Examination of Witnesses (Questions 540-559)
YVETTE COOPER
AND MR
GORDON BROWN
TUESDAY 27 FEBRUARY 2002
540. Were you consulted in any one of those
committees about the decision to change the rules about safety
cameras, last December?
(Mr Brown) No, I do not recall that.
541. Can I press you a bit further, because
we received evidence from some of the local authorities in Northampton,
Nottingham and Gloucester that they had put in place very innovative
traffic calming measures that had had quite startling impacts
on reductions in road traffic accidents. They say it was unfortunate
that health authorities in those areas did not keep the records
either in staffing reduction terms or in money terms of the impact
that those, up to 50 per cent, reductions in accidents had had
in those areas. Why is that the case? What will you do about it?
(Yvette Cooper) I think it is true that there is a
greater role that health could play at the local level in this
kind of field. One of the constraints, obviously, is around capacity,
but there is also a structural issue as well, that it has only
been, really, in recent years that closer partnerships between
health authorities and local government have been increasingly
developed through health improvement programmes and local strategic
partnerships, and so on. We have an opportunity with the development
of Primary Care Trusts to take that a step further, because the
Primary Care Trusts will each have a public health director and
will be, effectively, taking public health closer to the community
level. The potential, I think, is there for public health directors,
potentially using information gathered from the Public Health
Observatory, whose job it is to gather health information in different
regions, to do much more close work with local strategic partnerships
about things like where the hot-spots might be or, where you have
got something working, how do you evaluate it and how do you link
up the information. The problem that we have at the national level
is that Primary Care Trusts are only really just getting going
and that the data collection that we ask local areas to do is
considerable already. So I think there is the potential to do
considerably more than is being done, but that there will be capacity
constraints in relation to how fast that is possible to achieve.
542. It does sound a bit of a complicated answer
to a relatively simple question, which is what percentage of accidents
and emergency staff time is spent on road traffic accidents? Is
that kept as a separate record so that it can be monitored—with
graphs perhaps—so that if there is a new scheme we see the
graph going down, and if it starts going up we get worried? Is
that not a way in which your department could actually contribute
in a major way to putting pressure on the rest of the government
to get on with it?
(Yvette Cooper) We do not classify the information
in that way, at the moment.
543. You do not?
(Yvette Cooper) No, as I understand it.
Chairman
544. With the greatest respect, that information
already exists in A&E departments, because you actually have
the right to charge for road traffic accidents.
(Yvette Cooper) We have the information on the in-patient
data. I will ask Gordon to expand in detail on the things that
we do have.
(Mr Brown) The point is, Chairman, that essentially
A&E data will cover many, many injuries—many of them
being slight, many of them not connected with road traffic incidents.
The data we do have is from hospital in-patients; those who have
serious injuries and the ones that we want to focus more attention
on. Those data are fed back and compared with the police data
that come to the DTLR, and an attempt is made to gain a better
understanding once the diagnosis has been made and the long-term
effect of the accident has been established.
545. But not the other emergency services. You
do not seek to collate it from ambulance services or from fire
brigades?
(Mr Brown) What we are merely concerned about is the
actual diagnosis of the injury at the time, and therefore when
the person has been an in-patient—which, by itself, means
that it is a more serious accident—we focus on those cases
in particular, rather than what might be a relatively slight injury.
Helen Jackson: Finally, what we get in our surgeries
is the staffing shortages in accident and emergency hospitals.
If you can cut down, surely, that staffing time because of a reduction
in accidents, would that not help throughout?
Chairman: "Yes" will do as an answer,
Minister. Thank you.
Ms King: On that point, is data collection not
muddied by inaccurate reporting around the severity of injuries?
You talk about in-patients, but if they die after 30 days they
are recorded as seriously injured not dead. Obviously, that leaves
a problem. I wonder if you agree with the BMA who said that under-reporting
of road traffic injuries can have implications for assessing what
costs traffic injuries impose on the NHS.
Chairman
546. Do you agree with that?
(Yvette Cooper) I think I would accept that. Our data
collection is not designed around road accidents. It has been
designed around the needs of the NHS, specifically, to treat people
and to fund appropriately within the NHS. That is the way the
data system has been designed. Inevitably, the way that the data
is collected has to cope with a lot of different demands on it.
We have to balance the interests of not asking for too much data
so that we have our health service spending its whole time collecting
data. I do take the points that you are making, that there may
well be better ways in which we can collect data around road accidents,
and we will certainly look at that. The only caution I would give
is that we may not be able to do it, given the other constraints
on it. So I cannot give any guarantees about what is possible,
but I will certainly look further at that issue.
547. Let me be helpful to you, Minister, since
we are a very helpful Committee. It needs two or three researchers,
it needs a small budget from the Kings Fund and it needs somebody
thinking clearly about how they use your existing information.
You have it in the system, believe me. You have got to stop asking
people to take more statistics on board, you have just got to
look at what is under your nose.
(Yvette Cooper) That is an issue, probably, about
the data held by ambulance departments, but the issue we were
discussing about what we had in terms of the data that is collected
in A&E departments may be a more difficult area.
Mrs Ellman
548. Has your concern about class differentials
in accidents and safety been reflected in the Ten Year Plan for
Transport?
(Yvette Cooper) I think that the whole issue of inequality
is picked up everywhere really. The concern about the class differences
seems to be about deprived areas having higher incidents of speeding
than less deprived areas, but also having more children on the
streets and less places to play. Some of these issues are not
simply about the transport side of it, it can be that the kids
have no where else to go so they are playing on the street, there
could be broader quality of life issues. There is much picked
up in Neighbourhood Renewal Units as well in focussing on the
whole quality of life issues and about giving children other places
to play as well.
