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House of Commons

Friday 20 July 1990

The House met at half-past Nine o'clock


[Mr. Speaker-- in the Chair ]

Good Health

9.34 am

Mr. Roger Sims (Chislehurst) : I wish to call attention to the importance of promoting good health, and I beg to move,

That this House, noting that good health is to be valued and enjoyed, recommends the adoption of healthier lifestyles to help protect against major disabling and premature death causing conditions such as heart disease, stroke and cancer ; and urges the National Health Service to increase its efforts to promote such good health, through increased use of preventive measures such as vaccination and immunisation, screening services and the widespread dissemination of advice and information.

This Session we have spent a good deal of time discussing the proposed reforms of the national health service. Inevitably, there has been a great deal of emphasis on the treatment of injury, illness and disease. This morning I am inviting the House to turn its attention to steps which can be taken to avoid the incidence of injury and particularly of illness and disease.

The concept of preventive medicine is not new. The House will recall that in 1978 the World Health Organisation in the declaration of Alma-Ata issued a challenge to the world under the heading : "Health for all by the year 2000."

That involves a continuous programme of action. In 1985 the European office of the WHO defined 38 targets for the countries within its region. I have a copy of the booklet which summarises those 38 targets with me today, but the House will be relieved to learn that I do not intend to work my way through them all. Many of those targets concern aspects of preventive medicine.

The Government fully endorsed the principles underlying the "health for all" strategy, and issued a monitoring report covering the period 1985 to 1988. That report is available in the Library and I commend it to hon. Members as an impressive account of what has been done so far. When my hon. Friend the Minister for Health contributes to the debate, I hope that she will be able to assure us that there is a continuous programme aimed towards the targets of health of "Health for all by the year 2000", and tell us whether there are plans to issue another monitoring report to show what progress has been made. I want to put two propositions to the House. The first is that each individual has a responsibility in deciding what to eat, what to drink, how to conduct his personal life--in short, to use the jargon, to determine his or her life style. The individual has a responsibility to use available knowledge to minimise the likelihood of disease and illness and to maximise good health. My second proposition is that it is a Government duty to introduce and to implement policies that will encourage healthier living and

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discourage harmful activities. The Government should issue advice and information as freely as possible so that people can make informed decisions.

I am not this morning--or, I hope, at any other time--preaching or advocating nannying. I am reconciled to the fact that I will be accused of both those things, and probably of trying to restrict the freedom of the individual. There is a certain amount of double thinking on these issues. If we tell people that smoking can kill them, that excessive alcohol is harmful or that too much fatty food is bad for them, they tell us that we are trying to interfere with their private lives. However, if salmonella or listeria come to light or a drug is found to be harmful, the Government are immediately criticised for not making more information available, for not taking action and for not taking action sooner.

Surely it is right, and the responsibility of Government, to alert people to the facts and to tell them the consequences of their actions. If people choose a life style that is harmful, that is up to them--it is a free country--as long as they know what they are doing and, of course, they are not causing harm to other people by their actions.

However, a healthy life style benefits the nation as a whole. Human misery apart, disease involves heavy cost in terms of the lost productivity of goods and services, and the cost of treatment. The cost to the national health service of treating smoking-related diseases, to take just one example, is £500 million per year. What could we do with that sort of money in the health service? One way of promoting good health is through health checks. Some companies have schemes for their employees--we are fortunate in having a similar scheme in the House. In any event, an increasing number of doctors are now offering what my own general practitioner rather delightfully calls "MOTs". It is curious that we think it important that, after a certain age, cars should be regularly checked to ensure that they are roadworthy, but that we do not encourage such checks on their drivers. It is now the usual practice for GPs to carry out basic tests such as on blood pressure, when seeing patients, regardless of the reason for which the patient is attending the surgery.

This week I was interested to note that my right hon. and learned Friend the Secretary of State for Health has issued for discussion the report of the Standing Medical Advisory Committee on blood cholesterol testing, which has examined the cost-effectiveness of opportunistic cholesterol testing. That means that, whenever the opportunity arises, such as when a patient visits a doctor, the patient should be tested for blood cholesterol. The report is interesting, and suggests that such opportunistic testing would be well worth while. I hope that that idea will be pursued.

