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8 Jan 2003 : Column 257—continued

5.42 pm

Dr. Howard Stoate (Dartford): It is always a great pleasure to me to take part in health debates—as one of the few medically qualified Members, I follow with interest issues surrounding health delivery—but I feel that we might be having the wrong debate this afternoon. When constituents visit my surgeries, write to me or send me an e-mail, it is normally to ask what the Government can do to continue to improve health services in the local hospital, or to ensure that there are

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more GPs in the area and that social services have adequate long-term care facilities for elderly relatives. It is unusual that someone raises issues about who runs the facilities, unless something goes wrong. Most of the time, people are content to see the health service develop and services improve. They are not worried about who is delivering the service—unless something goes radically wrong, in which case they become very interested indeed. If services continue to improve, they are generally happy.

I believe that the debate should focus on how we deliver health care in our society and how we get the best health gain for the money we put in. All hon. Members on both sides of the House have said that there has been a 20 per cent. real-terms increase in health spending in this country and that that is welcome. The important thing is to ensure that that money is spent to the best possible effect and that we get the best possible health delivery and health gain from it.

Broadly speaking, there are two ways in which that money can be used to improve health care. First, it can be used to improve delivery of services. There has been significant improvement in my local hospital, Darent Valley hospital in Dartford, which is part of the Dartford and Gravesham acute NHS trust. The hospital went from no stars to one star now. It has just obtained agreement for a diagnostic and treatment centre to be a built—a #9 million investment that will enable an extra 3,000 elective surgery operations to be carried out each year. Accident and emergency facilities are improving and expanding. This week, the chief executive wrote to tell me that the hospital is now on track to achieve the two-week cancer target, and is well on the way to reaching the targets for both out-patient and in-patient waiting times. In other words, the hospital is making significant improvements in service delivery.

Dr. Evan Harris: Will the hon. Gentleman give way?

Dr. Stoate: No. There is little time and other hon. Members still want to speak.

This afternoon, hon. Members have asked about those trusts that are left out—that are not able to become foundation hospitals. It has been suggested that hospitals with one or two stars will not get a look-in and will somehow miss out. I take issue with that. In my area, where the hospital has one star, it is getting very significant improvements in its facilities, its management structure and its outcomes. It should not be assumed that just because a hospital is ineligible to apply for foundation status, it is automatically at a disadvantage.

In general practice we have the PMS pilots—for personal medical services—and advanced access, whereby patients will be able to see a nurse within 24 hours, or a doctor within 48 hours, of when they wish. That too is a significant improvement. The new GP contract, which I gather will be released sometime next month, will show how GPs can improve their facilities and their patient care, and develop their practices.

All that will, of course, have a major impact on the local health economy. I am pleased to announce that this morning my local hospital trust had a 14.5 per cent. increase in its capital allocation over the next three years, which will significantly increase its ability to improve health care services.

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I would like to focus on a radical rethink about the way in which we deliver health care, and how we view it. I want to look closely at what we really mean by the terms health, illness and disease. The World Health Organisation's 1968 definition of what constitutes health is about the complete physical, psychological and social well-being, not just the absence of disease. That definition will, I hope, encompass the vast majority of people in this country.

What constitutes illness behaviour? It was defined by Mechanic in 1962 as the actions taken by someone when they perceive themselves to be ill. According to some of the early work done on that idea, most people, when they perceive themselves to be ill, do not go to a doctor or a hospital casualty department; they do other things. They might go to a chemist or speak to their neighbours or their friends, and they will probably wait for a week or two to see what happens. Most people do not automatically rely on the NHS.

Only a relatively small number of people with disease—defined as an abnormality in structure or function of tissues or organs—need the acute services of the NHS. We have an obsession about the health service being synonymous with acute, expensive high-tech care. In fact, acute high-tech care is only one very small part of care delivery. The vast majority of people use informal methods; they go to the chemist, or their friends and family. Only a relatively small number of people use the acute care sector, and it is only a tiny part of the NHS—yet debate after debate in the House focuses on extremely expensive high-tech delivery as if that were the NHS.

