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I say let people eat what they like. Why shouldnt they push pies through the railings?
There is a great deal that we can do. There is not a lot of disagreement on this subject in the House. We want to make sure that there are fresh foods that are freshly prepared in schoolsand if that is not possible as many schools do not have kitchens, technologies and opportunities are increasingly available for fresh food to be prepared elsewhere without it having to be cooked on site, and we should use them.
Let us look at the Governments record on sexual health. There is an epidemic of sexually transmitted infections. That was not the case up until the mid-1990s, particularly because of the tombstone campaignthe 20th anniversary of the launch of that campaign by Lord Fowler and the then Government is a couple of weeks away. That showed what is possible when a national campaign is conducted that is designed not only to focus on those who are at risk but also to change the surrounding culture. Not only did we have the best record in Europe on prevention of HIV infection, but we had a substantial reduction in other sexually transmitted infections.
What have we had since? Chlamydia is up 147 per cent; syphilis is up 1,653 per cent; and HIV infection is up 111 per cent. The Government have recently promised £50 million for sexual health campaigns but they are actually spending only £3.6 million on them. In the early 1990s, the then Government were spending £15 million a year in real terms on the sexual health campaign. That figure has now fallen below £5 million.
Mr. Graham Stuart (Beverley and Holderness) (Con): The failure of public health campaigns nationally and the failure to invest in sexual health campaigns is matched locally by deficits in the NHS. That has led to cutbacks in sexual health services in the East Riding of Yorkshire, which is suffering precisely the epidemic that my hon. Friend has been talking about. My constituents want to hear answers this afternoon from Ministers who have let the public down.
Mr. Lansley: That is precisely the point. When Ministers published the White Paper, they said that, in one respect, there would be ring-fenced budgets. That was supposed to be the case for sexual health, which was turned into one of their six priorities. The Department of Healthstrictly speaking, I should say the independent advisory groupdid its own survey. It went to 191 primary care trusts: 33 of them admitted that they withheld some or most of the funding; 51 said that they absorbed the entire allocation into their general budgets; and 31 said that they were withholding funding from chlamydia screening. On the latest data, only 36 per cent. of primary care trusts have been conducting chlamydia screening, but the figure for that is supposed to be 100 per cent. by March next year. The sexually transmitted infections record is disgraceful compared with that of the past.
Paddy Tipping (Sherwood) (Lab): I am very interested in the reel of statistics that the hon. Gentleman has given. He seems to be advocating that targets are necessary: targets relating to sexual health and targets for the NHS. I thought he was against targets.
Mr. Lansley: The hon. Gentleman has not been listening. We are against top-down targets that impact on the services that clinicians provide. We are not against public health targets; I have never said that I am against public health targets.
The last Conservative Government had targets. [Interruption.] Perhaps Government Front Benchers would care to listen. Targeting ought to be an instrumental part of the performance-management process. It is not the job of the Department of Health to performance-manage individual hospitals, trusts and health care providers on the front line. It should be the job of the Governmentwhen we are in government, it will beto deliver on public health, so when in government we will set targets that we will impose on ourselves, and against which we will be measured. In 1992, Virginia Bottomley, the then Secretary of State, published The Health of the Nation White Paper, which was regarded as the model of its kindthe first public health White Paper from a major Government. Yes, it set targets, which was the right thing to do.
The Governments teenage pregnancy target is another that they are not going to meet. We are well below the necessary trend; indeed, our teenage pregnancy rates are not only the highest in the EU15, but the highest by a long way. Yet out in the fieldin places such as Bexleyfamily planning clinics are being withdrawn and emergency hormonal contraception is being removed from pharmacies. The teenage pregnancy budget in Coventry has been cut by 12.8 per cent., and 15 related posts are going to go.
Sarah McCarthy-Fry: On funding, surely the hon. Gentleman accepts that if his party had had its way, primary care trusts would not have had the additional funding that they received because his party voted against it.
Mr. Lansley: That is another example of the limited number of Labour MPs who trouble to come to our health debates not even listening. We have made it repeatedly clear that we have committed ourselves not only to resources for the national health service, but to ring-fencing public health budgets. We are fools to ourselves if we increase resources for the NHS, but do not ensure that such increased resources lead to primary prevention and awareness-raising, so that we can reduce future demands on the NHS.
Mrs. Ann Cryer (Keighley) (Lab): Will the hon. Gentleman explain to the House this afternoon what advice he is going to give to the Government, so that they can prevent our constituents from having unprotected sex? Unless he can explain that, I am afraid that he is not getting to the heart of the problem.
