Examination of Witnesses (Questions 20-39)
23 FEBRUARY 2005
RT HON
JOHN REID,
MP, MISS MELANIE
JOHNSON, MP AND
DR FIONA
ADSHEAD
Q20 Mr Jones: I do not object to that.
Every now and again you have to have a punt and it may work. It
may be one thing to do something when you do not have a lot of
evidential basis but you think it may work, but even so you should
be then measuring whether it is working after you set it up.
Dr Reid: Yes, absolutely.
Q21 Mr Jones: In the same way as the
Health Action Zones may or may not have worked, will you be measuring
this?
Dr Reid: Yes, we will, and the
process of evaluation on these—
Q22 Mr Jones: Can the committee know
how you are measuring it?
Dr Reid: Yes. Fiona?
Dr Adshead: There is evidence
that community-based educational models work. There is also some
evidence that psychologically-based behaviour change models around
smoking work. There is evidence around our smoking cessation services.
There is also some evidence around health eating and exercise
that these approaches work. We are currently developing a health
training model and as part of that we are working with a group
of academics to build a valuation in and we are going to be building
a valuation in throughout the programme so that we get real-time
evaluation, because one of the problems with the Health Action
Zones was that the evaluation came in some years after the programme
had started. So this time we want to learn as we go along.
Q23 Mr Jones: Sir Derek Wanless had something
to say about how you establish evidence as well and he said that
there had to be a body independent of the Department to analyse
evidence, in his words "to develop the cost-effective evidence
based on public health". The Health Paper rejected that recommendation.
Dr Reid: No. We have already got
the National Institute of Clinical Excellence, which now has a
world-wide reputation for evaluating treatments and we intend
to ask it to evaluate some of these things. Others will do internally
as well, because we have got a Health Information and Intelligence
task force, believe it or not, which is looking at both new ideas
and the evaluation of the ideas.
Q24 Dr Naysmith: Just before we leave
this sort of philosophical area we are in at the moment, the philosophy
underlying the White Paper and public health, we had some evidence
given to us by the Association of Directors of Public Health (this
was written evidence, we did not have a chance to question them
on it) and they rather welcomed the White Paper on choosing health
and its focus on lifestyles and individual choices, which we have
just been talking about. They then went on to say that health
improvement does need to also address the importance of the underlying
determinants of health, things like poverty, educational attainment,
housing, social networks and deprivations like that. They are
obviously of the view that not enough attention was paid to that
area, which goes back, as you know, because we have discussed
it before, to things like the Black Report, and so on. Why can
they make that criticism, and what do you say to it?
Dr Reid: I find it bizarre, Dr
Naysmith, and the reason why I am laughing is that since about
1844 some of us—I have not been around that long, but the
traditions from which I come believe that a lot of people can
make choices through their own free will but people do not make
them in circumstances of their own choosing or circumstances equal
to other people, and therefore some people in more deprived circumstances
will find it difficult to change their lifestyle. When I pointed
this out with reference to smoking, perhaps a young single mother
with very little money, in debt, with four kids on a sink estate,
and so on, and said that she might not find it as easy to change
as someone else, I was attacked by any number of people from the
public health field for stating precisely what you have just stated,
that if you want to help people change, whether it is diet, lifestyle,
or whatever, you have to help them change their social circumstances.
Therefore, far from being the person who ignored that, I was the
person who was championing it even in the most controversial of
areas. The second thing is, that is precisely why—
Q25 Dr Naysmith: I understand that. What
they are saying is there is not enough about it in the White Paper.
Dr Reid: I am just going on to
tell you. This is precisely why we had the biggest exercise in
cross-government collaboration—it may be that you think
it should have been even bigger—with the Office of the Deputy
Prime Minister on housing, the Secretary of State for Education
in terms of the protection of children and foodstuffs, and so
on, with Tessa Jowell on exercise, right across the spectrum and
for the first time ever enshrined that in a Cabinet Sub-Committee
chaired by me, MISC 27, which is still extant and will continue
on putting through the delivery of public health. So we are trying
to do that. It may well be that people feel we should have had
more cooperation in changing social circumstances, and if so I
welcome that because that is exactly where I am. I want to say
that we must encourage people to choose healthily. We cannot dictate
to them but one of the most important things we can do, as you
said, is change the circumstances in which they live. To put it
crudely, if you want to increase the chances of people giving
up, say, smoking, make them middle-class and you will find that
as horizons extend and opportunities and other things extend to
them if you look at the statistics you will find that the smoking
drops. So you do not just give them help directly on the question,
you do not just give prohibitions but you change the social circumstances.
