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Mr. Philip Hammond (Runnymede and Weybridge): Will the hon. Lady acknowledge that, when opening the debate, my hon. Friend the Member for Woodspring (Dr. Fox) specifically said that the motion was worded as it was so that he could make it clear that he was not suggesting that the Government public health policy was failing as a whole, but that there were certain failures that needed to be addressed?

Judy Mallaber: I said that it was the fairly measured comments made by Opposition Members that caused my

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surprise that the motion did not explicitly recognise that attitude. Someone outside reading the motion would not have taken that point. I explicitly acknowledged that Opposition Members' speeches had been fairly measured.

It is important that we applaud the successes of the programme. Before coming into the Chamber, I spoke to the southern Derbyshire consultant in communicable diseases. He told me of his fear that, once a specific illness had almost been eradicated, the public would not be so keen to get their vaccinations, leading to a danger that deaths would occur, whereupon the public would flood back, banging on the door, desperate to be part of the immunisation programme. My area and others have witnessed remarkable successes in terms of the incidence of and the number of deaths resulting from meningitis. As other speakers have said, we cannot be complacent. Even with the meningitis C programme, a number of people have still not been vaccinated. In the past year, cases of meningitis C in my area have arisen only among groups that have not yet reached the vaccination stage. There are still some who have not been treated under the programme.

The trauma, despair and terror of a village and an area that is imbued by such a disease are horrendous; there is hysteria, upset and anxiety. As was pointed out, we still need to find a vaccination for meningitis B. Parents and families must be on their guard, and it is important for that message to keep going out.

I thank my hon. Friend the Minister for Public Health for the quick response that she gave when I informed her of local fears that the Public Health Laboratory Service would charge for the polymerase chain reaction--or PCR--test, which has been important in identifying what is going on in relation to meningitis. The test has been one of our major successes in public health policy.

My neighbouring Member of Parliament, my hon. Friend the Member for Erewash (Liz Blackman), was influential in setting the terms of the debate about the flu vaccine. She initiated a debate on the matter last year in the House and was one of those who argued for lowering the age at which free inoculations can be given. The response given to the vaccination programmes by health authorities and all those involved has been remarkable.

I want briefly to mention broader public health issues. In my area and elsewhere, a number of imaginative initiatives are ensuring substantial success on the broader public health agenda, in direct contradiction to the terms of the motion. That success has occurred not only because we are putting massive extra resources into the health service--it is hard to see how the Opposition can square their incredible policies of tax cuts and maintaining spending--but because of the new structures and the way in which they are working.

I should like to give a couple of examples. The House recently discussed smoking cessation. My area now has smoking advisers, who are available in general practitioners' surgeries. Doctors can pass patients on to such advisers, who will provide assistance and talk to them about what giving up smoking will mean. If people decide to go ahead with the programme, the advisers can give them free nicotine patches. The chief executive of my primary care group said that her mother had been smoking 60 cigarettes a day for the past 40 years. As she pointed out, if she can give up because of the counselling programmes, anybody can.

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We have also managed to reduce waiting times for GPs by introducing another initiative under which counsellors work in their surgeries. When people go to a doctor with mental health problems, whether they have been caused by bereavement or specific problems in their lives, they can be referred immediately to counselling services within the surgery. Such provision is now available throughout Amber Valley. It is reducing waiting times and dealing with the difficulties that arise when GPs do not have time to get to the bottom of what is happening to the patients who present themselves in their surgeries.

There are a number of other imaginative new initiatives, such as the use of physio-triage within GPs' surgeries. The range of initiatives that have been introduced are making a genuine and important impact on public health. That is down to the new structures that are in place, which are enabling us to spread best practice and to make resources available in GPs' surgeries while also linking them into services in local community hospitals and acute hospitals.

My Conservative opponent in the forthcoming election has just been reported in the local paper as saying that she will conduct a survey of all the local health service failures and that she will pass on the results to the hon. Member for Woodspring. I hope that she will leaflet Ripley market, as I have done recently. I was astounded to meet two people in one hour who had just left Glenfield hospital. They were extremely bright after triple heart bypass operations.

When I mentioned the incident to the chief executive of my primary care group, she assured me that it had not been deliberate and that she had not planted the people there simply because she knew that I was leafleting. The group had decided to set up a major programme to deal with triple heart bypasses. I do not know whether it has a conveyor belt programme, but we are starting to make an impact. We need new structures as well as resources.

We have had major successes in public health. They have helped people who suffered unbelievable trauma in my constituency. I am grateful for the support and help of Ministers in dealing with some of those difficulties.

