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In my constituency, I run the Listening to Wellingborough and Rushden campaign. I formed it several years ago and its purpose is to listen to the views and opinions of local people and campaign on their behalf. One cannot campaign about peoples concerns without first finding out what they are. My listening campaign continually strives to ascertain local opinion through surveys, leaflets, meetings and events. One issue that consistently shows up in my
Listening to Wellingborough and Rushden survey as either the biggest or the second biggest concern is health care and the lack of local provision. I pay tribute to the excellent work of the doctors, nurses, support staff and medical professionals who work in my area. I am also grateful to the staff who run the two hospitals that my constituents useKettering hospital and Northampton general hospitaland those who run my local primary care trust. They daily struggle to provide top quality patient care while having to keep Government accountants satisfied. That is not an easy job and I thank them for their hard work in challenging times.
There is a major problem with health care provision in my area. I have raised it in this place previously and I will continue to do so until the Government do something about it. It is the historic underfunding of health care in north Northamptonshire. [Interruption.] Does the Minister want to intervene? No. The Leicestershire, Northamptonshire and Rutland strategic health authority is the worst funded SHAin the country, and within the SHA, north Northamptonshire is the worst funded area. How do my constituents stand a chance of having a fair and equitable share of decent health care when we are the worst funded area in the country relative to the capitation formula?
Mr. Philip Hollobone (Kettering) (Con): I congratulate my hon. Friend on making a powerful and pertinent point. Is not the position even worse than he describes because north Northamptonshire has some of the sharpest inequalities of any region in the country?
We are however the worst funded SHA relative to the national capitation formula which seeks to enable a fair, equitable distribution across the NHS...Indeed North Northamptonshire is our most pressurised health community. Northamptonshire Heartlands PCT which covers this population (including Corby with its severe health problems) is £32 million (9.9 per cent.) below capitation.
Those are not my words, but those of Sir Richard Tilt, former chairman of the SHA. Funding for the NHS in any area is based on the national capitation allocation formula. That determines what each PCT should get to ensure fair and equitable distribution of funding throughout the country. I have a problem not with the capitation formula, but with the Governments refusal to fund my area with its full capitation amount. Only last week, the Minister of State, Department of Health, the hon. Member for Leigh (Andy Burnham), confirmed:
By the end of 2005-06, the PCT was 4.4 per cent. belowits target allocation.[ Official Report, 28 November 2006;Vol. 453, c. 962.]
Laura Moffatt (Crawley) (Lab):
I am aware that I need to finish by 6.30 pm. I should like to refer to a couple of points that have not been mentionedthere
is little point in rehearsing the arguments that we have heard. I was losing the will to live after the Oppositions opening remarks about public health, given its genuine complexity and their approach to it. I am grateful that many more thoughtful speeches followed.
We are considering a complex subject, but it is rooted in poverty, ill health and poor housing. The Government are tackling it properly, as they should. I remember only one line in the speech of the hon. Member for South Cambridgeshire (Mr. Lansley) about health inequalities, but on many occasions Labour Members have identified that as the root cause of public health problems in our communities.
I listened with interest to the hon. Member for South-West Surrey (Mr. Hunt), who was naturally upset about the time that constituents waited for surgery. Of course, that time is much less than when the Conservatives were in power, but we are all missing a point if we do not do the work in our constituencies. However, one should not assume that South-West Surrey is the same as an inner-Manchester seat in the context of public health and waiting times. People in the former come forward much more easily and quickly for surgerythere are definite health inequalities in some of our inner-city areas that we need to tackle. Until we have a proper intellectual debate in this place, that will not happen.
I was upset to hear many Conservative Members comments about the fantastic work in our constituencies in the local strategic partnerships. They consider the way in which organisations such as local authorities and PCTs come together to tackle health inequalities in our constituencies. They deal with the fact that there may be huge inequalities in those constituencies and they have to micro-manage some aspects. That is why Sure Start has been so successful in getting into those areas.
We have heard much about the edifices of health care and how some Members are stuck on having to defend a specific hospital because any closure is perceived as a cut, when innovative thinking is about getting away from such perceptions [Interruption.] It is difficult. I understand why Conservative Members have to laugh because innovative thinking is the real agenda and they miss the point about, for example, breastfeeding services in our town centres and getting breastfeeding champions out there, and reducing childhood obesity by ensuring that women are able and supported to breastfeed, not in some hospital but in our communities. That work is being carried out in a positive manner.
