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Public Health
Mr. Speaker: I inform the House that I have selected the amendments in the name of the Prime Minister in both of today’s debates.
3.31 pm
Mr. Andrew Lansley (South Cambridgeshire) (Con): I beg to move,
That this House notes the Government’s failure to improve public health outcomes and to reduce health inequalities; believes that the gap between the public health of the UK and that of comparable health economies is unacceptable; identifies obesity, smoking, sexually transmitted disease, infectious disease control, teenage pregnancy, alcohol and substance abuse, the promotion of healthy lifestyles and screening for treatable disease as areas of particular concern; supports frontline staff striving in adverse circumstances to improve the health of the nation; is concerned about the shortage of public health staff due to the Government’s financial mismanagement; joins with the Chief Medical Officer in condemning the use of public health funds to tackle NHS deficits; and calls on the Government to ensure that funds for public health are spent on addressing remediable health issues.
The Secretary of State has called me to explain that she would be unable to be here, and I quite understand why that is so. We hope that we shall see her later in the debate. I understand that the Under-Secretary of State for Health, the hon. Member for Bury, South (Mr. Lewis), will reply to the debate, and that the Minister of State, Department of Health, the hon. Member for Don Valley (Caroline Flint), will lead for the Government—
Shona McIsaac (Cleethorpes) (Lab): They are a quality team.
Mr. Lansley: Yes, I admire them personally; it is politically that I have a problem.
It is five years since we last had a debate on public health on the Floor of the House. That debate was also on an Opposition motion. Today, we want particularly to look at the Government’s record on public health, two years after their White Paper and four and a half years after the Wanless report was produced for the Treasury. Tomorrow, the Chancellor of the Exchequer will come to the Dispatch Box and present his pre-Budget report. The Treasury has also received a tranche of other reports, including the Eddington report, the Leitch report and the Barker report, which was published today. I guess that the Cooksey report will be published tomorrow. The Chancellor is very good at commissioning reports. The day before his pre-Budget report, let us see how good he is at ensuring their implementation.
Two years after Derek Wanless published his report to the Treasury, he looked at what had been achieved. Let us remind ourselves how important this matter is. His report set out to the Treasury and the public that, looking forward 20 years from 2002, if the NHS were able to achieve what he described as a fully engaged scenario in which productivity improved and technology was fully utilised in the NHS, and in which
the public were fully engaged with their own health,the NHS would be spending £154 billion a year. If, however, the worst case scenario—that of a slow uptake—applied, in which those things did not happen, the figure would be £184 billion. There would be a£30 billion difference. He also expressed the difference in terms of life expectancy, predicting a difference of 2.9 years for men and 2.5 years for women by 2022.
The NHS has not achieved the productivity gains that Derek Wanless set out. We also know from the repeated delays and confusion surrounding the connecting for health NHS information technology programme that technology is not being taken up in the NHS in the way that he anticipated. I want to focus, however, on the simple fact that we are not achieving that public health objective.
In 2004, the final Wanless report said:
“the challenge now is delivery and implementation, not further discussion. An NHS capable of facilitating a ‘fully engaged’ population will need to shift its focus from a national sickness service, which treats disease, to a national health service which focuses on preventing it.”
In 1997, the Government said that there would be a new public health drive. Yet again, we have seen good intentions but a failure to deliver.
Mr. Russell Brown (Dumfries and Galloway) (Lab) rose—
Mr. Lansley: Does the hon. Gentleman want to try to explain that?
Mr. Brown: The hon. Gentleman mentions Mr. Derek Wanless. May I mention to him another gentleman, Professor Alex Markham, the chief executive of Cancer Research UK, to whom I spoke a couple of weeks ago? He said about the smoking ban:
“This is the most importance advance in public health since Sir Richard Doll identified that smoking causes lung cancer fifty years ago.”
Does he agree with Professor Alex Markham?
Mr. Lansley: The smoking ban is important, and it was a decision reached by Parliament, not by the Government. On the day of the vote on the smoking ban, the Secretary of State for Health said in the morning that she would vote for an exemption for clubs, but by the afternoon she was voting against that. The Government will not get any plaudits for that ban.
Mr. Adrian Bailey (West Bromwich, West) (Lab/Co-op): Will the hon. Gentleman give way?
Mr. Lansley: If the hon. Gentleman does not mind, I shall answer the hon. Member for Dumfries and Galloway (Mr. Brown) first.
