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Much has been said about sport, and I want to take issue with what the hon. Member for South Cambridgeshire (Mr. Lansley) said about the need for a lot more competitive sport. Those children who are a towards the end of the queue when the teams are being picked soon get the message and decide that they do not want to exercise because they do not want to make fools of themselves. That is not a positive experience. I have a pet hate about school sports days. Children who have little sporting ability in the traditional sense are often forced to enter races and be publicly humiliated.
If a child cannot read, they are not put on a stage and made to stumble through the alphabet or a passage of Shakespeare, yet little thought is given to the children who do not excel at sport. Too little thought is given to other ways in which children can take exercise healthily and find a method of exercise that is suitable for them. That could involve dance, games and all sorts of other things. I would ask that we try to get away from competitive sport in schools and think about increasing exercise and activity. This is happening more and more, but I worry when I hear people saying, Lets get back to good old hockey and football and other competitive sports.
John Mann: Is the hon. Lady aware that one of the great successes in school sports under this Government is that the biggest increase in participatory sport in primary schools has been in the use of non-competitive climbing walls? Schoolchildren of all shapes and sizes are using them in increasingly large numbers in our primary schools.
Sandra Gidley: I am pleased to hear that, because that is the kind of diversity that we should be encouraging. Children often want to try something new and different, and they could be hooked into exercise in that way. The traditional patterns work against that. Many adults feel that exercise is not for them because they were made to play team sports at school, rather than being encouraged to find a form of exercise that suited them
Mr. Bone: I remember watching my youngest son run around a running track and come last in his race, but that did not stop him. It encouraged him to go further, and he is now a pilot in the RAF. The hon. Lady is talking complete bunk.
It would be useful if we could look at ways of increasing the facilities for families to engage in sport together. It is often a positive experience for families to exercise together. Recently, I went to a Skip to be fit session at one of my local schools. Everyone has done skipping at school, but this involved digital skipping ropes, and the children were quite excited. The emphasis was on learning to skip on a six-week programme with a personal improvement assessment at the end of it. The children were not measured by their peers, but by themselves. Such personal improvement initiatives are much more positive and inspiring for children than those in which their performance is compared with that of others.
I was intrigued by the fact that the Government have spent £27,000quite a lot of moneyon pedometers. I have several pedometers, all of which seem to register different things. Most people wear them for two or three days and then chuck them into a drawer. What evidence base prompted that purchase? What analysis has been made of the cost-effectiveness of pedometers? We frequently talk about evidence bases: a new medicine cannot be licensed without a convincing evidence base. However, it seems that many well-meant public health interventions do not have an evidence base. With the varying inequalities in different parts of society, a little evidence about what works in different socio-economic or ethnic groups or on a gender-specific basis would be useful.
Dr. Murrison: Does the hon. Lady agree that although £27,000 is a lot of money, it is probably better spent than £20,000 on a piece of soft propaganda in the Health Service Journal? In the context of public health, does she agree that it is important to ensure that public money is spent in a reasonable and worthwhile way?
Sandra Gidley: It strikes me slightly that the Health Service Journal is preaching to the converted. An evidence base is needed to decide whether that is a more effective use of money than pedometers. I do not have the answer to that question.
I now want to move on to sex education. We have heard statistics bandied about on the subject today. A few years ago, the Select Committee on Health undertook an extensive inquiry on sexual health, and one of its recommendations, which is also one of my partys recommendations, is that sex education should start at primary school. Children at that age do not need to know everything, but it is important that they start to talk about relationships, which are an integral part of sex education. What conversations has the Minister had with her ministerial colleagues about that?
Teenagers to whom we have spoken say that teachers are often embarrassed about discussing sex. Logically, geography teachers are interested in geography, so that is what they teach, but schools do not have specialist sex education teachersunfortunately, geography
teachers attempts to teach sexual health were often slated. Will the Minister consider having properly trained, expert teachers, who are not embarrassed by the subject, delivering that part of the curriculum? The input of parents, who are keen to know what their children are learning at school, might also be useful.
