most ambitious and comprehensive programme ever initiated by any Government in this country to take people off benefits into work-will support people not only through better disability benefit assessments, which will help in health assessments, but
by ensuring that people in work are healthier because they are less likely to be poverty and more likely to be free of the distress associated with unemployment.
Mrs Anne Main (St Albans) (Con): In St Albans we are lucky that people live for quite a long time, but often elderly care packages are not put in place to allow elderly care patients to come out of hospital and into adult social care services. Will the proposals in the White Paper to give local government more control help to ease this problem?
Mr Lansley: As my hon. Friend may know, we are acting already. Through the spending review we have made very clear the NHS commitment to support local authorities in the delivery of adult social care responsibility, particularly through the integration of health and social care. That includes £70 million this year for re-ablement, £150 million in the next financial year for more re-ablement activity and nearly £650 million in the next financial year in direct support from the NHS for preventive and other activities to support social care. That will make a big difference to her constituents.
Diana Johnson (Kingston upon Hull North) (Lab): Hull city council's recent record is of raising sports charges, blocking free swimming, axing free healthy school meals, dragging its feet on smoking and allowing junk food outlets to open near schools. In the light of that record, I am concerned about local authorities taking control of public health. What safeguards will there be regarding local authorities whose public health agenda is more from the era of "Life on Mars"?
Mr Lansley: There we have it: the Labour party as the opponent of local government. I am sure that people will recognise that when we arrive at local government election time. The Labour party has never trusted local government but we are going to trust it. We are going to give it not only greater freedoms but greater powers and responsibilities. Not every local authority will be brilliantly successful, but at least local authorities are directly accountable to the people who elect them-those for whom the authorities will deliver services.
Philip Davies (Shipley) (Con): Many of the measures that my right hon. Friend proposes, such as the plain packaging of tobacco, forcing responsible drinkers to pay more for alcohol in supermarkets than they otherwise would and, bizarrely, forcing employers to allow women to breastfeed at work are a triumph not for public health but for the nanny state-something that we thought had gone out with the previous Government. Why is he still so wedded to the nanny state?
I am wedded to achieving improvements in public health. Interestingly, today I have been accused both of being an exponent of the nanny state and of having abandoned it in favour of "nudge". The truth is that, as one sees in the White Paper, there is a clear philosophy here that we will pursue a voluntary approach, regulate only where necessary and seek to have less intrusive and less interventionist approaches in order to make more progress more quickly. If we do not make progress through voluntary approaches, we will of course still have to protect the public's health and we will seek other measures to do so, but they have been tested to
destruction by the previous Administration. It did not happen-they did not succeed and they did not improve public health-but we are determined to do so.
Clive Efford (Eltham) (Lab): The Secretary of State consistently comes to the House and announces policies that seem to have been written on the back of a fag packet from the Minister of State, Department of Health, the hon. Member for Chelmsford (Mr Burns), but in his explanation on this morning's "Today" programme the Secretary of State could not even make his mind up about the fag packet. Does he understand that the time allowed for the implementation of legislation that has been passed by the House was meant to allow people who are consequential in delivering that policy enough time to plan for it? The delay that he has introduced has made it more difficult for people such as the newsagents whom he spoke about in his statement because they have to prepare. Are we going to have branding or not? Will packets be on display or not? What is the Government's policy?
Mr Lansley: I think that I have already answered that question. The hon. Gentleman at least among Opposition Members seems to have understood what it is to be in opposition: the point is simply to oppose and that is all he is doing. This is a positive statement and he should address it in that light.
Mr Edward Timpson (Crewe and Nantwich) (Con): Does the Secretary of State agree with local GPs in my constituency that one way to help reduce health inequalities and spend money in the NHS better is to review reporting mechanisms in the NHS and how they impact on referral decisions, particularly in-house referrals?
Mr Lansley: Yes. I know that the GPs in Cheshire are a very go-ahead group and I am looking forward to seeing how they take on these responsibilities. I have seen GPs recently make presentations showing that they can really take a grip on referral patterns. They can see referrals not just in terms of trying to interpret patterns and numbers, but on the basis of clinical judgment. The combination of clinical judgment and understanding and knowledge of commissioning and contracting leverage is the basis from which we can improve overall the commissioning of activity for patients.
