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Mrs. Bottomley : I have degrees from Essex university and the London School of Economics, I have worked for the Child Poverty Action Group, and I have lived with the defeatist talk that we are hearing from the hon. Gentleman. Of course he is right to say that there is an association between health and all the factors that he has mentioned. That is why such health variations are part and parcel of the health of the nation strategy, and that is why the Cabinet Committee is so important, involving Ministers from the various Departments.
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What the hon. Gentleman has failed to identify is how, in the context of many adverse social, economic and employment factors, we can reach out and provide a decent health service. That is what the GP contract did, what the immunisation targets have done, what the cervical cancer screening services have done and what the deprivation payments have done. That is what we seek to do, rather than adopting a defeatist attitude to the delivery of health care. We must ask how we can ensure that the health service reaches ever higher targets in areas of great social difficulty.Madam Deputy Speaker : Order. I remind the House--and that includes the Secretary of State--that interventions, by their nature, should be short.
Mr. Blunkett : I am delighted to find that the Secretary of State is, after all, traumatised rather than comatose.
The truth is that a Secretary of State whose White Paper does not once mention poverty or inequality, and mentions unemployment only in passing-- dismissing it as part of the section dealing with housing--cannot give Opposition Members any lectures about the university that she attended or the studies that she undertook. Deprivation and inequality in incomes are worsening the ill health of those at the bottom of the pile.
Let me take on the Secretary of State in regard to the subject of mental health, on which she has a well-deserved reputation. The section on mental health in the White Paper mentions suicide. The incidence of suicide is twice as high among unemployed men as it is among those in work, and premature deaths are one third higher. The Secretary of State can give me no lectures about her belief in equality or fairness.
What, then, would Labour do? Economic action is vital. We need greater equality, full employment and a new commitment to decent housing, adequate public transport and good education. Unlike the Conservative party, we are committed to health promotion and to primary health care in its widest sense. We are committed to investing in community care, so that we can support people at home rather than in private residential institutions.
We are committed to investing in our communities--investing in integrated community and hospital services, and in the reintegration of purchasing to ensure that coherent priorities are met. We are committed to unified district health authorities and family health service authorities ; to abolishing GP fund holding, which has distorted purchasing priorities ; to supporting and expanding the healthy cities initiative, which the Secretary of State did not mention ; and to linking economic and social policies for the real health of the nation. We are committed to the development of GP contracts which actually deal with ill health where it matters most--rather than health promotion clinics to make more middle-class people even healthier in south-west Surrey--and to directing resources towards improving the mortality rate.
In the past year, 42,000 people would not have died if social class 5 had been able to enjoy the income, conditions and well being enjoyed by social class 1. It is not just a matter of politics ; it is a matter of life and death for 42,000 people a year, 3,000 of them children.
We need a strategy for health, with a clear inter-departmental approach to the health of the nation. We need policies which are in the interest of the people, not in the interest of those who pay the Tory party. I refer, of
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course, to the state of Virginia, and what a state it is : the state from which the most predominantly used tobacco in Britain is obtained. A well-known brand is called Golden Virginia. We would ban tobacco advertising and introduce clear warnings. We would protect people from passive smoking and act against those subsidised European tobacco growers to whom the Secretary of State referred. Tobacco is the biggest killer in this country apart from poverty. That is why we would act against it. That is why 800 doctors put their money into and their names to the advertisement in The Independent today. That is why the Secretary of State should not have pre-empted the publication and recommendations of the Smee report by dismissing them before they even appeared.We shall put the health of the nation first. We shall put people before party. We shall be willing to put our policies to the vote. 6.20 pm
Mrs. Marion Roe (Broxbourne) : I am grateful for this opportunity to speak in the first health debate of this parliamentary Session--the first since I became Chairman of the Select Committee on Health. I am very proud and privileged to serve on such an important Committee. It has awesome responsibilities, as all who are involved in health care know so well. We shall certainly look forward to welcoming next week my right hon. Friend the Secretary of State to give evidence to our inquiry into tobacco advertising.
