Examination of Witnesses (Questions 526-539)|
TUESDAY 27 FEBRUARY 2002
526. Good afternoon, Minister, thank you for
joining us. Would you be kind enough to identify yourself, for
(Yvette Cooper) Thank you, Chairman. Yvette Cooper,
Minister for Public Health, and this is Gordon Brown with me,
who is the lead official in the Department.
527. Are you quite sure?
(Mr Brown) I do not look like him, do I?
528. The wrong accent. Do you have any opening
remarks, Minister, you would like to make?
(Yvette Cooper) Only very briefly, as I know you have
taken extensive evidence from other Ministers as well. Simply
to say that we very much welcome the Committee's investigation
in this area. Obviously, our perspective is from the point of
view of public health and the broader impact on health these issues
can have. We look at the prevention of accidental injury, the
promotion of exercise and, also, the prevention of pollution.
The one issue I would like to highlight and draw to the Committee's
attention is the fact that children from social class 5 are five
times more likely to die as pedestrians in a road accident than
children from social class 1. So this is an important issue when
it comes to tackling health inequalities as well. We have set
national targets for the first time in terms of narrowing health
inequalities. There is a lot of work going on across government
as part of the cross-cutting review on health inequalities to
feed into the spending review discussions, at the moment, so obviously
this is one of the areas covered by that as well.
529. So we can take it that your department
regards this as important a public issue as, for example, changing
the laws in relation to smog in the distant past?
(Yvette Cooper) We would not see it in isolation,
it is one of many issues. There is a specific issue in terms of
the number of child accidents, in particular, but in addition
to that there is an issue about quality of life and the impact
that can have on health as well. So, for example, it is not simply
about the actual accidents and the children who are harmed, or
the people that are harmed or killed in accidents, it is in addition
to all the other people who do not go out on the roads or do not
walk to school, or do not use the roads for fear of accidents
or fear of harm as well.
530. So how are you going to give a lead to
the population in these very important questions?
(Yvette Cooper) We obviously support the work being
done by the Department of Transport, Local Government and the
Regions in things like the home zones and the 20-mile an hour
limit. We work with both the Department of Transport, Local Government
and the Regions and the Department for Education and Skills on
issues around safe routes to school and encouraging more children
to walk to school or cycle to school as well. What we are looking
at, at the moment, is how we might be able to take those partnerships
further at the local level. We are looking at that under the umbrella
of the cross-cutting review on health inequalities; as to what
role in the future, for example, the public health directors in
Primary Care Trusts may be able to play in local strategic partnerships,
working with the local strategic partnerships and with the local
authorities around where are the key accident hot-spots, for example,
or what additional work might be done in schools in order to prevent
particular problems in particular local areas.
531. Your department is sitting on some very
specific and targeted information. Ambulance services, for example,
can not only predictwhere they have efficient systemswhere
particular accidents will take place, they can also predict the
time of day. Indeed, some ambulance services organise the provision
of vehicles on the basis of their predictive services. What effort
does the department make to gather that information together and
present it to those other departments who would most usefully
be able to put it into operation?
(Yvette Cooper) There is some work on data sharing
at the local level. I think I might have to pass to Gordon on
(Mr Brown) Basically, Chairman, there have been some
examples of local partnerships where A&E, ambulance and emergency
services work with the police and work with the fire brigade in
tackling local problems. We do feel, however, there is greater
scope for encouraging partnerships of this type. As you say, one
part of the situation has particular data that is of use to another.
We would particularly like to see this kind of data fed into the
local highway authority.
532. That is, if I may say so, aspirational.
This information exists. Greater Manchester can predict when they
are going to need ambulances, at what time of the day and what
kind of accident, on the whole, they are going to meet. What effort
is being made by your department to transmit those detailed statistics
routinely to those who not only design the roads, but those who
police the roads and those who control the roads? (After a
short pause) Are you telling me that this is a voluntary arrangement
between some ambulance trusts and some local police forces but
there is no effort by your department to ask, for example, those
of the ambulance services who have this data and have this software
what they do with the information?
(Yvette Cooper) Much of the software has been relatively
recently introduced and it does not simply include accidents,
it is predicting the overall need for ambulances in a particular
area. I think what we need to do, Chairman, is get back to you
on this. We will look into this in the department. This may be
an area where we could do more. I will certainly look into that
Chairman: Thank you very much.
533. How often do you analyse the cost of death
on the roads to your department?