Since 1996, gonorrhoea rates have increased by50 per cent.by nearly 61 per cent. in mensyphilis rates have increased by more than 2,000 per cent., and chlamydia rates by 197 per cent. Disappointingly, despite the chlamydia screening programme, even the last year-on-year increase was 4 per cent. Although the screening programme is welcome, its roll-out around the country seems to have taken quite a long time. Why does that programme screen 14 times as many men as women [Interruption.] Some of the early statistics show that it did. The disease is carried in equal numbers and most women are infected by a man. What has been done to address that inequality and to improve access to screening?
The latest sexual health awareness campaign is aimed at 16 to 24-year-olds. In an earlier contribution one hon. GentlemanI shall not embarrass him by mentioning him by nameclaimed that the campaign was effective because his children of that age watched the relevant programmes, but it neglects the older age group, among whom there has also been a significant increase in sexually transmitted diseases. I have in mind the generation who have had a long-term relationship, have split up, are back on the circuit, although I hate to call it that, and are sexually active againpresumably they were sexually active during marriage, so perhaps I should say that they are introducing themselves to new partners the second time around. They may not have appreciated the messages the first time, may have forgotten them or may have thought that they applied only to the young. What is being done to address that group?
The point was made that sexual health clinics for young people have been cut because the earmarked funding has not reached the front line. The 48-hour target for accessing sexual health services has not been met. The Health Protection Agency said in August that it was being met in 57 per cent. of cases, but we used an intern to do a mystery shopper exercise over the summer months and the figure for access was 31 per cent. Clearly, there is some way to go before that target is met. What is being done to achieve that?
Vaccinations have been mentioned, and a promising new vaccine will reduce the rate of cervical cancer. A decision on it is likely to be made in February. What discussions has the Minister had on vaccinating young women in particular? Can she say at this stage when a targeted vaccination programme for cervical cancer is likely to be rolled out for young people, and what age group it will cover?
I mentioned the sexual health inquiry by the Health Committee. The young people that it talked to referred to strong links between their behaviour and other factors and various pressures. There was peer pressure and media pressure, but one of the biggest
determinants of whether people had unplanned sex was probably the use of alcohol, which is the most commonly abused drug. Children are drinking at an earlier age. Government figures show that the cost of alcohol-related harm is approximately £20 billion a year. The national alcohol harm reduction strategy was launched a year ago in a blaze of publicity, but some of those key commitments have not been met. The audit of treatment services has not been finalised and no targets have been published. Only one in 18 people who need treatment get it. That masks a huge regional variation because in the north-east only one in 102 people who need alcohol treatment services can access them.
Alcohol Concern has called for the Treasury to have a public service agreement with the Department of Health and the Home Office. It also wants targets because it feels that things will not be taken seriously unless they are set in the same way as they are for drugs.
Mr. David Drew (Stroud) (Lab/Co-op): Gloucestershire has an alcohol arrest schemeI shall not call it by its acronym. It works in the same way as a drug treatment and testing order, and is very successful. For some time we have been asking for that scheme to be national. Does the hon. Lady agree that it is just the sort of scheme that should be taken forward so that we can try to deal with the issue when people are most acutely aware of the problem that they cause, which is when they are in the cells? If they take advantage of the help offered by the scheme, they realise that it has a high evidence-based result in dealing with alcohol problems.
Sandra Gidley: That sounds good to me, but I think that the hon. Gentleman should address his remarks to the Minister, who has the power to do something. I wish him luck, if the project really is evidence-based.
The problem with planning alcohol services is that there is no idea of which people need treatment, what treatment they need and where they are clustered. Unless that is monitored as it is for the purpose of drugs services, it will be impossible to develop alcohol services in the same way. Information on progress would be most welcome.