549. What about the areas where it is about
transport issues, the home zone areas and the lower speed areas,
do you think there is sufficient funding in the Ten Year Plan
to deal with the concerns you have expressed?
(Yvette Cooper) I think the issue is how we use the
resources we have to best tackle the inequality issue. That is
one of the things that the cross-cutting review round health and
equality is trying to pick up, whether it be home zones, whether
it be about issues about speed restrictions or whether it be about
the work done through healthy schools. We have a lot of programmes
at the moment where we could focus increasingly round inequality.
The Healthy Schools programme, which includes issues about safe
routes to schools, have not been heavily focussed on inequalities
before and that is one of the things we are looking at as well
and making that more focussed on inequality. If your question
is, could we do more to focus to on the inequality, yes, I am
sure we could and that is what we are trying to do at the moment.
550. Do you feel there is a sufficient link
between the concerns you are expressing and the priorities in
that Ten Year Plan for them to be reflected locally?
(Yvette Cooper) We found when we have had the discussions
under the umbrella for the cost-cutting review a lot of commitment
on the transport side on looking at the health and equality issues.
Have we got there yet? The answer is no, but we have certainly
found a lot of commitment from the Department to look at health
and equality issues in terms of their policies and how it impacts.
Mr O'Brien
551. Minister, the question of the speed of
traffic on urban roads is an issue we are addressing and we hope
that you will. I put it to you there has been a report published
in Nottingham and their survey shows that the closer people live
to main roads the more likely they are to develop asthma. Have
you done anything on that?
(Yvette Cooper) Some research has been funded. The
research you are talking about was part funded by the Department
of Health round asthma. In previous years there had been some
mixed evidence round asthma in children but this, I think, was
quite important. The Department of Health Committee on the Medical
Effects of Air Pollutants is going to consider a whole series
of studies round traffic pollution and closeness to roads because
it does seem to be, as you say, about the proximity to roads having
an impact on asthma. I think one of the interesting issues will
be whether there is further work that we can then do as a result
of that. The difficulty is what interventions you can then do
that would work. I think that that study did not so much look
at speed it looked at the density of traffic.
552. That comes to the next question, do you
support the implementation of 20 mph speed limits in these areas?
(Yvette Cooper) I think 20 mph speed limits are extremely
important, they have a big impact on accidents and that is why
we support the implementation of those. There is a separate issue
between the accidents which are linked to speed and the pollution
linked to traffic density.
553. If you support the 20 mph speed limit and
the fact that slower moving machines can generate more pollution
because of the density how does that impact on this research that
you are aware of and what are you doing about it?
(Yvette Cooper) I think that is why a lot of the work
round the 20 mph zones speeds have been in heavily pedestrianised
areas but you are right, there is a tension between maintaining
traffic flow, so you do not have slow, concentrated traffic making
pollution worse as well, that is a tension and I do not think
there is an easy solution to it. We need further study and further
research into the issues round asthma and pollution.
(Mr Brown) I entirely agree with that. I understand
that basically highway authorities do have a variety of approaches
they can take to traffic flows and were further research possible
in this area that might help them to direct how traffic flows
and how it could be directed away from the areas of pedestrian
density.
554. We have been told in the past that pollution
does effect the condition of asthma, this report says that it
creates asthma, do you agree with that?
(Yvette Cooper) We take the evidence and the advice
of the experts in this area and that is why we have asked the
Committee on the Medical Effects of Air Pollution to look at this
study in the light of all of the other studies, as well as advising
us. We can certainly write to the Committee again when we have
further advice on that.
Chairman
555. When you are looking at the 20 mph zones
will you bear in mind that some ambulance services get unhappy
if they have trouble with them in residential areas, they also
get unhappy if they get it outside A&E departments in major
hospitals. Someone needs to use a bit of common sense. Will you
sort that one out for us? Was that a "yes" minister?
(Yvette Cooper) Yes, but in the end it has to be sorted
out at a local level.
Chairman: We have "yes", we will let
you worry about the rest.
Mr Betts
556. In response to an earlier question you
said that you and your department had not been consulted by the
Department of Transport before their decision to make an announcement
about the sighting and colour of speed cameras, do you think you
should have been consulted?
(Yvette Cooper) I am not aware of the discussion that
took place at that time. In the end it is the responsibility for
their department to actually enforce the speed limits and enforce
the issues round speed. We are concerned about the impact that
it has on accidents but in the end they are the ones with the
expertise on how you enforce that and how you have the impact.
(Mr Brown) The task force were, in fact, aware of
work that had been done in Lancashire on this very area and as
a result of that work were supportive of the evidence this was
showing, the emerging evidence that these speed cameras could
have a great effect in reducing accidents. Had we been consulted
I am sure we would have been very supportive.
557. What sort of criteria do you think should
be used in making these decisions from your point of view and
from a public health point of view?
(Mr Brown) In supporting interventions which are shown
to have good success for reducing accidents.
558. The criteria is about reducing accidents.
You do not believe the criteria should be used according to whether
the public are in support of such cameras?
(Mr Brown) Compliance is always an important factor
559. The overriding criteria should be the reduction
of accidents.
(Yvette Cooper) In the end public acceptability does
matter. If you were purely concerned about health you would say,
"do not let anybody smoke", on other hand if people
want to smoke they have a right to smoke. In the end all of the
issues round public health do have to take account of public attitude,
what is acceptable to the public as well. From the Department
of Health we cannot simply take a view that only health concerns
matter, we can provide the advice and the response in terms of
health considerations but every department has to take account
of public acceptability.
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