The new doctors' contract encourages doctors to provide health clinics and to give patients free yearly check-ups. The contract obliges doctors to carry out such checks on the elderly. I find that admirable, although it is difficult to reconcile it with deterring people from having eye and teeth checks by charging them. I have demonstrated my views on that issue previously both in speeches and in my votes, and I shall not labour the point now, although I live in hope that Ministers will come to see the inconsistency of their policies on that.

The new contract also encourages child immunisations and cervical screening. The Government are developing programmes for both cervical and breast cancer screening. The patient's involvement is voluntary, but one cannot

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over-emphasise the importance of women over 20 taking advantage of the cervical cancer screening facilities which are becoming increasingly available, and of women over 50 taking advantage of the breast cancer screening facilities. However, when a women is tested, she should know the results within one month. That is the deadline that has been laid down by the Government. A delay of three months is simply unacceptable.

The House will recall that, last year, the Public Accounts Committee drew attention to coronary heart disease and urged improvements to the campaign to prevent it. The Committee made some telling comparisons between the costs of that campaign and the costs of treating the disease. In the context of coronary heart disease, the blood cholesterol report to which I have referred emphasises the importance of other factors, especially smoking and diet. The House will not be surprised if I say a few words about smoking, which is the largest avoidable course of illness and premature death. It is estimated that 110,000 people each year die before their time through smoking and that 90 per cent. of the deaths from lung cancer, bronchitis and emphysema are due to smoking. The evidence of the harm caused by tobacco products is overwhelming.

Happily, the incidence of smoking has declined, but as one third of the population still smoke, that proportion is still far too high. Especially worrying is the extent to which smoking is prevalent among young people, particularly girls. I commend the efforts of the organisation Parents Against Tobacco, with which my hon. Friend the Member for Ealing, Acton (Sir G. Young) is much involved. That organisation concentrates on ensuring that the law that makes it illegal to supply children with cigarettes is enforced. If the tobacco companies can encourage children to smoke, the chances are that they will have customers for life. There is no doubt that, if tobacco were invented now, it would never be allowed on the market. We must be realistic : it would not be practical to ban the sales of tobacco products completely. But what are the Government doing to try to reduce the extent of smoking? The Government spend £5 million per annum through the Health Education Authority and ASH on persuading people not to smoke. The tobacco industry spends £100 million per year trying to persuade people to smoke.

Why do the Government allow smoking advertisements? I grant that the present advertising is subject to controls, but how are those controls decided? We are told that they are decided by voluntary agreement, but that means that the Government and the industry sit around the table and have a cosy chat. The Department of Health officials say what restrictions they would like and the tobacco industry suggests the restrictions that it is prepared to wear, and a compromise is reached. That is not a voluntary agreement ; it is negotiated agreement. The fact is that the Department of Health is party to a negotiated agreement about how to promote the sales of a product that we know to be deadly in its effect.

I should like a complete ban on tobacco advertising and its promotion, especially when that promotion is associated with sport, which seems particularly cynical. I favour far stricter controls on advertising. I was sad that the Government opposed the EEC directive on health

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warnings. A draft directive is now under discussion, which involves strict controls on advertising. Only two Community countries are now opposing the proposals--West Germany and the United Kingdom. Why is the United Kingdom opposing the terms of that directive?

The increase in the tax on tobacco products was welcome, and one hopes that it will be steadily maintained. There is no doubt that increasing the cost of cigarettes dissuades people from smoking. Incidentally, it is worth reflecting that, at present, 1p on a packet of 20 cigarettes brings in about £40 million. In the next Budget, how about increasing the cost of cigarettes by at least the rate of inflation plus that extra penny, and devoting that £40 million to health education? While we are about it, would it not be sensible to take cigarettes out of the retail prices index, because it is illogical to include them?

Meanwhile, I welcome the increased adoption of non-smoking areas and, in some cases, of complete non-smoking policies in workplaces, restaurants, pubs and public places and such recent prohibitions on the underground and suburban trains.

Mr. Alex Carlile (Montgomery) : Will the hon. Gentleman join me in commending the British Medical Association, which recently sent out an invitation to a large number of doctors to attend a reception? It said on the bottom, "Black tie, no smoking." Does he share my anxiety about the number of doctors in practice today who smoke?

Mr. Sims : Yes, I endorse both the hon. and learned Gentleman's comments, but particularly the latter one. Doctors do not set a good example.

The more organisations and places that have no-smoking policies, the better. I was delighted to learn that this week Air Canada decided to introduce a complete ban on smoking on all its flights.