I pay tribute to my predecessor and to former members of the Committee who steered it so ably for 15 months. I am particularly grateful to the last Chairman. As part of his legacy, he has left me an excellent and acclaimed report on maternity services, about which I shall say more later.
Unlike the hon. Member for Sheffield, Brightside (Mr. Blunkett), I pay tribute to the Secretary of State for bringing forward publication of the White Paper "The Health of the Nation". There can be little controversy about the essence of the policy : to make people more aware of the need to be healthy.
When the hon. Member for Brightside complains about the Government's policies concerning poor housing and homelessness and their effect on health, I remind him, first, of the enormous sums of money that are being poured into the estate action programmes to revitalise derelict housing estates and, secondly, of the fact that the Labour party bitterly opposed housing action trusts, the purpose of which was to bring back into use thousands of empty homes, owned by Labour-controlled councils, that are in disrepair through neglect and bad management. So much for the Labour party's concern over homelessness.
The Select Committee on Health will shortly start an inquiry into NHS dental services, an inquiry which I hope the hon. Member for Brightside welcomes.
It is entirely sensible that the Government should concern themselves not just with being able to cope with ill health, and all that that brings with it, but with doing all that they can to prevent the onset of illness. Ill health is a tragedy, in terms not just of the waste of a country's resources but of the human cost--a matter of much greater concern to us all. It leads to the loss of the breadwinner, the awfulness of seeing a child suffer and the strain of long-term nursing or of coping with a relative who is severely disabled. All these things can bring with them untold human misery.
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It is good to see the Government taking the initiative and, once again, being proactive rather than reactive. The health service reforms, for which successive Conservative Governments are responsible, are shaping a health service that is better able to meet the huge demands upon it. That is a subject for the nation's gratitude and pride. Millions more patients are receiving the treatment they require, and millions more are being treated for ailments that even 10 years ago could not be treated. Let us, however, be in no doubt that demand and public expectation will continue to put heavy pressure on our health services. That is why I welcome this initiative.It is important that those of us who can do something to protect ourselves against ill health should do so, in order that the people who need treatment can receive it as quickly as possible. As a Conservative, I put great store by the responsibility of individuals to look after their own health, but that responsibility must be grounded in informed choice and a sharing of common objectives. We cannot legislate to stop people drinking, smoking, or even having sex, but we can and should inform them of the consequences of their actions.
Moreover, I believe that greater understanding of what is good and bad for us will lead to greater willingness of people to work together. For example, it is a pity that, when a family adopts a healthy diet at home, there is little encouragement, in schools or the staff canteen, for people to eat sensibly. Therefore, I am pleased that the White Paper places emphasis on health alliances between different agencies, groups and organisations. I hope that the Government will ensure that they all work together to produce common and easily understandable messages.
I congratulate the Government also on moving the health debate forward. As we have heard, much has been achieved already. Anybody who has seen a child with whooping cough or struck down with measles knows how sensible it is for children to be immunised. Similarly, any woman who has been saved from the horrors of cancer by timely screening is aware of the value of preventive medicine.
It is right that the goalposts should be widened, new targets set and our sights raised higher. While I applaud the Government on publishing the White Paper, I am concerned that the impetus that led to its publication should not be lost. When I read the White Paper, I was struck by the myriad good intentions. It speaks of targets to be attained, by means of strategies and schemes to be developed, of reports to be made and of action groups to be set up.
A great deal of activity is promised. Although a Cabinet Committee will oversee the implementation of the overall strategy--which I welcome as a positive sign of the Government's commitment, as well as their promise of periodic reports--would the Secretary of State contemplate issuing an annual report so that achievements could be recognised and unsatisfactory trends acted upon quickly? Such a report could be on the same lines as the chief medical officer's annual report on the state of public health. This one, however, should concentrate on the specific key areas and targets mentioned in the White Paper.