That is the converse of that statement, for which I was castigated
by many people.
Q26 Dr Naysmith: The second point which
comes out of the Directors of Public Health Association is that
they also say that not enough is made in the White Paper of preventative
programmes such as immunisation and screening. I know your answer
will be that there are other parts of the Department who are doing
that and looking at it, but in order to tie together the whole
of public health you have to sort of link it all together?
Dr Reid: I will ask Melanie to
come in on that, but just to say first of all that we had to decide
at some stage the limits of the envelope and there were things
like environment, toxicity, and so on, which were independent
of people. We decided that the limits of the envelope should be
basically on those issues which could be changed by people changing
their own lifestyle rather than by changing external things in
the main or having things done to people.
Miss Johnson: I think my list
of responsibilities, if you exclude the coronary heart disease
and cancer, things which are not only public health but wider,
is about some thirty-odd topics and obviously only about a dozen
of them are represented here. They are all very much mainstream
public health, including obviously things like vaccination and
immunisation. But they are not things about the lifestyle choices
generally that people are making, they are about the wider programmes
of public health, and we decided to concentrate on really what
in a sense is a most difficult area of public health, namely the
areas in which the choices of a lot of individuals determine whether
we are a healthy nation or not and the circumstances under which
those choices are made. I think it is the most difficult areas
that we have focused on. We of course recognise all the other
areas which play a very crucial role in public health and which
will continue to play that continuing role, in which regional
directors and others still have very important roles to play.
Q27 Dr Naysmith: Thank you. The final
point on that is that keeping things like that outside of the
White Paper, and people thinking this is the Public Health White
Paper, may mean that there is not specific money for some of these
things which are not in the White Paper and people will see what
is in the White Paper as a high priority and things which are
not in it may find themselves having to fight with other bits
of the budget to get that?
Miss Johnson: We have, for example,
at additional extra cost, just introduced recently the five-in-one
vaccination, an improve vaccination for children, so we are doing
things that are still costing us extra money. We are still doing
things to develop all of those programmes. We are looking at the
pneumococcal side of things now as well. All of these things are
developments. We have increased markedly the take-up of flu vaccines
amongst the over sixty-fives and in the under sixty-fives at risk.
All of those programmes continue to march forward at substantial
extra cost as part of the general circumstances, the general environment
in which lifestyle choices are being made and where we focus the
White Paper on those particular issues.
Q28 Dr Taylor: I think most of us will
welcome the White Paper tremendously, particularly the recognition
that prevention is better than the cure and it is cheaper than
the cure, but because the health service is really by habit a
sickness service there is a tremendous problem at PCT and Trust
level making relatively small expenditures on prevention which
in the long-term will save vast amounts of money elsewhere in
the health service but not for them. Have you any comments on
that? How can it be made easier to spend the money on prevention,
which will not save money immediately but will save money for
other departments, other parts of the health service later?
Dr Reid: I think that if you see
this in the context of the development of the National Health
Service, Dr Taylor, you will see that there will be either pressures
or determinants that are shaping people in this direction. The
trend that I mentioned earlier, which is the encouragement of
people to try and treat illnesses in the community at primary
care level rather than at hospital, I think will be accentuated
by people at the local PCT level recognising (and indeed GPs recognising)
that if you send everyone to hospital then they are going to have
very little money for anything else. The more you hand responsibility
down to the local level, and that will happen year on year up
to 2008—it is not uncontroversial; we have had discussions
on this, on various forms of it—the more people take responsibility
for that allocation of that money, their own priorities, and it
will obviously make sense to treat people in the community rather
than in hospital in many cases as much as you can. It is also
obvious to us and to you, and I think will be increasingly obvious
at the local level, that the saving of money by prevention rather
than cure (as you put it) is a good medium and long-term benefit
for the local area. Now, that is the first thing. The structures
we are putting in place I think will encourage that. The second
thing is that we intend throughout the National Health Service
(for purposes which are not that but incidentally will assist
in the question you asked) to try and encourage as part of the
culture change of the NHS the 1.3 million staff rather than just
to treat the sickness that they all treat in their own ways an
early identification of preventative opportunities. I gave one
specific example earlier on which was about drink but it could
be in a whole range of areas, whether smoking, lifestyle or obesity,
and so on. If we do that then I think that will have a rub-off
effect as well at the local PCT level.