The ludicrous to-ing and fro-ing about who hasnot achieved what misses the point about what is happening in many of our communities. The subject is complex, but we must understand the difficulties and why young people risk their sexual healththe madness on the streetsand do not think about protecting themselves. There are myriad reasons for that and todays challenges are different from those of many years ago.
The new public health challenges are different and need a great deal of thought. The Government are giving them that thought and using evidence to tackle many of the problems. They have stopped the silly
to-ing and fro-ing that we get from the Conservative party and are tackling what is happening in our communities.
Dr. Andrew Murrison (Westbury) (Con): We have had an entertaining debate this afternoon, although the quality has been mixed. We have heard a total of10 Back-Bench contributions, but before commenting on them I would like to quote Polly Toynbee in The Guardian newspaper on 12 November.
For the first time since polls began, the Tories are winning on the NHS.
Our policy is to create a national health service in order to ensure that everybody, irrespective of means, age, sex or occupation shall have equal opportunity to benefit from the best and most up-to-date medical and allied services available.
That gives the lie to the assertion by the right hon. Member for Rother Valley (Mr. Barron) that our party does not wish to address health inequalities. Winston Churchills statement was made in 1944, before the inception of the NHS, and it is clear that throughout the history of the national health service we have been committed to tackling health inequalities, and we will continue to do so.
Mr. Barron: I pointed out a number of issues relating to smoking and ill health and to the attitude of the previous Conservative Government in that regard. The hon. Gentleman was not here at that time, but does he think that those were the actions of a Government committed to getting rid of health inequalities?
Dr. Murrison: I cannot comment on that, but I can comment on the absolute catastrophe of the position taken by the Secretary of State for Health on smoking. We all remember the U-turns involved, and what that did for the debate.
My right hon. Friend the Member for Charnwood (Mr. Dorrell) restored us to a sense of reality withhis magisterial contribution. He clearly shares my sense of disappointment that health outcomes have not matched intermediate outcomes. The Government have done a great deal to address various aspects of public health, and they will have the figures to prove it, but they have not materially improved health outcomesand that is what we mean by public health. One director of public health recently told the BBC:
When money is tight, it is all too easy to raid public health budgets. In the end, public health loses out, storing up problems for the future. It is depressing.
Dr. Pugh: May I ask the hon. Gentleman a question about Conservative policy? I understand that it is their policy to have an independent NHS, yet I gather from todays debate that there would also be public health targets set by politicians. How can they possibly have both?
Dr. Murrison: I am not sure that I fully understand where the hon. Gentleman is coming from. Of course, it is right and proper to aspire to improving public health outcomes, and it is those outcomes that we are focusing on, rather than intermediate outcomes. Had the hon. Gentleman been here earlier to listen to my right hon. Friend the Member for Charnwood, he would have heard that point being explained extremely well.
Several public health issues have been ably raised by hon. Members today. My hon. Friend the Member for Mid-Bedfordshire (Mrs. Dorries) majored on sexual health, and she was quite right to do so. Ministers have said that by 2008, everyone referred to a genito-urinary medicine clinic should be able to have an appointment within 48 hours. However, as the average wait at the moment is 15 days, it would stretch our credulity to suggest that that target will be met.
The pièce de résistance is that the Government have not yet launched their £50 million advertising campaign on sexual health. On 11 November, almost two years after the then Health Secretary first announced the campaign, the Minister of State, Department of Health, the hon. Member for Don Valley (Caroline Flint), launched a £4 million advertising campaign to encourage the use of condoms. Asked by the shadow Health Minister Earl Howe where the remaining £46 million had gone, the Health Minister Lord Warner said that
it is stored carefully in the coffers of the NHS.[ Official Report, House of Lords, 21 November 2006; Vol. 687, c. 236.]
What utter nonsense is that? We all know that the money has not been squirreled away safely in the coffers of the NHSit has been used to sort out NHS deficits. All the public health money in my area has evaporated in this way.
John Mann: On a point of order, Mr. Deputy Speaker. Is the hon. Gentleman out of order in failing to declare his entry in the Register of Members Interests relating to the Wessex Pharmaceutical Group?
I am more than happy to declare my interest if the hon. Gentleman thinks that it is relevant to what I have already said. When I think that it is
relevant, I will announce it in the proper way. I am pleased to be an adviser to the Wessex Pharmaceutical Group, which covers a large part of the south-west, which I represent.
