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“There is strong anecdotal evidence from within the NHS which tells a consistent story for public health of poor morale, declining numbers, inadequate recruitment and budgets being raided to solve financial deficits in the acute sector.”
Even the Government’s erstwhile health guru, Derek Wanless, is saying disobliging things about the Government’s approach to public health. However, we heard nothing about the crisis in the specialty of public health, or the raiding of public health budgets, from the Minister today.
Kitty Ussher (Burnley) (Lab): The hon. Gentleman mentions anecdotal evidence, but I know that the factual evidence from my constituency is that mortality rates for cancer and heart disease have improved in the past 10 years. Why does he think that that has happened?
Dr. Murrison: I am not sure about anecdotal evidence. I will discuss evidence-based public health shortly, so if the hon. Lady will wait, perhaps we will talk a bit more about anecdote versus evidence, and I hope that my remarks will address her concerns. I understand that she has experience from her constituency, and the hon. Member for Slough (Fiona Mactaggart) mentioned evidence from her constituency, too. However, we have to consider public health across the country, and the evidence on that is clear.
Dr. Stoate: The hon. Gentleman is generous in giving way, and I genuinely wish to have a grown-up debate on the issues. He raised the important subject of obesity; I chair the all-party group on obesity, and we spend a lot of time and effort working in a cross-party way to try to sort out the issue. Will he explain what he thinks the Government should do on obesity that they are not currently doing, as I am sure that that would inform our debate?
Dr. Murrison: If the hon. Gentleman will allow me, I will come on to that. What he says about obesity is quite right. We have rightly spent a lot of time debating obesity this afternoon, and that is particularly timely, given today’s announcement from Ofcom. If he will bear with me, I will address his point in due course.
On 26 October, in a rare moment of candour, the Minister admitted that the gap in life expectancy and infant mortality has continued to widen since the target baseline was set. The life expectancy gap has increased by 1 per cent. for males and by 8 per cent. for females. The gap in infant mortality has increased from 13 to 19 per cent. In 1997, the Government pledged to vanquish social class health inequalities, but the fact is that they have got worse. Health inequalities are now the widest that they have been since the 19th century. They are positively Dickensian, and they are of the sort that Prime Minister Disraeli reflected on in his description of London’s rich and poor.
I feel for the Minister, because public health is a challenging brief, and there are few quick fixes, as the hon. Member for Crawley (Laura Moffatt), who is no longer in the Chamber, knows full well, as do the hon. Member for Dartford (Dr. Stoate) and I, as practitioners. We know how difficult it is to procure change, particularly when it comes to harmful life styles. Nevertheless, that challenge must be faced.
Kitty Ussher: I am grateful to the hon. Gentleman for giving way a second time. The Government have changed the funding formula and the way in which they allocate money within the NHS to include an element based on health inequality. Why does the Conservative campaign pack describe that as unfair?
Dr. Murrison:
We would like funding to follow the burden of disease, because that is what the NHS is for—sorting out the burden of disease. I will come on to describe how we think public health funding should be ring-fenced, but the hon. Lady needs to know that,
at present, money earmarked for public health is being siphoned off to pay for service elements. If we are serious about improving public health, which needs long-term investment, not quick fixes, the only way to do so is to protect it in some way. That is why I believe that the Minister, who was thoughtful on that point, will come round to the necessity of ring-fencing funding, if she is to achieve what she says that she wants to achieve.
Dr. Stoate: We are genuinely having a good debate, and that is welcome. The problem with public health is that it goes far wider than one Department. It involves housing, poverty, unemployment, education, the pensions system, transport, and planning. Public health covers literally every Department, without exception. Will the hon. Gentleman tell me how it is possible to ring-fence a budget that covers every single Department?
Dr. Murrison: We could perhaps start with smoking—we talked a bit about smoking, and we will talk about it more—and how that budget has been affected by deficits and the removal of money from the quit smoking campaign in order to sort out parts of the NHS deficit. I will talk about that and will give one or two other examples in my speech, so if the hon. Gentleman will be a little more patient, I might give him some examples that will support the case that I am trying to make.
I accept—the Minister was fairly candid on this point—that there is a judgment to be made on whether we continue to fund public health as we have done, or whether we protect it and ring-fence it in some way, just as the National Treatment Agency for Substance Misuse is protected. The Minister showed that she is under a slight misapprehension about what the agency does, which is a little alarming; it is not simply a Home Office responsibility, but covers a raft of health issues. A large part of that funding is for the treatment and prevention of substance abuse. It would be surprising if the Minister did not understand that.
Caroline Flint: Of course, I pretty much know what the National Treatment Agency does. It is responsible for supporting the development of drug treatment services, for improving the professionalism of drugs staff, and for prevention. I was trying to draw the hon. Gentleman’s attention to the fact that substance misuse occupies a different position in the NHS from public health. As I said, in future we may think differently about the treatment of drug misuse, but it is wrong to make a simple comparison between the work of the national treatment agency and that of drug action teams in the area of public health.
Dr. Murrison: I am grateful to the Minister, and I shall come on to discuss the agency’s work on alcohol.
