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Research suggests a strong link between social and economic disadvantage and early initiation into sexual activity. That wealth distinction is also evident in the number of teenage pregnancies and teenage mothers. Teenage girls from poorer backgrounds are four times more likely to give birth than those from affluent backgrounds. We have the highest rate of teenage pregnancy in Europe and one of the highest abortion rates. What kind of testament is that to a society, and what are the Government doing about the issue? I am sure that all hon. Members have heard of the
morning-after pill, which works before the ovum attaches itself to the wall of the uterus. It works better the earlier it is taken. If someone wants to get hold of it, they can ring their GP. The highest users of the morning-after pill belong to the ABC1 group. They may ring up their GP practice to make an appointment, only to be told that one is not available for five days. However, they will insist that they see a doctor or, alternatively, they can go to the pharmacist and pay £25 for the morning-after pill, because they can afford to pay it. [ Interruption. ] Hon. Members may wish to know that the morning-after pill is free from a GP practice, but it costs £25 at the pharmacy.
Sandra Gidley: Is the hon. Lady not aware thatin many areas, under a patient group directionthe EHC—emergency hormonal contraception—is available free of charge at pharmacies that adhere to certain protocols?
Mrs. Dorries: In fact, it is not available in many areas. It should be available in all areas, so that other groups can gain access to it. It is another case of the postcode lottery. In certain parts of the country, women have to pay £26 for the morning-after pill atthe pharmacy, which is open all hours, including Saturdays—anyone can walk into one—but that is not the case in other parts of the country. It is free in only a small number of areas, but to reduce the number of abortions in the UK—there are 600 a day—we should make it free at all pharmacists. After all, it is provided free by GPs.
Ms Diana R. Johnson: Does the hon. Lady agree that women should have the right to request abortion in the first 12 weeks of pregnancy without needing to secure a doctor’s approval?
Mrs. Dorries: I do not have any thoughts one way or the other on abortion in the first 12 weeks, but I believe that the limit for abortions should be reduced from24 weeks to 21 weeks, as I have argued previously in the House.
The Minister should keep her eye on the ball, and spend some of that £50 million on sexual health campaigns, as poor sexual health has blighted the lives of many teenagers. I urge her to make the morning-after pill free on demand at pharmacists, particularly in areas with the highest numbers of teenage pregnancies. I urge her to look at research that shows that women who have abortions suffer mental health problems later in life as a consequence, and to provide public health information to parents. She is throwing money at British pregnancy advisory service clinics, but will she look at more effective ways of reducing the number of abortions, instead of continuing to fund a growing industry with NHS money?
6.2 pm
Natascha Engel (North-East Derbyshire) (Lab):
I am grateful for the opportunity to follow the hon. Member for Mid-Bedfordshire (Mrs. Dorries), as I should like to pick up some of the issues that she raised. I thank the Opposition for again offering the House a chance to debate a hard-core Labour issue. Time and again, the Tories choose to debate the policies on which we are
strongest, pursuing hollow lines of attack without presenting clear policies or alternatives that we can debate. In their constant to-ing and fro-ing, defence appears to be the best form of attack. They have been at it for several hours without providing any proper debate, which is rather tiring. However, I thank them for raising the issue of public health in the House.
Public health, as I said, is one of Labour’s great success stories. As the Opposition said, for the first time we have a Minister with specific responsibilities for public health, who liaises closely—this is a key point—with officials in the Department as well as with welfare officials, with the Treasury on matters such as income equality, with education officials and, most importantly, with the social exclusion unit. Our strongest achievement in public health is the social exclusion agenda. We introduced the national minimum wage and tax credits, both of which have helped to tackle low income—a major factor in poor public health. We introduced welfare reforms—along with some Opposition Members who have participated in today’s debate, I served on the Committee that considered the Welfare Reform Bill—that command widespread consensus.
Public health is the key to delivering the welfare reform agenda. For example, encouraging people into work helps them to achieve better health. Today’s debate, however, has had a narrow focus. We have looked at teenage pregnancy—an important issue, I accept—but it would be nice to broaden the debate. Since we have been in government, we have delivered phenomenal achievements in education. We have never seen anything like Sure Start and children’s centres, which have revolutionised the way in which we deliver public health, enabling us to engage with young parents, including teenage mothers, in a radically different way. I have made any number of visits to Sure Start projects and children’s centres in deprived communities in my constituency. I have seen children eating fruits that I have never seen before, and they were enjoying the experience. Recently, I visited a children’s centre in the most deprived ward in my constituency. The vast majority of kids were from Traveller families, and a third of the children at the centre had special needs. Staff engaged not just with the children but with their parents, bringing them into contact with education, to which they have not had access before. That is public health, and we have delivered it.
