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Sir Robert Smith: Is the hon. Gentleman aware that Conservative Members also supported that Bill?

Mr. Hammond: I am sure that the hon. Gentleman is right, but he should be cautious. He will recall that in Committee he accused my hon. Friend the Member for Rutland and Melton (Mr. Duncan), who was then shadow Minister of State for Health, of having offered the Opposition's support for the Bill during its passage. Having checked the record, the hon. Gentleman was forced to withdraw that remark.

The Minister for Public Health also apparently supported the moves that the hon. Gentleman introduced in his Bill, in a speech to her constituents, so I will be interested to find out the Government's position, not on the wisdom of introducing energy efficiency measures or even the link between energy efficiency in homes and demand for health care, but on the crucial issue raised by the new clause: should responsibility for insulating people's homes--ensuring that they have energy efficient homes--be taken on by the Department of Health and bodies within the NHS in addition to the huge burdens that they already carry? They have their work cut out; they do not need any additional burdens.

Mr. Denham: I recognise the concern that thehon. Member for West Aberdeenshire and Kincardine(Sir R. Smith) expressed about fuel poverty and its impact on health. The Government take that matter seriously.

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I shall explain why the action that the Government are taking nationally, coupled with the framework for local action now offered by health improvement programmes, offer the right way forward. It is important to clarify the Government's position and the suggestion that the Deputy Prime Minister supported the Health Care and Energy Efficiency Bill. I am advised that, on 26 May, my right hon. Friend the Deputy Prime Minister wrote to the hon. Member for Newbury (Mr. Rendel), who had put the original question. My right hon. Friend made it quite clear that the Government were not able to support the Health Care and Energy Efficiency Bill, so it would be a little wrong to suggest that we were attempting to improve the Bill of the hon. Member for West Aberdeenshire and Kincardine.

In relation to what the Government have done, we have, of course, reduced value added tax on fuel and on energy saving materials so that people can more easily afford to keep warm and insulate their homes. We realise that many pensioners currently face particular difficulties; that is why in the March Budget, my right hon. Friend the Chancellor of the Exchequer announced an increase, from this winter, in the annual winter fuel payment to £100 for more than 7 million pensioner households. That is also why the minimum income guarantee was introduced through income support from April this year. We have released substantial additional funds to help to improve our housing stock; in total, about £5 billion is being made available over the lifetime of this Parliament for investment in housing.

In addition, we set up a review across Government of policy on fuel poverty, which included discussions with more than 60 organisations that are expert in that field. Last month, the Under-Secretary of State for the Environment, Transport and the Regions, my hon. Friend the Member for Mansfield (Mr. Meale), published our proposals for action in the document "Fuel Poverty: The New Home Energy Efficiency Scheme". The Government have invited views on those proposals and we aim to have the new programme in place by April 2000. With the additional £150 million made available following the comprehensive spending review last year, the new home energy efficiency scheme will have a total budget of nearly £300 million for the first two years. An important body of national action is already well under way.

In relation to the scope for local action, clauses 26 to 32 of the Bill establish a framework for equally wide-ranging action on inequalities at local level. In particular, clause 28 requires a health improvement programme to be prepared in every area. Clauses 29 to 31 introduce new flexibility as to funding and operational arrangements at the boundary between the NHS and local authorities, where that will help to promote the health of local communities.

Health improvement programmes bring together all parts of the NHS, local government, local communities and their representatives, local employers, businesses, schools, and so on, to develop and implement plans to improve local health and health care. The programmes are not merely about improving services; they will also involve broadly based action to tackle the wider determinants of ill health. Although a contributor--possibly a substantial one--to health improvement programmes will be the NHS itself, not all the actions identified for a health improvement programme will be

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funded or developed by the NHS. Other partners, especially local authorities, will play an important role--as will voluntary bodies.

I resist the idea suggested by the hon. Member for Runnymede and Weybridge (Mr. Hammond) that we should try to maintain some sort of Berlin wall between the part of the health service that treats ill people and the action taken by the NHS and other partners to try to tackle the causes of ill health. Of course it is important to use money efficiently and effectively; however, I do not accept the absolute separation that the hon. Gentleman seemed to suggest. He will know from our debates in Committee that we believe that the health improvement programme and the new flexibility between the health service and local authorities introduced by the Bill are extremely important. They will enable new forms of joint action. There will be increased scope for funding transfers between the NHS and local authorities--not only across the boundaries between the NHS and social services, but on a wider front in matters such as housing, where that will best advance local health and well-being. There will be new ways of working together--through pooling budgets, for example.

