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The Conservatives were the party that reduced the standards for building public housing; they removed nutritional standards for school meals; they offered a paltry £10 Christmas bonus to pensioners; and they had a cold weather payments system understood only by the weather man, leaving old people unprotected.
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Perhaps the ghost haunted the hon. Gentleman with memories of the tripling of child poverty and the doubling of pensioner poverty. Let us not forget that the Conservatives reintroduced mass unemployment into British society and presided over recessions and repossessions, with all of the health consequences that followed, thus consigning a generation to the scrap heap.

Although the hon. Gentleman did not mention health inequalities today, he has done so in the past, so I give him credit for that.

Mr. Stephen O'Brien (Eddisbury) (Con): It is in the motion.

Caroline Flint: I stand corrected. Perhaps the hon. Member for South Cambridgeshire did mention health inequalities in his speech. However, when his party was in power, the phrase never passed the lips of Tory Ministers, who preferred to talk about “health variations”. Labour Members have not shied away from tackling the underlying causes of poor health, however challenging they are. There are no short-term fixes, but there is certainly no excuse for inaction.

Dr. Andrew Murrison (Westbury) (Con) rose—

Caroline Flint: I will give way shortly, but let me make this point: is the epiphany that we have witnessed today the result of visits not only from the ghost of Tory Christmas past, but from the ghost of Tory Christmas present? After all, it was the Conservative leader who argued and voted against Labour’s increase in national insurance to pay for increased investment in the NHS. I am sure that my hon. Friends were making a note of all the spending commitments that the hon. Member for South Cambridgeshire made during his speech. It is he and his leader who, after voting against increases in NHS investment, now tell their Back Benchers that more of the money should go to Conservative areas.

Perhaps the hon. Gentleman is having sleepless nights over his other pledge on direct funding to areas with the greatest burden of disease. If that were implemented, the whole Government Front-Bench health team would receive more money for health for each of their constituencies, while each of the Conservative Front-Bench spokesmen would see less NHS money in each of their constituencies.

Let us give Conservative Members some credit. Perhaps the conscience of the hon. Member for South Cambridgeshire has at last been pricked by the ghostof Tory Christmas future warning him that hisshadow Chancellor’s spending rule for a future Tory Administration would lead to spending cuts of£17 billion for public services and huge cuts in the NHS. It is a wonder that the hon. Gentleman is any shape at all to come to the Dispatch Box, given the few nights of decent sleep that he must have had.

Dr. Murrison: Let us have a dose of reality, shall we? On the subject of health inequalities, perhaps the Minister remembers saying:

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Will the Minister also stop wasting taxpayers’ money, such as the £20,000 that she spent on the silly advert on health inequalities that she placed in the Health Service Journal, and put the money where it can really do some good?

Caroline Flint: It would be very easy to think that we could come to power and, with a wave of the wand, rectify all the unnecessary damage that the Tory Government did in nearly 20 years in power. If one examines the various reports produced during the Tory years—the Black report was just one—one sees that a widening health inequalities gap was being identified in the 1980s— [Interruption.]

Mr. Speaker: Order. Let the hon. Lady speak.

Caroline Flint: We have been very honest and up-front about the widening gaps. Action must be taken to put things right, and I shall make some points about the matter later in my speech.

Fiona Mactaggart: My constituency represents a clear example of how a determined focus on tackling health inequalities can begin to produce results, using the health trainers about which the hon. Member for South Cambridgeshire (Mr. Lansley) was so scornful. When I was first elected, the health inequality—the gap in life expectancy—between Slough and the rest not only of the south-east, but of England and Wales, was growing. It continued to grow in 1995, 1996 and 1997, but since then it has declined and begun to narrow. That has happened because we in Slough have used health trainers well. Our focus is delivering a reduction in health inequalities, so such a thing can be achieved elsewhere with that kind of determination on the part not just of individuals, but of companies.

Caroline Flint: My hon. Friend makes an important point. Progress is being made in Slough and in other parts of England. Part of our work at the Department of Health is ensuring that we provide the correct information and advice on how to tackle some serious and challenging targets.

When we were elected in 1997, we faced chronic underfunding of the NHS, increasing waiting lists,staff shortages and the disarray inherited from the Conservative party. I make no apology for the fact that we had to give our attention to that situation and that it had first call on our resources. None the less, we are the first Government to appoint a Minister for Public Health and to work across government to put right the Conservatives’ neglect. We are the first Government for decades to tackle the root causes that undermine health and well-being and to give leadership in response to the nation’s concerns.

Mr. Burrowes: The Minister talks about pity and inequality, but does she not pity people in the north-east who are dependent on alcohol? Of every 102 people who need treatment for alcohol dependency, 101 cannot get access to it in the region. What will she do to extent the remit of the National Treatment Agency for Substance Misuse to alcohol?

