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Many young people understand the need to protect their sexual health, but they are often reluctant to visit specialist clinics. Those who do used to have long waits. We have more to do, but I am pleased to tell the House that today, two thirds of those attending such clinics are seen within 48 hours. Two years ago, that figure was only 38 per cent. Through an active partnership with Boots the Chemist, the Government can promote services to 20 million customers each week. Chlamydia
testing kits have been issued to 31,000 customers, with 15,000 returned to date. In association with the Co-op’s 740 pharmacies, we were able to supplement the Government’s messages on condom use in the run up to Valentine’s day and I was pleased to be at the Co-op in Rossington to support its endeavours to encourage safe sex and condom use. I was asked a question on this issue at the last Health questions and it worried me then, as it should also worry Opposition Front-Bench Members, how many Conservative Back Benchers seemed to dissolve into laughter at the mention of the word “condoms”. I am not sure how that will help us to have a grown-up and less embarrassed debate about these issues.
Teenage pregnancies are at the lowest rate for 20 years. They have fallen by 11 per cent. for under-18s and 15 per cent. for under-16s since 1998. Along with my colleague in the Department for Education and Skills, the Minister for Children and Families, my right hon. Friend the Member for Stretford and Urmston (Beverley Hughes), we are working particularly to identify some of the areas that could do better and learn from best practice in some other parts of the country, where the success rate in reducing the number of pregnancies among young women in this age group is very good.
Fiona Mactaggart (Slough) (Lab): Will my hon. Friend join me in congratulating health authorities in Slough where teenage pregnancies have dropped from 121 in 1998 to 77 in 2005 and will she welcome the narrowing of health inequalities experienced between Slough, one of the poorest areas in Berkshire, and the constituencies around us? We now have fewer deaths from the big killers of heart disease and stroke.
Caroline Flint: I very much congratulate Slough on those efforts and I congratulate my hon. Friend on her championing of tackling health inequalities and dealing with some of these challenges so realistically. It is not easy. What I have been trying to do as public health Minister is to make the connections between strategies to tackle teenage pregnancy and strategies to tackle infant mortality. Statistics on infant mortality show that some 60 per cent. are related to teenage pregnancy, which is partly to do with issues about smoking in pregnancy, low-weight births and so forth. Again, we have to be smarter about connecting these different issues together in order to understand how best to tackle teenage pregnancy and, in doing so, how best to tackle infant mortality as well.
On sexual health, we know that Chlamydia is a major reason for infertility, which is one of the reasons why the Department is funding Infertility Network UK to survey primary care trusts on access to in vitro fertilisation treatment and also to ask questions about Chlamydia screening. If we had more Chlamydia screening and greater awareness of the need for it—not tomorrow or next year, but down the road—we could make a difference to the numbers of people presenting with infertility problems as a result of contracting Chlamydia at an early age.
Mr. Baron: I thank the Minister for giving way, but she has already spoken for 25 minutes. In further response to the question put by the hon. Member for Slough (Fiona Mactaggart), will she please explain why health inequalities have actually widened under this Government?
Caroline Flint: To be fair, I have taken a good number of interventions and I will come on to that issue shortly. I have already touched on some the issues around health inequalities.
I would like to draw attention to some of the issues often raised about the funding of public health. There are some, including Conservative Members, who have suggested, and continue to argue for, a strict ring-fencing of moneys for public health. I understand where they are coming from, but I think that it is misguided and short-sighted. We have moved from a situation whereby Whitehall prescribed everything from the centre to thinking much more about how to devolve resources and decision-making to the front line. That is not to say that we should not have resources at national level for the different aspects of public health, but we should be wary of the broader danger of ring-fencing, which could lead to public health being compartmentalised. It may provoke a narrowing of the public health effort.
Let me provide the House with an example. Either at the last Health questions or the one before that, I was pleased to point out that Plymouth took some “Choosing Health” money, but also some other money relating to “healthy communities”, which it packaged with other resources available for the regeneration of communities. Plymouth set a priority for healthier communities. When all that money was brought together, it far exceeded the “Choosing Health” money that was part of the formula allocation. Public health is important, and we have to have resources to make it happen. We also have to think more widely and in a more sophisticated way about how we can align different budgets to make better sense of the money that can be provided.