Q29 Dr Taylor: Can I take you back to
alcohol specifically? Various Members were not very keen to take
on the questions on alcohol!
Dr Reid: There are no declarations
of interest made!
Q30 Dr Taylor: No, no declarations of
interest. We have been told that alcohol consumption across Europe
is falling but in this country it has doubled in post-War years
and illnesses, particularly cirrhosis, have trebled between 1970
and 1998. These are figures from Sir Liam Donaldson. There is
the worry that not only is alcohol linked with cancer of the liver
but certain other cancers. We are not really quite clear what
measures proposed in the White Paper will reverse this trend because
this is really a preventative measure which should not cost much.
Dr Reid: First of all, I think
you are right in the emphasis that you place on this, Dr Taylor.
I myself was interested that in the whole of the debate we had
about the consultation out there we had a huge amount of controversy
and discussion over smoking and hardly anybody in the press was
interested in alcohol. I was trying to say that smoking was not
the only issue that was facing people and I asked for some figures
in the course of our discussions. There are at least one hundred
and fifty thousand hospital admissions every year. I think it
is probably true that 75% of people in prison are there as a result
of violent offences, alcohol-related. There are at least fifteen
to twenty-two thousand deaths a year caused through alcohol and
the estimated cost to the NHS every year of alcohol-related illnesses
is of the order of £1.7 billion, which coincidentally is
the estimated amount, I think, for smoking-related illnesses as
well. So it is a very serious subject indeed.
Q31 Dr Taylor: So what are you doing
about this?
Dr Reid: One of the problems we
had in taking as well defined measures on it—and you are
entitled to ask that—would I have liked to have gone further
and done more? The answer is, yes. Why did I not? The answer to
that basically is related to what Mr Owen Jones asked us earlier,
and that is that the evidence on how to identify and how to treat,
and so on, and what treatments were available, was not as well
developed as in many other areas. So one of the first things that
we are doing—and you legitimately asked us what are we doing
about it—first of all, this is the first time we have got
a coordinated strategy for alcohol, the Alcohol Reduction Strategy,
which I can go through if you want. Secondly, as a result of discovering
the lack of information really that was available to us during
a consultation, we have undertaken a national audit of the demand
for and provision of alcohol treatment and this will provide,
I hope, a comprehensive picture of the current availability of
treatment and it will highlight the gaps in supply of treatment.
I will receive that report later this month and I think that we
will be able to send it soon thereafter to yourselves should you
want that, Chairman. It will be followed up then by what in the
management jargon is called "a local tool-kit" that
will allow access to local need. The National Treatment Agency
will be publishing models of care in alcohol guidance on the organisation
of alcohol treatment in our review of treatment effectiveness
and that piece of work and the results of the national audit will
provide the foundation for the very programme that you are calling
for. So yes, I would rather we had been able to do this earlier.
Yes, you are right in the importance I believe is placed on it
and sometimes is not outside where drugs and smoking get much
more of the attention. It will also benefit partly from what we
call the "pill treatment budget" which is distributed
to drug action teams throughout the country and from May of this
year the Department of Health will be piloting a programme of
targeting, screening and brief interventions, giving short-focused
advice and guidance to those identified as being at harm from
alcohol abuse as it arises in the course of other treatment inside
the NHS. I could go on and describe various other things. With
the Portman Group we are engaging the industry—
Q32 Dr Taylor: With respect, Secretary
of State, I am trying to get at it earlier than alcohol problems
that require treatment. The Health Development Agency says quite
clearly that the only effective method of really tackling harm
is to restrict the availability of alcohol and the first one would
be a very unpopular measure but it would be to raise taxation
and raise the price. That appears to be perhaps the only really
effective method of reducing it. What is the Government's views
on raising taxation on alcohol?