I should like to ask the Minister, who has some experience as public health Minister, whether she thinks that responsibility is correctly pegged at the level of Minister of State? A Conservative Secretary of State for Health would have responsibility for public health, too, because public health in all its ramifications has not been given the exposure or priority that it deserves. The fact that we are debating shortfalls—
Dr. Murrison: I am not going to give way to the hon. Lady for a little while, although I promise to do so if I have time.
Given the great complexity of public health, it is a pity that the Government have sought to balkanise it and set responsibility for it at a relatively junior level. In December, the Minister rightly pointed out that the Black report of 1980 did not receive the attention it deserved, but she did not admit that in 1999 her Government ignored the Acheson report, which covered almost the same ground. That omission was not corrected today. This is the first time that we have debated public health in Government time for more than four years, although the Opposition have been extremely generous in using much of their own time to do so—we did so as recently as December—because we think that it is an important subject.
The Government, however, have been busy. They appointed a public health Minister and have proceeded to churn out publications of breathtaking vapidity, culminating in last October’s “Health Challenge England”. They launched their “Small change, big difference” public health campaign in April. Small change indeed! Will the Minister confirm that expenditure on that extravaganza totals £13,360?
I am reminded of that campaign only because “Small change, big difference” has been recycled as a catchy soundbite on the front of the document that we are discussing. “Health Challenge England” is big on anecdote disguised as case study, but two and a half years after the “Choosing Health” White Paper, we are entitled to expect an update with a clearer sense of direction. Indeed, the document is evidently so inconsequential that the Minister did not even bother to mention it in her 30-minute rant the last time that we debated public health on 5 December. Ministers cite reductions since 1997 in mortality from cancer and cardiovascular disease, but are we seriously expected to believe that they are responsible for those reductions? Deaths from those causes are happily in long-term decline, and current trends are simply extrapolations from the 1970s and 1980s.
Fiona Mactaggart: The hon. Gentleman did not attend a meeting earlier this week at which Professor Mike Richards said that in his opinion the reduction in cancer deaths is accelerating faster than predicted by the long-term downward trend.
Dr. Murrison: I was not at the meeting, but a friend who was there tells me that Cancer Research UK disputes that. Clearly the issue needs to be looked into a little further, but I think it is generally accepted that the trends were established in the 1970s and 1980s and have continued pretty much in a straight line since then. We should celebrate that. It is excellent, and a tribute to the hard-working professionals in the field and the international research effort. However, it is extremely unedifying for Ministers to come here and quote figures, saying that their policies and their efforts have made all the difference. I do not believe that that is the case, and it is counter-intuitive.
Dr. Murrison: I must make progress.
The Department of Health likes to cite 150,000 lives saved from coronary heart disease since 1996, but in November it was forced to admit that between 1978 and 1996 the equivalent figure was more than 500,000. Spurious claims from Ministers are simply not on. No wonder two thirds of doctors now trust the Opposition more than they trust the Government.
We know that over the past 10 years obesity, sexually transmitted disease, alcohol-related disease, teenage pregnancy, antique infections such as tuberculosis and syphilis, hepatitis and the consequences of drug abuse have become markedly worse in England, but how do we compare with our European neighbours? When we turn to the World Health Organisation for the information, we find that Britons are the fattest Europeans. Our children are getting fatter faster than children anywhere else in Europe, and the Office for National Statistics notes that they are becoming less active.
Mr. Michael Wills (North Swindon) (Lab): Will the hon. Gentleman give way?
Hon. Members: He has only just come into the Chamber.
Dr. Murrison: I am sorry, but I will not give way to the hon. Gentleman.
The rate of HIV infection here is 1.6 times the European average. Alcohol consumption has been flat-lining in the United Kingdom, but falling elsewhere. British people can expect more years of unhealthy life than people in most European countries. Our abortion and teenage pregnancy rates top the European league table. TB per head of population a stone’s throw from here exceeds the level found in several developing countries identified as TB hotspots.
The Minister likes to speak of encouraging best practice, but she has given no indication of what lessons she has learnt from our neighbours who are doing rather better than us. We have heard from the chief medical officer about the poor state of the specialty of public health. England has haemorrhaged directors of public health posts, and the reconfiguration of primary care trusts is leading to further reductions; yet on 3 October 2005, strategic health authority finance directors were told:
“the Department of Health is working to ensure that the overall numbers of public health posts are not reduced.”
Clearly it is not working hard enough, as the number of posts has fallen from 300 to 152.
In the local government reorganisation of 1974, public health doctors ceased to be medical officers of health employed by councils and they retreated to the NHS. I am delighted that the Government are now encouraging joint NHS-local government appointments, but what assessment has the Minister made of the catastrophic fall in the number of public health doctors, and what measures will she take to repair that broken specialty?
Yesterday I met representatives of Alcohol Concern. The organisation has received reports of significant cuts in alcohol services, which it ascribes to deficits. Eighteen months ago, £15 million was announced for alcohol services, but Alcohol Concern reckons that it has disappeared. I wonder whether the Minister can
account for it. Alcohol Concern contrasts alcohol services with services related to other forms of substance abuse. Those are funded and regulated through the National Treatment Agency for Substance Misuse, which means that the money is ring-fenced. Three times as many people die from alcohol as succumb to the effects of drugs, and in public health terms the evidence would lead us to prioritise alcohol. So much for evidence-based policy-making.