The White Paper contains many matters of enormous interest. My Committee will look at them, in particular at
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those which relate to pregnancy and childbirth. The Select Committee on Health has done an exceptional amount of hard work on the maternity services and has produced a report that has been well received by the Government and professionals alike. The importance of good maternity services for the welfare of the mother and the well being of the child cannot be emphasised enough. That is at the centre of the Committee's report. It places emphasis on the provision of continuity of care for the mother throughout pregnancy and childbirth.There are many other recommendations, most of which are designed to promote the health care of both mother and baby so as to avoid complications or unnecessary illness--aims that are entirely compatible with those in the White Paper. Some of the recommendations, especially those at local level, are being acted on and others are being studied. At the last count, three committees were considering the different points that the Select Committee had raised. Midwives and I hope that the committees will report as soon as possible so that the Select Committee's recommendations can be acted on quickly. I should like to take the debate on maternity services and the welfare of the mother one step further. Few people are aware that as many as 10 per cent. of all recently delivered women develop post-natal depression. In some cases, depression may be so severe that women need out- patient psychiatric help, and many need drug therapy. In view of its common occurrence, it is surprising that so little attention is given to it. Many books on pregnancy and childbirth hardly mention it, if at all, and it is not usually discussed in ante-natal classes.
Many mothers who are at risk could be picked up. Mothers who are most at risk are those who have had a history of mental illness or a tendency to it within the family, those who have experienced fertility problems and who experienced a difficult birth with their child--who may have experienced a lot of intervention--or those who experienced the trauma of a child being taken into special care. My right hon. Friend the Secretary of State rightly pinpointed tackling mental illness as one of her key tasks. Mental illness is a double curse, because it is so destructive of a person's confidence and of his or her ability to help themselves. In that context, post-natal depression is doubly vindictive, because a mother becomes frightened for herself and particularly frightened about her ability to look after her baby. More could be done to recognise the dangers of this affliction. I urge my right hon. Friend to consider this matter as appropriate for inclusion in the overall objective of reducing the incidence of ill health caused by mental illness. 6.32 pm
Mrs. Alice Mahon (Halifax) : I congratulate my hon. Friends the Members for Sheffield, Brightside (Mr. Blunkett) and for Bristol, South (Ms. Primarolo) on their elevation to the Front Bench. We have a new team, who I think will do a first-class job for the party. I was impressed by the opening remarks of my hon. Friend the Member for Brightside.
I should declare my education. I did a degree at Bradford university and spent 11 years working in the national health service, which may explain the different approach of myself and the Secretary of State. The White Paper is an attractive publication, and if I were giving the
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Government marks out of 10 on how it looks they would be reasonably high. If I were giving marks for its content, they would be fairly low, because it is fairly lightweight and skirts around many of the issues that we believe to be important.What is not included in the document is vital to the health of the nation. My hon. Friend the Member for Brightside mentioned Beveridge. Fifty years ago, in 1942, when Beveridge drew up the famous plan that gave birth to the national health service, he outlined what he saw as the five giant evils of the day--want, disease, ignorance, squalor and idleness. The NHS was to be part of the attack on those evils, particularly on disease. However, he made it clear in his report that they were all linked. He knew that one could not attack disease without attacking how people spent their lives, what they ate, how they were educated and how they fed, housed and clothed themselves. On publication day in 1942, a mile-long queue formed outside the Government bookshop in central London and around 70,000 copies were sold within hours. Three weeks after publication, a Gallup poll found that 19 out of 20 adults had heard of the Beveridge report and that most approved of its recommendations. It touched the heart of the nation, which awoke to the content of the report like a slumbering giant. People stirred and voted for a Labour Government, who introduced the national health service, and we should never forget that.
We are witnessing a similar phenomenon today with the Government's callous and inhumane treatment of the miners. Yesterday, we saw the Government's hatred of anything collectivist or anything to do with communities. The Government should be fearful of the mood that is abroad, which we witnessed yesterday. Since they announced the pit closures, we have seen what I, as an old trade unionist, would call a massive failure to agree between the people of this country and the Government. The British people will put the national interest first, whereas the Government will put first their idol-- the market. The report is a wasted opportunity. How can any document on the health of the nation fail to address such issues as poverty, low income, bad housing, homelessness and unemployment? Page 26 of the document mentions
"healthy cities, healthy schools, healthy hospitals, healthy workplaces and healthy homes",
but fails to offer any solution to the housing crisis, so it is worth nothing. It does not acknowledge that the housing crisis is the worst since after the war. Halifax is not the poorest town in the country by any means, but almost 7,000 people are waiting to be housed by the council. An average of 100 families are made homeless every week, and young people sleep rough or on somebody's settee. The White Paper could have begun research into homelessness to find out exactly how many people are suffering from it, but it chose not to do so. It could have considered the inner cities and how many unemployed people experience bad health because of the stress of unemployment. It could have undertaken research into the inadequacy of the benefit system.
