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Dr. Andrew Murrison (Westbury) (Con): I am grateful to the hon. Lady for giving way at this early stage. She referred to our apparent opposition to the “smoking” clauses in the Health Bill. Can she perhaps
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clarify that, because we have always made it clear that it would be our intention to have legislation covering smoking in enclosed public places? I would like her to clarify the misleading impression that she has given.

Caroline Flint: For 18 years, the Conservative party had the opportunity to bring legislation in. It failed to do so. We wrote in our manifesto that we intended to legislate. I do not recall the Conservative party manifesto saying that it intended to legislate.

Mr. Stewart Jackson (Peterborough) (Con): Will the hon. Lady give way?

Caroline Flint: I will make a little more progress. I will be happy to give way at a later opportunity.

Today, individuals have greater choice and greater sources of information. Crucially, in many respects, much of the public are wealthier, better educated and living longer, with greater expectations of life and higher expectations of public services than ever before.

Mr. Kevin Barron (Rother Valley) (Lab): In relation to the intervention by the hon. Member for Westbury (Dr. Murrison), perhaps we should judge the Conservatives’ attitude to smoking in public places on the basis of the amendments that they tabled to the Health Bill, which were not for the comprehensive smoking ban that we will have on 1 July.

Caroline Flint: I agree totally with my right hon. Friend. In a number of areas—tobacco control, the ban on advertising, the world-class services in the NHS to support people to give up smoking, and the legislation that will come into force in England on 1 July—we need take no lessons from the Conservative party.

Mr. Stewart Jackson: I am listening intently to the hon. Lady. Before she gets too rhapsodic in her oratory, perhaps she could answer two points. If the Government’s record is so good, why is it that the number of health service professionals working in public and community medicine focused on public health has been cut by a fifth since 2001, and why has there been a cumulative reduction of £300 million in expenditure on infectious diseases under her Government?

Caroline Flint: We have seen a growth in the number of people working in health improvement. That is not to say that there should not be more. As I develop my contribution, I hope that I will engage the hon. Gentleman in looking beyond what have sometimes been stifling demarcation lines between public health and other areas of the health service, and in looking at the opportunity for every health professional to be a public health advocate. Beyond the health service, in local government and in the public, private and voluntary sectors, we can put public health at the heart of many organisations. They should see it as an opportunity to deliver on their agenda, whether it is regeneration, educational attainment or, importantly, providing people with the health and well-being to get the most out of life.

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Dr. Howard Stoate (Dartford) (Lab): I am grateful to my hon. Friend for giving way at this early stage. She has been generous with her time. Does she agree that one of the biggest public health problems is health inequality and that the Government are doing an enormous amount to reduce poverty and to ensure that people get back to work? Those things in themselves will make an enormous difference to the health of the nation. Therefore, they are very good public health measures in themselves.

Caroline Flint: I agree. We are the first Government to say plainly that health inequalities are a real problem and to set challenging targets. That is not to say that we have completed our journey, but one has to acknowledge the problem and set the targets to make a start in the right direction.

Mr. John Baron (Billericay) (Con): Will the Minister give way?

Caroline Flint: I will shortly. I have given way quite considerably in the last few minutes.

Today individuals have greater choice, but they want more. They demand access to services locally, at times that suit them, not at the convenience of the system. They want to walk in. They want easy access to information via the internet or advice via NHS Direct. They expect quick appointments. All of those were impossible in the Tory Britain of 10 years ago. Today, with a Labour NHS, they are almost taken for granted.

Placing public health at the centre of a modern health policy is essential. Government policy has to provide a comprehensive response to the vast changes in lifestyles and attitudes that, far from being unique to Britain, are features of many modern western societies. International travel and migration, affluence, over-consumption, sedentary lifestyles, shift working and convenience food are all aspects of modern, western society, but all contribute to new health challenges. Other changes, such as binge drinking and poor sexual health clearly have serious long-term consequences. A failure to face those challenges is not an option.

The maintenance of good public health involves a change in the relationship between Government and individual. It involves every adult, every parent, safeguarding their own health and that of their dependants—individuals becoming the guardians of their own health and well-being.

On that crucial issue, the public agree with Government. Recent surveys by the King’s Fund reveal that 89 per cent. of people agree that individuals are responsible for their own health. They also reveal that 93 per cent. of people agree that parents are more responsible than anyone else for their children’s health, and that 86 per cent. believe that the Government’s role is to prevent illness and to provide information and advice.

Laura Moffatt (Crawley) (Lab): Does my hon. Friend the Minister recall a recent visit she made to Crawley, during which she looked at, among other things, public health measures, and specifically at a cooking class delivered through Sure Start to help parents to cook decent food for their children and thereby improve their health and performance at school? Is that not an example of the way in which we can truly get through to parents and help them look after their children better?