Sexual health is an important issue, but it is difficult to discuss, both inside and outside the House. Parents, for example, are uneasy talking about sex education, sexually transmitted infections and contraception. We need to be more adult in our approach, and we must continue to raise the issue without embarrassment. The Labour proposal to employ nurses in schools is quite brilliant, as it would go a long way towards removing the embarrassment factor in sex education. I would argue, however, that the introduction of sex education at secondary-school level is too late. It should be offered in primary schools, and we should introduce legislation to that effect. It is fantastic that 80 per cent. of schools have taken part in the health schools campaign. It proves that if the will is there we can introduce change, so we should provide sex education in primary schools.
We need to tackle sexually transmitted infections more effectively. It is important to make contraception far more readily available, but the Department of Health has ring-fenced £300 million—that figure is separate from the £4 million for national campaigns on sexual health—for primary care trust budgets. Some PCTs—not my own, I hasten to add—have used that money to pay off deficits, which is wrong. We must make sure that others do not do so, but it is important to accept that that £300 million has been ring-fenced.
Mrs. Dorries: If that is the case, why did Lord Warner say that most of the money was still sitting in NHS coffers?
Natascha Engel: The Opposition cannot have it both ways. If they wish to argue that PCTs are spending that money on their deficits, it cannot be sitting in Department of Health coffers. That £300 million is targeted at sexual health services, which the Government have listed as one of their top six priorities, so it will make a fantastic contribution.
Mrs. Dorries: Lord Warner said:
“My Lords, it is stored carefully in the coffers of the NHS. As the noble Earl is aware, the NHS is a very cost-conscious organisation, which tries to ensure that it uses its money wisely...we have to evaluate each of these campaigns to see how effective they are and then consider the next steps.”—[ Official Report, House of Lords, 21 November 2006; Vol. 687, c. 231.]
Steps to allocate the money, however, have not been taken.
Natascha Engel: I shall not even bother to answer that.
I would like to pick up one of the points that the hon. Member for Mid-Bedfordshire made earlier about sexual health services being taken out of acute units into general practice surgeries. That is a key element of what we are trying to do—to localise, to make more familiar and to make it easier for young men and women to access those services. I do not know how many gynaecological units the hon. Lady has visitedin her own constituency or elsewhere, but those environments are not as friendly as general practices.
Anne Main (St. Albans) (Con): May I say that our genito-urinary medicine unit consultant, Dr. Pat Munday, resigned because she was short-staffed after posts were frozen? She operates a drop-in unit. She says that people do not always want to go to their GP, as they want the facility of sexual health units, so it is no good just saying that everything can be moved back into GP surgeries.
Natascha Engel: Obviously, diversity of choice is an issue and people should be able to go wherever they feel most comfortable. We also need to recognise that confidentiality is a big issue. These services shouldbe available at GP clinics, at polyclinics, which are absolutely key in this sphere, and at acute units. The real issue is that we need to ensure that those services are available and can be accessed, especially by young men and women, so that we tackle sexually transmitted infections. I end there.
Mr. Deputy Speaker (Sir Michael Lord): Order. It is anticipated that the winding-up speeches will start at about half-past six, and four hon. Members are seeking to catch my eye, so the arithmetic is self-explanatory. I hope that Members will bear that in mind as they make their contributions.
6.11 pm
Mr. Jeremy Hunt (South-West Surrey) (Con): First, it is a pleasure to follow the hon. Member for Dartford (Dr. Stoate) in this debate, as both he and I have put some of the issues that we have talked about into practice. We both entered a competition for MPs’ fitness with Men’s Fitness magazine. I pay tribute to the hon. Gentleman for winning the competition, but I warn him that I came top on the running machine, so I hope that he has the stamina to listen to what I have to say.
It is also a pleasure to follow the hon. Memberfor North-East Derbyshire (Natascha Engel) and I want to answer her central question. She asked whythe Opposition have brought about today’s debate. The reason is very simple: a central plank in the Government’s public health policy—addressing health inequalities—has been a failure.
There has been much discussion this afternoon about the distant past, but in the near past—the last nine years—life expectancy has still been seven to eight years lower in the poorest parts of the country and the inequality has widened by two years for men and five years for women. The crucial reason is not a lack of good intentions, but a lack of understanding that investment in public health—not in clinical services, however critical—is most important for successfully addressing health inequalities.
The chief medical officer’s annual report on public health spelled that out very clearly. He said that investment in public health was falling as a proportion of expenditure in the NHS, that the number of public health professionals was static and that public health budgets had been raided and used to fund deficits. We heard a raft of statistics showing why the Government’s policy is failing. Alcohol-related deaths are up; tuberculosis infections are up; syphilis up; chlamydia up; obesity rising; and smoking declining, but inequalities persist among smokers.
The failure to understand the difference between morbidity and mortality is critical because, in the end, the incidence of poor public health has to be matched with investment in public health and the incidence of disease has to be matched with investment in clinical services. The result of that misunderstanding is a grossly unfair funding formula.