Mr. Lansley: That, from a Government who abolished the Health Education Authorityterrific!who have a record on public health of modest, limited expenditure on targeted campaigns, but who never do the thing that experience suggests is absolutely necessary: changing the culture and the climate.
We do not need to look into a crystal ballwe have experience. There is a book showing that there was a time, in the mid-1980s, when a campaign changedthe culture regarding protection against sexually transmitted infections. The next campaign will not be the same, but we must have ring-fenced budgets that are, in part, used nationally to deliver such a culture change.
Peter Bottomley (Worthing, West) (Con): The hon. Member for Portsmouth, North (Sarah McCarthy-Fry), who has a genuine interest in this issue, might like to consider that, by helping to change the associated culture, the number of instances of drink-driving by young men was successfully cut by two thirds in two years. Money matters, but so does the culture. Does my hon. Friend agree that if the Labour Members who keep intervening on him looked at the last two lines of the Governments amendment to our rather good motion, they would notice that the Governments justification for cutting funding for the south coast and elsewhere by about £400 per person is denied by that amendment, for which they will vote? According to that amendment, the differences in morbidity and mortality will be addressed by other issues. The Government might like to give that money to the south coast, so that we can keep our hospitals and accident and emergency departments and treat people where they want to be treated.
It is absolutely right that we ring-fence public health budgets, and part of the reason for doing that is so that they can be set at levels proportionate to the measures and programmes that are proven to have effect, in order that we can deal with health care outcomes directly. That does not mean, however, that that is the only way of dealing with health outcomesfar from it. As colleagues in all parts of the House have made clear, in order to deal with poor health outcomes we must address a range of issues, such as relative deprivation, socio-economic status, poor housing, and diet and nutrition, among many others.
My hon. Friend mentioned alcohol. Alcohol-related deaths have doubled in the past 14 years and there was a 30 per cent. increase in alcohol-related hospital episodes between 1997 and 2004. Professor Roger Williams, a leading hepatologist told me:
The situation is terribly worrying. We are seeing every week young women with end-stage or very severe liver disease and we never used to see as many before.
Then there is drug abuse. The number of people using class A drugs frequently has gone up by a third, from 1.1 per cent. in 1998 to 1.6 per cent. in 2005-06. On cannabis, the Department of Health has had no influence on policy. If it had, Health Ministers would have persuaded their Government colleagues that sending the kind of messages they put out on cannabis use is deadly dangerous. There will be an epidemic of schizophrenia if young people in their teenage yearsmany with a predisposition towards that disease in such circumstancescontinue to take cannabis at current rates.
Mr. David Burrowes (Enfield, Southgate) (Con): I share my hon. Friends concerns about the effects of cannabis. Will he also highlight concern about the lack of attention given to alcohol abuse? The Department of Healths estimates show that about £1 of every£3 spent on accident and emergency treatment may be related to alcohol misuse. Is not it a scandal that the National Treatment Agency for Substance Misuse has no dedicated funding for alcohol rehabilitation and aftercare services?
When we consider infectious diseases, we find that HIV has more than doubled and that there has been a 20 per cent. increase in tuberculosis reports in England in two years. In 2001, Ministers promised a strategy on hepatitis C by the end of the year. It was not published until July 2004. According to the Governments estimates, a minimum of 200,000 people are infected with hepatitis C but are undiagnosed. Failure to treat them could lead to 100,000 patients with end-stage liver disease some years hence.
John Mann (Bassetlaw) (Lab): As the hon. Gentleman knows, hepatitis C is primarily caused by intravenous drug use. In his discourse, will he outline precisely what his partys drug policy is, especially in relation to intravenous drug use?
Mr. Lansley: At the last election, my party was clear about our determination to put resources into drug rehabilitation and to present drug users who enter the criminal justice system with a clear choice: either the criminal justice system would take responsibility for them or they would move into drug rehabilitation.
What has the Department of Health been doing about infectious diseases over the last year? Statistics issued by the Department last week showed that between 2004-05 and 2005-06 its net expenditure on infectious diseases went down from £1.5 billion to£1.2 billion, which includes the 20 per cent. reduction in the budget of the Health Protection Agency. Given the agencys current work, one wonders how sensible that reduction was.
The public health budget is not just for primary prevention, but for secondary prevention. The Governments amendment refers to bowel cancer screening. By the end of December, 500,000 people should have been screened through the new bowel cancer screening programme; the number will actually be only 100,000.
