The Minister of State, Department of Health (Mr. John Denham): Violence to staff in the national health service is unacceptable. A cross-Government campaign, the NHS zero tolerance zone, was launched last October with targets to reduce violence against staff by 20 per cent. by April 2001 and 30 per cent. by April 2003. Changes have also been made to the choice of medical practitioner regulations to combat violence against GPs.
Mr. Lewis: I thank my hon. Friend for that answer. How many verbal and physical attacks on NHS staff have been recorded recently? More specifically, can he assure my constituents in Bury, South that he and other Health Ministers liaise with the Home Office to ensure that those brought to the courts and convicted of such attacks on NHS staff feel the full force of the law?
Mr. Denham: My hon. Friend raises some important issues. Our surveys show that about 65,000 staff suffered physical and verbal assaults last year. One of the aims of the new strategy is to ensure that all such incidents are recorded, so the figure will probably increase in the short term as people are encouraged to report them. He is right that cross-Government co-operation is important. We work closely with the Home Office and the Lord Chancellor's Department on that strategy. For example, the Lord Chancellor, who is president of the Magistrates Association, has said that it is entirely legitimate for magistrates to respond decisively to a particular form of criminal behaviour, such as assaults on NHS staff, and to impose a sentence that has a deterrent component. In the Bury area, where the police, the health authority and the magistracy co-operate closely, there has been a reduction in violent incidents against staff of some 24 per cent.
Dr. Peter Brand (Isle of Wight): I congratulate the Government on the work that they have done in improving casualty departments and, therefore, reducing, I hope, threats of violence in them. Employing more porters has helped in that respect. Can the Minister give an assurance that community staff will not be forgotten?
Mr. Denham: The hon. Gentleman raises an important issue. We shall produce further material as part of the campaign, either at the end of this month or at the beginning of August, which will provide guidance to staff, health authorities and employers in mental health and community health settings and the ambulance services because those staff are at particular risk. On mobile phones and other forms of communication, I agree that employers should make proper assessments locally. [Interruption.] The hon. Gentleman sighs, but the work done by individual members of staff varies, so it is important that the working position of each of them is considered. In circumstances where such measures would add to their safety, I certainly think that employers should put them in place.
The Parliamentary Under-Secretary of State for Health (Ms Gisela Stuart): Air ambulance services in England are financed largely through public subscription. We support existing services by providing qualified paramedic crew through the national health service.
Mr. Heath: Given that there is evidence that air ambulance services can result in a significant reduction in deaths in transit and from head injuries and in the amount of time spent in intensive care, is not it extraordinary that they are entirely dependent on public subscription and charitable fund raising? Even more extraordinarily, I am told that some ambulance trusts charge air ambulance services for providing paramedics to go out and save people. Would it not be better if this country were to follow the example of Germany, where there is properly co-ordinated, comprehensive air ambulance cover, which is at least partly publicly funded?
Ms Stuart: I fear that I have to disagree with the hon. Gentleman because the evidence on the clinical outcome is by no means as persuasive as his question would suggest. Professor Jon Nicholls made it clear in his report, "The costs and effectiveness of helicopter emergency ambulance services", that the evidence is not convincing. All the local studies on the outcomes, including those in London, have not made the case for air ambulances. However, it is important that we support them. In some areas they are most appropriate, not least in the hon. Gentleman's area, where the NHS provides 14 trained paramedics to support the service. According to all our evidence, the optimal solution for the 11 air ambulances in the current structure would be to work with the ambulance services, the police and the military when necessary.
Helen Jones (Warrington, North): When my hon. Friend considers the financing of air ambulance services, will she also consider the position of those independent air ambulance services that are sometimes used by the
Ms Stuart: That is an important consideration and my hon. Friend may be aware that in the north-west consultation is taking place in the working group on developing proper proposals and protocols for transfer. We agree with her basic sentiment and will certainly take that forward.
Mr. Ian Bruce (South Dorset): Will the Minister consider carefully the evidence that has come forward, particularly in rural areas, on air ambulances and the way in which they are funded? I understand that the lottery is not willing to provide funds to help the NHS with air ambulances, although a lot of money has been taken from the lottery to replace old NHS equipment. There is not the additionality that people are looking for, but surely additionality is important. I should be grateful if she considered that carefully.
