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Ms Diana R. Johnson (Kingston upon Hull, North) (Lab): Will the hon. Gentleman comment on the joint
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public health director of the PCT and the local authority in Hull, who has been able to get out a clear message to the local authority and health services in the area to promote things such as healthy school meals? We have free healthy school meals in all our primary schools, which leads to the issue of obesity which the hon. Gentleman mentioned. That is a positive thing, which Labour has delivered.

Mr. Lansley: I am grateful to the hon. Lady for mentioning that point. She clearly has not read, and should read, Conservative party policy at the last election. It was the Conservative party's policy—my policy—that we should have jointly appointed directors of public health between the NHS and local government. [Interruption.] Is the Minister saying that that is now her policy? It is not actually her policy. It is happening in some places and it is welcome, but it should be a policy. We are here to debate the Government's policy and not what is happening only in some places.

Health improvement and preventive services are patchy in quality and variable in coverage across the country. That is not me saying that; the Government were saying that in their "Choosing Health" White Paper in November 2004. Why is that so? It is because there is no distinct, discrete organisational function or financial structure that ensures that public health is focused in individual localities. The Government do not even know how much money is spent on public health. They cannot measure it because it has been absorbed into primary care trust allocations. I have asked how much is being spent, but I have not received a reply. We also need evidence, and I have asked the Minister about the evidence for the things that were being thrown like bones to the press before the publication of the recent White Paper.

Surely health action zones were intended to be part of the piloting of innovative mechanisms for delivering improved public health and a reduction in health inequalities. Some Members no doubt remember the setting up of 26 health action zones across the country. Can the Minister tell me what happened to them and what the results were? The concluding comment in a draft report on the national evaluation of health action zones—it says that it is not for quotation, but I will quote from it—states:

I will not try to quote from the rest of the report, because it is rather difficult to disentangle, but the thrust of it is that it is vital to influence the mainstream—something that was not done—and that, if one is going to achieve these things, it is vital to have a focus that is not interfered with by constant diktats on priorities from the Department of Health. Health action zones were not free of such interference, and were constantly being told what to do by the Department of Health.

Health action zones were set up as a gimmick, and the poor people charged with running them found that the zones were marginalised. There were other priorities and, in the end, the evaluation did not show that the zones had had much impact. That is the nature of the Government's approach—it is one gimmick after another. The Government announced lifestyle checks in the press prior to the publication of the White Paper,
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and the implication was that they were going to be of immense benefit. On every occasion that we have mentioned them, Ministers, including the Under-Secretary, have moved closer and closer to the proposition that they consist simply of reminding people at certain points to think whether they need to visit their doctor, and no more than that.

A great deal could be done that would be beneficial—and I keep telling Ministers so—but not necessarily at the age of 11, 18 or 50. If Ministers believe in the checks, where are the school nurses? The hon. Member for Kingston upon Hull, North (Ms Johnson) mentioned the initiatives that have been taken in Hull, but where are the school nurses that should be in every school so that health services have a consistent visible presence for young people between the ages of 11 and 18, and, indeed, under 11, and can encourage them to understand how they can improve their health and to understand the risks that they run. Those are precisely the things that impact on behaviour, and which are important in the most deprived areas of this country if we are to change the behaviour of young people in those areas.

Rosie Cooper: I wonder whether the hon. Gentleman has heard of Healthworks and various programmes operated by the St. Helens and Knowsley primary care trusts. They operate what some people would describe as fitness checks. Others might call them very quick medicals. People are tested for their weight, cholesterol and various other things. Those tests give an indicative view of whether they should go to see their doctor. They do not take place in a surgery. In Knowsley, they take innovative form, as they take place in working men's clubs and youth clubs. The people involved in the programmes are attacking the health inequalities. That is the kind of thing that we need to push.