Dr Reid: On the first one, which
is how to tackle it—if I can divert just for a second, Chairman—you
may not know, Dr Taylor, but when Kier Hardy published his first
manifesto in 1894 the first demand he made was that there be home
rule for Scotland, Wales and Northern Ireland, which has now been
delivered. The second demand he made was that there be a minimum
wage, which has now been delivered. The third demand he made was
the end of hereditary power in the House of Lords, which is now
delivered, and the forth was a ban on the production and sale
of alcohol. We did consider putting that to a commission of the
Scottish Labour Party to decide how much action we should take
and how quickly on it, but we have no plans for that and I would
not like anyone behind you with their pens to start running on
it! On taxation, we leave that to the Chancellor. I note what
you say on that, but matters of taxation are for the Chancellor.
However, it is true that sensible drinking requires the engagement
of the industry and the Portman Group, which operates with the
industry. We are engaged with them on this. Do I think that we
are all doing enough on this, including Government and industry?
No, I do not. Do I think that the audit that we are carrying out
in terms of treatment, which includes early identification as
well, will tackle the problem? No, I do not. Do I think that the
amount of persuasive marketing and advice to people to drink sensibly
is in any way a counterbalance to the amount of general persuasion
to drink out there? No, I do not. If you ask me, avoiding taxation,
what I think is the solution, there are several levels of the
problem. There are people who drink at home, perhaps silently,
and that is an obvious problem. Then there are the people who
are reasonably affluent, though maybe young, who are involved
in binge drinking. Then there are not so much the people who binge
drink in pubs, bars, and so on, but who drink the cheap fortified
wine or other cheap drinks in areas that I am sure some of our
colleagues here represent, which is a problem, on street corners,
and so on. So we need a much more comprehensive strategy for dealing
with those things and I hope that the audit we are carrying out
will be the beginning and not the end of the action that we take
on it, Dr Taylor.
Dr Taylor: Thank you.
Q33 Chairman: Could I just ask a question?
Going back to the point about the limited amount of responses
on alcohol on the consultation on the White Paper, I was very
struck and I think the Committee was struck when we were looking
at obesity at the very limited evidence that we received on the
connection between alcohol consumption and obesity. I think this
is an area of great interest. It seems fairly obvious to one or
two of us that there may just be a connection there, but why is
it in terms of a society we do not seem to be doing anything about
it? We do not seem to have that response that you would have expected
in putting out the proposals that you were considering.
Dr Reid: You are asking me a question
which I will immediately be challenged on by Mr Owen Jones as
to my evidential base. I can give you my own view on this. I think
that people do not think of the passive damage from alcohol the
way they think of the passive damage from smoking, but the passive
damage from alcohol is enormous: the number of people who are
killed in drink-driving accidents, the number of people who are
injured through drunken violent incidents, the number of people
who are in jail and the cost to society of that through alcohol-related
problems. It is sometimes on a Saturday night sixty to 70% of
people in accident and emergencies being paid for by the state
come there as a result of alcohol and yet it is an integral part
of our lives for most people because they do not abuse it. Most
people do not abuse it and also used in a sensible, entertaining,
social fashion it is a fantastic addition to the social life of
all good, healthy, sensible people. Whereas things like smoking
one cigarette damages your health, one drink does not damage your
health. So it is a much more difficult thing, Chairman, to classify
as entirely detrimental to health because it is not. Drinking
a few glasses of red wine is very good for you and from where
you come from drinking a few glasses of beer is regarded as good
socially as well as on the health side. So it is harder, I think.
My own view is that if we are gong to tackle some of these problems,
particularly with young people, the only real solution—and
you mentioned tax—is to make it uncool because I do not
believe that prohibition and curtailments, and so on, work on
these things because sometimes for young people that has the disadvantage
of making it appear cool rather than uncool.
Q34 Chairman: Richard, it struck me that
we have got your second election pledge that you are going to
increase the tax on alcohol. Is that right? The first one was
that old people should clean up graveyards! The second pledge.
Over to you.
Dr Reid: I did notice that. I
think it is a contribution to the General Election campaign that
the Liberals have now pledged, and David has now pledged, to introduce
a tax on—what was it, a doubling of the price of beer?
Chairman: Go on, Richard! Over to you.
Q35 Dr Taylor: I am moving off that subject
but going on with reducing the availability of alcohol, which
really seems to be the only way of cutting the amount people drink.
Another way would be restricting the hours and the days of sale.
I should think most MPs have been approached by constituents with
the worries about garages selling alcoholic drinks way on into
the night. So at the moment it is incredibly easy to buy alcohol
at any place. Have you any plans to reduce the availability by
restricting the sale in any way?