Mr. Toby Jessel (Twickenham) : Has my hon. Friend noticed that it is increasingly difficult for passengers who arrive comparatively late and check in perhaps only 40 or 50 minutes before take-off, to book a non- smoking seat? It seems that airlines are behind the public demand for smoking and non-smoking seats. Is not there a case for the Department of Health to suggest to Transport Ministers that they and their counterparts in other countries should discuss with airlines how airlines can keep ahead of the public demand instead of behind it and allocate more seats for non- smokers?

Mr. Sims : Yes, my hon. Friend is absolutely right. Another interesting example is the London surburban trains on which I travel daily. The trains used to have three non-smoking carriages and the fourth was a smoking carriage. Increasingly, one found that the only carriage in which one could get a seat was in the smoking carriage because more and more people wanted to sit in the non-smoking one. Now British Rail has recognised the very point that my hon. Friend makes and the train is completely non-smoking. I have not received any letters of complaint and I have not heard that any have been written. The arrangement has been generally accepted. Such policies discourage smokers. That must in itself be good. It certainly makes life more pleasant and healthier for others. There is increasing evidence of the harm that can be done by inhaling other people's smoke--passive smoking, as it is called.

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I also mentioned diet. That can be more difficult. At times it is hard to distinguish between advice from experts and advice from eccentrics. Fashions change. Different reports come from different quarters and can cause confusion. At different times we have been told that butter and sugar are either good or bad for us. The latest advice this week is that we should all eat garlic. That is an interesting suggestion but an anti-social one.

The Government have their own advisory bodies on foodstuffs. Perhaps we should consider a way in which the definitive, authoritative recommendations on food matters can be given wider publicity. Some basic principles have been established. As a general rule, we should limit our consumption of fatty foods, sugar and salt and eat plenty of fibre. The House will be pleased to note that porridge has now been established as particularly good for us. The Food Safety Bill now going through the House deals with the marketing of food products. It is important that we should know what we are eating and its quality. It is equally important that in legislation from the House or in EEC directives the restrictions are not such that they prevent producers from making legitimate claims for their products.

The House will be familiar with the "Look after your Heart" campaign, which recently celebrated its third anniversary. I was pleased that the booklet about the health service, which has been put through every door and has caused some controversey, on which I shall not comment, includes the "Look after your Heart" pamphlet. The pamphlet incorporates some particularly useful and easily read quick-reference guides on matters such as eating, exercise, alcohol, smoking and so on. I hope that it will be widely read. Perhaps even those who are not completely in accord with the Government's NHS reforms will realise the value of inserting the "Look after your Heart" campaign pamphlet in the booklet.

I mentioned alcohol a few moments ago. The booklet to which I referred reads :

"Drinking can be enjoyable and safe, as long as you don't overdo it. But too much alcohol can be bad for your heart and liver and cause problems at work, with family and friends."

Perhaps I should declare my interest. The House will be aware that I am parliamentary adviser to the Scotch Whisky Association. I can say with every confidence that the association would wholeheartedly endorse that advice.

Moderate consumption of wines and spirits does one no harm. Indeed, it may do one good. I am sure that I am not alone in occasionally enjoying a whisky at the end of a busy day. But there is no doubt that excess is harmful. I also enjoy a glass of beer from time to time. I am glad to see the increasing popularity of the low-alcohol beers and lagers, which I now find quite palatable. It is encouraging to see the extent to which young people drink low-alcohol drinks and soft drinks, particularly if one of a party intends to drive.

Dr. Kim Howells (Pontypridd) : Does the hon. Gentleman agree that, increasingly, problems are surfacing among young people as a direct result of over-consumption of alcohol, often by people who are below the legal age to drink? Does he further agree that that is partly due to the continuing glamour and style of presentation of alcohol in advertisements? Young adults continue to believe that it is glamorous to drink hard drinks and that it makes them look like the glamorous people in advertisements. Does the hon. Gentleman agree that the rules on alcohol advertising should be tightened?

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Mr. Sims : Yes. Of course, spirits are not advertised on television. Some of the drinks that are advertised on television or elsewhere are given a certain aura and glamour, which is not appropriate. It is a pity that some young people are influenced by those advertisements. Young men in particular seem to think that it is manly to drink far more than is good for them. It does them no credit. It makes them rather disagreeable socially and does a great deal of harm to the health.