Caroline Flint: I do not think that people need pity. They need action, and the north-east provides an interesting example of what we have done. We have
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mapped what treatment is available, and it is clear that there are gaps. That is why, with the NTA, we have provided models of care for alcohol treatment. It is why, just in the past few weeks, with St. Georges, university of London, and Newcastle university, we have initiated a trailblazer programme of brief interventions for people who are drinking in a way that is hazardous to their health. In that way, we are building the evidence base for why action is necessary and what practical action needs to be delivered on the ground. Different responses are required for chronic alcoholics and for those who go out binge drinking on Friday and Saturday nights.

Tackling public health is bigger than having responsibility for the health service. Through the new deal we have reduced unemployment by helping1.5 million people into work, which I believe helps to improve the quality of people’s lives.

Andrew Gwynne (Denton and Reddish) (Lab): My hon. Friend spoke about Tory Christmas past and Tory Christmas present, but for my constituents there were no Tory Christmas presents. Through the winter fuel allowance and the Warm Front grants, we have come a long way from the days when Tory Ministers told pensioners in my constituency to knit woolly hats.

Caroline Flint: My hon. Friend is absolutely right. The Warm Front scheme has helped thousands of families on low and fixed incomes to install central heating or upgrade old and inefficient heating systems; the winter fuel allowance has been a boost to pensioner households; and Sure Start has been vital to starting children off on the road to better health. All those initiatives have had an impact on health, and all have been rejected by the Conservatives, time and again.

Rob Marris (Wolverhampton, South-West) (Lab): May I congratulate my hon. Friend and the Government on something that the hon. Member for South Cambridgeshire (Mr. Lansley) recognised only grudgingly? The national bowel cancer screening programme was started in Wolverhampton and is, I believe, the first health screening programme in the world to cover both men and women.

Caroline Flint: I thank my hon. Friend for his intervention. I know that he will work to ensure that the programme is working properly in his area. It is easy to pour scorn on such initiatives, but that programme is a world first—just one of many that we are achieving in public health.

John Bercow: Given that alcohol abuse is fuelling violence crime and that reducing addiction is crucial to reducing reoffending, will the hon. Lady tell the House what discussions she has had with the Home Office about the fact that prisoners at Grendon and Spring Hill prisons in my constituency who have committed alcohol-fuelled crimes cannot get access to publicly funded treatment, which they desperately need?

Caroline Flint: I regularly have conversations with Home Office colleagues. I am happy to follow up the case that the hon. Gentleman raises. Part of our work
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with St. Georges, university of London, and Newcastle university deals with interventions, whether in a police cell or in an accident and emergency department, when people have drunk too much for their own good, which could result in antisocial or seriously violent behaviour. We are trying to find ways of capturing those moments to redirect people into programmes—not necessarily programmes suitable for chronic alcoholics, but programmes for those who drink hazardously in a way that regularly affects their behaviour.

I can tell the hon. Gentleman that recent figures from the British Beer and Pubs Association indicate that alcohol consumption per head has fallen by 2 per cent. over the past 12 months.

Mr. Burrowes: Not for children.

Caroline Flint: That is the first decline in nine years, but I am not complacent. There are concerns about children and young women. However, the proportion of 16 to 24-year-old women who had drunk more than six units on at least one day in the previous week has fallen to 22 per cent. from 28 per cent. in 1998. We must be cautious about these statistics, but there seems to be a growing awareness of the impact of alcohol. I hope the hon. Gentleman will agree that our campaign to point out to young people that although alcohol makes them feel invincible, they are actually very vulnerable under its influence, will strike home. The feedback from that campaign has been extremely positive.

Mr. Graham Stuart: The Minister announced two years ago that £50 million would be spent on public health campaigning for sexual health. Recently she announced that only £4 million would be spent. Does she share my disappointment at that change? Does she think that £4 million is adequate and that no improvement could be gained from greater expenditure from budgets that have already been allocated?

Caroline Flint: More to add to the shopping list. I am interested in what works and what is effective. That is why our campaigns in the Department are not only focused on what we do nationally, but are much more targeted at the groups that we most want to reach. We provide PCTs and community organisations with materials that they can use locally. We also work through the magazines that young people— women and men—read, which have an added reach beyond that of TV campaigns and radio adverts.

Mr. Simon Burns (West Chelmsford) (Con): On targeted public health information, particularly to young people through magazines, can the Minister explain why, if that approach is such a good one, the incidence of various sexually transmitted infections has increased so dramatically? The tombstone campaign in the late 1980s and early 1990s was a high profile campaign to get a strong message across, and right up until 1995-96 we saw a dramatic decrease in levels of HIV and other STIs because of condom use, as opposed to the dramatic increases that have taken place since the introduction of the targeted approach.

Caroline Flint: I shall be happy to deal with that in more detail later.

