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What have the Government done on smoking since 1997? We have now got a ban on advertising and promotion in the UK, and it has been argued for abroad as well. What happened in 1993-94 when there was a Conservative Government and I introduced a private Member’s Bill to ban tobacco advertising and promotion from the Opposition Benches? It was talked out by the Conservatives and not supported by Ministers. Two years later, what happened to warnings on cigarette packets about ill health when the then
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Member for Worsley, Terry Lewis, introduced a private Member’s Bill on that? It was talked out and not supported by Conservative Members who then sat on the Government Benches.

I could go on about tobacco, but let me ask this: what other Government have matched what this Government have done on tobacco? They have brought smoking cessation targets into communities that suffer ill health because of smoking. That link has been known for decades, yet it has been denied in this House when Members have wanted to introduce legislation to put things right.

The banning of smoking in public places is also good, although I should say that when the Bill was first published last year my view was that it could have been a bit better—and, indeed, it was a bit better after it had passed through this House and the House of Lords and this House had a vote on it. As a consequence, we are going to bring in the biggest and most comprehensive smoking ban in public places. It is bigger than any of those that have been introduced in the seven states of the United States and than those in Ireland and Scotland, and Wales and Northern Ireland might come in before 1 July next year. It will be probably the biggest public health promotion that any Government have taken on. In campaigning against the smoking industry because of the ill health and deaths that it has caused over the years, I have received very little support from the Conservatives.

Mr. Stewart Jackson (Peterborough) (Con) rose—

Mr. Barron: However, I am always happy to get converts.

Mr. Jackson: The right hon. Gentleman is making a passionate case for the significant increase in NHS expenditure, but is he happy with the current situation? For example, patients with conditions such as age-related macular degeneration are subject to a postcode lottery. After nearly 10 years of a Labour Government, such patients are literally going blind in one eye before they are even prescribed the drugs that they need to treat their condition. Is the right hon. Gentleman content with that?

Mr. Barron: I have met representatives of the Royal National Institute of the Blind and of one of the drug companies that is introducing a drug for AMD. Such drugs have yet to be licensed and when they are, they will go before the National Institute for Health and Clinical Excellence before they are prescribed—if that is what NICE decides. However, we need to bear in mind certain issues, which I discussed with a health Minister in some detail. I am concerned not about the situation now, but about what might happen when such drugs are licensed. For example, our constituents will be pressing to receive such treatment, but perhaps NICE will take that into account. If the hon. Gentleman is interested in this issue and wants to chat to me about it, I would be more than happy to do so.

In the Government’s amendment to the motion, which I support, they talk about some of the steps that we have taken, such as providing 2 million four-to-six year-olds with fresh fruit at school. I saw for myself last
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week the trays of apples that a school in my constituency provides for its children. That contrasts greatly with a previous Government, who not that long ago withdrew the provision of milk in primary schools in my constituency. It is true that this Government could do better and could provide more; nevertheless, that contrast is the truth of the matter. As my hon. Friend the Minister said, it was the freshly elected then Conservative Government who, in 1980, reduced the nutritional level of school meals, and I still do not for the life of me understand why. Although this was not true of my family, for many of the families that lived on the estate that I lived on as a child, sadly, the school meal was probably the only hot meal that their children got. That any Government anywhere could reduce the nutritional levels of school meals is farcical.

On the new healthier standards for school meals, the Opposition have really come into their own. During an earlier intervention, I referred to an incident in September in a neighbouring Rotherham constituency that did not really put Rotherham in a good light. We had the spectacle of two parents pushing a supermarket trolley loaded with burgers, chips and the like through a graveyard and then passing them through the school railings to children who did not like the new school meals introduced by Rotherham metropolitan borough council. The council has been recognised nationally for its healthy school meals initiative, and the vast majority of the schools in my constituency have met all the standards that have been set; in fact, some were meeting them years before they were introduced. I have been interested in this issue for many years, and when I have visited schools during my time as an MP, I have always talked to them about it.

However, during the week of the Conservative party conference, the Opposition Front-Bench higher education spokesman, the hon. Member for Henley (Mr. Johnson), said:

This is someone who is supposed to aspire to government—who, as an Opposition Front-Bench education spokesman, is responsible for education matters. I realise that his brief is higher education, which is a slightly different matter; however, how irresponsible can someone in his position get?

That was a dark time for Rotherham. Anyone who listens to the debate in Rotherham and who reads the letters in the local weekly paper that I am quoting from will realise what the reaction was. There was a heavy reaction against what those parents were doing. However, the result may be that we are having a better debate about food and health.

Some people think that the hon. Gentleman is something of a hero. One person said:

She capped off her comments by saying:

She went on to say, “I’ve got a bit of weight myself”, or words to that effect.

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If that is seriously the level of response from Opposition Front-Bench Members to the incidents in Rotherham— [ Interruption. ]

Madam Deputy Speaker: Order. May we please have the debate conducted in the usual way?