I wonder whether we should consider doing more to support youth clubs and other facilities. I am sure that one of the problems in some areas is that pubs are the only place for young people to go. Of course, when one goes to a pub one has a beer, then another and then another. That is something that we should examine.

We must accept that, sadly, some people become addicted to alcohol. I commend the work of the alcohol advisory services, such as my local one, which are often started by volunteers. They merit support from the district health authority, which mine receives, because their work is saving national health service expenditure. The issues surrounding alcohol have been addressed by the ministerial group on alcohol misuse. Perhaps when my hon. Friend the Minister speaks she can tell us a little about its present work.

Another factor in health promotion is exercise. All credit to some of our parliamentary colleagues who take part in the London marathon. It is a little beyond most of us. Within the precincts of the palace we have a gym, which is a valuable facility used by many members of staff. There are an increasing number of private gyms in places such as the City, which are well used. There is an argument for giving some sort of financial incentive to employers to provide gyms for their staff. The extent to which private gyms are used suggests that the facility would be much appreciated. Indeed, it would be in the interests not only of the staff, but of the company to keep its employees fit.

Jogging is a simple form of exercise that appeals to some. I enjoy a weekly swim. The problem there, as with several other sports, is the limited number of facilities and the expense of providing them. Some of the best sports facilities are in our schools. Although some schools make their facilities available to the community, others lock their doors evening after evening and throughout the weekend, which is a pity. With the introduction of local management of schools, some governors may consider making the facilities on the school premises more available to local people when they are not needed by the school. In that way they would make a contribution to the community and to community health. They could reasonably make a modest charge, which would add to school funds.

One of the themes of my motion and my remarks is the need for our fellow citizens to be well informed about health and how to promote their own good health. One source of advice is one's general practitioner and another is the local pharmacist. He or she is always ready and willing to play a part in promoting good health in the community and to give advice and information. Chemists are also a valuable means of disseminating a whole range of good material produced by organisations such as the Health Education Authority and the British Heart Foundation, whose pamphlets are reflective, well presented and readable. I am sure that hon. Members will be familiar with the publication "Pharmacy Healthcare".

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It is the report on a scheme to provide freely information on health care issues through community pharmacists. It has done well and is worth expanding.

Whatever steps are taken, injury, illness and disease will occur and sometimes unexpectedly, for example, an accident in the home or on the road or a heart attack. If someone who happens to be on the spot can render first aid, it may literally make the difference between life and death. The July issue of Which? carries an interesting article on first aid. It explains how easy it is for people to take a variety of courses in first aid. People should be encouraged to do so. Again, perhaps employers could give employees time off for a course to ensure that several people within the company are well trained and able to carry out first aid, should the need arise, as is happily the case in this building.

I have had some correspondence with my local director of education on the matter and I was rather surprised to learn that

"there is no statutory requirement for a First Aider to be present at Schools.".

He did go on to say :

"We do obviously feel that this is beneficial and we encourage both teaching and non-teaching staff to participate in the First Aid training."

I had asked him to what extent first aid training was available to pupils, to which his reply was :

"There is not a lot of time to encourage First Aid with pupils." With the new curriculum, that is understandable, but I should have thought that it would be valuable if first aid training was made available to pupils immediately after school. I am sure that many youngsters would be interested in it. Certainly, St. John Ambulance or Red Cross would be happy to provide instructors.

I have taken the advantage of having won first place in the ballot of private Members' motions to address the House for longer than should normally choose. I am aware that even then, I have not touched on a whole range of issues that are relevant to health promotion. Acquired immune deficiency syndrome, for example, almost merits a debate on its own. On the whole, the Government have conducted a good campaign in an extremely sensitive area. Whatever they said or did, they were bound to be criticised.

I have not mentioned housing, which is relevant to health, or pollution. In the past day or two we have seen some of it and the figures show the frightening amount of pollution over London because of the present weather conditions. Family planning is an important part of health promotion. All those are relevant factors and perhaps later in the debate some of my hon. Friends will address themselves in greater detail to those topics.

Mr. Jessel : I have agreed with almost all of my hon. Friend's speech until now. Can he explain why family planning is relevant to health promotion? It is not a disease for a woman to give birth to a baby.

Mr. Sims : How long do we have? I should have thought that plenty of examples spring to mind, where the general standards of health of a family and its individual members are lower than they might have been, had the mother been able to take family planning advice and restrict her family. Any health visitor could answer my hon. Friend's question in great detail. He may well wish to pursue the point later.