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In 1994-95 under the previous Conservative Administration UK health departments reviewed their health promotion strategy and came to the conclusion that community-based and self-help groups were often better placed to develop targeted health promotion than Government or their agencies. I believe we need a mixture of both, but I shall come to sexual health later in my contribution, if the hon. Gentleman will be patient.

Public health, as I said, is not just a matter for the Department of Health. Individuals, communities, employers, public services and the voluntary sector all have a part to play in shaping health and well-being, but Government must be willing to lead.

Ms Diana R. Johnson (Kingston upon Hull, North) (Lab): Will my hon. Friend join me in congratulating the jointly appointed director of public health in Hull, who was appointed by the local authority and the PCT, so that there can be joined-up thinking to ensure that public health improves in Hull?

Caroline Flint: Indeed, and I am pleased that in Doncaster we are following the same route. For the past couple of years we have encouraged closer co-operation with local government. That is starting to pay dividends. One aspect of that is the joint appointment of public health directors at a local level, which can only add to what we can achieve beyond health and in the wider community.

I am sure that hon. Members in all parts of the House will agree that today’s challenges are very different from those of 100 years ago. In the 19th century and early 20th century, most premature deaths were due to infectious illnesses, often striking people down in infancy or in the prime of life. In 1854, 600 people died from cholera caught from the infected water of the Broad street pump in London. But times change and the challenges are different today. We are living longer, so the diseases of middle life and old age are more pertinent now than they were 100 years ago.

Thanks to the investment by this Government, we have made changes that are improving public health. Life expectancy has continued to increase both for males and for females in England as a whole, and for those living in communities with the worst health and deprivation. Sixty per cent of those communities—the spearhead areas—are on track to narrow the life expectancy gap between their areas and England as a whole by 10 per cent. by 2010. The gap that meant that someone was more likely to die of heart disease or cancer if they were poor is narrowing.

The NHS and local authorities are key players in tackling health inequalities. For the first time ever, the issue of health inequalities is one of the Department’s top six priorities for the NHS, and from next April it will be a mandatory target for local authorities through local area agreements. The figures for children dying before their first birthday are the lowest ever, and the latest figures suggest that the infant mortality gap between our poorest families and the rest of the population has stopped widening. We cannot be complacent, as I said, but there are indications that the efforts of many people on the front line are starting to have an impact.

None of this is accidental. One lesson that we have learned is that to prevent these problems recurring from
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generation to generation we have to intervene early in life. “Healthy Start” and the healthy schools programme are two examples of this. “Healthy Start”, which was launched nationally last Monday, is the first major reform of the world war two welfare food scheme to meet modern dietary requirements. The healthy schools programme lays down the building blocks for our young people. Last year, we decided that we needed to highlight and prioritise healthy eating and physical activity in order for a school to become a healthy school. It is a voluntary programme, but more than 80 per cent. of schools have chosen to participate and are reporting real benefits, including the provision of at least two hours of sport and physical activity. That figure was less than 30 per cent. in 1997-98, when we came into government, so we are making progress.

Jeremy Wright (Rugby and Kenilworth) (Con): I am sure that the Minister agrees that one of the most effective ways of combating childhood obesity is to persuade children to walk to school and to engage in more outside activity in their leisure time. Does she accept that one of the reasons why that does not happen is that parents do not trust their children to play outside because they do not regard it as a safe environment? Is that something else that she would like to talk to her Home Office colleagues about?

Caroline Flint: Of course, tackling antisocial behaviour is a major part of tackling that fear. I have always said that antisocial behaviour is about the victims, who are often children and young people. This is not an anti-child or anti-young person measure—it is about creating the right environment for children to play outside. The Department is researching the reasons why people come to accept the basis for change. That is important. It is not just up to me to have a few bright ideas every day—we have to back it up. As the hon. Member for Rugby and Kenilworth (Jeremy Wright) suggested, we have found that parents who are asked about physical activity and what stops them letting their children play outside say that safety is one of the issues and that they therefore trade off playing outside against watching TV or playing computer games. That is why our work with the Home Office, local government, sports clubs and community organisations is so important in creating an atmosphere that is conducive to encouraging people to be more healthy in their everyday lives.

Good voluntary initiatives do not end with the public sector. The food and drink industry has been working closely with the Food Standards Agency to reduce the levels of salt in processed foods, and excellent progress is being made. Many manufacturers and retailers have accepted the need for simpler front-of-pack labelling of salt, sugar and fat in food. When I came into this job, that was not a unanimous view, and they were discussing whether such labelling was suitable, but we are now at a stage where the industry has signed up to recognising its importance. We have agreed with the industry that there will be independent research to see which system works best for consumers. Early indications show that shoppers have found the multi-coloured, or traffic light,system most useful when they are running busy lives and trying to choose between one shepherd’s pie and another. We will be monitoring the situation and providing independent research with the FSA whereby we can all agree on the best outcome.

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