Mr. Nigel Evans : Does the hon. Member agree that the greatest number of empty council houses are under the control of Labour authorities as opposed to Conservative authorities?
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Mrs. Mahon : I absolutely disagree with that. The statistics support my argument, but I do not want to go into them.
Page 28 of the White Paper says that the
"Government will continue to pursue its policy to promote choice and quality in housing, having regard to health and other benefits." Those are empty words ; the White Paper offers absolutely no help. If the Government want to help, the Minister and her colleagues could contact their friends in the Department of the Environment and ask why they will not allow councils to spend their capital receipts on building affordable housing to enable people to move out of squalor and into decent homes. Why did not health Ministers object to the enactment of the Housing Act 1988, the new rules of which made tenants so insecure and caused much more stress? Why do they not do something about what is happening to housing associations, which were to plan for special-needs categories such as elderly people? Housing associations now have to find the money to repair and maintain their properties, whereas previously they received grants. That repair and maintenance bill is being met by tenants and pensioners, who can ill afford it.
Report after report has highlighted the state of our crumbling schools. The White Paper talks about our schools being healthy places. Health Ministers should get in touch with the Department for Education and also ask the Prime Minister what he will do to tackle the backlog of maintenance in some of our schools.
The Government poll-tax cap the poorest councils in the country, so they can do nothing about housing.
What upsets me most about the document is the way in which it refers to nutrition and to advising people to make healthy alliances between different agencies, without ever mentioning schools meals, which have played an important role in the nutrition of children, especially children from poor families in this country for nearly 100 years.
In 1906 an Act of Parliament enabled councils to raise money on the rates to provide school meals, and the Education Act 1944 made it compulsory for every local authority to provide a school meal for any child whose parents so wished. Children's health is clearly related to the food that they eat, yet the schools meals service has been under constant attack from the Government since 1979.
The Black report, to which my hon. Friend the Member for Brightside has already referred, valued schools meals so highly that it recommended that they be provided free, yet in the same year the former Prime Minister, now Lady Thatcher, abolished local authorities' obligation to provide meals, except for children entitled to free school meals--yet she was the one who talked about letting children grow tall. Unfortunately, she meant only those children whose parents had healthy bank balances. Since the Education Act 1980, school dinners are no longer required to meet nutritional standards. The Secretary of State should at least have included that fact in her document.
In 1988, 400,000 children lost their entitlement to free school meals following changes to the Social Security Act, and compulsory competitive tendering threatens the very existence of that valuable, indeed vital, service.
As a member of the Select Committee on Health, I tried to get the Committee to recommend that school meals should be provided for all children at an affordable price
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or free for people on very low incomes, and that national nutritional guidelines should be restored. That was when we drew up the report on pre-conceptual care, which preceded the maternity services report. The first of those reports emphasised the need for a healthy diet, so that healthy parents would produce healthy children. That seemed like common sense ; it did not seem revolutionary, but something which we should all encourage. Alas, another golden opportunity was missed, because Conservative Members have voting habits which in our opinion harm the health of the nation time and again.Another key area identified in the report is that of HIV infection, sexual health and drug abuse, especially involving young children. The report's treatment of that area is light weight. Why are the Government not funding the health education co-ordinators' post from March 1993? Health education co-ordinators have been praised by everyone including Her Majesty's inspectorate from the Department for Education. They do a valuable job to combat a scourge which we all deplore--young people getting involved with drugs. Yet the Government will not fund them. Clearly councils cannot afford to do so. If the Secretary of State really believes that she can attain her targets and reduce such abuse she must rethink the approach to that problem. The White Paper identifies mental illness as a problem. In an earlier intervention, I tried to question the Secretary of State about prescriptions and health benefits. If people with a mental illness live in the community and are hard up they still have to pay for their prescriptions--many people in benefits have to do so. Often those prescriptions are not renewed, the person regresses and ends up back in hospital. It is a false economy not to ensure that such people get their medication.