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Mrs. Teresa Gorman (Billericay) : I intervene so that we can have a woman's voice in this, as family planning generally concerns women more than men. Before we had family planning, the most frequent cause of death for women was from illegal abortions. Just one statistic is that 5,000 women a year died in that way. Dr. Marie Stopes and other pioneers introduced family planning because such deaths were the cause of misery and large families had difficulty raising their children. That is how the family planning movement began. For women, it is one of the most beneficial developments in preventive medicine that I can think of.

Mr. Sims : I am obliged to my hon. Friend for that intervention, which confirms my point that family planning is an aspect of health promotion. Other hon. Members may deal with that issue later in the debate.

I hope that I have demonstrated that, as I suggested in opening, there is much that the individual can do to enjoy a healthy life and to minimise calls on the national health service, that there is much that the Government are already doing, but that there is plenty of scope for them to do more. That is the message that I endeavour to convey in my motion, which I hope commends itself to the House.

Mrs. Audrey Wise (Preston) : I agree with the statement : "The best prescription for good health is decent housing, pure water and clean air-- all of which need a government committed to good public services and high standards for the environment."

That is a quotation from the Labour party document entitled "Looking to the Future", which will be the basis of the policy of the next Labour Government. During my remarks I shall refer to some of the points made in that document.

The hon. Member for Chislehurst (Mr. Sims) was right to refer to housing. I appreciate that he could not deal with the issue at length because, as he said, he has raised a many-sided subject and time is limited. But I wish to emphasise that many families are desperate because they are homeless. I refer not simply to the young homeless but to those who are statutorily homeless, people with children and pregnant women. It is impossible to be healthy and homeless. It is a contradiction in terms. Yet the capacity for local authorities and individuals to tackle the problem of homelessness is constrained at all points and made virtually impossible to resolve because of the squeeze on local government finances.

Many families suffer from overcrowding. Again, one cannot be healthy, physically or mentally, if one is living in overcrowded conditions. Many people's homes are in a bad state of repair. Repair and improvement grants have helped, but they have never been easy to obtain. They became even more difficult to use when the Conservatives removed tax relief from loans for improvements, which made it harder for people to make the necessary contribution to the cost of repairs, which they must make in addition to any grant that they obtain. It is impossible for people to be healthy if they are living in poor, and perhaps damp, conditions.

Let us not forget those whose homes are satisfactory but whose health is affected because they are stressed by the fact that the amount they must pay to live in their homes has increased almost beyond recognition through increased mortgage rates. In other words, even people who thought that they had solved their housing problems are facing difficulties and stress.

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There are so many facets to the subject that the hon. Member for Chislehurst has raised that it is difficult to know where to draw the boundaries. For example, I recall a discussion with a group of women members of my trade union, the Union of Shop, Distributive and Allied Workers. Although the discussion was about health, particularly women's health, it soon developed into a discussion of wages. They decided that a major cause of ill health among them and their fellow workers was stress, caused mainly by the fact that they did not earn enough. Because they were working and were also poor, they were suffering from the poverty of low income and the poverty of time. In other words, they were suffering both material deprivation and stress. Clearly, a discussion of health can easily develop into a discussion of low pay.

Coupled with the stress of low pay is stress caused by working conditions and employer attitudes. I have spoken previously in the House about the conditions of supermarket check-out operators, and I do not apologise for raising the issue again. I have observed that occupational health, injury and disease is usually regarded with the male stereotype in mind, and, for example, accidents in mines and on construction sites. But the health of many women workers doing ordinary jobs, such as supermarket check-out operators, is impaired because of their conditions and hours of work. They suffer back strain and repetitive strain injury from the sheer spread of the operation and the fact that employers are determined never to allow them a moment even to glance round. The supermarket owner allows his customers to build up into large queues rather than risk a check-out operator not having a queue waiting to be dealt with.

When I last raised this subject in the House I spoke of the time stress imposed on supermarket check-out operators. Even in a well-organised trade union shop, they may be expected to work to a norm of processing 20 items a minute. A target such as that is incredibly stressful, mentally and physically. It is positively bad for a person's health and the members of my trade union suffer, especially after doing that type of work for several years. That state of affairs could be corrected by supermarket owners easing up on the speed, by offering more variety of work to the staff and by providing more reasonable working hours and better wages, enabling employees to take advantage of the better hours. A shop worker recently told me, "The employer thinks he owns you body and soul." People who are driven to feel like that may be prevented from enjoying a good state of health, mentally or physically.

