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Public Health
3.32 pm
The Secretary of State for Health (Mr. Frank Dobson): The new White Paper which I am presenting to the House today is called "Saving Lives: Our Healthier Nation", and that is exactly what it is about. It spells out how we want to save lives by stopping people becoming ill in the first place.
We aim to save 300,000 lives by 2010 by reducing the death rate from cancer in people under 75 by at least one fifth; by reducing the death rate from coronary heart disease and stroke in people under 75 by at least two fifths; by reducing the death rate from accidents by one fifth; and by reducing the death rate from suicide by one fifth. Those are ambitious targets, which should mean that we become a healthier nation. They are bigger reductions than we suggested in the Green Paper--and unlike the Green Paper, those tough targets now apply not only to people under 65, but to people under 75.
Those targets are backed by action. On cancer, it is action against smoking, action to improve diet, action to improve screening uptake and quality, action to modernise cancer scanners and equipment, and action to improve treatment. On heart disease and strokes, again there will be action on smoking and diet and also action on blood pressure and exercise, action to cut heart attacks and action to improve rehabilitation.
However, that is only part of the story. We are not only setting tougher targets than the previous Government: we are explicitly aiming to do something quite different. Poor people are ill more often and die sooner, so we are going to tackle the inequalities in health, which grew under the previous Government.
Our policies are designed to improve most of all the health of the least healthy. The national health service has a big part to play, but our strategy requires a three-way partnership between the whole Government, local communities, families and individuals. None can succeed without the others. We reject the idea that individuals are powerless victims of their fate, but we also reject the Tory idea that individuals are entirely to blame for their own poor health.
We need to use all the means at our disposal tomake it possible for everyone to lead a healthier life. Unemployment, low wages, poor housing, crime and disorder, lack of education, and environmental pollution all make people ill. The Government are taking action to tackle them. The windfall levy, opposed by both the Tories and the Liberal Democrats, provides jobs and training for young people; and 400,000 more people are now in work than when we were elected. Low pay is a health hazard, so we shall improve the health of more than 2 million people and their families through our introduction of a national minimum wage. This autumn, those families and many others will be further helped by the working families tax credit. Many thousands more will benefit from having a decent home to live in as a result of our increased investment in new and better homes for people who are badly housed at present. Improved educational standards are providing economic opportunity and pathways out of social exclusion.
The Government will play their part, but so too must communities. In some areas, whole neighbourhoods are unhealthy because of poverty, pollution, crime and
disorder. We must target effort on those neighbourhoods. The most deprived areas are being helped by the extra effort and extra funding that flows from regeneration schemes, from health and education action zones, from lottery funds going into healthy living centres, from the replacement of substandard general practitioner premises, from the sure start programme for children, from the healthy schools project, and from our £96 million public health development fund.
We want to work with community organisations, local councils and health bodies to ensure that those programmes are delivered on the ground. Every health authority will have to draw up and implement a health improvement programme that identifies and meets the particular health and health care needs of its area. That is because priorities differ in different parts of the country, with different individuals and groups having different problems--for example, respiratory disease in areas of heavy industry, or formerly of heavy industry, or the higher incidence of heart disease or cancer among certain ethnic groups. Local councils, businesses and voluntary organisations will all be involved in developing and implementing those plans.
Fluoridation illustrates the new approach. The White Paper makes it clear that we will conduct an independent expert review of the safety and benefits of fluoridation. If that shows that fluoridation is beneficial, local authorities will be given new powers to require water companies to fluoridate where there is local support for doing so.
We also propose to strengthen the public health professions and to develop extended roles for health visitors, community and school nurses, and midwives. The new primary care groups will enable GPs and practice nurses to draw upon their unique relationship with patients to help to promote better health. Many of the groups are already doing that.
We want action by Government and action by communities, but that cannot be the end of the story. Individuals and families must play their part--for example, on smoking, which is the biggest single cause of avoidable death and of inequalities in health in this country. We have a twin-track strategy to stop the tobacco companies recruiting new smokers and to help existing smokers to give up the habit. Unlike the Tories, we accept the overwhelming evidence that tobacco advertising helps to get children addicted, so the Government intend to play their part by banning advertising from December. However, we also accept that individuals need help to give up smoking, which is why we are making free nicotine replacement therapy available to poor smokers who want to give up.
That is a recognition of the fact that up to now most health promotion strategies have actually widened the health gap, because the better-off have taken more notice than the worst-off. We need to develop strategies that have the most impact on the least healthy. That is one reason why the White Paper announces our decision to replace the Health Education Authority with a new hard-hitting Health Development Agency, with a much bigger role in working out and delivering the approaches that will work best.
