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The Government’s 2005 election manifesto pledged to restrict the advertising of high-fat, high-salt and high-sugar foods to children. As has been mentioned, Ofcom recently announced its intention to restrict advertising, and we will keep a watch on that situation. That is another example of Government leadership. We made the case that there was an imbalance in the relationship between the advertising of high-fat, high-salt and high-sugar foods and children, and we wanted the regulator to apply itself to the problem. We will see what happens, and how the measure changes the balance, but we have left open the option of legislating in future, if we think that it is the right thing to do.
Money and legislation have never been the Government’s only tools. When a consensus can be reached, we may sometimes make quicker progress towards common goals through voluntary means, and we are open to discussions on those voluntary means. I am proud of the fact that the Government took a lead and contributed to a shift in emphasis, and to a consensus in favour of healthy choices and healthy living.
The Government are impatient to ensure fewer needless deaths. We have a right and a responsibility to intervene more decisively, when that is required. The Health Protection Agency, which is unique and a true world leader, is a one-stop shop dedicated to protecting the general public’s health from infections, chemicals, poisons and radiation. We are the first country in the world to introduce the meningitis C vaccine, and we immunised 13 million children in year one. Deaths from group C meningococcal disease have fallen by90 per cent. in all age groups, including among those not offered the vaccine. Thousand of children’s lives have been saved and 10,000 cases have been averted as a result.
We have continued to promote the measles, mumps and rubella triple vaccine, which saves lives, and which has been shown repeatedly in research to be the safest method of gaining mass immunity to measles, mumps and rubella. I hope that all Opposition parties will support the best medical advice on that important issue. We continue to improve the protection that we offer to children in this country. In September this year, pneumococcal vaccine was added to the vaccines routinely offered to babies. It protects against a serious form of meningitis, and we expect it to save many children’s lives every year. Our flu vaccination programme will offer 15.2 million vaccinations this winter, which is 1 million more than last winter.
Dr. Murrison: Will the Minister remind the House of why, for three years in a row, the Government have failed to deliver the flu vaccine on time?
Caroline Flint: As the hon. Gentleman will know, this year there was a manufacturing problem with the vaccine that no one could have foreseen, and we had to deal with that. On vaccine delivery, I remind him that we negotiate the total amount of vaccine, based on what we identify to be the need of the population— and, I must say, we have allowed the vaccine to be provided on the NHS to an ever widening group of people. It is up to general practitioners and primary care trusts to make their orders for vaccines.
Of course, we want to improve the system, but the picture varies across the country. In many places, the authorities are on top of the issue, and district nurses provide the vaccine in people’s homes. In those areas, the rates of vaccination are increasing. However, it seems that other areas are not on top of the problem, and we have to understand that. We should support GPs, and we are working on doing that. That is why my right hon. Friend the Secretary of State has asked for a review of the issue, to see how we can improve. However, that should not take away from the positive progress that we have made. We are considered to be one of the world leaders in flu vaccination, and other countries rightly look to us, and our developments in that area.
Our extended breast cancer screening programme, which now includes 65 to 70-year-olds, has screened over 600,000 more women, and it saves 1,400 livesa year. As my hon. Friend the Member for Wolverhampton, South-West (Rob Marris) said, the bowel cancer screening programme, which is a world first, will detect some 3,000 cases each year within three years.
Sandra Gidley (Romsey) (LD): I welcome the extension of breast cancer screening to an older age group, but does the Minister accept that the highest rate of breast cancer is among older women who are not screened? What is she doing to raise awareness among people in that age group?
Caroline Flint: We continue to consider how we can improve awareness. We must make sure that we are not complacent about providing a screening programme; we should make sure that women of all ages who are currently eligible take advantage of the screening programme. I will pass on the hon. Lady’s comments to the Minister of State, Department of Health, myright hon. Friend the Member for Doncaster, Central (Ms Winterton). We keep all such issues under examination, and, obviously, we want to do the best that we can for women in all age groups, as far as priorities and resources allow.
Caroline Flint: I must make progress, because I want to give some time to sexual health issues. We have addressed the subject of prevention and the lifestyles that put the public at greater risk. Things have changed since the 1980s, and we have to face up to the ignorance surrounding HIV and AIDS. Today, images of people dying are not as prevalent on our television screens. We have to consider how people perceive HIV and AIDS. That is partly because we are a world leader in medical support and treatment. However, the consciousness of young people has changed, so we must deal with different attitudes to HIV, AIDS and other sexually transmitted infections.
Mr. Burns:
Does the Minister accept that today’s generation is too young to remember that education programme? Young people are ignorant of the serious dangers of HIV, so the use of condoms and other measures have not succeeded in keeping the levels of sexually transmitted infections and HIV down. It is therefore crucial that we do not use targets which,
statistics show, are ineffective, but develop a hard hitting campaign so that everyone understands the problem.