I agreed with much of what the hon. Member for Chislehurst said, particularly about smoking. Stressful conditions encourage people to smoke, in that they seek escape from stress by smoking. I myself believe that it adds to life's stresses, but that is not the way in which many people see it on a day-to-day basis, so they make a wrong decision and smoke. The hon. Gentleman was right to say that at least a part of the answer would be to ban advertising and sports sponsorship and promotion by tobacco companies. We do not simply need exhortation, and we certainly do not need to spend large quantities of taxpayers' money on a counter-advertising campaign. As a non-smoker, I resent my taxes going on counter-advertising when it would be easier, simpler and more effective simply to ban advertising in the first place. I agree with the hon. Member for Chislehurst about that.

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As long ago as 1986, in a Labour party document called "Women and Health", the Labour party committed itself to prohibiting the advertising of tobacco except at the point of sale. That is one item that receives some cross-party support. I guarantee to put pressure on the Labour Government, after the next general election, to stick to that pledge. I am pleased that the hon. Member for Chislehurst is trying to persuade the Conservative Government to have a similar policy-- albeit unsuccessfully.

Child health is also adversely affected by poverty and bad housing. It is an uncomfortable fact that at present in our society people with children are relatively worse off than those without children--that applies whatever the level of income. I am not talking about the most poverty-stricken people, although their problems are the greatest. At all levels of income, having children makes people less well off than others with similar jobs and salaries. Although I think that children bring a great deal of joy, the logic escapes me as to why children should be regarded as necessarily having to bring with them a poorer lifestyle, which affects not only parents, but the children themselves. It means that, in families with children everyone involved is relatively worse off than others from the same social background, without children.

I am pleased that, within its first year of Labour government, my party will increase child benefit at least to make up for its loss of value since 1987. It is disgraceful that increasing child benefit has not been a priority--indeed, it simply has not occurred ; child benefit has been frozen. If we are really concerned about wanting children to live in healthy families, we must improve families' incomes. Child benefit is the way to do that throughout all levels of society. If anybody is worried that child benefit also helps the rich, we can increase taxation on the rich and get the money back that way. We should not destroy the universality of such a splendid benefit. I commend Conservative Members to pressurise their Government to lose no more time in restoring the level of child benefit. They should not leave it to Labour. We shall do it and so reap a great deal of credit. I shall be pleased about that, but I do not suppose that Conservative Members will be.

The provision of well woman centres is particularly important in the provision of health services generally. I call them "centres", not "clinics" because that is a less clinical, more welcoming name, which suggests a blurred edge to the function of such centres. That is important because women can be deterred from seeking medical help if their anxieties are vague or they are not sure that their complaint is a matter for the doctor. They might have a worry that is impinging on their health and could be helped by some other means, for example, other professional advice, or a self and mutual-help group. Well woman centres are important because they can serve that function, and the woman does not feel that she is "wasting the doctor's time"--a phrase that is often heard when people, especially women, are wondering whether they should go to the doctor, but fear that they might be wasting his or her time. Most doctors would probably agree that patients who worry about that are precisely the ones whom they would like to see and are least likely to waste their time. The provision of informal well woman centres, where women can go if they have worries that are

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vague and anxieties that straddle medical and other problems, is an excellent idea. There is no doubt that there is a huge demand for such centres from women.

As long ago as 1986, in our document "Women and Health", we talked about the promotion of well woman centres and made pledges to enable women to see women doctors. Such a policy could not be brought in overnight because there would have to be changes in training arrangements and in doctors' career structures to enable there to be large numbers of women doctors at all levels and in all specialties of the profession. That objective will need some work, but it is necessary because many women are deterred from seeking medical advice as they find it difficult to locate a woman doctor to see. That is intolerable.

It is also important for people to get a good start. I believe that preventive medicine begins even before conception. The Labour party "Women and Health" document states :

"Pre-conceptual advice, pregnancy testing and parent craft classes should be provided and ante-natal discussion groups and post-natal support groups encouraged by group practices of midwives based in the community."

Pre-conceptual advice and thought is one of the new, valuable advances in preventive medicine that should be encouraged, and we are pledged to do so.