Having produced the “Health Profile of England”, and a profile for every local authority of the health outcomes for its community, we need to determine how we can better identify what is spent on prevention, so that accountability can be built in for the health outcomes and the money that is spent on dealing with them. In some areas, we might find that money is being spent but not delivering the outcomes that we want, while another area with less money might be adopting a different approach and forming different partnerships that might be proving more successful.
Dr. Murrison: This is an important point of debate. Given the argument that the Minister is pursuing, why is the National Treatment Agency effectively ring-fencing money for one particular aspect of health care, namely, substance abuse of a particular kind? If money can be ring-fenced for that—and successfully so—should it not be ring-fenced in the wider public health arena?
Caroline Flint: As a Minister in the Home Office, I was responsible for the national drugs strategy. Now, at the Department of Health, I am responsible for drug treatment, and I am pleased that the hon. Gentleman acknowledges how successful our strategy has been in that regard. We are way beyond the target that we set ourselves for the number of drug misusers in treatment, and we have now set an even more effective challenge for retention in treatment. There is no point in people dipping in and out of treatment without achieving any success.
I have thought about this matter in a considered way. For the most part, we are talking about people who are addicted to heroin and other illegal substances. Let us face it, that is not the most popular area when it comes to providing resources. That is why, in this instance, we felt that we had to ring-fence the money. Comparisons may be drawn with public health, but I am trying to demonstrate that public health is a much wider area for engagement than drug treatment. People may disagree with that, but it is a view that I have come to. The bigger game in this area is that we should not compartmentalise public health. Every health professional—the cancer surgeon, the GP, the district nurse—must be an advocate for prevention and for good public health.
Public health goes beyond the health service and beyond the Government. It must be based firmly in the real world and address the circumstances in which people adopt particular habits or lifestyle choices. It must also encourage them to make changes. Fundamentally, public health must view people as individuals. It must look holistically at where they live, what kind of education they are getting, what kind of work they have access to, and how they will be able to continue to work if they suffer ill health. It needs to consider whether their community is safe. Is it an environment in which people will go out and walk and cycle and use the outdoor amenities? Or is it a community in which it is unsafe to do those things, and in which demotivation is likely to set in?
Public health is about viewing people not merely as Mrs. Patel the diabetic, Mr. Brown the coeliac or Ms Jones the breast cancer patient. It is about identifying people’s lifestyles and preferences, so as to reach the right people with the appropriate messages. The Department of Health is leading the way in utilising the tools of social marketing, in which we have been greatly assisted by the National Consumer Council and other organisations. This will help us better to understand what gets in the way of people improving their health, to identify how to get round the problem, and to provide the resources nationally that can be picked up by local government, employers, the local health service and community organisations to provide smarter, more targeted messages, rather than indiscriminate mass communication. It will also help us to support stronger commissioning to provide the right services—rather than a one-size-fits-all model—to reach into a community or an individual’s sense of well being to get some really different results.
The hon. Member for Billericay (Mr. Baron) raised the issue of health inequalities. I hope that everything that I have said so far is interwoven in some way with the challenge of health inequalities. One of the difficulties is that there is a moving target. The reality is that everybody is living longer. People might say that, in some respects, we have never been better off. However, people who are more affluent, more educated, live in better surroundings and have access to the internet—that probably includes many people in the House—are running forward faster than people who live in poorer communities, where housing is poorer, where the environment outside people’s front doors is hostile, where, through the generations, a style of eating or a habit of inactivity has set in, and where
people do not feel that they have got the most out of the education system. Those challenges are daunting, but not insurmountable.
I have to tell Members on the Opposition Front Bench that we are credited throughout the European Union with being at the forefront of tackling the problem. We are looked to by other European Union countries, which, in many ways, are only just starting to tackle this difficult area. We are seeing some progress, although we want more. Three fifths of the spearhead areas—the local authority areas in our most deprived neighbourhoods—are on track to narrow the life expectancy gap for men or women, or both. The reduction in the average death rate from cardiovascular disease among the under-75s in spearhead areas has exceeded the national average reduction since the mid-1990s.