Mr. Barron: The level of Opposition Front-Bench Members’ response to the incidents in Rotherham following the introduction of healthier school meals in September shows that they have a long way to go before they will believe even half of the motion they tabled today.

Last Friday, I visited the Whiston and Worrygoose junior and infant school in my constituency, because it had just received its second basic skills award for literacy and numeracy. I always make an effort to go to primary schools when such awards are made because, in constituencies such as mine, decades of under-attainment in literacy and numeracy have led to many problems, including ill-health, as has been well recorded by public health professionals.

The school meals are cooked on site, and I held an impromptu discussion with some year 6 children about the new menu, which I had already had a look at during my visit. The level of their debate was far higher than the hon. Gentleman’s comments about what happened at Rawmarsh school. As I said earlier, Opposition Front-Bench Members have a long way to go before they start tabling motions about public health, and especially about obesity.

In general, public health issues are far more challenging than for the past 150 years. In the past, it was simpler to deal with things that had an impact on public health, such as sanitation, the lack of fresh water, bad housing and dirty air, before the clean air legislation of the 1950s. All those things had a bad effect on public health but they were reasonably easy to tackle—be it by central Government or, in most cases, by local government. Of course, that is not to say that there is no bad housing or that housing could not be better, but its public health effects are not as great as they were in years gone by.

The issues that will lead to public health problems in the 21st century are affected by the individual decisions we take each day, in terms of our lifestyles and of what we eat and drink. The Government have to tackle those things. In part, that can be done by education. Educational campaigns are a cheap and effective way of raising awareness of health problems, but evidence suggests that awareness does not always translate into changed behaviour. Adolescents do not necessarily smoke or drink less as a result of health education programmes. I have campaigned against smoking for many years and I have always felt that we will never completely stop young children trying cigarettes. There will be some success but it will never be total while cigarettes exist. The important thing is to continue those education programmes.

Another area where there can be success, and has been success in the past, is taxation. One thing to the credit of the Opposition is that, when they were in office, the then Chancellor of the Exchequer, the right hon. and learned Member for Rushcliffe (Mr. Clarke), put a health tax—an above-inflation tax—on cigarettes. The figures show that that reduced
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consumption. When the Conservatives went into opposition, he got a job as vice-president of British American Tobacco. I do not know whether that was cause and effect, but the people there were not very happy with him at the time. Taxes on alcohol also reduce consumption. That does not mean to say that people will stop drinking or smoking, but there is an effect.

One thing that we could do, and that has been effective in the past, is to bring in restrictive measures, such as the banning of tobacco advertising. Some of the big public safety areas—outside this area—include things such as seat belts in cars. I remember them being put in when I was first driving, when it was not compulsory to wear them. It was only when legislation was passed that take-up levels of people wearing seat belts became as high as they are today. The same could be said in relation to drinking and driving. When measurement was brought in and we said, “This is an offence. You will lose your licence,” things quickly got a lot better.

I want to finish with two points about where we should go in the future. As I said, I do not think that all these things are a matter for the state. I certainly do not think that they are necessarily a matter for the national health service. There is a lot evidence that other organisations—I think that the Government call them non-governmental organisations or the third sector—can have great influence in relation to what is happening in our health care system or, perhaps I should say, individual needs.

A note was passed around earlier about weight loss programmes in South Cambridgeshire. I have with me the outcome of research that was done on a slimming referral service in Derbyshire. The report is from the journal of the Royal Institute of Public Health. It was a collaboration between the Southern Derbyshire health authority as it was then, and Slimming World, which is a high street company that helps people to lose weight. I know that Weight Watchers does that too, so I am not advertising one against the other. The referrals are beginning to work. There is no question about that, looking at the report that I have here. It provides evidence that, sometimes, these types of referral schemes are better than going to see a dietician locally and being told to go away and lose weight, and getting advice such as, “Don’t eat this. Don’t eat that.” Instead, people sit in the village hall with somebody who has been through the process, who usually leads the class, and can tell people about how easy it has been.

One of the things that struck me about this scheme is that, of the 107 patients who were originally referred, 97 enrolled, 62 completed the free 12-week course and 47 went on to self-fund the next 12-week course and did it themselves, and stayed with that weight-referral programme. There are experts out there—not necessarily working for the national health service, but working close by—who can help in many ways with individuals who have weight-loss issues, which, if not tackled, will certainly lead to disease and, potentially, an early death in years to come.

GlaxoSmithKline nutritional health care had a study done about how to get families involves in physical exercise, as well. We had a debate about rugby or football at school. Well, all that stops at 16 anyway, but
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what about the vast majority of kids, who are not much good at rugby or football at school? We always think that exercise is about people who are involved in one sport or another, but exercise could be going to school or work on a bicycle. It could be many things. We need to learn where there is evidence—not just in the national health service; in wider organisations—and make sure that that evidence base is the real area where we start decision making. The national health service should have been taking evidence-based decisions for the past 60 years, but, sadly, its track record on that has not been good. It is about time that we got better, especially in areas in which individual lifestyles will have an impact on public health in the years to come.