The maternity care that the mother receives after conception, the birth and post-natal care also have a great effect on the start given to the baby and the family unit. We want such care to be greatly improved. It is wrong that women and babies should have unnecessary hurdles to overcome because they have had a bad start. The Opposition believe that more research is needed into post-natal depression. A baby cannot have a good start if it is born to a mother who becomes deeply clinically depressed as a result of the baby's birth. There is not half enough research into that problem. As with many factors affecting women, it is neglected.

The Opposition also believe that continuity of care should be provided for expectant mothers. Starting with anti-natal care, and carrying on through the birth into post-natal care, every women should have a midwife with whom she can identify. The midwife would have the opportunity to exercise her professional skills to the full because she could watch that woman's progress and the birth of her baby from the beginning of pregnancy to the end of the post-natal period. That would be a vast improvement on the present, hopelessly fragmented approach to maternity care.

I was somewhat disappointed that the hon. Member for Chislehurst did not mention the need for free eye and dental checks, which I know he supports--

Mr. Sims : But I did.

Mrs. Wise : In that case, I apologise to the hon. Gentleman : I must have missed it. So we agree. The Opposition find it a paradox that the Government claim to favour prevention, yet put a financial hurdle between people and two of the most proven preventive procedures. I should have thought that people face enough discouragement from consulting a dentist through their own fears. They do not need charges to make matters worse.

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My son is an optometrist, and a week or so ago he saw a lady who, he discovered, was suffering from a detached retina. He feared that it had been detached for some time. Detachment does not necessarily happen in one fell swoop, obvious to the patient. It can commence, then worsen. My son referred the woman for immediate hospital treatment, and I am pleased to say that she was operated on within a day-- but the hospital did not have any great expectation that it could save her sight. So she was given expensive operative care, which the hospital is duty bound to carry out as long as there is any hope--but how much more sensible it would have been--and how much better a use of resources--if the woman had been seen several months earlier when her problem was only beginning. Then, the operation would have saved her sight.

The lady told the hospital that although she had been worried about her sight she had worried even more about her capacity to pay for an eye examination. It was the cost of the examination that had deterred her until her anxiety became so acute that she decided to seek advice. At that stage it was too late. That is tragic for her and it is a waste of the resources of the national health service. It is also distressing for the professionals who have to care for such patients. It upset my son that he had not had a chance to see her earlier and it undoubtedly upset the surgeons too. We should not burden our health professionals with extra stress of this sort. I look forward to the election of a Labour Government and the fulfilment of our commitment to restore free eye and dental checks. A couple of days ago an interesting press release about the conditions in which food should be kept emerged from the Department of Health. The Government propose to introduce temperature controls to food retailing and delivery--a good step. I am sorry to have to criticise that good step, but I must do so because the Government are also acting as a brake on the speed of introduction of their own new controls. They are phasing in the temperature controls to ensure that retailers can bring their equipment up to standard. Fair enough, but the time scale is outrageous.

The first requirement is that from April 1991 food must be kept at no more than 8 deg C ; so far so good. However, much perishable food should really be kept at 5 deg or less, as the Government acknowledge. They are laying regulations to that effect, but they will not come into force until April 1993. It is one thing to say that retailers need time to bring their equipment up to standard, but it is disgraceful to allow them nearly three years during which people, including pregnant women, may continue to eat food contaminated with listeria organisms, which can keep growing at 6, 7 or 8 deg.

I am sorry that the Government are spoiling their initiative that way. Of course retailers need time, but not three years. The application of technology and of money--there is plenty of that in the grocery trade-- could ensure that the process is carried out in much less time, given the will to do so. I shall regard the Government as being directly to blame for cases of listeria that occur between now and 1993 because food is not kept below 5 deg. The Government know what should be done and are wilfully allowing too long in which to do it.

The Government's move is also an insult to large sections of the retail trade. If the equipment of some retailers is in such a bad state that it needs three years to bring it up to a scientifically reputable standard, I am appalled at the lack of thought that those retailers have

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given to food storage. However, I believe that the best retailers could meet a much tighter deadline, and it is unfair to them to allow their competitors to get away with inadequate food storage arrangements for close to another three years.

The reported figures of cases of listeria infection may represent only the tip of the iceberg. It is not an easy disease to diagnose or to trace back to its causes. But it is scientifically accepted that listeria organisms can grow under refrigeration, and that food must be stored at less than 5 deg C to protect us from this common organism. Precautionary action should certainly be taken before April 1993.