Dr Reid: I will ask Melanie to
respond to you, but if I may just say something first of all,
Dr Taylor, because it gives me the chance to counter the myth
that the recent Licensing Act was only about extending the flexibility
of hours. It was not. It brought in a local accountability element
because local councillors rather than just those connected with
the local judiciary have a power and responsibility and it brought
in a range of restrictions which could be more effectively and
more speedily implemented to premises where there were abuses
of alcohol sales or use going on. So on your question, "Have
you any plans to bring in some form of punitive or restrictive
measures in law?" yes, we have brought them in actually.
We brought them in through the Licensing Act brought in by the
Secretary of State—I cannot remember who it was now. When
they were brought in most of the coverage that was received in
the press on this was on the flexibility of hours and missed out
the fact that we were bringing in some fairly punitive and restrictive
potential measures which could be applied at a local level.
Miss Johnson: First of all, just
on the cost of alcohol point, before you enter it into your election
pledges and on the evidence-based question, looking at Continental
comparisons you would not necessarily draw the conclusion that
you seem to be coming to about the sensible use of alcohol and
taxation levels. So I simply enter that as a caution into your
thinking. Secondly, if I may go back to the behavioural points
again a little bit more because when we think about drinking and
driving or wearing a seatbelt, for example, a huge change has
been brought about in general public acceptability, as the Secretary
of State is saying, in terms of what people are prepared to do,
what they think is right, by public campaigns to educate at the
end of the day. The vast majority of people have bought into those
campaigns. They have been hard-hitting, they have been long-term,
they have been repeated and they have targeted the points that
people are most sensitive on. I know from talking to the Portman
Group, for example, they have run some advertisements, which you
may or may not have seen but I am sure they can supply you with
a video of them if you are interested, which are aimed at young
drinkers. The picture of them is that they are out of control
and they know from the research they have done that young people
do not like the notion of being out of control.
Dr Reid: It is uncool.
Miss Johnson: That is not the
picture that they want to see of themselves. So targeting things
like those sorts of areas in terms of behaviour change I think
is very important and we will be working more with them. But also
on the point about the more punitive sort of restrictions, and
so forth, there is an important place for those and that is why
on cigarettes we have said we are clamping down on under-age sales.
On alcohol, the Licensing Act already has a number of measures
in it which does that. It makes it an offence to allow any person
under sixteen to be present in licensed premises exclusively or
primarily used for the sale of alcohol unless accompanied by an
adult. Between the hours of midnight and 5.00 am it is an offence
for somebody under sixteen to be present on those premises and
for the first time it makes it an offence to sell alcohol to people
under eighteen anywhere in England and Wales. I think we want
better enforcement as well coupled with this, and certainly the
Home Office and ourselves are very committed to seeing that better
enforcement in place. I think these are part of the measures,
coupled with a much better education, which are important in tackling
the issues that we face. We are working on a new sensible drinking
message which will be available later on this spring. I think
spring in this case is a bit of an elastic season, as I have often
found the civil service does have an elastic season for spring.
It will produce a new sensible drinking message. It will be unit-based
still because we know that there is still a degree of understanding
of the unit-based analysis, as it were, of alcohol. But we need
to think about how we get those messages across, how we reach
the right audiences and really stepping up by a significant amount
our efforts in getting those messages across to young people,
particularly from mid-teens through to mid-twenties because that
is probably the age group which is most affected by these issues.
Q36 Dr Taylor: Do you think you will
be able to have any effect on those slightly older drinkers who
are drinking far more than they should and for whom the extended
drinking hours will make that even easier?
Miss Johnson: The extended drinking
hours are a matter for the local authorities and I think the evidence
is, if you are talking about the 2003 Licensing Act, that at the
moment many places are not extending significantly their drinking
hours. But it is a matter for local authorities. So if there is
disruption, disorder or other consequences being seen in the locality,
local councils now have the power to take not only short-term,
immediate punitive steps by closing premises but also longer-term
steps about the future of the licensing arrangements. So there
is a considerable panoply of powers at a quite local level to
reflect local behaviour, local need and a local view about what
is necessary in dealing with the issues.
Q37 Dr Taylor: So my local ambulance
drivers, who have been approaching me with their alarm about the
increased use of ambulances for drunks with the increased length
of drinking hours should be approaching their local council?