The British Medical Association is concerned about the threat to public health specialists from recent reconfigurations. It is feared that, because of deficit recovery plans, primary care trusts will seek to reduce rather than increase the number of consultant public health posts. It is probably too early to predict the number of displaced public health cliniciansthe information is unlikely to be available for a few monthsbut may we be reassured today that the specialists work force will not be reduced?
What is the way forward? We need a greater evidence base. Statistics are finally being collected, which will help us to target interventions, but there is still far too little evidence about what really works. Links with education need to be strengthened so that children can build on personal, social and health education at school, and are educated for life. We also need a wider and more flexible use of the work force. There are a good many people with access to the public, such as nurses, health visitors and midwives. Pharmacists were mentioned earlier. I probably speak with a small
amount of self-interest, but in pharmacy staff we have in-built health trainers who do not need to be trained themselves. Some are already being used, but the opportunity is not yet being maximised.
Another problem is that when services are commissioned, the commissioners often do not think about the wider public health benefits. Evidence relating to the new contract shows that what is being commissioned is pretty much what was in place before, and that the opportunity to pay for more services has not been grasped.
We should be clever in our use of the media. The Minister spoke of links with local government, but they could be stronger. In many instances the quality of housing is still far too low, and housing is one of the main determinants of future health. Transport is important, too. It has been demonstrated numerous times that when cycle lanes are introduced children cycle to schools, but there is not much of a Government imperative to make that happen.
Mr. Kevin Barron (Rother Valley) (Lab): I am sorry that I had to be absent for some of the speech of the hon. Member for Romsey (Sandra Gidley), and also some of the speech of my hon. Friend the Minister. I was asked several weeks ago, as Chairman of the Health Committee, to speak at a reception on the Terrace given by the all-party thrombosis group.
the gap between the public health of the UK and that of comparable health economies
is too wide. Anyone who studied the past 20 or 30 years of public health investment would probably begin to understand why that is so. When in government, the Opposition paid scant regard to the issues that created our present health inequalities and bad health care indexes. They rejectedpresumably for ideological reasonsthe notion of a direct link between social class and health, placing responsibility entirely on the individual with no reference to housing, environment, occupation or income. I have been in the House for some yearsfor two decades, in factand remember many debates on public health.
Mr. Paul Truswell (Pudsey) (Lab): Does my right hon. Friend remember the Black report on inequalities in health, which is generally regarded as a seminal work on the connection between inequality and ill health? It was smuggled out in photocopied form over a bank holiday weekend by the previous Government.
The Conservative Government just did not believe what the Black report saidor many other reports by individuals and organisations that had for years been
saying why we suffered health inequalities in this country and why public health in some communities was not what it should be.
Dr. Murrison: In similar vein, does the right hon. Gentleman remember the Acheson report that dealt with the same social model of disease, and does he remember the treatment that Labour Ministers gave to that report?
Dr. Murrison: I am surprised that the right hon. Gentleman, who is Chairman of the Health Committee, does not know about this, but for his information it was published in 1998, and it was one of the first reports that the Labour party commissioned on coming into office.
Let me move on. There has been a conversion in recent weeks and monthsit has happened over the past 12 months since the right hon. Member for Witney (Mr. Cameron) took over the leadership of the Conservativesand it seems remarkable to people who have been involved in the health debate over many years. I am not sure what lessons have been learned.
The last time I spoke in an Opposition day debate, I discussed issues referred to in the national health service campaign pack that was put out by the Conservative party. It accused the Chancellor of the Exchequer of causing all the problems in the national health servicepresumably by almost trebling the budget in the comparatively short time that we have been in office. In that campaign pack, it is also stated that the current NHS funding formula is unfair:
Labour have specifically added an element to the allocation formula which aims to tackle health inequalities.
If the Conservatives do not recognise why the funding formula has to be weighted in some areas in thatway, they do not have, and never have had, any understanding of the causes of ill health in this country. Sadly, communities such as those that I represent have had health inequalities compared with other parts of the country for probably all of the past 60 years when the national health service has been in place and in years before. That has never been tackled, but the Government are now tackling it.
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