The promotion of good health is a many-sided subject. Of course people must make good personal decisions about their life style. It is sensible not to smoke ; it is sensible to take exercise and to try to eat as healthy a diet as possible--although that is sometimes ruled out by a lack of income. But individual decisions in the matter, although important, are by no means the whole story--they are not even the main story. Without collective action and provision it is impossible for people to protect their health to the extent that we should all wish. In food storage, for example, we rely on Government regulations on retailing. We can make our own decisions in some ways ; I have decided that I do not want to buy anything stored at more than 5 deg C, but how do I know it has been? I must make another decision-- to cut out of my diet a whole range of foodstuffs that are perfectly healthy in themselves, provided that they have been stored properly. But I cannot make a personal decision that can cover that--just as we cannot make personal decisions that satisfy the housing needs of the population or ensure that we will all have adequate incomes. We rely on trade unions, employers and Governments to do those things.

The promotion of good health is the responsibility of all of us ; however, it is especially the responsibility of the House and of Governments not only to encourage but to facilitate good health, through the provision of improved standards in all the areas that we are discussing this morning.

10.40 am

Sir George Young (Ealing, Acton) : I congratulate my hon. Friend the Member for Chislehurst (Mr. Sims) on both his choice of subject and his speech. The non-sermonising "Jimmy Young" note that he struck was exactly right. I also commend him on the large number of subjects that he managed to cover. As he hinted, his choice of subject is timely.

For much of this year, the health debate has revolved around the role and structure of the national health service and how it should respond to changing patterns of demand, changing types of illness, new treatments and changes in medical technology. This morning my hon. Friend has righly switched the spotlight away from the national health service, and back to the role that the individual must play in improving standards of health.

I strongly believe that we have reached the point of diminishing returns in trying to secure improvements in the nation's health through investment in traditional curative medicine. Of course we must maintain that investment, but the improvements in health that all hon.

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Members want to see are far more likely to result from changes in individual life styles than from an increase in throughput in our hospitals.

What does that mean to a party whose traditions might suggest that it should not intervene in individual life styles, and whose instincts might lead it to the view that, if people do not wear seat belts, or if they want to smoke, that is a matter for them and not a matter in which Government should intervene? I do not agree with that view. One does not have to be a socialist to appreciate that, if the resources available to the National Health Service are finite and if those finite resources are used to treat avoidable illnesses, there will be fewer resources left for unavoidable illnesses.

A consultant at St. George's hospital--before it moved from Hyde Park corner--summed up the position very well. He was about to operate on a patient who suffered from a serious but not acute illness, and who had a rare blood group. The consultant had assembled, with some difficulty, sufficient quantities of blood of that group to enable the operation to proceed. However, just before the patient was anaesthetised, there was an accident on Hyde Park corner and a motorist who was not wearing a seat belt was rushed into the hospital, critically ill. He had the same rare blood group as the consultant's patient ; and, inevitably, the supplies were diverted towards the motorist and away from the patient.

That graphically illustrates the point that my neighbour's life style is of consequence to me. We live in an interdependent society, and when health care resources are rationed, we all have a stake in how they are spent.

I do not regard it as tenable for any party to claim that it should be neutral on the question of individual life styles. How a party then discharges its legitimate interest in individual life styles is another matter. An individual should be encouraged to make sensible decisions about his or her life, but it cannot be left to the marketplace, although many of my hon. Friends might like to do that. Let us take the issue of smoking, which was touched on by my hon. Friend the Member for Chislehurst. If it were left to the marketplace, the information that an individual received would be wholly one-sided, and any decision based simply on that information would inevitably be wrong. For an individual to reach a relevant decision about his life style, he must have all the relevant information. As the tobacco industry will not provide that information, inevitably the Government are drawn in. They can either do what was suggested by the hon. Member for Preston (Mrs. Wise) and simply ban the advertising of tobacco--with which suggestion I have some sympathy--or they can make available to the individual the contrary information, so that he has access to both sides of the equation before he reaches a view.

The same is true of the promotion of alcohol. The Government have a legitimate interest in ensuring that the information on which an individual bases his decision is well balanced. The notion that the Government should be neutral and stand back on those issues is not one that I can support.

The Government set the parameters for many of the decisions that are made. It is the Government who decide by whom alcohol should be consumed, at what age, where and at what times. The Government fix the price for both alcohol and tobacco : that is another reason for them to take a sensible and coherent approach to these issues. As was implied by my hon. Friend the Member for Chislehurst, this is not just a matter for the Department of

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