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Dr. Stoate: I am grateful to the hon. Gentleman for giving way again. He knows that I share his worry about AAA; it is a very important issue on which I have done a fair amount of work. The problem is not the screening for abdominal aneurysm, which is a very simple ultrasound test, but putting in place the services that are needed—the vascular surgeons, follow-on care and intensive care beds. He is absolutely right that we could probably save 3,000 lives a year if we screened every man at the age of 60, but the problem is that it will take some time to train the vascular surgeons and put the facilities in place. I am fairly pleased that the Government are at least on the case, and I hope that they will introduce such an arrangement as soon as possible.
Dr. Murrison: I am grateful to the hon. Gentleman for his intervention. He will be aware that a few days ago the surgeons who were involved in the pilot visited the Palace of Westminster, and we managed to screen about 30 parliamentarians from all parties, from the Lords and the Commons. The exercise was a huge success, and I know that the Minister received some parliamentary questions as a result of it. I am not sure whether the hon. Gentleman was one of those tested; perhaps not, as he is certainly too young to be in the target population. If he had attended the exercise, however, it would have been explained to him that the resources are in place. We are not talking about large resources in terms of surgeon or theatre time.
Indeed, all that work has been done, and the national screening committee has looked at it. I have been in correspondence with the Minister on the matter, however, and there appears for some reason to be a reluctance to get the process started. I am sure that she will eventually get it started, but, as I said, it is a pity that there is such a delay. The hon. Gentleman said that 3,000 lives a year could be saved, which is perhaps a bit optimistic, but a conservative estimate of 200 people a month is reasonable. It is a pity that we are losing those people unnecessarily when the evidence suggests that we should be using such an arrangement. That is the important point: the evidence suggests that we should be doing this, and it perhaps does not suggest that we should be engaging in some of the other interventions about which the Minister seems so enthusiastic.
On evidence-based policy making, I would like to refer to a parliamentary answer that my hon. Friend the Member for South Cambridgeshire (Mr. Lansley) has received from the Minister of State, Department of Health, the right hon. Member for Doncaster, Central (Ms Winterton), who has recently arrived. The question was:
“To ask the Secretary of State for Health what the evidential basis is for the statement on page 10 of the National Director For Heart Disease and Stroke’s report entitled “Mending Hearts and Brains”, published on 5 December 2006, that 5 per cent. of patients used to die while waiting up to two years for heart operations.”
“‘Mending hearts and brains’”, the document in which the figure of 5 per cent. features, is a personal report from the National Clinical Director for Heart Disease and Stroke. This figure of 5 per cent. reflects a judgement based on expert professional knowledge and experience rather than research evidence, of which there is little”.
The Minister was therefore being sold anecdote as evidence until my scrupulously evidence-based hon. Friend prompted her to be more inquisitive.
It is extremely important that we are clear that public health should be rigorously evidence based. My hon. Friend, at any rate, would be very much an evidence-based Secretary of State for Health. We would not engage in some of the more dubious interventions of this Government, who have been going down rabbit holes left, right and centre. That simply is not helpful, and it brings public health into a degree of disrepute.
A pattern is emerging characterised by loose adherence to the concept of evidence-based policy making and a willingness to sort out the deficits of the acute service by siphoning funds from more elective areas: notably, training and public health. Let us be clear: all politicians have a horizon that rarely extends beyond four or five years. That is the problem for public health: for as long as funds are not protected, it will always be first in line to be tapped when times are tough. To succeed, as Derek Wanless has said, we need a long-term commitment to public health. Given the raid on funding identified by the CMO, that means ring-fencing; there is simply no other way. I am sure that the Minister will come to realise that in the fullness of time.
Mr. Wills: Will the hon. Gentleman give way?
Dr. Murrison: No, I will not give way to the hon. Gentleman; he arrived late, and he did not hear the Minister’s opening remarks.
The Government have at least set up the Public Health Interventions Advisory Committee. We thank the Minister, as we will certainly use the new structure to generate public health policy that is rooted more firmly in the evidence.
Let me finish with the wise words of the chief medical officer. In last year’s annual report, Sir Liam said that the lack of progress on public health is more compatible
“with the Wanless ‘slow uptake’ scenario than with the ‘fully engaged’ scenario”.
How does that candid admission of failure square with the Minister’s upbeat assessment today?
3.58 pm
Mr. Kevin Barron (Rother Valley) (Lab): In answer to the hon. Member for Westbury (Dr. Murrison), I hope that his Front-Bench colleagues will be a bit more responsible in their comments about Anita Roddick’s celebrity launch earlier this week for hepatitis C than they were about Jamie Oliver’s celebrity launch in relation to healthier eating choices in schools. At a school quite close to my constituency, a group of parents tried to defeat the introduction of healthier meals, and the hon. Member for Henley (Mr. Johnson) said that there was nothing wrong with them pushing pies through school railings—probably a habit that he picked up in the Bullingdon club when he was up at Oxford.
