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Mr. Dawson: Will the hon. Gentleman give way?

Tim Loughton: I should like to make some progress, because we have very little time left. The hon. Gentleman and I will have plenty of opportunity to discuss other matters tomorrow in Committee on the Children Bill, as we have, with great enjoyment, for the past two weeks.

Earlier this year, the Royal College of Midwives estimated that there is a shortage of 10,000 midwives. I am afraid that the Government are trying to disguise the seriousness of that by grouping midwife vacancy rates with those for nurses and health visitors and using head counts instead of whole-time equivalents.

The problems in midwifery were mentioned by the hon. Member for Braintree (Mr. Hurst), who talked about the lack of choice for mothers in his constituency, and by the hon. Member for South Swindon (Ms Drown), whose great expertise in this area will be missed.

The 10-year plan may be comprehensive and thick, but we need urgent delivery—well before 2014, not merely by 2014.

I want to single out two specific areas of children's health, the first of which is mental health. My right hon. Friend the Member for Charnwood majored on that. It is fascinating that, given what happened 40 years ago, we are merely reinventing the wheel. We must redefine our aspirations and confront the difficulties involved in connecting them to delivery.

Some 24,000 teenagers a year seek professional help for self-harm, but that is the tip of the iceberg, as many more do not seek it. That is indicative of all the extra pressures on young people today. Suicide rates show that those pressures are not being addressed early enough. Mental health services still really work only when crisis point is reached. Last year, 50,000 antidepressant prescriptions were issued, some to children as young as six. Recently, there have been worries over suicidal tendencies linked to certain drugs. There is a lack of clinical data on the suitability of adult drugs for children, dosage rates and so on. There are 1.2 million children with mental health problems in this country. However, the scandal is the lack of in-patient beds nationally. There are only 628 in-patient beds nationally for children—that is six beds per 100,000 children. Only one third of trusts make special provision for mental illness in children with learning disabilities.
 
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A report by the Royal College of Psychiatrists for the Department of Health stated that 60 per cent. of child and adolescent admissions to wards was deemed to be inappropriate. The Mental Health Act Commission pointed out that, between 1999 and 2001, 1,082 children were admitted to hospital under the Mental Health Act 1983, and that 62 per cent. of total admissions of children and young people were to adult wards. One of the Under-Secretary's predecessors admitted to me in a written answer that there were 64,920 occupied bed days for patients under the age of 18 on adult psychiatric wards in only one year.

The state of mental health facilities for children and young people is a national disgrace. The new draft Mental Health Bill makes no statutory requirement to improve the position, aside from the capacity problems. How quickly will the NSF deal with that?

Diabetes and the higher incidence of type 2, adult onset diabetes—now recorded in teenagers—is the second matter that I want to raise in the short time available. The great difficulty is that the Government are not aware of the extent of the problem. The Minister of State, Department of Health, the hon. Member for Doncaster, Central (Ms Winterton), who has responsibility for diabetes, told me in a written answer that the information is not collected centrally for the number of children who develop type 2 diabetes. Will the NSF quantify the extent of the problem before we can start to tackle it properly?

The Government have prevaricated on the obesity challenge for too long. Our obesity problem among young people is second only to that of the United States. One third of British children are overweight. One in 10 four-year-olds are classified as obese. Dietary problems continue to exist. For every 25g of green vegetables that children eat, they consume 100g of sweets and chocolates. After seven and a half years, we are still waiting for a public health strategy that starts to tackle the problem, which is getting chronically worse.

There are many other chronic conditions and I was pleased that asthma is one of the special exemplars. It is the most chronic disease in the United Kingdom. Thirty-five per cent. of childhood GP visits are for respiratory infection and 132 boys per 1,000 five to 15-year-olds are treated for asthma.

We need to tackle many other preventive priorities now. It should have happened earlier. The Under-Secretary said that healthy children become healthy adults. We should have done much more to tackle the explosion in sexually-transmitted diseases and the 23 per cent. of 15-year-olds who smoke.