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Caroline Flint: I agree wholeheartedly with my hon. Friend; not all parents need such classes, but some do. That is why there is not a one-size-fits-all approach to this issue. I also saw in Crawley the sport and leisure centre providing services for GPs to refer people with long-term conditions to exercise classes, and Crawley hospital being transformed in terms of supporting urgent care, and also physiotherapy for people with long-term conditions. I congratulate all the health professionals in Crawley—GPs, nurses and others—who are thinking about how they can make their hospital truly a community hospital, and a hub for the primary services not of today or yesterday, but of the future. I congratulate my hon. Friend on the part that she has played and for being brave enough to enter into that debate.

Mr. Baron: I thank the Minister for giving way; she is being generous in taking interventions. In answer to the question posed by the hon. Member for Dartford (Dr. Stoate) about the importance of health inequalities, can she explain why all the evidence—including the Government’s answers to certain questions—shows that health inequalities have widened under this Government?

Caroline Flint: I will attend to that issue later in my contribution, and I shall be happy to take an intervention from the hon. Gentleman at that point if he is not satisfied with what I say.

People have the freedom to make choices, but the Government have a role to play in helping them make more informed choices about their health, and it is important to understand that some people, families and communities might need more support than others. For example, 50 per cent. of adults say that they are trying to eat well, and the Government can help in that by encouraging simple front-of-pack labelling to assist people in judging whether food is high in salt, sugar and fat. By engaging with Netmums, an online forum for mothers—250,000 mothers are registered on it—we are involved in discussions about front-of-pack labelling, and also about advertisements aimed at children for high-fat, high-salt, high-sugar products. That is an example of how we are looking beyond the traditional ways of engaging with communities and the public, and how we are exploring how we might better listen to the current concerns of mothers.

By leading the debate, the Government can influence the actions of the private sector. Credit should go to the Sainsbury’s wheel of health initiative, the first simple food labelling device, which was informed by both Government and the Food Standards Agency advice, but which was devised by Sainsbury’s. Six million customers a week see its wheel of health labels. Independent research will determine exactly which labelling system is developed, and I acknowledge that other systems are being used by different retailers and food producers. What is clear—I think that this has been accepted by those from the food retailing and production sector who are involved in this debate—is that we will adopt whatever the consensus among consumers supports. I hope that that will happen.

Anyone who doubts the willingness of the private sector to promote the public interest should look at another project that we have engaged it with: Project
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Neptune, the food manufacturers’ commitment to reduce salt levels in food by 30 per cent. over a three-year period. I again congratulate the food producers who have engaged constructively in reducing the levels of salt, and also in promoting awareness of the dangers of salt in our diet if that exceeds the 6 g a day that the FSA recommends.

I know that there are good health reasons for the changes that are taking place within our food producing and retail sector. I also know that, realistically, for many companies in that sector it makes good business sense, too. I am pleased that in the last few years we have seen health become no longer a fad, but a trend. Those businesses that want to be associated with good health, and therefore to encourage consumers to choose their products, understand that business and health can come together, and the Government have a leading role to play in the debate on that.

Mr. David Evennett (Bexleyheath and Crayford) (Con): The Minister highlighted consensus, and that is the most important thing. There must be consensus in the food industry, consensus in the voluntary sector and consensus across this House, because we are all involved in the debate to improve the health of our constituents and the entire country. [Interruption.] I do not want to take interventions from a sedentary position on my intervention. I am supporting what the Minister said about consensus, but that needs to go much wider than just the industry and the Government.

Caroline Flint: That is clearly so, and I can give the hon. Gentleman many examples of such consensus. I have not even begun to talk about the changes in our relationship with local authorities. From 1 April, for example, there will be a mandatory target regarding health inequalities. Legislation going through the House at the moment is forming the basis for statutory health and well-being partnerships, which will result in closer collaboration such as the joint commissioning of health services by local government and the health service. I could go on. There are plenty of such opportunities, and we are the Government who are seizing the moment and helping to make that happen.

Research also shows that 79 per cent. of parents accept responsibility for the quality of their own children’s diets. It is not the role of Government or of any other organisation to unseat the primary role of parents in influencing their children; they are rightly the most important influence on their children’s lives. However, where the Government have to be the parent by proxy—during school hours, for example—we can help not only the children but the families. We can help by guaranteeing the quality of school meals and bringing in nutritional standards that can make a real change to the food that our children eat in school every day; by providing fruit in school for 2 million children; by supporting breakfast clubs; and by discouraging fizzy drink vending machines and promoting water in schools. Not one of those four initiatives to support healthier diets for children was undertaken by the Conservatives during nearly two decades in power; all of them were undertaken in less than one decade by
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Labour. [Interruption.] As my right hon. Friend the Member for Redditch (Jacqui Smith) says from a sedentary position, the Conservative Government did away with nutritional standards.