The Secretary of State should be able to answer a question from a Back Bencher about whether the review on health benefits is anywhere near complete.
I am conscious of the time, so I shall make only a couple more points. The Select Committee's report on maternity services expressed horror that the DSS could not comment with authority on the adequacy of income support rates for providing a balanced diet for pregnant women because the research was not available--some members of the Committee had already known that, but some had not. Any document that does not deal with that problem has singularly failed in its duty to pregnant women. The omission is disgraceful.
We concluded, too, that there should be no discrimination in benefits for pregnant women. Why should women under 25 get less in benefits than older women? There is nothing in the document to support the recommendation in the Select Committee's excellent report.
I understand that today the Government launched their Winter Warmth telephone line, which is intended to do something about elderly people and fuel poverty. Any elderly or sick person who believes that he or she will receive help with fuel bills or insulation costs will be bitterly disappointed. The scheme, like the document before us, is a candy-floss scheme, pretty on the outside, but with little substance inside. I should like the Secretary of State to go back to the drawing board and bring back to the House a report that really attempts to slay the five
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giant evils identified by Beveridge. Goodness knows, there have been enough victims of Conservative health policies over the past 13 years to make that a priority.6.45 pm
Mr. Sebastian Coe (Falmouth and Camborne) : I am grateful to have the opportunity to address the House this evening. Hon. Members may recall that the last time I was due to deliver my maiden speech an altogether different delivery overtook me--the birth of my daughter, a week before the House rose for the summer recess. I link that comment with my great thanks to Epsom general hospital for what they did not only that evening, but throughout the week that my wife spent there. First, I must pay tribute to my predecessor for his deep commitment and personal involvement with the Falmouth and Camborne constituency, with whose stewardship I am both privileged and proud to have been entrusted for the foreseeable future. I pay tribute to his predecessors, too--from both sides of the House--who ably served my constituents during the long and proud history of the Falmouth and Camborne division. I also thank the people of my constituency for giving me the opportunity to serve their interests in this place. The Falmouth and Camborne constituency is unique and vibrant and so are its people. They come from a breed that has long learnt to eke out a difficult living against hostile elements--at sea, on land, or under the ground. It was in view of the rich and strong tradition of tin mining, and because of the generations of miners who sought their livelihood in that industry, that my decision on the vote last night was so marginal. I greatly welcome the review of the mining industry announced by the Government.
Since the loss of the tin mining industry, my constituency has never fully recovered either as a community or as an economic area. That may change now, and we have to encourage a level of industry and other economic activity which I hope will continue. Certainly this constituency's current Member of Parliament will press at every available opportunity the needs, desires and hopes of his constituents.
As an apprentice and a newcomer to the team, I thank many hon. Members for the support and guidance that I have received in the past few months--and, of course, I offer my thanks for the invaluable advice that is always available from the Whips Office.
In my previous life, I had advice, and guidance usually given after the event, from coaches, from team managers and from trainers. Sport has never been noted for its 20/20 foresight.
There is a far more important and serious issue that I wish to address today. The nation's health and fitness is an issue in which effective advice and guidance can literally be a life saver. The single most important factor in the future success of the United Kingdom, either as an economic or as a cultural force, is the health and well-being of its citizens. The provision of an effective and efficient national health service, free to all, is fundamental to the future prosperity of this country. No hon. Members here today would dissent from that view.