5.30 pm

Mr. Stephen Dorrell (Charnwood) (Con): I intend to be reasonably brief. I congratulate my Front-Bench colleagues on focusing the House’s attention on public health as the core of this country’s health policy. When we discuss the national health service and health policy, we focus too often on the machinery of health delivery, rather than the objective of delivering public health standards. The House of Commons is today holding the Government to account on the delivery of health outcomes using the national health service and all other instruments of public policy at their disposal, which is what they should be accountable for.

As my hon. Friend the Member for South Cambridgeshire (Mr. Lansley) said, the fact of the matter is that there have been disappointing trends in a wide range of health outcome measures, such as alcohol and drug-related disease, the incidence of tuberculosis and sexual health. Those three measures have already been mentioned, but one could continue to list other measures of health outcome on which the value that the taxpayer—and the patient, more importantly—has received from the money spent on the national health service has been disappointing throughout the past decade.

The hon. Member for Sherwood (Paddy Tipping), who is no longer in the Chamber, latched on to part of the speech made by my hon. Friend the Member for South Cambridgeshire and said, “Oh, now what you’re interested in is targets.” However, targets for health outcomes are precisely what the Government should be setting, before holding themselves to account on the delivery of those targets. We were the first Government in office to do precisely that. The White Paper “The Health of the Nation”, which, I think, was published in 1991, set health outcome measures that defined the objectives for the delivery of health policy. The disappointing aspect of the past few years is that we have not used taxpayer pounds effectively enough to deliver those health outcome objectives.

My hon. Friend could have gone on to talk about not only average health outcomes, but differential outcomes in various parts of the country and health inequalities. It is often said—it has been said again today—that the Conservative party has somehow denied the existence of health inequalities or the link between social class and health inequality, but that is simply not true. It is one of those oft-repeated assertions that does not reflect reality. Of course it is
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true that social background and a wide range of other issues influence health outcomes and form someof the background to health inequalities. One of the criticisms of the Government is that their management of the health service has been insufficiently focused on using taxpayer pounds to address precisely the reasons why the national health service was established: to narrow health inequalities and to even up the experience of health treatment in different parts of the country.

It is not difficult to find out why the Government’s record on delivering those objectives has been disappointing. Indeed, one does not need to look further than the July 2006 report of the chief medical officer to read many of the causes of that disappointing record. The situation is easily summarised. A vicious circle has been allowed to generate over the past decade, and weak public health discipline in health service management has led to weak commissioning. Indeed, for part of the Government’s period in office, they were not even interested in the principle of commissioning. I am pleased that they now recognise the importance of commissioning in the management of the health service, but they are disabled from delivering strong, effective, evidence-based commissioning because of their long period of disinterest in both commissioning and the development of the public health discipline as the key evidence base for strong commissioning. Weak commissioning has led to misdirected spending in the NHS, which has led to poor outcomes when measured against health outcome objectives.

That has resulted in what taxpayers overwhelmingly now recognise in the record of the present Government. A huge sum of money has been spent on health care in our country—a sum of money that, I am pleased to say, the Conservative party strongly supports. Government Members like to assert not only that the Conservatives are blind to health inequalities, but that we oppose the Government’s health spending programmes. Neither assertion is true. What we oppose is unloading such a sum of money on the health service at the same time as weakening its management and thereby undermining its capacity to deliver good value for money.

Over the past decade, the national health service has failed to target resources on the real health priorities, partly because, in his time as Secretary of State for Health, the right hon. Member for Holborn andSt. Pancras (Frank Dobson) set out to abolish and destroy the structures that allow NHS management to target resources at genuine health need. Now, those structures have been reintroduced and the Government are struggling to make up the ground that they lost in their early period in office.

The House does not have to take my word for that, or the word of my hon. Friend the Member for South Cambridgeshire. As I have already said, the position is set out clearly in the report of the chief medical officer, published in July. He says:

and he makes it clear that that reorganisation has weakened the capacity of public health managers to direct resources at need. He continues:

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It is a classic case of the urgent squeezing out the important.

More positively, the chief medical officer recommends a series of actions. There is no point in well paid and, more importantly, authoritative public servants issuing statements recommending action to Ministers, who should heed those recommendations, if Ministers let the reports simply gather dust on the shelf.

Mr. Barron: Did the right hon. Gentleman take all the action that the CMO recommended he should take when he was Secretary of State for Health?

Mr. Dorrell: I doubt that I did everything that the chief medical officer recommended that I should do, but I would never have objected to anyone pointing out to me what the CMO had recommended and asking me why we were not doing it. My challenge to Ministers takes the form of the three recommendations in relation to the public health discipline that the CMO made, publicly, in July.

The first recommendation is:

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