(Yvette Cooper) We have figures on the cost of treating
all injuries. Unfortunately, the category includes treating all
injuries and poisoningsthat is the way the data is collectedwhich
is roughly calculated at 2.2 billion in 2000. I know the DTLR
have estimated the total medical and ambulance costs of traffic
accidents in 2000 as £540 million. We know that each person
who is admitted to hospital as a result of a traffic accident
is estimated to cost the NHS an average of £494 per day,
and each person who is treated without being admitted is estimated
to cost an average of £402.
534. Why do you not bill the driver in these
circumstances, for the full cost?
(Yvette Cooper) Where compensation is paid in respect
of a traffic injury the Department of Health is able to recover
the cost of hospital treatment from the insurer. So that was put
in place. There are some difficult issues to balance here. There
is, I think rightly, partly the principle of being able to recover
compensation, but at the same time recognising that the health
service provides care regardless, and does not make it conditional
on being able to recover resources and so on. So we do do that
kind of thing already.
535. You do not have any direct control over
that as an issue, do you? The control of that is within other
departments, not yours, for the impact and that cost.
(Yvette Cooper) In terms of the cost of actually causing
the accident, do you mean, having the impact on the health service?
Yes, that is right, and that is one of the reasons why we have
got, for the first time, the cross-cutting spending review taking
place across all departments. Part of the problem with health
is that often many of the causes are actually outside the field
of health, they are outside what the NHS doeswhether it
is unemployment, whether it is road traffic accidents, whether
it is poverty or poor housing, and those kinds of things. So we
have a wide range of areas where, effectively, health picks up
the bill for problems that may be caused elsewhere. What you need
to do is to take action across a whole range of fields in order
to actually reduce the bill for health as well. So the reason
for setting up a cross-cutting review around health inequalities
was exactly to try and do that, with the Treasury holding the
ring at the centre, to look at all of the different causes of
ill-health and, particularly, health inequality, and where the
priorities for investment should be if you want to turn that around.
I know that is not an individual answer to your particular question,
but I think it signifies the right sort of approach across all
536. Would it be better for your department
to have control of the publicity budget rather than the Department
(Yvette Cooper) I do not think so. We often find when
we are dealing with different health issues that it will cross-cut
other departmental issues. I have given evidence to other committees
and so on before and there is often discussion about are departmental
boundaries drawn in the right place. I think if we tried to include
everything which had a health impact in the Department of Health
it would be huge. However, other people have, equally, tried to
argue that all the things to do with public health should be taken
out of the Department of Health. I do not think that would be
the right approach either. I think it is right that the DTLR has
control of that because, in the end, they have responsibility
for implementing speed limits and making sure they are enforced,
and all those kinds of issues as well. They also do the detailed
research on the impact of speed limits or the impact of different
proposals around roads, and on accident levels as well.
Mr Donohoe: What are you doing to get your medical
professionals out of their cars?
537. That may be rather beyond you, Minister,
speaking as somebody who has five doctors in their family.
(Yvette Cooper) We actually have something that was
put in the national service framework for coronary heart disease,
to get local NHS trusts to draw up their own green transport plans
for individual areas in order to try and promote and extend the
support for healthy routes to work, ways of using bikes or walking
to work, and so on. That is being drawn up as part of the national
service framework and that is part of the requirement for the
NHS in different areas, and is under way at the moment. Because
the NHS is such a big employer in the country, that potentially
could have considerable impact over time.
538. How do you liaise with the DTLR and the
Home Office about this issue of speeding and road safety? What
are the mechanisms you use?
(Yvette Cooper) The mechanisms are at official level,
and I will pass over to Gordon to, maybe, say a little bit more
about it. At the ministerial level we are in the process, at the
moment, of discussions around the spending review process and
around health inequalities. That is just taking place at the moment
with different ministers. Perhaps Gordon can say more.
(Mr Brown) Thank you, Chairman. There are various
levels, as the Minister has said. There are various committee
levels and we are invited to attend various transport committees
and sit on those committees and be there to represent the Department
of Health. There have also been various specialist groups that
have been set up.
539. Has there been one on speed?
(Mr Brown) There has not been one on speed but there
has been one on the spending review, which has just been mentioned,
in which transport played quite a major part, especially in accidents.
We also had an Accidental Injury Task Force which has been a cross-government
and cross-sectoral task force, looking at all kinds of injury
and accidentagain, at which we had a DTLR representative.