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Caroline Flint: With the leave of the House, Mr. Deputy Speaker.

We have had a useful debate, and I have heard interesting contributions from Members on both sides of the House. One of the issues that have confronted the Government is 18 years of disinvestment in the NHS by Conservative Governments. During that time, services were cut in many areas. I understand that that included
 
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two dental training schools. Clearly it will take time to change a system that has suffered from underfunding and insufficient engagement for a generation.

Mr. Bone: Will the Minister give way?

Caroline Flint: No, because I gave way to the hon. Gentleman during my opening speech and he did not stay for the whole debate. [Interruption.]

Mr. Deputy Speaker (Sir Alan Haselhurst): Order. There should not be sedentary interruptions.

Caroline Flint: I think you will see in Hansard, Mr. Deputy Speaker, that I gave way extensively during my opening speech. As I now have less time than was taken by the hon. Member for Billericay (Mr. Baron), I want to make some progress.

Tackling public health issues is hugely important. The situation will not change overnight, but we must accept the challenges, some of which have embedded themselves over many years. There has been an increase in sexually transmitted infections, for instance, but in many other respects we live in a world that is very different from the world of 10, 20 and 30 years ago. I pay tribute to the Labour politicians who established the national health service, but their concept of the health service that was needed then was very different from the service that we need today.

Many other things have changed. Work has changed enormously. In my constituency, a mining constituency, the number of miners who suffer from respiratory disease is heartbreaking for those individuals and their families. At least the miners must be encouraged by the Government's decision to meet the claim for compensation for that industrial disease.

We in the Labour party have an historic commitment to fight for ways of tackling inequalities. That has meant fighting for safe working conditions, decent housing, a national minimum wage and—in earlier campaigns—clean water, public sewerage and public parks. Those campaigns are all part of the overall picture.

I think that all Members agree that, in general, everyone is living longer and everyone is healthier, but we must deal with the gap caused by health inequalities. One reason for that gap is the way in which services are being delivered, but there is another reason. It is interesting, but we have not much time in which to explore it. Research suggests that those who are better off and better educated can gain access more quickly to NHS services such as information and an understanding of how lifestyle choices affect health, and that that enables them to make choices more quickly. That is part of the problem. The more we provide such services, the more the better off take advantage of them before poorer people can do so. We must therefore provide services in a different way because there is no "one size fits all" solution. It is not enough to organise national education campaigns with advertisements on television, or to provide services on the internet. We need to find a better way of working in communities to give people the support that they need.

Mr. Lansley: Will the Minister give way?

Caroline Flint: No.
 
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Reference was made earlier to the need for people to feel confident about talking to their GPs, demanding services and making their voices heard. I am afraid that it is an indication of modern life that more affluent people are often more confident, shout the loudest and get the services, whereas poorer people perhaps have less confidence and do not. That is unacceptable. For some reason, GPs do not want to work in our poorest areas, which is also unacceptable. Perhaps they prefer working in more affluent communities.

The hon. Member for South Cambridgeshire (Mr. Lansley) asked about reductions in the incidence of cancer and coronary heart disease, and the reductions are 9.4 per cent. and 24.7 per cent. respectively. The figures are not absolute—they constitute a reduction in the gap between the average for England and the figure applying to the five most deprived areas. I accept that infant mortality has risen: it rose by 19 per cent. in 2001–03, and by 19 per cent. in 2002–04. That is unacceptable, but there was no increase during the second tranche, which I hope shows that the situation is not getting worse. [Interruption.] I have accepted that the figure has risen, but it has stabilised and we must try to reduce it.

On obesity, the hon. Member for South Cambridgeshire will be aware that we are doing a tremendous amount of work with the food industry and others on food labelling and the reformulation of food.

Mr. Lansley: Will the Minister give way on that point?

Caroline Flint: No, I am not going to give way.

We are doing important work with schools through the healthy schools programme, but, of course, another important factor is the choices that parents make for their children, which is why we have to work with families as well. I should also point out that status reports on health inequalities are published annually on the departmental website.

On public health structures, I am glad that the Conservatives agree with us about joint appointments, which we are encouraging. My first speech as Minister with responsibility for public health was made at the invitation of the Faculty of Public Health. I pointed out at its conference that, in my view, that is the direction in which we should go, and there some very good examples of such practice. However, we must recognise that it is more than just a question of appointing someone to serve the local authority and health services in a joint capacity; there must also be a change in the culture and mindset of all the organisations involved, so that they can work together. Local area agreements are important in that regard, and the consideration of health inequalities must form an integral part of the assessment of local authorities.

The health trainers programme is based on the Bandera study, which is a psychological behaviour change model. It shows that one-to-one, structured motivation techniques empower individuals to change their lifestyles. In our view, providing such services to those who are taking advantage of other forms of information and support is a good way forward. The National Institute for Health and Clinical Excellence is working closely with us on the development of the life checks model.
 
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Respiratory disease is an issue that we take very seriously, and it is on our list of key interventions. However, circulatory diseases account for the largest proportion of excess deaths in spearhead areas: some 70 per cent. among males and 63 per cent. among females. By way of contrast, respiratory diseases account for some 18 per cent. of such deaths. However, we obviously all these issues seriously, and it is important to deal with them.

My hon. Friend the Member for Mitcham and Morden (Siobhain McDonagh) told us about her area and the question of where the new hospital is to be located. It has to be acknowledged that the issue is not just health inequalities and services, but regenerating communities; the new hospital will play an important part in that regard. The hon. Member for Bristol, West (Stephen Williams) talked about pharmacies playing a greater role, and this Government are providing such opportunities. Our proposal to allow pharmacies and nurses to play a greater role in prescribing will allow them to add to the role played by GPs; they will not replace GPs. They will add to the mix of people who can deliver health services in our communities. Men's health was also raised in the debate, but I dealt with that extensively in my opening speech.

I congratulate the councillor to which my hon. Friend the Member for Kingston upon Hull, North (Ms Johnson) referred on her innovation. I welcome the fact that there is a joint director of public health in that area, but I hear what my hon. Friend says about East Riding, which does not have the same level of health inequalities as other areas, but seems to spend money rather more unwisely than does Hull itself. That is something that we should talk about more when we consider good management and delivery.

My hon. Friend the Member for Denton and Reddish (Andrew Gwynne) spoke well about what is happening in his area, and said that it is not just a matter of health for everyone. I think that the hon. Member for Torridge and West Devon (Mr. Cox) misunderstands health inequalities. I accept that rural areas face different problems, and we have trained the health trainers programme for Devon and Cornwall—

It being Six o'clock, the motion for the Adjournment of the House lapsed, without Question put.

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