What we can argue about is the way in which the service is delivered and resourced, and what its priorities should be. The Government have unequivocally pledged the continuation and development of a national health service
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free at the point of delivery. That overriding principle must for ever be upheld and constantly repeated. It is the one non-negotiable, fundamental principle in my book.The aim must be to continue to improve a free national health service, but a free national health service does not preclude the demolition of a number of apparently sacred cows, nor does it preclude the re-ordering of priorities within the system, provided of course that that re-ordering is based on solid reasoning, produces tangible benefits for patients and other users, and is fully explained to national health service employees and users alike. Those who believe that the structure and organisation of the national health service should remain inviolate in the face of medical advances and demographic changes, the sole requirement being simply more funding, do not reside in the real world, nor do they have any genuine regard for the effective use of public finance or resources.
The national health service is Europe's single largest employer, with more than 1 million people and a budget of more than £36 billion, in itself an increase in real terms of 48 per cent. since 1978-79. Those figures are impressive, but as politicians we must recognise that they are Monopoly figures, literally too large for many people to grasp.
In truth, we must also realise that £36 billion matters not a jot when a person's sole concern is whether there is an ambulance, a doctor, a waiting room, a surgery, a hospital bed or a nurse immediately available when needed. As over the years the national health service has come to be perceived as available on demand, such concern is understandable.
Of course the reforms were overdue and hugely welcome, but within them there are still a few issues which need teasing out. One crucial issue, which I believe receives far too little attention and resourcing, is health promotion and education. The best way to help the national health service is to ensure that people do not become ill in the first place. While we go about our duties in the House next week, 455 people will die from coronary heart disease. As we go about our duties in this place next year, 40 million days will be lost through that disease. When we link that to the simple statistic that £2 billion-worth of production will also be lost, we know that those statistics should lie heavily on every Government departmental desk.
The deaths and losses will not be spread evenly throughout the country. The poorest sections of our community in the inner cities and the rural areas will shoulder more than their fair share of that burden. For towns such as Redruth and Camborne, which are an amalgam of the two, that burden will be noticeable.
The real crime of the figures is that they are preventable because the causes are preventable. We have heard about some of those causes today : being overweight, too little exercise, high blood pressure, high cholesterol levels and smoking. Yet while the national health service will spend £500 million next year on the treatment of coronary heart disease, it will spend barely one fiftieth of that on prevention of the same disease.
Tobacco, alcohol and confectionery manufacturers will spend about £700 million next year on advertising their wares--20 times the budget currently going into health education. Strikingly, the Government will also take £12 billion in excise duty and tax from alcohol and tobacco. I find those figures difficult to reconcile, just as I continue to find the sponsorship of sport by tobacco companies irreconcilable.
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It is abundantly clear that there must be more resources and that a higher priority must be given to health education, properly targeted at the section of the population who are most in need. There have been a few tentative though welcome bites at that particular cherry. The White Paper "The Health of the Nation" places health promotion high on the agenda with preventive campaigns targeting particular diseases, such as breast cancer, cervical cancer and AIDS, and unhealthy practices such as drug abuse. That is welcome, as are the significant role and efforts of the voluntary sector and the whole raft of charities operating in this arena.One issue which must be addressed is the complete separateness of health promotion, and sport and recreational departments at national and local level. There is a wide recognition in the White Paper that moderate and careful exercise is a crucial ingredient in every individual's good health and well-being, yet the public fund two organisations--the Health Education Authority and the Sports Council--with their attendant administrations, broadly to undertake health and fitness promotion. I had the unique experience of serving on the boards of both organisations. It is clear that they will have to work far more closely together to avoid the inevitable waste of precious resources and the duplication of time, effort and funding. Their co-operation with the Department of Health in the national fitness survey is welcome, as is the Department's inclusion of the physical activity policy development group, which is a further welcome move along that road.
Part of the work of the group is to consider the feasibility of setting targets in physical activity and how they might be achieved. However, I find it a little disconcerting that in the 20 years since the inception of the Sports Council and in the 10 or so years since the inception of the Health Education Authority's predecessor, the Health Education Council, we are only now turning to physical activity targets and the prioritisation. At the end of the day we cannot force people to adopt active, healthy living patterns. What we can and should do is to ensure that as wide a range of information, advice and guidance is freely and readily available to everyone. The final choice will be for the individual, but that choice must be an informed one.