On infant mortality, we have seen a widening, and now a stabilisation. I am not complacent about that. One year’s figure is not good enough as a basis for a theory about how we are doing. However, in the last year and a bit, we have undertaken some national in-depth analysis of why some communities seem to be doing better than others on the target areas of life expectancy and infant mortality. That has allowed us to have far greater insight into the ways in which the partnerships at a local level should identify both the people most at risk and the options to effect change and close that gap faster than ever before. We know that, for infant mortality, the 43 highest rates are in 43 particular local authority areas. I know that there is the will and the commitment from those working in our health service, and in our local authorities and beyond, to bear down on this issue and make a difference.
We cannot do everything from the centre, but the Department of Health has a right to be able to do the things that cannot be done at local level: providing an overview and also national support, based on sharing best practice, to effect the quickest change. As I said before, one has to start by acknowledging health inequalities. Difficult though it may be, setting a target is one of the ways in which we can focus our attention. Clearly, we will be answerable in that respect in a way that the Conservative Governments of previous years were never answerable.
Mr. Baron: Although I agree with some of the points that the Minister makes, the simple fact is that the Government set themselves a target to reduce health inequalities and they have singularly failed to achieve that target—not by a narrow margin, but by quite a wide one. Does that not suggest to her that there have been failures in the Government’s public health policies?
Caroline Flint:
It would be nice if every time there were a general election, we could start with a blank piece of paper and a situation in which what had gone before had no effect on the people of today. The fact is that, when we came to power in 1997, there were more children living in poverty and we did not have the sort of programmes that address health inequalities. I make no bones about the challenge of shifting the effects of not just 18 years of the Tories, but hundreds of years of health inequalities. We take responsibility for setting in
motion the ways in which we can address that problem and we are making progress in a number of areas. That is not to say that there is not more to be done, but one has to start by understanding the problem and then trying to change society. That is what the Government are about. We are making progress and we will continue to do so.
Fiona Mactaggart: My hon. Friend is right to recognise that some things can be done nationally, while others can be done locally. I can cite an example from Slough, where the Department of Health has sponsored a project on diabetes identification involving the Dr. Foster unit. The project has improved people’s awareness of diabetes, which is an important contributory factor to coronary heart disease. When I was first elected, I was shocked to discover that my constituency was in the top 10 towns in the country for early deaths from heart disease among males. As a result of that, we have a locally-determined clinic that 98 per cent. of diabetes patients are attending. The attendance was 50 per cent. at the old clinic, which just happened to be in Windsor, which does not have as much diabetes as Slough, but is better at arguing for facilities.
Caroline Flint: I commend Slough for its approach. That adds to what I have been saying. We know that there are often fewer GPs in our poorer neighbourhoods than in our most affluent neighbourhoods. We have thus had to take legislation through Parliament not only to free up opportunities for pharmacists, but to allow nurses to do some of the jobs that could previously be carried out only by doctors. Such a process cannot happen quickly—legislation does not happen quickly. However, it is necessary to identify problems, find solutions and take action to change the way in which health services are delivered. That is the path that we are on, and although the Conservative party has opposed it, we will ignore that and continue to do what is right and effective.
Dr. Stoate: I am sure that my hon. Friend agrees that we need a grown-up debate on this issue, instead of just slinging statistics at each other across the House. One of the biggest problems involving health inequalities is the rising tide of obesity in this country. I know that my hon. Friend is doing a good deal of work on that extremely difficult and intractable problem. However, the fact remains that the population of this country is getting rapidly obese. We have to understand the causes of that and we will have do something fairly major to tackle the problem if we are to narrow the gap on health inequalities.
Caroline Flint:
I absolutely agree. The situation has developed over at least the past 50 years. The problem cannot be resolved per se through political dogma. We need to identify the problem and do something about it. That is why awareness of five a day is important. The latest figures show that the consumption of fruit and vegetables increased by 7.7 per cent. in one year. The increase was something like 2 per cent. in the year before that, but the trend was in the opposite direction in the previous year. I was cheered by one of the biggest increases that we have seen in fruit and vegetable consumption in any one year. Although I am
not against a bar of chocolate every now and again, I am pleased that confectionary sales are going in the opposite direction.