We must bear in mind the reduction in mortality rates from cancer, which have been sustained over a period of time, but at broadly the same trend rate. In which period of time was the reduction in the prevalence of cigarette smoking among adults the greatest? The answer is: from 1980 to 1990, when it reduced from 39 to 29 per cent. In the eight years since this Government came into office, it has reduced from 28 to 25 per cent. The previous Government set a target to bring the prevalence of smoking down to 20 per
cent. by 2000. That was not reached, and it has not been reached since. If the hon. Member for Dumfries and Galloway is saying that smoking has been historically the most preventable cause of death, he is right. Action on it is necessary.
Mr. Bailey: Does the hon. Gentleman think that allowing tobacco advertising will reduce the prevalence of smoking, given that he and his colleagues voted against the Bill to ban it in 2002?
Tim Loughton (East Worthing and Shoreham) (Con): We did not vote against it on Third Reading.
Mr. Lansley: My hon. Friend reminds me from a sedentary position that we did not vote against it on Third Reading— [Interruption.] If the Minister wants to tell us about smoking, let us deal with that.
Smoking rates are not falling as quickly as they did in the 1980s. Among young women in particular, smoking has not decreased as it ought to have done. This year, did the Government have a national campaign to coincide with national no smoking day? No, they did not. The two preceding years saw a 50 per cent. and a 40 per cent. increase in quit rates in the first quarter as a result of such campaigns. This year, in the absence of such a campaign, quit rates decreased by10 per cent. in the first quarter and calls to the helpline decreased by 30 per cent. Does the Minister wish to tell us why the Department of Health did not have a national campaign to promote giving up smoking this year? That campaign has not happened.
John Bercow (Buckingham) (Con): In light of the pervasive cynicism about politics and politicians, and given that it is important that we should practise what we preach, does my hon. Friend agree that the Smoking Room of the House should be renamed and the practice there prohibited?
Mr. Lansley: I am always so grateful to my hon. Friend for his questions. Happily, I am not responsible for any House of Commons matters and will not venture into that territory.
Obesity is now the single most preventable cause of premature mortality. Since 1997, obesity in men has risen from 17 to 23.6 per cent. and obesity in women has risen from 19.7 to 23.8 per cent. In 1998, the Government abandoned the target that existed before 1997, but the Labour party’s 1999 public health White Paper mentioned obesity only once in the context of it being a risk factor for coronary heart disease. It had no strategy for dealing with obesity.
In July this year, the Office for National Statistics published the time use survey, which looks at how people spend their time. Its results astonished me.
Steve Webb (Northavon) (LD): Will the hon. Gentleman give way?
Mr. Lansley: Let me explain the point first.
In that survey, 15 per cent. of adults in 2000 said that they spent some proportion of their time during the day in sport and outdoor activities. By 2005—just five
years later—that had fallen to 10 per cent. While there has been a complete absence of any strategyto promote physical activity on the part of the Government, what are we getting instead? A dramatic reduction in the number of adults engaged in physical activity, especially sport. Lottery funding for sporthas reduced from nearly £400 million in 1998 to£264 million.
Mr. Andy Reed (Loughborough) (Lab/Co-op): Will the hon. Gentleman give way?
Mr. Lansley: I shall give way to the hon. Member for Northavon (Steve Webb) first.
The reduction of lottery spending on sport by a third has occurred at precisely the same time as a dramatic reduction in the number of people engaged in sporting activity.
Steve Webb: On the subject of how people use their time, I take the hon. Gentleman back to how he used his time in May 2005, when he was a passionate advocate for the patient’s passport. Will he explain what impact that would have had on public health?
Mr. Lansley: No, because we are debating public health now.
The Minister told us this morning about pilot projects that deal with physical activity. I am happy that we have had the local exercise action pilots. I am also happy that they have demonstrated some success. However, I am surprised that the Government thought that exercise referral schemes only happened in the context of their pilots.
Mr. Reed: Will the hon. Gentleman give way?
Representing the constituency that I do, I am sure the Minister will be aware of the south Cambridgeshire physical activity strategy and the exercise referral schemes in the area, which is part of an evaluation conducted with the Medical Research Council’s epidemiology unit. The proposal for that evaluation said:
“A recent review of evidence on exercise referral schemes that included the findings of a Cochrane review reached the following conclusions”.
I shall quote just the first one:
“Exercise referral schemes showed positive moderate sized effect on increasing self-reported physical activity in the short term but evidence of sustained effect beyond 12 months was lacking.”
That is why the evaluation is taking place.
I looked at the so-called evaluation that the Government published with their pilot this morning. It says:
“Overall the data supports the view that exercise referral is an effective intervention for initially engaging and facilitating physical activity change in adults and older adults”.