The Minister rightly talks about smoking. It is captain of the men of death, but she did not compare the fall of 10 per cent. in smoking rates between 1980 and 1990 with the 3 per cent. fall on Labour’s watch. I hope the Health Act 2006 may save the 600 lives a year that are said to be lost to passive smoking. Indeed, I look forward to debating on Monday a raft of statutory instruments supplementary to the anti-smoking clauses of the 2006 Act, and I look forward to supporting, for example, a proposal to raise the age for sale of tobacco from 16 to 18. But what a horlicks the Government’s stewardship of those smoking clauses was. The Secretary of State campaigned for an exemption for private clubs in the morning, experienced a damascene conversion over lunch, and voted against the exemption in the afternoon.
Another, far less amusing U-turn was the withdrawal of the highly effective national quit smoking campaign last year to save cash. What was the result? Calls to the national helpline plummeted by 30 per cent. over the relevant quarter and there was a 10 per cent. fall in quitters after five successive years of increases. So much for evidence-based policy making, and a strong argument for ring-fenced public health funding.
An even stronger argument is the strange disappearance of funds destined for sexual health campaigns. In January last year we learned that £50 million was going on safe sex campaigns; £4 million materialised. When my noble Friend Earl Howe asked in November what had happened to the balance, Lord Warner replied:
“My Lords, it is stored carefully in the coffers of the NHS.”—[ Official Report, House of Lords, 21 November 2006; Vol. 687, c. 236.]
A fat lot of good it will do in the coffers of the NHS. What is the money doing there? It is there as part of a slush fund to offset the Government’s NHS deficit and, of course, to shore up the job of the Secretary of State for Health, which depends upon it.
The problem with politicians is that they hold in insufficient esteem the evidence base that underpins evidence-based policy making. Celebrity-based policy making is an entirely different matter. Call me an old cynic, but I wonder whether Anita Roddick’s brave announcement—and it was a brave announcement—about her having hepatitis C has energised the Department of Health into launching what we understand will be a welcome publicity campaign for hepatitis. The Hepatitis C Trust, which I met on Tuesday, is understandably extremely miffed that it has not been consulted by the Minister. It points out that “Health Challenge England” ignores hepatitis C completely, as evidently do most PCTs, which have left the hepatitis C action plan, such as it is, on the shelf gathering dust.
Given the alarming increase in hepatitis C, the trust is understandably alarmed. I ask the Minister to speak
to the trust, which feels upset about the way it has been treated. It is upset about what appears to be a knee-jerk reaction by the Department in response to recent media events. It is interesting that guru Wanless himself says:
“What we do not need is simply a list of frenetic and uncoordinated short-term activity, which can be stopped as easily and quickly as it began”,
by which he means— [Interruption.] The Minister says rubbish, but that is what her guru said.
Caroline Flint: The rubbish that I was referring to was the idea that we have just thought of our campaign on hepatitis C. We have been holding regional road shows throughout the country over the past year at least, in which we have looked at how we can deliver at local level, involving people who can raise awareness and those who provide services. I get feedback about how the road shows have been received. I understand that they have been very successful and more are planned.
Dr. Murrison: We look forward to those that are planned. I am sure that Anita Roddick, who, as I say, has been extremely brave in her remarks to the press recently, will play a full and active part. It is a pity that it requires a celebrity to highlight such an issue for the Government—the Jamie Oliver effect. [Interruption.] I have to say to the Minister that it is all very well saying that things are rubbish and that I should move on, but I suspect that Wanless himself will continue to make disobliging comments about what she is doing in public health. He is quite clear that she is engaging in frenetic and unco-ordinated short-term activity—the sort of thing that can be stopped and started just like turning a tap on and off. Wanless is referring to the sort of activities that the Minister mentioned in her interventions regarding plans for hepatitis C.
I have had exchanges with the Minister through a number of parliamentary questions and answers. I asked about what she has done to anticipate the burden of disease that will arise as a result of hepatitis C infection. I have to say that what I have had back is a big “I don’t know.” The Government clearly have no idea about what this time bomb involves and have made no preparations to manage it. In public health terms, that is deeply and profoundly worrying.
Developing his characterisation of a Government thrashing about in public health, Wanless attacks what he calls
“loose proposals for personal trainers which do not seem well rooted in evidence or particularly clearly thought through”.
He goes on to suggest that these appendages of the “Choosing Health” White Paper are
“gimmicks that will discredit the public health function”.
For the price of eye-catching but unproven health trainers, we could have, for example, a national programme for screening abdominal aortic aneurysm. We know that that will save thousands of lives, because the pilots have been done and the evidence base is very strong. Every month the Minister delays, however, 200 elderly men die unnecessarily. Screening does not appear at all in the 34 pages of “Health Challenge England”. So much for evidence-based policy making.
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