Several hon. Members, especially the hon. Member for Barnsley, East and Mexborough (Jeff Ennis), mentioned hospices. There is no excuse for poorer funding of children's hospices when compared with adult hospices. The Under-Secretary is wrong when he claims that giving more money to children's hospices would mean taking money away from PCTs for palliative care. The problem is that the money that PCTs should use for palliative care is being spent elsewhere. They rely on the good will of voluntary contributions to charitable hospices, especially children's hospices, to provide that service. As a patron of one of my local hospices, I know that that happens.
 
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The inclusion of a section on incontinence noted that at least 500,000 children suffer from nocturnal enuresis and a significant number from daytime wetting. I welcome the section's inclusion for which many of us lobbied. Some of us took part in one of the most humiliating photo opportunities last week in the launch of the Bog Standard campaign. The hon. Members for Richmond Park (Dr. Tonge) and for Kingswood (Mr. Berry) and I had to pose for photographs through a cardboard loo seat. The point was that we need to improve standards of school loos.

If the NSF is to work, it must be joined up. We need to have regard to the 750,000 children who live in poor housing and the 30 per cent. of looked-after children who are not immunised. We need to do much more with carers—I am glad that that has been acknowledged, but child carers, too, need to have far greater help. We must do far more for children's nurses who currently perform the role of glorified social workers and do not do nearly as much of the preventative stuff as they formerly did.

We welcome the NSF but it will be judged on outcomes and the urgency of the action, not the thickness of the documents and the number of tsars that are created. We need a greater sense of urgency than the Government have displayed to date.

6.49 pm

Dr. Ladyman: We have had a good debate which has hinged on a number of key themes. The hon. Member for East Worthing and Shoreham (Tim Loughton) and the previous two speakers, my hon. Friend the Member for Lancaster and Wyre (Mr. Dawson) and the right hon. Member for Charnwood (Mr. Dorrell), have focused on many of them and asked perfectly valid questions. No one has dissented from the fact that the national service framework document is an excellent statement of our aspirations for the national health service and for health and social services for our children. The question is: is it going to work? Can we make it happen?

My hon. Friend the Member for Lancaster and Wyre paints himself as a curmudgeon. I would not describe him as such, although he can sometimes be a bit of a miserable old beggar. Is he missing something that my right hon. Friend the Minister for Children, Young People and Families and I are seeing? We are not blindly optimistic about our ability to get people to co-operate and to work together on this, but we have to be optimistic. Leadership has to come from the top, and if our heads are down and we do not believe that this can happen, believe me, it will not happen. We therefore have to set about this task believing that we can bring it about.

We are not blindly optimistic, however. We know, because we talk to the people who are providing these services all the time, that we have to overcome barriers such as turf wars, self-interest and inertia. Such barriers are found not just in one of the organisations that we are talking about; they can be found in every single one. Perhaps the right hon. Member for Charnwood is right, however, to put this task into the category of "This time we're going to make it happen".

This time, there are differences. In the Children Bill, there is a statutory obligation on all these organisations to co-operate. The director of children's services will
 
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have a strategic role in producing a plan for the improvement in services. The mandatory commitment of the national service framework is in place. Several hon. Members, including the hon. Members for South Cambridgeshire (Mr. Lansley) and for Romsey (Sandra Gidley), talked about the inspection process. We have a clear strategy for ensuring that we inspect the national service framework on a regular basis and try to deliver it.

The fact that we have a Healthcare Commission that operates at arm's length from the Government gives us a new tool to work with that we previously did not have. The commission is now putting in place a strategy for inspecting the progress of the national service framework and for monitoring how the framework is further to be delivered, so that we shall end up with it being delivered everywhere within the 10-year period. The hon. Member for South Cambridgeshire asked for a time line to be applied everywhere, but instead we ought to have local time lines everywhere that we can follow and use to judge progress. That will be different in different places because there are different demands in different places. If I were the Member of Parliament for an inner-city constituency with a high ethnic minority population, I would want the initial thrust of the work to be done on inequalities, and on ensuring that we are reaching the minority ethnic communities. However, I have a different kind of constituency, so I would expect to see the priorities there reflecting my community. Each Member of Parliament will have the same opportunity.

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