Several Hon. Members rose --
Mr. Deputy Speaker (Mr. Geoffrey Lofthouse) : Order. No fewer than 20 hon. Members wish to catch my eye during the debate. It would appear that some of them may be unsuccessful. It would be helpful if hon. Members would bear that in mind and be as brief as possible. 6.59 pm
Ms. Liz Lynne (Rochdale) : I pay tribute to the hon. Member for Falmouth and Camborne (Mr. Coe) on his excellent maiden speech. The White Paper states that there are significant variations in ill health in England and other countries. Why are there variations? What will the Government do to rectify them? I have concluded that the health of the nation depends on the wealth of the nation. There are areas of England which are obviously less prosperous than others. Some members of the Government at last seem to be
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admitting that wealth is a factor in health. We need more job opportunities and better housing. Those two factors alone have an enormous impact on health.I am glad that the Government have at last recognised that. However, instead of simply recognising it, they should act. They should be providing more jobs, not fewer. The Government should announce today that they will allow councils to spend the money raised from selling council houses so that people can have decent, healthy homes in which to live. If one lives in rundown, damp housing, one is more likely to suffer from bronchial conditions. Everyone knows that poor income and poor health education lead to poor diet, which in turn leads to heart disease, diabetes and so on.
The Government have raised many hopes with their White Paper, in the same way that they raised many expectations when they originally announced their community care reforms. The White Paper states that it is
"important to maintain the quality of care and support provided for chronically sick people, elderly people, mentally ill and handicapped people."
However, many people who work in community care doubt whether, come April 1993, those good sentiments will become a reality. Similarly, there are fears that all the fine words in the White Paper are just that and have no substance.
The White Paper admits that the success of the strategy will depend on the commitment and skills of the health professionals within the NHS. I hope that the Government will now value and properly reward those professionals who carry so much of the burden of introducing those reforms.
I am pleased that the Government now accept that smoking is an addiction and will encourage people to stop smoking and prevent children from starting. However, I am disappointed that no extra money has been pledged for anti-smoking campaigns. I am appalled that the Government have failed to enforce a tobacco advertising ban, when evidence from New Zealand and Norway shows how effective a ban can be, particularly with children.
As has already been said, more than 700 British scientists and clinicians have paid for an advertisement in today's Independent stating that there is now strong evidence that tobacco advertising encourages children to smoke. The Government should listen to those who know. I hope that Hanson and Rothmans, who each gave £100,000 to the Conservative party in the latest year for which figures are available, are not affecting the Government's policies.
According to a Health Education Authority report, one in five people in my constituency die every year as a result of smoking. An estimated 599 residents were admitted to an NHS hospital because they had an illness caused by smoking. Those figures come not from a tinpot organisation, but from a book published by the Health Education Authority. However, the Government have still not banned tobacco advertising. What stupidity, cynicism and short-sightedness. The White Paper targets four types of cancer for reduction. I welcome the inclusion of breast cancer in that list, but note that the 25 per cent. reduction applies only to
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"those invited for screening". The Government concentrate on the 50 to 64 age group. There is no guidance for general practitioners to screen women over the age of 40 in families with a history of breast cancer.Cancerlink is disappointed that no targets are given for treatment and support. The quality of life of cancer patients has been left out of the White Paper. The inadequacy of resources available for personal and family counselling must be tackled.
With regard to mental health, there is no mention of the fact that there may be a link between mental health, homelessness and redundancy. What sort of health problems have the Government caused the miners and their families over the past few days? The way in which the pit closures were announced was callous in the extreme. However, more than that, as a consultant psychologist has said, the sudden shock of the announcement of such a speedy and savage cut is equivalent to a sudden bereavement, road accident or terrorist bombing. Some people may never recover from the way in which the announcement was made. However much the Government might change their mind, the immediate shock was real ; the stress has been caused and the damage has been done.
The White Paper contains no specific targets for the reduction in the incidence of mental illness or for the promotion of mental health. The Alzheimer's Disease Society is especially disappointed that the Government have not set targets. There should be targets for support and accommodation for those leaving long-stay psychiatric hospitals.