9.15 pm

Mr. Peter Luff (Mid-Worcestershire): I point out to the hon. Member for Amber Valley (Judy Mallaber), who spoke in generally measured tones, that I could reveal a different story about coronary care in Worcestershire and the west midlands. However, that is not the subject of the debate.

The debate is important and has been measured. I welcome that. It was intended to be about issues of real anxiety to people outside the House. Those issues deserve to be addressed seriously. I was genuinely puzzled by the comments of the hon. Member for Wirral, West (Mr. Hesford), who questioned the point of the debate. He spent much of the early part of his speech doing that rhetorically. He should realise that this place exists to address the concerns of people outside it and that it is not irresponsible but responsible to deal with them. Were the hon. Gentleman in his place, I would ask him what was the point of Parliament if not to tackle such anxieties.

I was encouraged by the opening remarks of the hon. Member for Amber Valley. She began to draw us towards the two important issues that underlie the debate. How

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does society and Parliament debate risk? How do we deal with anxiety about risk? Those questions are relevant not only to health but to many aspects of public policy. For example, they apply to transport policy. Despite the tragic incidents on the railways, it remains safer to travel by train than by car. The shift from trains to cars increases the risk to which people are exposed. However, people feel that they are in control of a car and not of a train. They are making a mistake because they are at the mercy of other drivers, but they believe that they are safer.

On MMR, people want to take control and make decisions about vaccinations for their children. If a child contracts a disease, the parents will not blame themselves. However, if they believe--rightly or wrongly--that their action in getting the child immunised has led to autism or some other condition, they will blame themselves. That is a crucial difference.

There has been a series of health scares in our nation. They have often been unfounded, but they have led to declining respect for professionals and politicians who advise on health. We should be genuinely worried about that. I therefore emphasise to the hon. Member for Wirral, West, who is now in his place, that it is important to conduct a measured debate on the subject.

We should also be frank about our lack of knowledge of diseases. I am inclined to believe that we have the necessary knowledge to reassure people about MMR. However, I am glad that my children are old enough for me not to worry about making the decision. We do not have such knowledge about other matters.

When I was Chairman of the Select Committee on Agriculture, we spent a long time considering the link between tuberculosis in badgers and in cattle. We have no idea what the link is. The science is unclear and almost non-existent. We may believe that we know through anecdotal evidence, but we do not. That is often the problem in public health matters. Bovine tuberculosis is not irrelevant to the debate because there is increasing evidence of farming families contracting the bovine form of the disease. That seems to be related to their exposure to cattle, and is a matter of considerable anxiety.

We must grapple with the reality that we do not know how to manage risk and that sometimes we cannot reassure people because we do not have absolute knowledge.

MMR has been the focus of the debate, and I, too, will focus on it. The World Health. Organisation recommends an immunisation rate of 95 per cent. to avoid the spread of a new epidemic in the population. Our immunisation rate for the three diseases controlled by MMR is only 88 per cent., and in some parts of the country the rate is only 75 per cent. We are therefore at genuine risk of epidemics of the three diseases involved.

I hope that the Minister and the Secretary of State will ask themselves again where the real balance of risk lies. I know that this is a difficult and controversial area, but I have to say that Governments are no longer respected by people out there: they are no longer trusted to give secure and safe advice on public health policy.

The Secretary of State said clearly at the Dispatch Box that MMR was the best way of dealing with the problem, but even if the Government are entirely right I do not think that he will reassure people. Many will still be worried and will opt for no vaccination at all. That could have serious consequences, as we seem to see already

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from the current statistics. I do not say this in a partisan way, but the Minister cannot duck it: immunisation rates have declined over the past few years, having reached about 92 per cent. in 1996-97.

I hope that the Secretary of State and his ministerial colleagues will realise that in public health policy it is sometimes necessary to choose the least worse option. I recommend a twin-track approach. There should be reassurance--I welcome the reassurance that the Government are trying to give about MMR--but parents who are not reassured should be offered the alternative of treatment on a single-vaccine basis. I realise that that would involve problems in doctors surgeries and a greatly increased work load. It is not an easy solution, and it is not without its costing problems. It should, however, result in an increase in overall immunisation rates.

Some children will be exposed to measles, mumps and rubella for longer than is necessary, which is bad: I do not rejoice in it at all. It is possible, however, that we shall manage to raise the overall immunisation rate to the critical 95 per cent. level.

This has been a good-natured debate, which has approached the issues seriously. However, I ask the Government to consider whether what the official Opposition are saying, in a non-partisan fashion, may represent the best way of avoiding the spread of dreadful diseases whose effect is often underplayed now that we have lost our experience of them.

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