We are examining the way in which are weighing and measuring at children’s schools so that we can have the most comprehensive database in the world to allow us to plan better, to be more effective in helping parents to support their children and to identify where the problems really exist. Again, we must look beyond the here and now, which is why the foresight project is not only examining obesity now, but considering the situation five, 10 and 20 years down the road to determine what might be possible to tackle obesity, which is a problem not just in the UK, but worldwide. I read in the paper this week that the Italians are worried about obesity, even in the communities in which the Mediterranean diet is most dominant.
Dr. John Pugh (Southport) (LD): Research that came out yesterday suggested that we had the most obese women in Europe and almost the most obese men—we were beaten only by Malta. I am not saying that the Government are in any way to blame for the variation throughout Europe, but does the Minister have an explanation for it?
Caroline Flint: As I said, the Mediterranean diet that people have in certain parts of Europe, which is probably considerably healthier on the whole than the usual diet in our country, has perhaps protected people in many ways. We live in a society in which car use is perhaps greater than in others and in which some of the more physical jobs no longer exist—there is no reason to go back to those jobs because some of them were associated with health problems.
We are not on our own in having the problem either in Europe, or worldwide. When I attended the World Health Organisation Europe conference on obesity in Istanbul last year, I was reassured by how many countries were looking to us because we were ahead of them on trying to tackle the problem. Today, I have made it clear that the Government must arm the ordinary citizen to better look after their own health; to empower the parent to better maintain their child’s health; and to complement this with the services, often community based, to help people overcome barriers to good health. That gives people individual responsibility, but with the Government on their side.
There is no complacency from the Government about the challenges ahead and the cultural change that will be involved. New approaches to public health require a reformed NHS, with new partners and new ways of working—reforms that place more services in the community, closer to home, and reforms that improve transparency, such as providing insight into the pattern of services provided by GPs.
The new emphasis on public health is a policy direction whose time has come. The smoking ban has been widely welcomed; food labelling is now widely accepted; reducing salt, sugar and fat in food is not contested; five-a-day is part of the conversation with consumers; and building exercise into daily routines is regarded as common sense. All that illustrates that public health messages are becoming part of the nation’s vocabulary.
Public health is the forward looking, preventive face of the NHS, and Britain today is among the world leaders, treating people as individuals, meeting complex needs, addressing personal choices and tackling real inequalities. Public health will continue to be central to the work of a reformed, smarter, 21st-century health service. Public health demonstrates the Government’s ambitions for the nation’s health, ambitions shared by the British people. Only by working together can we make the difference, and that is what we will continue to do.
3.26 pm
Dr. Andrew Murrison (Westbury) (Con): I wonder what our constituents will make of the complacency that is evident in the Minister’s remarks. The press today correctly reflects public anxiety over soaring obesity rates and reports that nearly a quarter of adults are now classed as clinically obese.
This morning, Ofcom announced its proposals on the advertising of HFSS foods—those high in fat, sugar and salt—to children, yet the Minister did not refer to that once. We broadly welcome those recommendations and we are particularly pleased that a decision has now been made. We are delighted that it will be reviewed in autumn 2008. Clearly that is an important announcement, and I should have thought that the Minister would start her remarks by referring to it , but on that subject she was silent.
Caroline Flint: If the hon. Gentleman reads Hansard he will see that I referred to the restriction on advertising to children. I am pleased to say that we made it clear in our manifesto that we would seek to restrict the advertising of HFSS foods to children. I wonder why it was not the subject of the Conservative party manifesto.
Dr. Murrison: I am grateful to the Minister for her intervention. She has at least put that on the record, but I think that she will find, when she checks Hansard tomorrow, that she did not mention Ofcom, and I believe that she should have done so.
In “Health Challenge England”, we find that the Deputy Prime Minister has a key role in the fight for the national waistline. Apparently he leads a cross-cutting Cabinet Sub-Committee on health improvement. Indeed, obesity requires an interdepartmental response. However, last month the Public Accounts Committee took a look at that pillar of the “Choosing Health” White Paper and found that any cross-cutting on obesity has been characterised by “dither”, “confusion” and a lack of co-ordination.
The Minister has come here today, brazenly and despite all the evidence, to convince us of the brilliance of her Government’s stewardship of public health. Back on planet Earth, the Government’s own chief medical officer is a dissenting voice. He says:
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