Miss Johnson: Indeed. The local
council has all the powers now to deal with that on a local basis,
and much stronger powers than the magistrates would have had previously
under the old arrangements.
Q38 Siobhain McDonagh: If we can look
at the kind of licensing rules, there are suggestions that while
the local authorities do have more powers now, they are given
a very strong set of guidance which is restricted and the alcohol
industry will also be able to appeal to the courts if they do
not get the decision they like from their local authority. Are
local authorities in theory able to determine the number of pubs
to give licences to, who to choose and who to close down, but
in practice have their hands tied by Government guidance?
Miss Johnson: I think the point
about the licensing arrangement is to give local decision-making.
If at the point at which decisions are being made there is not
a good justification for it in some shape or form, the fact is
that most councils, I think, will be trying to make their judgments
on the basis of good evidence. I used to be a magistrate at one
time and I have sat and made licensing decisions and I know limited
information ever came to the magistrates generally and very little
often was done at that level to change practice. There was certainly
no overview of the community because it is a licensing by licensing
decision. The councils can now take a much broader view than that,
and I think for the first time they have the powers to affect
things in a way which will be positive. But that is not the main
thrust of what we are trying to do on public health. The main
thrust of what we are trying to do on public health is to identify
those who are at risk from alcohol. So, as the Secretary of State
has already said in answer to an earlier question, those who turn
up a couple of times at A&E who have clearly been drinking
will be identified and the right ways, the sensitive ways of dealing
with that and suggesting that they may want to get treatment or
to see somebody to talk about sensible drinking will be put in
place, and we are looking at how that can best be done through,
for example, the initial contacts in A&E through to other
services. Secondly, we are working on all of this area of sensible
drinking and the binge-drinking culture, which I think is the
thing that most concerns the public now, although I am sure, along
with Members of the Committee, you will have all had contacts
from a lot of the consultants who work with those who are affected
by long-term drink and the effects of long-term drink on various
aspects of health who are concerned about that. We share their
concerns, but I think often that is where the treatment services
and the audit that we have put in place is important because those
people may need longer term support to give up their drinking.
It is not just about the sensible drinking message. If you are
a long-term, very serious drinker, you will in effect have an
addiction of some kind and you need the sorts of supports for
alcohol that we have been providing for drugs for some time, and
that is being done on a much more systematic basis with the same
sorts of standards being introduced and a much greater look at
where the services are, what treatments are available, what works
and how we develop that in the future, with some money behind
it in the White Paper which we have put in here for that.
Q39 Siobhain McDonagh: Thank you. Several
submissions to the Committee have expressed surprise at the White
Paper's identification of the Portman Group as the sole named
non-statutory partner in the Government's response to alcohol
problems, not least because its record has been severely criticised
in the scientific press. Why do you involve the Portman Group
but ignore reputable medical bodies which are free of drink industry
connections?
Miss Johnson: We are happy to
see anybody who would like to meet with us and forward this agenda.
Obviously in the case of the Portman Group they have money at
their disposal as a result of the industry funding. We are certainly
looking to them to make a bigger contribution on getting across
the right messages about alcohol and drinking and playing a much
more responsible role with us in encouraging the responsible use
of alcohol in our society. I met a colleague of all of ours (I
will not say who it was) who brought some consultant from her
local hospital in to talk to me recently, to share experience
and talk about the nature of the work that was going on and that
she was aware of in relation to alcohol-related illness and demands
on the health service. So we are always happy to receive input
and to have a dialogue with any of those interested in tackling
these problems.
Dr Reid: I think the point to
make in direct response to the point you make, Miss McDonagh,
is that we want to work with anyone from the voluntary sector
or anywhere else who wants to help us to combat irresponsible
drinking which damages people's health and damages other people's
lives, but we identify the Portman Group because they were related
to industry, because we do believe that the industry has a responsibility
here, a responsibility which will not be discharged only through
the Portman Group but could be discharged through the Portman
Group if it was more active and better funded. So we will be encouraging
that in that direction. So ironically, we chose it. People may
say, "Why are you only choosing this?" We are not only
choosing this. We say, okay, if this is the vehicle through which
the industry wishes to tackle some of the messages they want to
put across then we will work with that and encourage it to be
better funded and more active.
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