Caroline Flint: It is not an either/or issue. Targeted work is helpful in gay and African communities, but the hon. Gentleman will agree that our most recent campaign—“condom essential wear”—is important, too. We want people to think about taking condoms with them on a night out, as they are as essential as their car keys, lipstick and wallet, and are a good way of preventing sexually transmitted infections. The message applies to everyone—by using a condom one reduces the risk of contracting not only HIV but chlamydia and several other sexually transmitted infections. I welcome the hon. Gentleman’s support, and I hope that he will encourage his hon. Friends to support our campaign, as some of them have not been open about the need for such sex education.
Mrs. Nadine Dorries (Mid-Bedfordshire) (Con) rose—
Caroline Flint: I will not give way, as I wish to make progress.
Our chlamydia screening programme has screened more than 100,000 young people—an increase of 40,000 on the previous year—and we have set targets to ensure that by 2008, everyone referred to a genito-urinary medicine clinic is seen within 48 hours.
I am proud that the Government have moved a step further in their attempts to support people who wish to give up smoking. We promoted smoking cessation on the NHS, which has made a major contribution by persuading 1.2 million people to end their smoking habit since 1998. From 1 July next year, all enclosed workplaces and public places will be smoke-free, which is a landmark step that we were persuaded to take by our hon. Friends and other hon. Members. However, we triggered the debate by saying that we were going to legislate, thus providing the platform for the free vote on 14 February. I echo my hon. Friend the Member for Dumfries and Galloway (Mr. Brown) in quoting Professor Alex Markham, who described that landmark step as
“the most important advance in public health since Sir Richard Doll identified that smoking causes lung cancer fifty years ago.”
The motion offers false promises. The Opposition want improved services, but they refuse to support any action to tackle local deficits. They claim to back local health professionals to improve public health, but they oppose every local reconfiguration of service. They have identified a list of public health issues, without offering the means to tackle them. In one breath, they demand the loosening of Whitehall control, but in the next they demand the ring-fencing of funds for public health from the centre. The Conservatives face all ways, and they do everything that they can to avoid any long-term decision that involves change in any locality. The hon. Member for South Cambridgeshire has shown today that tough decisions are still something his party is unwilling to make. We are leading a huge cultural change in health, by moving from a crisis service dominated by hospitals to a system in which prevention and the promotion of health and well-being take their legitimate place in good health policy. We make no apology for setting targets to reduce health inequalities, or for taking action across government to
achieve them, whether by improving housing, home insulation, school diets and opportunities for sport and physical activity, or by reducing unemployment. We are dealing with the problem, and we are getting on with the job and producing results. That is the difference between our party and the Opposition.
4.38 pm
Sandra Gidley (Romsey) (LD): I welcome the opportunity to discuss public health, which is undervalued and under-discussed. I wish to set our debate in the context of equality, because while overall health has improved, health inequalities remain. Whether we look at geography, social class, gender or rage, there are inequalities galore.
I may not have heard the Minister correctly, but I thought I heard her say that inequalities were narrowing. In a parliamentary answer in October this year she said:
“In England average life expectancy for males is 76.6 and for females 80.9, in the spearhead group it is 74.6 for males and 79.4 for females. The slower rate of improvement has led to a widening of the relative gap in life expectancy between England and the spearhead group.”—[ Official Report, 25 October 2006; Vol. 450, c. 1962W.]
That strikes me as very disappointing. Given the extra money put into the spearhead PCTs, I would be interested to know whether it reached through to public health budgets. If so, the money is clearly not yet being spent in the most effective way. When the Minister sums up, I hope that we will hear what is being done about that problem. Some of the spearhead PCTs are back on track, but more than 30 are currently off track to meet their share of the 2010 target.
It is useful to take a cradle to the grave approach. I hope that the Government will accept that good health starts in the womb and that good antenatal care is vital. Although antenatal care is a key factor in the spearhead PCT programmes, the Minister will know from a previous debate that in some areas, mine included, antenatal education has been axed as a result of deficits. The explanation put forward is that mothers have a one-to-one with their midwife to discuss birth options, but surely the Minister would accept that one of the wider benefits of antenatal classes is ensuring that women receive good targeted public health messages. Some of them are about diet and exercise, which can help to get children off to a good start. If the Minister would commit to investigating the demise of antenatal classes, many people would be thankful.
It is at birth that inequalities begin. Recent figures show that a baby boy born in Kensington and Chelsea can expect to reach, on average, the ripe old age of 82.2. In Glasgow, however, the age falls to 69.9. That is a devolved matter, so to stick to the English exampleof Manchester—closer to home for some Health Ministers—the age is 72.5. Women are a little luckier as the comparable ages are 86.2—an extra four years over the men—in Kensington and Chelsea, 76 in Glasgow and 78 in Manchester.