I would like to tell the House about my own area of Guildford and Waverley. The hospital and community health services budget for 2007-08 is increased by 2 per cent. because there are many older people, but it is reduced by 25 per cent. because of a lack of deprivation. What is the impact? Last year, my constituents had to wait twice as long as people in Manchester for ear, nose and throat elective surgery. They had to wait nearly twice as long for breast surgery compared with people in the Health Secretary’s Leicester constituency; and three times as long for trauma and orthopaedic work as people living in the Prime Minister’s Sedgefield constituency.
This year, as a result of problems in the funding formula, my constituents face the closure of Milford hospital, a community rehabilitation hospital, and of the Royal Surrey County hospital—one of the top accident and emergency hospitals in the country, which happens to have the joint lowest mortality rate, as well as being a foremost cancer specialist centre.
I want to brief, so I shall make just one final point. Another vital factor for public health is stability in budgets, but in my area of Guildford and Waverley, there was a budget increase of £9 million last year, while this year it has been told to reduce spending by £16 million. There is a phrase for that—boom and bust. If we are to change people’s attitudes—we have talked about the importance of doing that this afternoon—it requires sustained investment over a period of time, not boom and bust.
Today, the Prime Minister is reported to be telling the NHS Confederation that service improvements in NHS hospitals are being implemented to ensure that the very sick have speedy access to specialist care, but also to treat people more conveniently closer to home.
Anne Main: On that very point of access to specialist care and specialist nurses, two out of four specialist breast cancer nursing posts have been frozen in my hospital owing to cuts and deficits, yet there has been a target that all those diagnosed with breast cancer should have access to specialist nursing—a targetmet only in 74 per cent. of cases in my area.By withdrawing funding and making cuts, the Government are penalising specialist nurses.
Mr. Hunt: From what my hon. Friend says, it is clear that my constituency is not the only area suffering from boom and bust.
I return to what the Prime Minister is saying. He talks about all these so-called improvements, but which part of the country is he talking about? In my part of the country, he is closing our local hospitals, closing our accident and emergency services and health inequalities are rising. Inequality in access to health care is rising and the Prime Minister has delivered a boom that has become a bust. People are saying that enough is enough.
6.17 pm
John Mann (Bassetlaw) (Lab): I have a few questions for the Minister. The healthy living project in my constituency has the ambitious vision of becoming a centre for sport and learning with a GP practice, community nurses and youth workers built into it. Will the Minister take a particular look into that idea, not least because the aim is to build health facilities on a school campus in order to create a new concept of an extended school?
Secondly, will the Minister look into the “Do it4 Real” project run by the Youth Hostel Association, which the Minister with responsibility for youth is currently considering refunding? It is important to see how children from disadvantaged communities are being engaged in a summer school for all kinds of backgrounds and communities—with healthy and active living as a theme. Will he reflect on the uniqueness of that external organisation and how it has helped to provide opportunities
for the development of basic cooking skills for today’s microwave generation? Could that particular programme be taken to another level—perhaps with slightly older children—and develop some key skills that children will require for healthy living as they get older?
Thirdly, will the Minister look into the possibility of conducting a longitudinal study, comparing three-to-18 schools with schools to which children change at age 11, to assess whether the engagement of young people is any different in the different types of school, particularly in respect of their involvement in healthy lifestyles? That involves both the food that children eat at school and their active participation.
My fourth question is aimed more at the Opposition and I am sure that Conservative Front Benchers will want to illuminate an issue that has remained unclear for some time. Will the hon. Member for Westbury(Dr. Murrison) clarify his party’s precise drugs policy on heroin injecting rooms, which have been supported on a number of occasions by his party leader? How precisely will they fit into a public health agenda, should the Conservative party ever be returned to power?
Conservative party policy at the previous election was to provide rehabilitation places for 18,000 under-18s. However, it has not yet explained its policy on the 200,000 adults who have an addictive drug problem. Where will they be treated?
The motion refers to “comparable health economies”. On drugs policy, it would be helpful to know which country, in the opinion of Opposition Members, mirrors Conservative party policies on drugs most closely.
6.20 pm
Mr. Peter Bone (Wellingborough) (Con): It is a great pleasure to follow the hon. Member for Bassetlaw (John Mann), who made his points succinctly.
The amendment claims that the Government are tackling inequalities. In their 10th year in power, they have failed miserably and completely to do that, especially in north Northamptonshire. It was right for Her Majesty’s Opposition to use the Opposition day to highlight the Government’s failure to reduce health inequalities.
Let me begin by setting out the founding principle of the national health service. It is that everyone should have access to similar health provision wherever they live in the country. [Interruption.] That was greeted with derision by Government Front Benchers. It is unfortunate that they do not believe in the founding principle of the NHS. That principle is that all people should be treated fairly. However, in my area it is not upheld. Under the Government, my constituents do not benefit from a national health service, but are instead victims of a postcode lottery health service.
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