Andrew Gwynne (Denton and Reddish) (Lab): The Secretary of State mentioned that the Government are investing £560 million in encouraging sustainable forms of transport, such as walking and cycling, but given that the Department for Transport is systematically un-ring-fencing many of the transport budgets for local government, what guarantees can he give that that pot of money will be spent on that specific purpose?
We have been very clear in the spending review and subsequent announcements that we will take the ring fence off many of the grants provided to local government, because we trust local government and we expect those in local government who are responsible for such things to be accountable to their electors. Where public health is concerned-this is separate from the point the hon. Gentleman makes-NHS money will
be ring-fenced in the hands of local authorities for health gain. There will be many appropriate uses, so the ring fence will in no sense, I hope, have a constraining effect.
Dr Daniel Poulter (Central Suffolk and North Ipswich) (Con): I am sure that, like me, the Secretary of State recognises that different population groups offer and present different public health challenges; for example, the Asian community has higher rates of cardiovascular disease. Does he agree that the White Paper presents an excellent opportunity for local authorities to address specific local concerns that are relevant to their NHS populations?
Mr Lansley: Yes, I do. My hon. Friend is absolutely right. The structure proposed in the NHS reform White Paper in July was to bring local authorities and the NHS together to undertake joint strategic needs assessments leading to a combined strategy. Understanding the causes of ill health, and understanding where ill health is occurring and where the greatest areas of unmet need are in a community, will impact positively both on NHS commissioning and on local authorities.
Fiona Mactaggart (Slough) (Lab): I welcome the proposal to give public health responsibility to local government, but will the Secretary of State assure the House that his intention is to build on proven successful initiatives, such as the family nurse partnership that works with teen mothers in my constituency, and health advocates? In contrast to GPs who, when offered an opportunity to give out membership of slimming clubs, managed to give only one in six months, health advocates managed to gain about 2,000 regular participants in slimming clubs, thus helping to deal with the obesity problem in Slough.
Mr Lansley: I am grateful to the hon. Lady. At least I know that she supports the proposal to transfer the responsibility to local government-not something I discovered from the reply of the right hon. Member for Wentworth and Dearne (John Healey). The short answer is that I have already announced that over the next four years we will double the number of family nurse partnerships, so we shall indeed support them. More than that, as Sir Michael Marmot made clear, it is vital that we combine the targeted support that the FNPs can give and a restored universal health visiting service to help every family as they start out.
Mark Lancaster (Milton Keynes North) (Con): One of the clearest indicators of health inequalities is life expectancy. In two near-neighbouring wards in Milton Keynes, there is a variation of 12 years, which is a staggering figure. How can we address this problem?
Mr Lansley: My hon. Friend is absolutely right. The truth is that we know we have to take action nationally, and we will, not only through health protection but through much more effective health screening, immunisation programmes and an early start in the health visitor programme, for example. It will be for his local authorities and communities to get together to ask how they can address the inequalities. That will be vital to achieving health improvement in his community.
Ms Gisela Stuart (Birmingham, Edgbaston) (Lab): Last year, Birmingham had about 500 confirmed cases of tuberculosis and there were calls for the city council to have compulsory city-wide inoculation programmes. Under the Secretary of State's newly conferred powers, is that something that local authorities could now do?
Mr Lansley: No; the response to infectious diseases will continue to be the responsibility of the Department of Health, with a more integrated Public Health England incorporating the responsibilities of the Health Protection Agency and recommendations from the Joint Committee on Vaccination and Immunisation and others. There was a lot of important debate about the discontinuation of the BCG inoculation. My view is that targeted action in areas with high prevalence of TB-as there is in a small number of places-is more appropriate than the introduction of any generalised inoculation at this stage.
Pat Glass (North West Durham) (Lab): Is not part of the problem the way in which Departments continue to operate in silos, so the Secretary of State for Education can cut the school sports initiatives with no impact on educational outcomes, but massive impacts on health? The Department of Health can consistently underfund children's health services such as speech therapy and mental health, with very little impact on the Minister's Department but massive impact on education outcomes. Is the statement not just evidence of more silo working?