Ms Stuart: It is easy to assume that air ambulances would always provide solutions, certainly in rural areas, and Cornwall was one of the first to have an air ambulance. However, it should be remembered that civilian staffed air ambulances operate only during daytime hours and that the task has its own hazards. For example, there have been a number of civilian deaths in the past few years during such operations so we need to look much more closely at how we get to patients more quickly, whether in rural or urban areas. Our work to improve the ambulance service and support the air ambulance service, rather than thinking that extending air ambulance services would solve the problems experienced in some rural areas, is the right way forward.
The Secretary of State for Health (Mr. Alan Milburn): Infant mortality rates have fallen for very many years, but there remains a gap between those born into affluent families and those born into more deprived families. We are currently developing a national plan for the NHS, which will set out a programme of change and improvement to address some of those problems. It will confirm that the Government's ambition is not only to improve the health of the population overall, but to narrow the gap between the worst off and the better off.
Ms Blears: I thank my right hon. Friend for that reply. I have no doubt that he is aware of the research from Sussex university that shows that more babies die in Britain than anywhere else in northern Europe, that babies born into the poorest families are twice as likely to die as those born into professional families and that in inner-city areas such as mine--Salford--30 per cent. more babies are likely to die than the average for England and Wales.
Good food and access to nutrition is one way in which we can begin to tackle that scandalous inequality. Will the Government support schemes launched by my education action zone and sure start to provide free school fruit and to ensure that we provide extra money for young mums and pregnant women to improve their diet? Access to fresh fruit, healthy food and good standards of nutrition are crucial to provide good health for future generations.
Mr. Milburn: This is a very serious issue that deserves to be considered seriously. From visits to my hon. Friend's constituency, I am aware of the good work that is being done by the local authority, the NHS and other players. On health outcomes, she is absolutely right that the gap between the richer and poorer parts of Britain remains stubbornly wide. On infant mortality rates, there was a three and a half to fourfold difference between different health authority areas in the last year for which we have figures. Although progress has been made over many decades to reduce infant mortality rates in England and across the United Kingdom, none the less it is also correct that our infant mortality rates remain above the European Union average. We must address that. To do so, we must not only achieve the proper focus on prevention and treatment, but take action across the Government to tackle some of the root causes of ill health. My hon. Friend is absolutely right that there is a clear correlation between poverty, ill health and, sometimes, infant mortality rates.
Mrs. Caroline Spelman (Meriden): Will the Secretary of State explain how his decision to cut the budgets of 11 health action zones in the poorest part of the country, including Salford, will help those plans to cut infant deaths?
Mr. Milburn: I was not aware that the hon. Lady was a signed-up member of the health action zone fan club; obviously I was wrong. I know from her views about the national health service that she likes to visit NHS hospitals to see what it is like for those who do not have private health insurance. I think that that is what she had to say on the record in The Health Service Journal.
There has not been a cut in the amount of money going to health action zone areas. This year, the average increase per zone area budget is 37.5 per cent. Individual HAZs are seeing increases of between 10 per cent. and more than 70 per cent. That is not a cut, but an increase.
Fiona Mactaggart (Slough): Is my right hon. Friend aware that inequalities within some health authorities are even greater than those between health authorities? My constituency comes within the Berkshire health authority. For 20 years, the health authority's view of ending health inequality has been to ensure that it does not spend a penny more in Slough than is spent in the rest of the county. Indeed, over the years it has spent much less in Slough, with the result that infant mortality and deaths from heart attacks and strokes are comparable with those in the inner-city area represented by my hon. Friend the Member for Salford (Ms Blears).
Will my right hon. Friend ensure that health authorities are given instructions to tackle the sort of inequalities to which I have referred so that the people of Slough can enjoy the same excellent standard of health that is enjoyed by the people of Wokingham down the road?
Mr. Milburn: My hon. Friend is right to say that there are inequalities between areas and within health authority areas. We have made it clear that over time we expect health authority areas will be able to move their allocations to primary care groups and trusts so that they begin to address inner health authority problems and inequalities so that there is a fairer distribution of cash between health authority areas and within them.