Raiding public health budgets can kill.
Finally, how about the Governments attention to infectious diseases in general? In the year ending31 March 2006, they spent £300 million less than in the previous financial year. What commitment does that show to tackling new and emerging infectious diseases, as well as the antique infectious diseases that have once again raised their ugly heads in our country?
I want briefly to mention oral public health. The reason that I am interested in this subject is that, two weekends ago, I spent an enjoyable weekend learning how to put in fillings and to treat dental pain. That is something that the Secretary of State knows all about, because it is no longer categorised as a dental emergency. Oral public health means the services provided by dentists in the course of their work to ensure that there are no cancers and to give general advice on health issues. We find that, despite the protestations in the Choosing Health White Paper, access to NHS dentistry has shrunk. How on earth is that improving public health?
The hon. Member for Dartford (Dr. Stoate) discussed raising the age of sale for tobacco, and I am pleased to say that we support this proposal. I seem to recall that my right hon. Friend the Member for North-West Hampshire (Sir George Young) was in the forefront of the argument that the age of sale should be raised to 18, and I entirely agree with him.
The hon. Member for Bassetlaw (John Mann)talked about substance abuse and asked about the rehabilitation places that we would establish when we are returned to government. Of course there will be a mixed provision of drug rehabilitation places, as I imagine there are under this Government, and I would cite the example of Clouds house in my constituency, which does excellent work in this respect.
It is essential that our public health policy shouldbe firmly rooted in the evidence. Public health interventions impact on peoples lifestyles, and can impact on our personal liberties. It is therefore doubly important that anything that we do in this place should be firmly rooted in the evidence. We must have fad-free public health. It is difficult to conduct large-scale randomised control trials in public health, and the Cooksey review appears largely to ignore the issue. The discipline is bedevilled by its precarious evidence base. The right hon. Member for Rother Valley (Mr. Barron) referred to fruit, and of course fruit is important. My children enjoy it at school, but we have to assess the long-term implications of that policy. It is by no means clear that that particular intervention will be sustained in the longer term.
showed that increased consumption of fruit and vegetables was not sustained when childrens participation in the scheme came to an end.[ Official Report, 9 October 2006; Vol. 450, c. 633W.]
We do not have evidence of the efficacy of health trainers, as several right hon. and hon. Members have pointed out. There is evidence, however, of the efficacy of abdominal aortic aneurysm screening, as my hon. Friend the Member for South Cambridgeshire mentioned. Between 2,000 and 3,000 lives could be saved each year by that screening, yet I know that the Minister has to date refused to meet the consultants who are conducting the pilot on that intervention, which is a great pity. Annually, that programme could save more lives than are likely to be saved by the smoking clauses of the Health Bill. We need to reflect on that.
I hope that the Minister will comment on malnutrition among the elderly, about which Age Concern is particularly exercised. If the Minister wants a public health intervention that might work, remedying malnutrition among the elderlywhich, scandalously, often gets worse when they are admitted to hospitalwould be such an initiative.
Hepatitis C needs to be addressed urgently. According to the Hepatitis C Trust, we face a public health time bomb. It says that there is a delay in producing a comprehensive strategy to tackle the disease, a failure to ensure that PCTs implement Government strategy once finally produced, and an ineffective awareness-raising campaign. Delay, failure and ineffectivethose seem to be pretty good bywords for this Governments approach to public health. The trust wonders why hepatitis C screening is not part of the quality and outcomes frameworkand given the scale of the damage likely to be caused by hepatitis C, so do I. It points out that the Department of Health awareness campaign on the subject cost £2.5 million, as against the £280 million spent on persuading people to switch to digital television. The campaign has been a failure, as the number of diagnoses has remained static. The cost of failure is likely to be enormous and I see nothing in the Governments plan for the national health service that will accommodate that failure through investment in hepatology. Given the Ministers failings on public health, she needs to give that close attention.
BelatedlyI try to be fair when I can do sothe Government have set up the Public Health Interventions Advisory Committee under the auspices of the National Institute for Health and Clinical Excellence. It might start by considering the areas of neglect highlighted today. It might also try to stop up some of the rabbit holes down which consecutive Public Health Ministers have been temptedchasing headlines, I am afraid, rather than public health.
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