Mr Lansley: That is all complete nonsense. On sport and activity in schools, my right hon. Friend the Secretary of State for Education is supporting schools and mainstreaming funding for sport and physical activity into school budgets; my right hon. Friend the Secretary of State for Culture, Olympics, Media and Sport is working to support competitive sport and the sport Olympics; and I am working to stimulate physical activity through Change4Life school sports clubs, increasingly in the primary sector as well as in the secondary sector. We are working on all that together and it is entirely complementary.
Dr Julian Lewis (New Forest East) (Con): Given the commitment to popular choice, can my right hon. Friend confirm that when responsibility for putting fluoride into drinking water is taken away from strategic health authorities, the people who have the final say on the matter will be the people who drink the water?
Mr Lansley: The responsibility will be transferred to local authorities, and they will have the same obligation to consult their population as exists in the present legislation. In my view, local authorities are more accountable to the population that they serve than strategic health authorities have been in the past.
Catherine McKinnell (Newcastle upon Tyne North) (Lab):
The Secretary of State said in his statement that politicians need "to stop telling people to make healthy choices" and actually help them to do it. He said that
they need to stop nannying people, but nudge them "to make healthy lifestyles easier", and that "rather than lecturing people...we will give them the support they need to make their own choices". Can he explain how failing to implement the tobacco display policy is forwarding those aims?
Mr Lansley: The hon. Lady does not seem to understand. We have made no announcement in relation to the tobacco display regulations- [Interruption.] They were approved by Parliament before the election. We have made it clear that we are looking at a tobacco control strategy. I made it clear just now at the Dispatch Box that, beyond anything done by the previous Government, I am considering the question of the plain packaging of cigarettes, which in itself could be a significant additional weapon in our armoury to reduce the initiation of smoking among young people and the visibility of cigarettes. When we publish a tobacco control strategy, we will weigh up the wide range of such factors.
Robert Halfon (Harlow) (Con): Harlow parents will welcome the extra support for Sure Start, particularly after the scares from the Opposition at the last election. Will my right hon. Friend set out the measures that the White Paper takes to support other local charities that do so much to combat drug and alcohol abuse in my constituency and elsewhere?
Mr Lansley: I entirely agree with what my hon. Friend says. I appreciated visiting a children's centre in Roehampton just this morning to see how it was bringing together all the opportunities. Important among those was the relationship with health visitors and their signposting role in relation to that service and others. Through the White Paper, we will, in a number of respects with which I shall not detain the House now, focus on how we can work with social enterprises, the voluntary sector and charities in order to deliver health improvements. As that will involve factors such as behaviour change, the ability of charities to work with people at a personal level and to be highly innovative will be important in making it successful.
Margot James (Stourbridge) (Con): I welcome the liberation of public health from its ivory tower. It will be able to do much more good in the real world. Can my right hon. Friend say a little more about how the health and well-being partnerships might work with businesses, the police and other relevant agencies to reduce alcohol-related admissions to hospital?
Mr Lansley: When we publish the alcohol strategy, there will be more to say about that, but it is already clear that we can do much more on local community alcohol partnerships, which have demonstrated their success in places such as St Neots in Huntingdonshire, so that enforcement and work to prevent young people from purchasing alcohol when they should not do so is much more successful. We can also work much more effectively on improving alcohol labelling, and we are working through the responsibility deal to look at those opportunities, too.
James Morris (Halesowen and Rowley Regis) (Con): I welcome the Secretary of State's statement. Does he agree that in local areas it is important for local government to work closely with the voluntary sector, particularly on preventive mental health services?
Mr Lansley: Yes, I entirely agree. The extent to which charities and the voluntary sector can initiate new ideas is woefully underestimated. This is not just about local authorities, and still less about central Government saying, "Here is a programme, would charities like to bid to run it?" Even more importantly, we must be clear that charities should now come forward to anticipate the resources needed to improve public health, and to suggest their own innovations to deliver better health for their communities.