With regard to public health, the issue of smoking has been mentioned, and the hon. Member for Westbury referred to some European countries. I do not know whether other Members saw in The Sunday Times this week the extraordinary article, which I
assume was accurate—perhaps I am naïve—under the headline “MEPs’ cigarette ban goes up in smoke”. By all accounts, it appears that the European Parliament had decided to introduce a smoking ban within its confines on 1 January this year, but withdrew it after a few days.
“A 12-member committee of MEPs, which included some smokers, decided that the ban, which had been in place in the parliament’s premises in Brussels and Strasbourg since the start of last month, was ‘unenforceable’”
and had been withdrawn. According to the article, a UK Independence party member, Nigel Farage, said:
“‘I have been ignoring it since January 1...and I have smoked in more places than before.’”
[Interruption.] The hon. Member for Hemel Hempstead (Mike Penning) says that it is no business of the EU where people smoke. I hope that we get a more responsible approach from 1 July when it comes to smoking in public places.
Mike Penning (Hemel Hempstead) (Con): I do not know whether the right hon. Gentleman noticed that when we voted on the smoking ban—and I joined him in the Lobby—the Conservatives had a free vote, instead of being whipped like Labour. Decisions were made by individuals.
Mr. Barron: Labour MPs had a free vote. Indeed, the hon. Gentleman and other Opposition Members put their names to an amendment that I tabled against the Government motion. There were free votes all round, and a sensible decision came from that. Hopefully, we will see a more responsible attitude here on 1 July than we are seeing from legislators in the European Parliament.
I welcome the opportunity to debate the events that have moved us on from the “Choosing Health” White Paper. Irrespective of what is said about which Government have been good or bad over the years in public health terms, such a White Paper has not been introduced by any Government before, and it took a while for this Government to do it.
I want to consider some of the major issues. It is not so much a case of how far we have come, but what public health challenges all of us face in the 21st century. The basis of the White Paper is that in 2004 one in five people were obese, and as a result, in less than 20 years there is likely to be a 5 per cent. rise in strokes, an 18 per cent. rise in heart attacks and a 54 per cent. rise in type 2 diabetes. It is hardly surprising that the World Health Organisation estimates that if we could eliminate the major risk factors—smoking, obesity and physical inactivity—the great majority of cases of heart disease, stroke and type 2 diabetes would be prevented. Worldwide, that would be an extraordinary achievement and one of the biggest moves we could ever make towards improving the health not just of the British public, but of the public throughout the world.
We all have to recognise that the threats to public health in this century are different from those in centuries past. Public health is no longer about clean drinking water, better housing and better sanitation, but about individual lifestyles and habits. It is not easy to deal with those. We cannot increase physical activity
simply by building new infrastructure, welcome as that is. Two major sports and swimming centres are being built in the next few years in my constituency, and they will be a landmark in terms of giving people the opportunity to take part in physical activity.
We cannot stop people smoking either. A great effort has been made to deal with that, and that effort continues. Smoking cessation has been targeted by the Government for the first time, and a major improvement in public health will come of it in years to come. Nor can we stop people binge drinking or taking part in risky sexual behaviour just by passing laws. We must accept that it is not as easy for legislators to have an effect on the health of the public as it was in centuries gone by. We cannot end obesity with a vaccination programme—although I have no doubt that the pharmaceutical industry is looking into that. Indeed, some quacks advertise now, normally on the web, saying that if people buy their pills and take just a couple a day, they will lose weight. That is quackery, and weight loss does not work like that. We shall have to wait and see whether the pharmaceutical industry finds a cure in the years to come, but it has not done yet, so other factors need to interact.
Mr. Graham Stuart (Beverley and Holderness) (Con): The right hon. Gentleman says that it is difficult for Government to bring about behavioural change. However, does he agree that in one area, sexual health, Government action and campaigning have made a difference? Therefore, does he share the disappointment of Conservative Members and people throughout the country involved in that area that funding for sexual health campaigns has been cut from £50 million to just £4 million?
Mr. Barron: I do not know about sexual health campaigns, but more investment certainly needs to be put into sexual health clinics. My own PCT has not been able to bring in chlamydia screening. It would have done had it not been for the top-slicing this year because of the irresponsibility and overspending in other parts of the national health service. I do not blame that so much on the Government. The PCT’s intention was to bring in better sexual health services. The inappropriate and irresponsible actions of other people working elsewhere in the health service meant that we were unable to do that this year. I wait with great interest to see if we will do it when we get back the money that has been top-sliced. I will be on my feet if we do not; let me put it no more strongly than that at this stage.
In every case, Government action must be designed to enable people to make healthier choices for themselves and for their families. We know that individual choices play an increasingly important role in determining health outcomes, and that it is far harder for people to make healthier choices if they are struggling with unemployment or disability, trying to bring up a family on low income, live in a damp and overcrowded home or in a neighbourhood blighted by crime and antisocial behaviour. We know that for far too many people, the cards are stacked against them before they are even born.