Mr. Lansley: Of course we need to reach out. Perhaps the hon. Lady was not in the Chamber when we discussed the White Paper when I said that the pharmacy contract was a very good example of such initiatives. It is perfectly possible for pharmacies to offer a range of opportunities, including cholesterol, chlamydia and blood sugar tests. I have seen, for example, what Lloyds pharmacy has done to promote diabetic testing among south Asian groups. There are many opportunities for such tests, and the pharmacy contract permits them. The problem is that the primary care trusts are not commissioning them. Pharmacies are keen to offer testing. That would be particularly beneficial for men, who go into pharmacies for various reasons. Given the large disproportion between women attending GPs' surgeries and men attending GPs' surgeries in the middle years of life, that would be a good way of offering men health tests. It is important that that is done.

The record that the Government published in mid-August last year shows a failure to achieve their national targets. They have not failed in every respect, but there are too many trends in the wrong direction. There are as many negative warning signals as positive ones. An improved public health structure is vital to overcome that.

Health inequalities include not only inequalities of outcome, but inequalities of access, which must be removed. There, too, the Government have recorded a
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significant level of failure. It would be excessive for me to list them all, so I shall highlight a few examples, such as the availability of drugs. There are inequalities in the availability of specific drugs such as Herceptin not only between primary care trusts in England, but between England and Scotland in respect of that and other cancer drugs.

There is also a substantial disparity between the United Kingdom and other countries. Not least because of the work of Cancer Research UK and other cancer charities, we have more and, I would argue, better cancer research than almost any other country in Europe, but is our take-up of cancer drugs in this country comparable to that in other European countries? No. We are slower to take up new drugs. That is deeply offensive to people in the UK. They contribute more than £40 million a year to cancer research, but the benefits of that do not flow through as fast as in other countries, unless people are willing to pay for treatment themselves.

There are disparities in access to dentistry. In my constituency there are virtually no opportunities to register with NHS dentists, and that is true of many other constituencies across the country. We have disparities in access to health services. We heard from my hon. Friend the Member for Beverley and Holderness (Mr. Stuart) about community hospitals being shut down. That was happening but has been reversed, under the campaigning pressure that we brought to bear, but those hospitals are still not safe by any means. Especially for people in rural communities the length and breadth of the country, those hospitals—

Ann Winterton: I am grateful to my hon. Friend for raising that matter. It is vital for my constituency, which is predominantly rural—not just farmhouses dotted round the countryside, but small towns and large villages, where access to services at the district general hospital will be jeopardised by the future health care programme. Maternity, obstetrics, paediatrics and children's services may be removed in an area where one in six people does not own a car and there is no meaningful transport. Is that not another example of health inequalities between the rural and the urban areas?

Mr. Lansley: My hon. Friend is right. We must address such inequalities of access and, like so many of the problems that we are discussing, that is not achieved merely through changes in the NHS. A wider range of changes are needed to tackle rural issues.At the outset, the Minister mentioned Sir Donald Acheson's report of 1998. Of 39 recommendations in the report, only three were directed to the national health service, so the problem goes wider than that.

In our earlier exchange about resource allocation, the Minister made some perfectly fair points but she did not answer the question. Resource allocation is still being decided across the country on the basis of assumed and aggregated data in respect of deprivation and age. We increasingly have data that would allow known morbidity in a community to be the basis on which NHS resources are allocated. I hope that the advisory
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committee on resource allocation will start to make those changes. That would make an enormous difference to many parts of the country.

At the same time, we should isolate the resources that have to go to any community to provide good-quality services to meet the levels of mortality and morbidity that are occurring in those places, and, as distinct from that, recognise the need for separate allocated resources to impact upon health inequalities and poor outcomes arising from a wide range of factors. That separation was part of our policy at the last election, and I am still convinced that it is right to have dedicated public health resources. Otherwise, we end up in the current situation, with, for example, dramatic disparities between the allocation of resources in England, Scotland and Wales. Because those resources are not necessarily being directed to public health outcomes in some places, they are not necessarily delivering the best health outcomes.

I saw an example of that when I was in Manchester last week. Hope hospital in Salford is taking large numbers of referrals from Northern Ireland, with referral letters going back to 2001. Northern Ireland does not have small amounts of money going into it for the provision of hospital services—it is just that it is extraordinarily inefficiently provided. It is evident that the shifting of resources across the country is not reducing inequalities of access or of outcome. It is all about delivering a reformed system.

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