Mr David Burrowes (Enfield, Southgate) (Con): My right hon. Friend will recognise the description of alcohol treatment as a Cinderella service, which is sadly not just a seasonal description but often the soft target of cuts by PCTs. I therefore welcome the opportunity in the White Paper for pooled budgets and for co-ordination between public health service directors and children's services directors to prevent and tackle alcohol misuse.
Mr Lansley: I am grateful to my hon. Friend, because I think that through these measures we will help to integrate drug, alcohol and sexual health services, rather than see them in silos. Even in primary care trusts, those services have often been treated as completely discrete activities, because they have been related to specific targets that central Government have set, rather than part of an holistic community view of how we improve health.
"There is strong anecdotal information from within the NHS which tells a...story for public health of poor morale, declining numbers and inadequate recruitment, and budgets being raided to solve financial deficits in the acute sector."
Andrew Percy (Brigg and Goole) (Con): I support any moves to reduce the use of tobacco throughout the country, and that is why I support the smoking ban so much, but will the Secretary of State assure us that when we look at the tobacco display ban we will consider all the international evidence from countries such as Canada and Ireland, which have found that the ban has not been the slightest bit effective in reducing the number of people who smoke?
Mr David Evennett (Bexleyheath and Crayford) (Con): I welcome my right hon. Friend's statement and, in particular, the ring-fenced public health budget and the increased role for local authorities. Is he aware that under the previous Government many PCTs cut funding for public health and plugged gaps elsewhere?
My hon. Friend makes a very important point, and that was not all that happened. On the money available to primary care trusts for what is termed the healthy living programme, there is no correlation between how much trusts spend relative to health
deprivation, so in places with the poorest health outcomes trusts on average do not spend any more on discretionary health improvement activity. That is why our proposed health premium is so important. The places with the poorest health outcomes will clearly have the money they need to undertake specifically preventive work to raise health outcomes.
Bob Blackman (Harrow East) (Con): I warmly welcome the proposals to transfer public health to local authorities and, indeed, the ring-fencing, but will my right hon. Friend clarify how we will enforce the spending of that money on public health, so that there are no blurred edges and local authorities cannot fund their other services from within that ring-fencing?
Mr Lansley: I bow to my hon. Friend in his understanding of local government. My experience and understanding of local government is such that I know that the people involved are very concerned about improving health in their communities, and these resources will be available for that. Those people will not only be accountable to the people who elect them but accountable through the incentive mechanism of the health premium for the delivery of improving outcomes in the reduction of health inequalities. They will have an in-built incentive in the funding system to use those resources to deliver the outcomes that are collectively agreed, co-produced with local government. If they do not do so-if they spend the money elsewhere-they will not see the increase in resources that would otherwise flow.
Anne Marie Morris (Newton Abbot) (Con): Given the Secretary of State's support for Sure Start, will he clarify his plans for Home-Start, as several families in my constituency are concerned that it will lose funding?
Mr Lansley: I will write to my hon. Friend about that. We are very clear that we are going to introduce a universal health visitor service, which has been lost in recent years. That element of universal support to all families when babies first come home is an absolutely integral part of getting them on the right path. We think that not just targeted but early support for all families will have disproportionate benefits in the long run.
Andrew Griffiths (Burton) (Con): I applaud the Secretary of State's commitment to tackling alcohol misuse and his determination to ban below-cost selling. However, does he share my concern that a definition of below-cost selling that is duty plus VAT, which would still allow supermarkets to sell a bottle of wine for £1.90 or a can of lager more cheaply than a can of Coca-Cola, will fail to deliver the outcomes that he is looking for?
Mr Lansley: My hon. Friend tempts me to pre-empt announcements which properly fall to my colleagues in the Home Office. I will leave it to them, if I may, to make those announcements, and we will debate the issue then.
Mr David Nuttall (Bury North) (Con): Is my right hon. Friend aware that in Bury people will be happy and prepared to take responsibility for their own health provided that there are fully functioning children's and maternity, and accident and emergency, departments at Fairfield hospital?
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