This is typical of the Government’s gimmicks. We know that physical activity among older adults in particular gives benefits. What we want to know is what schemes are likely to deliver sustained benefits that justify the investment. Those benefits may well justify
such investment, but the Government parade, as they always do, the fact that they have done something. They say that there is an evaluation. We know that it has not been sustained beyond 12 months. The Government do not talk about an evaluation that will assess whether exercise referrals work and in what circumstances because, lo and behold, they are happening in south Cambridgeshire.
Mr. Lansley: I give way to the hon. Gentleman.
Mr. Reed: I thank the hon. Gentleman for finally giving way. As he knows, I have a passion for sport and physical activity. Representing Loughborough as I do, I must not only engage in such activity, but take great pleasure in doing so. Does the hon. Gentleman accept that the last Government’s record—up to 1997—was pretty atrocious, especially in relation to school sports? I admit that this Government took some time to recognise school sports’ full value, but will the hon. Gentleman acknowledge that the investment now being made—two hours of sport per week within the curriculum, possibly four hours by 2010—will make an enormous difference to the future? Will he apologise for the last Government’s record and confirm that enormous strides are now being made, while even greater advances are being achieved in adult sport?
Mr. Lansley: I am glad the House has been spared the need for a speech from the hon. Gentleman, but I do not accept what he has said. The Government said in 2001 that there would be two hours of sport a week for all school children. Currently 80 per cent. of children are getting those two hours, which include preparation and playground time but not actual engagement in competitive or any other sport.
I do not dispute the value of the objective. My hon. Friends on the Culture, Media and Sport team have been first-rate proponents of the delivery of not just sport but competitive sport in schools, and I think it important too. Loughborough notwithstanding, my eldest daughter is reading sport and exercise science at Exeter, my old university; I think that Exeter will serve her rather well.
Sir Nicholas Winterton (Macclesfield) (Con): My hon. Friend is making an excellent speech. On Saturday, I visited the Bollington leisure centre in my constituency. Those in charge of the gymnasium told me that a number of general practitioners were referring elderly people to the gym on prescription, because their health would benefit. Does my hon. Friend approve of that? I believe that such prescription by GPs is a very worthwhile endeavour, and should be extended.
Mr. Lansley: I will pass my hon. Friend a copy of “Fitness 4 Health”, a leaflet which advertises the south Cambridgeshire exercise referral scheme, supported by both the primary care trust and the local authority. In 2004-05, the 176 local health professionals registered with the scheme made 430 referrals. It was particularly important to those with type 2 diabetes.
I entirely agree with my hon. Friend about the importance of such schemes; I do not underestimate it. I am merely saying that the Government should not get away with claiming that they somehow invented exercise referrals, or that they have evaluated them. The same things are happening elsewhere.
We have not yet talked about obesity in children, but that situation is also deteriorating seriously. There has been a 50 per cent. increase in the proportion of boys with a body mass index over 30, and a 40 per cent. increase among girls. Our children are getting fatter faster than children anywhere else in Europe. That returns us to the point made by the hon. Member for Loughborough (Mr. Reed): we need more sport in schools, and also outside them. Conservative Members are committed to ensuring that sport receives lottery funding, but it must be increasingly well used.
Dr. Howard Stoate (Dartford) (Lab): I entirely agree with the hon. Gentleman that childhood obesity is the big issue that we must face, given a trebling in the number of obese children over the past 20 years. Does he agree that one way of tackling the problem would be a meaningful ban on the advertising of food that is high in fat, salt and sugar, which should begin at the watershed so that no advertisements for such foods appear until 9 pm? Parents and others understand what the watershed means, and could protect their children from such pernicious advertisements.
Mr. Lansley: I personally think that Ofcom has launched a very sensible consultation to which it is right for us to respond, but there is a bigger deal: enabling parents to construct a good diet for their children. That is absolutely central.
Advertising might have a part to play, but getting the diet right, and parental control of children’s diets, is instrumental. When the former Secretary of State launched the White Paper in November 2004, I said that it was wrong to have a simplistic traffic-light system and that it would be better to have a system that was geared to guideline daily amounts. The Government have now accepted that proposition. They abandoned what they said in November 2004 but so much time has gone by, in which so many retailers and food manufacturers have brought in competing systems, that we continue to have confusion. It would have been much better if the Government had listened to us in the first place and had put in place a system that was GDA-related and used traffic lights, and which could have commanded greater support in the food manufacturing community.
Mr. Kevin Barron (Rother Valley) (Lab): In relation to parents, children and food, the hon. Gentleman will remember the incidents in September at a school in Rotherham when some parents tried to defeat the healthy menu that had been introduced by feeding food through the school railings. Does the hon. Gentleman agree with his colleague, the hon. Member for Henley (Mr. Johnson), who serves as a shadow Education spokesman, and who declared:
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