NHS figures show that more than 90 per cent. of episodes of illness, as perceived by patients and as taken to medical professionals, are dealt with by GPs, practice nurses and other health professionals in the primary care setting.

Dr. Harris: Will the hon. Gentleman give way?

Dr. Stoate: Only if it is a very short intervention, because I do not have much time.

Dr. Harris: Does the hon. Gentleman think that the slogan XSchools and hospitals first" helps or hinders his attempts to educate his colleagues about the importance of primary health care?

Dr. Stoate: I knew that the Liberal Democrat spokesman would have to score political points, because that is what he does. I am trying to widen the debate away from party politics. I am trying to use the debate to widen the subject as far as possible and to consider other aspects of health care.

As I was saying, more than 90 per cent. of episodes of health delivery are given in the primary care setting; that is where the bulk of health care takes place.

Public health is a subject that we do not debate often, but the biggest cause of ill health in this country is poverty, including relative poverty, which causes diseases such as obesity, diabetes, heart disease and cancer. In 1911 the Registrar General, Stephenson, set up the disease classification by social class, and even as

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long ago as that, he made it clear that virtually all diseases are related to social class. In those days social class was a good measure, but these days we tend to use socio-economic status, because that is a fairer measure of the way society is now.

Every disease that I can think of, apart from malignant melanoma, is actually a disease of poverty and low socio-economic status. That is where the really big debate needs to take place. Almost all diseases—certainly obesity, diabetes, which is a major drain on the NHS, and heart disease and cancer, which are both major killers—are diseases of relative poverty in this country.

Things are so bad that a child born in some parts of Manchester is likely to live 10 years less than a child born to a similar family in Devon. We should all be concerned about that. What should we do about it? That should be the really big health debate—public health care and what we do about delivering public health in our society. During the recess I was fortunate enough to have a pamphlet about public health in children, which I wrote with my researcher, Bryan Jones, published by the Fabian Society. We looked hard at what constitutes good public health measures for children and young people so that we could try to avoid a major epidemic of obesity in young people. Obesity among children has doubled in the past 10 years and has now reached epidemic proportions. The figures are similar to those in America, where it is becoming a major public health issue. In the pamphlet, we looked at what we should do about food in schools; advertising sweets, crisps and so on to children; what we should do to educate parents to give their children better nutritional advice; what we should do about food poverty; and children and exercise.

The House should look more widely at what we should do as a nation about public health issues, including obesity reduction measures, ways of teaching kids to eat more healthily, teaching schools to provide better nutritional facilities and helping them to provide better sports facilities; and making sure that parents are properly educated about delivering good nutritional advice to their children. In the pamphlet, for example, we suggest tax breaks for shops in food-poor areas to encourage the setting-up of shops in rural or inner-city areas where it is more difficult to make ends meet. We believe that such changes could make a significant improvement to the health of the nation.

In the few remaining minutes, I want to widen our debate. Health care is critical, but we must not focus purely on the high-tech end of the market and assume that it is a marker of the failure or success of Government policy. We must look at the issue far more broadly. I am pleased that the Under-Secretary of State for Health, my hon. Friend the Member for Salford (Ms Blears), who has ministerial responsibility for public health, is on the Front Bench, because she is instrumental in the Government's policies to deliver high-quality public health. It should not be forgotten that this Government are the first to have a Minister with specific responsibility for public health, which is extremely welcome.

We should widen the debate and look at public health in its entirety to make sure that children, the next generation of society, are treated in the best possible way and are given the best possible start in life, as well as the

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best educational and sports facilities. That does not necessarily cost a fortune. In fact, if the next generation is brought up to be healthier, stronger, fitter and more able to care for itself, spending on expensive, acute and high-tech hospitals would be reduced. There is a genuine risk that if we do not do something about obesity in children now, they will pre-decease their parents in significant numbers, which should concern us all. I am pleased to have had a chance to contribute to our debate, and I hope that other Members will have a chance to make their contributions.

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