Two years ago, the Governments White Paper described how pharmacies would be used to roll out new ways for people to access screening services. Only 1.5 per cent. of pharmacies across the country have been commissioned to provide local enhanced screening services. Only 26 per cent. of pharmacies have been commissioned to provide stop-smoking services. During the local elections I visited a pharmacy
in Haveringin the constituency of my hon. Friend the Member for Romford (Andrew Rosindell)and the pharmacist told me that they were in the middle of providing smoking cessation services but had been told to stop because the primary care trust had withdrawn the budget. It is all to do with finances.
We have talked about the smoking ban. Rightly, we concluded that we might save 1,000 lives that way. The bowel cancer screening process might save more than 1,000 lives. Breast cancer screening saves perhaps 1,000 or 1,500 lives a year. What about abdominal aortic aneurysms? Where is the Governments action on that? Some 2,400 people with ruptured aneurysms go into accident and emergency departments every year; 50 per cent. of them die. What about men who are over 65? A Gloucestershire pilotI do not know whether the hon. Member for Gloucester (Mr. Dhanda) is presentlooked at a screening programme. It is straightforward and involves an ultrasound that is like the ultrasound that pregnant women have during the course of antenatal care. Research on that was published in 2002.
The National Screening Committee said, yes, we should have such a programme. The Ministers predecessor said that there was going to be an action plan by the end of 2004. It is now the end of 2006. More than 1,000 lives are lost a year from ruptured aortic aneurysms, but there is no screening programme. The Government, through the White Paper, buy 1,200 health trainers, for which there is no evidence base. We have an evidence base for saving lives through a screening programme, but the Government are doing nothing.
In all the ways that I have described, public health has lacked priority and urgency. The Government produce document after document. There is a stack of them. I have a pile of them here and another pile back in the office. However, as Derek Wanless said, we need delivery and implementation, not more discussion. We need research so that there is an evidence base for what is being done. Derek Wanless has agreed with the Conservative partys policy. I said before the election that we need a Secretary of State for public health, not just a Minister for public health. We need the Department of Health to focus on public health. We need a ring-fenced public health budget and an enhanced chief medical officers department. We need directors of public health, jointly appointed by local authorities and the primary care trust, who have those ring-fenced budgets
Those people should have the opportunity to use those budgets, using an evidence base, to deliver right across not just the NHS, but the public and private sector. As Professor Liam Donaldson, the chief medical officer, said in his report, which was published
this July, we need the public health work force to know that it is supported in that way. He said:
There is strong anecdotal information from within the NHS which tells a consistent story for public health of poor morale, declining numbers and inadequate recruitment, and budgets being raided to solve financial deficits in the acute sector.
Frankly, even since he wrote that, the reorganisation of primary care trusts, which Ministers said would not lead to a reduction in public health staff, has led to precisely that. More jobs have been lost among the small number of qualified public health staff. At the end of his article, Professor Donaldson said:
It is time for things to change.
welcomes the Governments trebling of investment in the NHS by 2008 which is crucial to improving public health and tackling health inequalities; notes that this extra investment has enabled a huge expansion in preventive services including extending breast cancer screening to women aged 65-70 which has helped increase the number of breast cancers detected by 40 per cent. since 2001 and the first ever national bowel cancer screening programme which will detect around 3,000 bowel cancers a year when fully rolled out; acknowledges that this Government has done more than any previous government to help people give up smoking, including banning smoking in all workplaces and public places from 1st July 2007; further welcomes the help and support being given to people to live healthier lives including two million 4 to6 year olds now receiving a free piece of fruit or portion of vegetable, new healthier standards for school meals, clearer food labelling, new health trainers and NHS life checks; and recognises the unprecedented action this Government has taken to tackle the root causes of ill health and health inequalities including helping more people find work, lifting a significant number of children out of relative poverty and taking action to tackle poor housing.
I ask the House to pity Opposition Members, who have to attempt coherent speeches after the confusion, hypocrisy and brass-necked cheek to which that we have just been subjected. The hon. Member for South Cambridgeshire (Mr. Lansley) springs forth with the zeal of a convert to public health, but his conversion to public health is rather like that of an Ebenezer Scrooge who has been awoken in 2006 to the need to changeby the nightmare of a Tory Christmas past. The nightmare reminded him of all that his party could have done with nearly two decades in power, and all that it did to undermine the public health of this country.
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