I say that despite the fact that this Government have greatly improved many of the factors behind the existence
of greater health inequalities in some communities than in others. I say that despite the fact unemployment in my constituency has reduced dramatically, and employment has increased dramatically, under this Labour Government. That does not mean that everything is rosy in terms of health inequalities. It is not, and the Government recognise that. I am pleased that they do.
We also know that things do not have to be like this. That is why, after decades, the Government have decided to do something about health inequality. To use the phrase that the hon. Member for Westbury (Dr. Murrison) used to describe health inequalities is nonsense. I will go on to the issue of widening health inequality; I will not duck it, but to say that it is Dickensian is nonsense.
Dr. Murrison: It is 19th century.
Mr. Barron: Well, let us look not at Dickens but—the hon. Gentleman will love this—at Frederick Engels, who looked at the condition of the working classes in Manchester in the 1850s. What was the average age at which males in Manchester in the 1850s died? It was 47. The idea that statistically we can compare public health, or the health of the public, now to what was happening in Victorian times is nonsense. I say that honestly to the hon. Gentleman. Next time we have a debate on public health—I hope that the Opposition will use a bit of their time for that—we will look in greater detail at how public health and the health of the public have improved not just since 1850, but even in the past 10 years. That is well documented.
The Government want and are working towards a fairer society. That has meant that there has been fairer funding in the NHS, and more funding per head has been allocated to constituencies such as mine, because of health inequalities. The disease burden is quite high. The formula bandied about by Opposition Front Benchers a few months ago would mean that we got even more money. I would be more than happy if we were to move on to a “disease burden” system of funding health need, but other issues need to be taken into account.
Over the past 10 years, the Government have been making health services better in communities that have more health inequalities. Twelve years ago now, my constituency—or Rotherham metropolitan borough council I should say, as that was the geographical area on which this was measured—had the highest ratio of patients to general practitioners in England and Wales. We do not have that now. That is not down to doctors. The vast majority of them are private, independent business people, and although they work for the national health service they set up their own businesses according to where they want to live and raise their families. Clearly, under the system that has been in place, Rotherham has for 40 years or more been one of the places where they would not want to set up in business and raise their families. One of the reasons for that might be health inequalities—the disease burden that exists there, and therefore the high work loads in constituencies such as mine.
I have nothing but praise for GPs, but those ratios have for years and years been far too high—they have been the highest in England and Wales. The national health service is an organisation that I support, but it
did, or could do, nothing about that until this Government landed on the Government Front Bench. They changed the local contracts so that primary care trusts themselves could employ doctors to work in such areas—so it was not up to doctors to think that they wanted to set up in business there. Instead, the PCT could put doctors into single-handed practices; they still had high patient ratios and work loads, but it could help and assist them. Those matters should have been on the national health service agenda decades ago, but they never were. However, under this Government they are. This Government have been able to do that, and over time that will improve the situation in this country.
The hon. Member for Billericay (Mr. Baron) made several interventions about what has been happening in the past few years. The White Paper “Choosing Health: Making healthy choices easier” clearly outlined a fundamental strategic shift towards public health, health prevention and moving care closer to people in their own communities. Other White Papers have followed it in terms of moving care and taking pressure off the acute sector by moving treatment out into the primary sector. The danger—it has always existed, and could have happily been solved—is that the new emphasis on health promotion and healthier choices leads to an increase, rather than a decrease, in health inequalities. They have not returned to the levels of Dickensian days or Victorian days, but when more choice is made available to people, the better off—the people who have always made better choices, such as the better educated—swiftly take on board messages about diet, smoking, drinking and exercise. Historically, that is what they have done; the more such choices are put into the public domain, the more of them will act on such messages, so it appears that there is a widening of health inequalities.
I am not saying that the position at the bottom end is perfect. However, although inequalities might be widening—the middle classes and the better educated might nowadays be taking better decisions than they have done—that does not mean that the health of the people at the bottom is not also increasing; on the contrary, it is. Therefore, when we address the question of widening health inequalities, let us get it into perspective. There is a widening of health inequalities, but the health of the people at the bottom, who have always been disadvantaged for whatever reason, is improving. Their lifestyles are improving as well; they are not Dickensian, Victorian, Edwardian or anything else. That is an important issue, and if the Opposition have not thought it through, they ought to.
Mr. Wills: I am grateful to my right hon. Friend for giving way, and I am glad that he is not quite as anxious as the hon. Member for Westbury (Dr. Murrison) about my intervening on him. Does not the point that my right hon. Friend is making about health inequalities powerfully reinforce the case for integrating all public services at local level? That is happening in Swindon, in terms of the local area agreement and the integration of the PCT, social services and the borough council. Will not such steps help to tackle the kind of inequalities that my right hon. Friend is talking about?
Mr. Barron: That is the very point that I was about to move on to; I was going to end my remarks by discussing it. However, before I do so, I shall give way to the hon. Member for Billericay, if he wishes to speak.
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