After the birth of their child, mothers have to make a choice about feeding and it is widely acknowledged that breast feeding is best. Again, it is strongly associated with social class. Figures comparing breast feeding rates between 2000 and 2005 show that the overall rate has fallen—and mostly in the lower social
classes. I welcome the new scheme for food— [Interruption.] Yes, healthy start is right, and I welcome the healthy start scheme, but surely alongside it there should be some targeted information about healthy breast feeding.
Sandra Gidley: The hon. Member for Cleethorpes (Shona McIsaac) intervenes from a sedentary position, but the information that the Minister sent me shows no evidence that there is such information. I look forward to seeing it, as providing it is an opportunity worth taking.
Another problem for the Minister to deal with is the World Health Organisation code on milk formula. We all know that advertising of formula is banned, but there are few restrictions on follow-on formulae. Some baby milk manufacturers use misleading adverts, making it difficult to see that they are actually advertising follow-on formula milk. I suggest that some of the messages coming through to women from parenting magazines, which are read by many, are counter-productive.
Steve Webb: Although I welcome my hon. Friend’s comments about encouragement for breastfeeding through the healthy start programme, is she aware that it includes vouchers for powdered milk? Does not that send mixed messages in the context of encouraging breastfeeding?
Sandra Gidley: It sends a mixed message, but it is better than the welfare food scheme that preceded it. Under that, I believe that one could not spend the vouchers on anything but milk.
Caroline Flint: In answer to the point that the hon. Member for Northavon (Steve Webb) made, we had to strike a balance with an individual’s right to make decisions—and, clearly, breastfeeding is not possible for some women for several reasons. However, we are phasing out the further discounted infant formula that used to be available in our baby clinics so that we can focus more on promoting breastfeeding.
Sandra Gidley: Sure Start has been mentioned. It is easy to “knock, knock, knock” in such a debate—and plenty of material exists for that, as my Conservative colleagues demonstrated—but we must pay tribute to schemes that have worked well.
The Parliamentary Under-Secretary of State for Health (Mr. Ivan Lewis): There is a “but” coming.
Sandra Gidley: No, there is no “but”.
I pay tribute to the Sure Start scheme. My only criticism, which is mirrored throughout the country, is that a ward in my constituency has a deprived area, but because it is a large ward that also encompasses an affluent area, interventions in the deprived area were obtained only through a little jiggery pokery. However, we got there.
The Government’s commitment on school nurses is interesting and I welcome it. It appears to be an about-turn. School nurses, especially those based in secondary schools, are well placed to provide much information, but figures for them were not collected until recently. Answers to a parliamentary question in May showed that, of the 309 PCTs that existed then, 103 did not employ a single qualified school nurse. I appreciate that the target is not meant to be reached until 2010, but clearly much work remains to be done, and it would be interesting to learn how it will be made a priority.
Although the Minister was positive about the meningitis vaccine, childhood vaccination rates have fallen. That is probably partly due to the adverse publicity surrounding measles, mumps and rubella, but I hope that we shall learn in the wind up how the issue will be tackled.
Other inequalities that have not been mentioned include those in dentistry. The British Association for the Study of Community Dentistry surveyed 5-year-olds in 2003-04. There was a sevenfold difference between PCTs with the best dental health and those with the worst. People in social classes 3, 4 and 5 are three times more likely to lose their teeth than those in classes 1 and 2. Given that in many parts of the country it is difficult for children to gain access to a national health service dentist unless their parents go private—some PCTs have recently put a stop to that—what are the Government doing to improve dental health and the public health messages about oral health in young children? Many parents simply cannot access an NHS dentist, although I appreciate that provision is patchy geographically.
Let us consider the growing problem of obesity—perhaps I should not have put it in that way. The figures are stark. The British Medical Association estimates that there already 1 million obese children under 16. If the trends continue, one fifth of boys and one third of girls will be obese by 2020. I welcome the moves to restrict food advertising, but that does not give the complete picture because societal influences are far more complex than that. The “McDonald’s mothers” have been mentioned, and it is not helpful when politicians, whatever their party, claim that there is nothing wrong with feeding pies through the school gates.
There is clearly a big educational task. Perhaps there is a way to use Sure Start or ante-natal classes to ensure that mothers are better equipped to feed their families healthily. In schools, they often do not receive the necessary education on providing a healthy diet.
Ms Diana R. Johnson: Does the hon. Lady deplore the proposal by her Lib Dem colleagues in Hull to remove the free healthy school meals in all our primary and special schools? Those meals give our youngsters a very healthy start.
Sandra Gidley: I cannot really answer for my colleagues in Hull— [ Interruption.] I do not know the full story. It might have been prompted by a funding problem from central Government— [ Interruption.] What would hon. Members expect me to say? It would be unfair to comment on that situation when I do not have the full facts.
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