The continuing squeeze on local authority budgets and reduced funding for the voluntary sector is completely ignored. Anyone who believes that that is not important should see the number of homeless people sleeping rough in London. People are also sleeping rough in Manchester and every other city in the country. A number of those people suffer from mental illness.
I welcome the fact that accidents feature in the White Paper. However, like the Royal Society for the Prevention of Accidents, I wonder why non-fatal injuries are excluded. Non-fatal injuries cost a lot more in total than fatal injuries and many injuries lead to medium and long-term disabilities.
Alcohol targets are dealt with under heart disease and accidents. That is disappointing, because alcohol is related to a wide range of medical conditions and deserves its own heading. I would also like the Government to give a commitment on complementary medicine. The full benefits of that type of health care are not yet fully understood.
All in all, I welcome certain aspects of the White Paper--at least it is better than nothing. At last we have some sort of strategy for health, but it does not go far enough. What good are those fine words if the money is not there?
I ask the Minister to make a commitment today that the health budget will not suffer when the public spending cuts are announced and to announce that there will be a real, substantial increase to meet the health needs of the people of this country. Anything less than that commitment makes a mockery of the White Paper.
7.8 pm
Dr. Charles Goodson-Wickes (Wimbledon) : It gives me great pleasure to congratulate my hon. Friend the Member for Falmouth and Camborne (Mr. Coe) on his maiden
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speech. He has shown his dedication, ability and achievements in other fields and I am quite confident that, whatever distance he chooses here, he will be as successful. We look forward to hearing more from him. I am aware in particular of his interest in the ghastly problem of the misuse of drugs in sport and we look forward to hearing him pursuing that line as well.After my right hon. Friend the Secretary of State for Health made her debut in the health conference in Brighton, my wife said to me, "Doesn't she look pretty?" I countered by saying, "Didn't she make a good speech?" I should make it clear to my right hon. Friend, in her temporary absence, that those compliments are not mutually exclusive.
"The Health of the Nation" has been considered very widely in its Green and White forms over the past 16 months. I urge the House to make certain that we maintain the momentum and achieve another target--its implementation by April next year.
Never has the phrase "prevention is better than cure" been more appropriate. I talk, I believe, as the only practising physician or surgeon in the House. I have been involved in preventive medicine for 20 years, in the Army and on behalf of many companies ranging from mining and engineering to the service industries. I was also proud to serve on the medical advisory committee of the Industrial Society. My right hon. Friend the Secretary of State has more than a passing acquaintance with that society through her father's outstanding leadership of it.
However, there is still widespread ignorance of the issues addressed in the White Paper, not least because the emphasis on medicine, that unique blend of science and art, has historically and naturally concentrated on curing illness. The advent of screening medicine to detect conditions in the early stages and to be able to make a pre-symptomatic diagnosis, linked with advice on how to avoid other afflictions, is a relatively new concept. It has largely been pioneered in this country by the private sector, but the national health service has played an important part. Perhaps we are seeing an acceleration of the trend of having a health service rather than a sickness service, with the ultimate aim being the physical and mental welfare of everyone in this country.
I have often noted over the years that if one says that one is involved in occupational medicine it is a conversation stopper. That branch of medicine, catering as it does for the effects of a job on a patient's health and vice versa, might be an important aspect of the evolution of health care in this country. In France, many--perhaps most--employees are entitled not only to a pre-employment medical but to a retirement medical and, often, annual medicals which might or might not be funded wholly or partly by the state. The context of a schedule for screening will obviously vary widely in depth and quality, but the legitimacy of various tests is constantly being reassessed. I agree with the hon. Member for Rochdale (Ms. Lynne) that one should re-examine the age limits for breast screening for women.
"The Health of the Nation" also addresses a rather more parochial issue-- health in the workplace. We should be doing ourselves a disservice if we did not start to consider our own lifestyle in this place. In my written evidence to the Select Committee on Sittings of the House published in February, I said :
"As a practising physician I have to see colleagues, and in particular Ministers, being forced to live a lifestyle which is
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