Mr. Stewart Jackson: I thank the Minister for giving way; she is being very generous in taking interventions. Conservatives would not disagree with anything that she has said, and we congratulate the Government in that respect. However, does she consider it the job of a responsible Government to ameliorate the impact of the abuse of alcohol, which it is said costs the Exchequer £20 billion a year—and is that assisted by introducing a 24-hour drinking regime?

Caroline Flint: Very few establishments have 24-hour drinking licences. It is interesting to note that Opposition Members are very partial in quoting aspects of the reform of drinking legislation. Before we introduced our legislation, it was very difficult for local authorities working with the police to revoke licensees’ licences. We had an archaic bureaucratic system involving magistrates, and trying to make any changes at all was like walking through treacle. Now, we have the powers to enable communities to be more involved, and to have a say when licences are issued. Where licences are provided, the ability exists to close down an establishment if it operates in such a way as to cause problems in the community. We have also increased the offences for disorderly behaviour and selling drink to under-age people, for example. Let us have a grown-up debate and acknowledge that, be it alcohol or food, the problems that are impacting today have developed over a number of generations. We must address the issue in a rounded, thoughtful and sustainable way.

Dr. Stoate: In my area we have not 24-hour drinking but flexible hours, which have reduced town centre disorder by allowing clubs and pubs to close in a phased manner, thereby giving people a chance to leave the high street in an orderly fashion. However, the real problem with alcohol is that it has become cheaper in real terms in the past 20 years and more readily available, particularly through outlets that are open for many hours during the day. Some supermarkets use alcohol as a loss leader, selling it for as little as 40p a litre, for example, to entice young people in. That is one of the main problems associated with binge drinking. Will my hon. Friend look at that issue, which we need to examine?

Caroline Flint: My hon. Friend makes some pertinent points. Better management of, and timing of the hours of, licensed establishments can be a positive aspect of community management, particularly, but not exclusively, in our town centres. We have also engaged with the alcohol industry on the labelling of products, for example, and I hope that there will be an outcome to those discussions shortly.

We will also discuss the issue of promotions, not only in licensed establishments such as pubs and clubs, but in retail outlets. Indeed, more retail outlets have 24-hour licences than other establishments. At least, that is my perception of the situation from what I see in my local community.

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Another issue is the education of our children and young people, and that is why the Department of Health is working with colleagues in the Department for Education and Skills to improve it. Some 80 per cent. of schools are now participating in our voluntary healthy schools programme—nobody is forcing them to take part—which covers the primary and secondary sectors. In order to be a healthy school, schools have to address not only eating, physical activity and emotional development, but substance misuse, sexual health and alcohol and cigarette use. I am encouraged by that programme. Schools have asked for it and we are trying to provide it. I hope that it will provide greater consistency in the information, advice and support that children and young people need to make informed choices. Parents also need to be engaged and we will do whatever we can to support parents to take that personal responsibility for themselves and their children.

Research tells us that the overwhelming majority of smokers accept that the habit is bad for their health, but reveals that they need support to kick it, which is why our world-leading NHS stop smoking services were established in 1999. Some 1.6 million fewer people smoke today compared with 1998 and I hope that the new smoking legislation coming into effect in July will see a further reduction in the numbers who smoke. We still face some challenges in that area.

Mr. Bob Blizzard (Waveney) (Lab): I very much welcome the smoking ban, but does my hon. Friend share my concern that we will end up with lots of people standing outside buildings smoking and creating piles of cigarette ends on the pavement, which will be a public health risk? Will she work with local authorities to ensure that they take the appropriate action through the litter control tools that they possess so that we are not wading through dog-ends outside offices and other establishments?

Caroline Flint: I understand the point that my hon. Friend makes and, together with local authorities and environmental health officers, it is an issue that we are considering. We want to try to streamline the implementation of the legislation as much as possible. It is the biggest exercise of its kind anywhere in the world. I sometimes find that quite scary, but it is also very exciting and a real opportunity. The implementation is not the end of the story and we have to ensure that we engage people so that they do not just smoke outside instead, but seek to give up smoking full stop. Ideally, people should not start smoking in the first place. We certainly do not want to turn our communities into ashtrays because everyone is smoking outside.

From 1 October, we will raise to 18 the age at which people may purchase cigarettes, and I commend the campaign by my hon. Friend the Member for Barnsley, East and Mexborough (Jeff Ennis) on that issue.

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