Mr. Hammond: I have listened to the Minister's remarks. Does he not think, however, that there will be great difficulty in explaining to the public why waiting lists are getting longer, why more treatments are ceasing to be available, and why the NHS is not allowed to prescribe drugs, if he is seen to be diverting resources from the provision of treatment for people who need it to long-term solutions that are one step removed from the immediate health care agenda?

9.15 pm

Mr. Denham: That very much depends on the type of intervention and the use of money involved. Let me give the hon. Gentleman an example--one of which, I confess, I became aware only when preparing for the debate--so the hon. Member for West Aberdeenshire and Kincardine can think that he has achieved something. From my knowledge of the case, it appears to be a reasonable use of resources by a health authority, although it will obviously have to be compared with others.

The scheme was run by the Cornwall and Isles of Scilly health authority and involved a grant of £300,000 being made to councils to fund central heating and insulation improvements in homes occupied by families with children who suffer from asthma. The health authority took the view that the poor health of the children selected was directly connected to the cold, damp houses in which they lived. The improved homes housed 108 children suffering from asthma. Provisional results for 71 children show that, before the improvement, 68 children slept in an unheated bedroom and 43 in a damp or mouldy bedroom; those numbers fell to three and 15 respectively. Significantly, there was an improvement in the respiratory symptoms suffered by the children with asthma and a significant reduction in the number of school days they lost because of asthma.

I have not studied the scheme or assessed it for myself, but I should not like to rule out intervention of a sort that not only brought noticeable benefits to the children in health terms, but that, by reducing the number of school days lost due to asthma, helped to tackle some of the

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consequences of ill health. In our programmes to tackle social exclusion, the Government try to join up such factors. If children cannot go to school because they are too ill, they are less likely to get a good job; they are more likely to be ill because of unemployment and so more likely to add to the costs of the health service.

Everyone involved will have to consider how to use funds prudently. Health improvement programmes involve health authorities and local authorities, which have their own capital resources and which benefit from the release of capital receipts. I hope that that framework will enable the creation of partnerships that identify which organisation is best able to invest, because it seems to me that interventions of the sort I have described can bring significant benefits. A scheme in Birmingham focused on improving the heating and insulation of homes to reduce occupants' risk of ill health and hypothermia. The scheme was targeted on people who were recipients of benefit and who were at risk of hospital admission; they were referred by their GPs, who advised directly on the likely health gains.

The new flexibilities the Bill will allow will make it easier to support staff working at the interface between health and housing, and help health authorities and local authorities to respond to the needs of local people in the round. They will enable the NHS and local authorities to think more inventively, to develop innovative solutions to long-standing problems and to use local resources in new and imaginative ways. Local action on the wider determinants of ill health might cover a wide range of issues, including fuel poverty; housing and the environment; action such as the sure start initiative, which brings health, social services and education together to give young people a better start in life; and access to good and affordable food.

My reason for directing the hon. Gentleman's attention to health improvement programmes rather than accepting the specific measures that he proposes is that an important principle of the health improvement programme approach is that it should combine concerted action on national priorities with a focus on the most pressing local concerns. The scale and impact of fuel poverty is likely to vary from area to area: an area with a large elderly population and poor housing might want to give the issue very high priority; in other areas, fuel poverty might be a lower priority for the health improvement programme.

It is right that there should be local flexibility, so I see no case for prescribing a mandatory annual review process to tackle fuel poverty alone. I point out that, if this were to become a matter of such overwhelming importance that universal action was required across the health service, clause 28 allows the Secretary of State to issue directions about the matters to be dealt with by health improvement programmes and their form and content.

It is encouraging to see the enthusiasm with which local partners are already responding to the challenge of improving health and tackling inequalities. I have provided some relevant local examples already. I believe we are right to allow local flexibility of approach, and I do not believe the case has been made for mandatory local reports on energy efficiency matters--still less that those reports should be repeated annually. While I recognise and respect the hon. Gentleman's commitment to action

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on fuel poverty, I hope hon. Members will agree that the Government have introduced the correct framework for national and local action and that new clause 8 is neither necessary nor appropriate.

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