Individuals and families can help one another. That is why we are launching a health skills programme that will give young people first-aid skills and health information; that is why we are launching our expert patients
programme to help people with chronic diseases such as asthma and diabetes better to manage their conditions. That will be good for the NHS and good for patients, as fewer complications mean better health and less demand on GPs and hospitals, with resources used to tackle the highest priorities.
The White Paper sets out long-term plans for improving the health of the nation and reducing inequalities in health. They really are long-term plans: their full benefits will show up only in a decade or more. That is the time scale involved, but it is no reason for delay. It is all the more reason for getting on with it: 300,000 lives saved, 300,000 reasons for action.
Fifty-one years ago this week, the national health service, which Nye Bevan founded, came into operation. We all benefit from the far-sightedness of that Labour Government, whose action cut inequalities in access to health care. By itself, that action could not reduce inequalities in health, but common justice requires that we do so.
Conservative Members who represent areas where people are comfortably off and pretty healthy should recognise that ours is a simple but difficult aim. We want to help to make sure that the standard of health of the people they represent in Surrey or Sutton Coldfield is shared by the people we represent in Barnsley or Bethnal Green. That is what we mean when we say that we want to end the divisions that mar our society and instead create a genuine one nation. I believe that that is what all decent people want, wherever they live and whatever their own state of health. That is why I commend the White Paper to the House.
Dr. Liam Fox (Woodspring):
Usually, farewell performances get a better cheer than that. The Opposition would welcome any genuine measures to improve the health of the people of the United Kingdom, but we deserved better than the right hon. Gentleman's remarks.
There are some aspects of the White Paper that we welcome. Since the publication of the Green Paper, the Secretary of State has changed the targets, but I am sorry that he has not widened them. For example, the expert patients programme he outlined for asthma and diabetes is welcome, but it is not a substitute for targets, which we wanted. Of course we need to send positive health messages to the population--lose weight, eat sensibly, exercise more and, as it says in "Ten Tips For Better Health":
Let me give one example. The section on defibrillators says:
If, as the Secretary of State said, cancer scanners are to be modernised, are more staff to be recruited to operate them and interpret the results? There is currently a shortage of both radiographers and radiologists. At a time when fully trained obstetricians and gynaecologists are being laid off, how does that give comfort to women suffering from cervical or uterine cancer? The reality does not match the rhetoric. If exercise is to be encouraged, why has sport been removed from the national curriculum for primary schools? Does the right hon. Gentleman genuinely believe that suicide rates are the best way to measure the prevalence of mental illness, and on what basis has he arrived at that judgment?
If the White Paper is big on rhetoric, it is short on facing up to the big issues. The new approach was well illustrated by the Secretary of State's remarks about fluoridation: if it is shown that fluoridation is beneficial and there is local support for it, local authorities will be given powers in that respect--but only after there has been an independent expert review. Information on fluoridation is pouring out of the Department of Health, but the Government refuse to make a decision because somebody, somewhere, might not like it. That is a cowardly and pathetic approach to public health.
Rather offensively, the Secretary of State suggested that the Conservatives had said that individuals were responsible for their own ill-health. No Conservative Member has ever suggested such a thing. However, the Government cannot solve all the nation's health problems; the right hon. Gentleman was correct to say that there must be a partnership. He said that there must be a three-way partnership between the whole of Government, local communities, families and individuals--four parties, not three. There was no mention of the medical profession, which seemed to be noticeably lacking from what he had to say--perhaps because he has alienated almost all its members in recent times.
Perhaps the worst part of the statement came at the end, with the Secretary of State's class warfare rhetoric. As a result of Conservative economic policies and his party's very large majority, many of his Back Benchers represent the constituencies that he says are very affluent and therefore need less money. His ugly soundbites will offend many inside and outside both the House and the medical profession, as well as the natural decency of many people who care about those less fortunate than themselves. Is he saying that there is massive inequality in the allocation of money in the health service on a geographical basis? Will there be a transfer of resources from the Prime Minister's beloved middle England, or is the rhetoric merely aimed at those voting for a London mayor?
"Manage stress by . . . talking things through . . . Practise safer sex"
and
"follow the Highway Code."
Those are important messages for the public, but the White Paper is heavy on gimmicks and short on substance.
"members of the public can use them as soon as it is clear that they are needed"
in, for example, supermarkets, railway stations and airports. How are members of the public to know when a defibrillator is needed? How will they be trained? What
will any indemnity consist of--will the Government provide blanket indemnity? If the Government are truly concerned, it would be better to spend the money on improving ambulance response times.
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