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Caroline Flint: We have had a wide-ranging debate, which demonstrates the breadth and scale of the challenges we facenew challenges that I suggest need new solutions. If we do the same old things in the same old ways, we will get the same old results. As I have made clear and as the public knows, it is not all down to the Government to meet the public health challenges of lifestyle. There are things that we can and must dosmoking legislation, for examplewhen people cannot do it for themselves. There are things that we can support people in doing and things that only they can do for themselves and their families. It is a complex area. All that is not about me passing the buck, but about having a realistic debate on the challenges that we face at the beginning of this new century.
It has been a good debate, in which I took 17 interventions in my opening remarks and we have heard seven Back-Bench speeches as well. I hope that everyone who has taken part feels that they had a good opportunity to air their concerns.
In the time that remains, I shall try to deal with some of the points that have been raised. The hon. Member for Westbury (Dr. Murrison) argued that the reductions in mortality rates were simply due to trends during the 1970s and 1980s. Other hon. Members made the point, however, that we cannot assume that such reductions will continue even at the same rate, let alone at an accelerated rate, without additional measures and policies. This is true in a number of areas. I do not deny that smoking rates have gone down during Administrations other than Labour Administrations. However, when we consider some of the core, hard-to-reach communities, the task becomes more challenging, and that is where we are today. That is why the issue of health inequalities is so important. They raise particular challenges that would be left unchecked without Government intervention and support.
The hon. Gentleman and others asked what we were doing to replace the specialists in public health who had gone. Department of Health data do not verify the suggestion that there has been a significant reduction in capacity in public health. There were 718 specialists in 2000, 634 in 2002, and 788 in 2004. The data for 2005 have yet to be established. We are working with various public health organisations to track what has happened post-PCT reorganisation. The welcome development of more jointly appointed public health directors is a sign of how we can sustain the public health role in a way that is different from the approach that we have adopted in the past, which involved a purely health perspective.
There have been Government debates on public health in the past four years. We had a Government debate on health inequalities just a year ago, and there have been other opportunities as well. I am always open to participating in Adjournment debates; in fact, if anyone is interested, I shall be here for the one that is taking place after this debate.
The question of our sexual health campaign and the £50 million was raised. We have not spent only £4 million on the campaign; that was what we spent on our Condom essential wear campaign. In the run-up to Valentines day, we targeted our campaign through the radio stations that young people listen to, and the magazines that they read. We have been looking at more targeted ways than simply using big adverts to reach into those communities.
It is also important to recognise, whether in regard to sexual health, smoking or obesity, the way in which we have engaged other organisations to be the front face of some of our communication campaigns. That is an important part of the way in which the Government are making a difference. Sometimes, with the best will in the world, when the Government say something, they do not get listened to. That is why getting the British Heart Foundation, Cancer Research UK and other organisations to help us with these campaigns has been very positive. We fund those organisations in numerous different ways.
We should be proud of our record on tobacco cessation services. Tobacco Atlas, which is run by the World Health Organisation, says that the UK will see the greatest decline in tobacco use in the world between 1998 and 2008. We were second only to New Zealand in April 2006. Over a period of three years we have had more than 800,000 remaining as quitters. So, yes, there is more to be done, but I think that we can be pretty proud of the Governments record on this.
Several hon. Members have mentioned the Public Accounts Committee report, to which we will respond shortly. I suggest that some of the evidence on which the Committee based its case has been attended to in the interim, since it first started on its report. I acknowledge, however, that tackling obesity is a complex issue that requires commitment across government and outside government in a more joined-up way. Part of that involves putting in the foundations to make a difference, and our weighing and measuring exercise will establish the largest database of its kind in the world. It is important that we get that right. An excellent example can be seen in Westminster, where parents have been engaged and best practice has been applied. I am looking forward to the roll-out of that exercise later this year.
I am very pleased about the Ofcom announcement. We said in our last general election manifesto that we would seek to restrict the advertising of high-salt, high-fat and high-sugar foods to children. Ofcom has announced its intentions on that today, which is welcome. We shall monitor the impact of those measures closely, to determine whether we need to look at giving the Government a further role in changing the balance of the promotion and nature of food advertising, particularly to children.
On food labelling, our leadershipwithout the heavy hand of regulationhas made an impact. My hon. Friend the Member for Waveney (Mr. Blizzard) and others have raised the question of which system
works best. I think that the colour-coded, or traffic lights, system seems to be working well. That certainly seems to be the case from what I have seen and heard from the public. An important aspect of the labelling system is whether it leads to food manufacturers reformulating their foods to get more of them into the amber and green categories. My focus was particularly on foods that were used as meals, such as sandwiches and soups. If the industry wants to label tomato ketchup, that is fine, but we were conscious of the meal replacements or products that are used as meals, such as cereals and so forth. They cause the most problems for mums and dads shopping for their families. That was our approach. If the industry wants to widen that further, that is its choice. It is not something that I pressed on the industry.
When it comes to public health being evidence-based, we are trying to achieve a more robust attitude. That is why the National Institute for Health and Clinical Excellence produces guidance on the promotion of good health and the prevention of ill health. However, we need to look at achieving a balance, so that we can try to improve the evidence base without allowing certain ways in which we work to paralyse us when it comes to doing anything. We were conscious of the good GP referrals scheme in relation to physical activity, which has flourished in the last 10 years. We did not want that to be stopped inadvertently because people felt that there had to be a huge clinical trial to justify its existence. However, it is in the interests of public health to try as much as possible to make sure that we can have the same sort of authority as other parts of the health service.
The Government have done a lot to improve screening. I understand that the national screening committee has advised that screening for men aged 65 can be recommended in principle. It did not recommend screening for women. That is in relation to abdominal aortic aneurysms, which were mentioned earlier. We have noted that and asked for further detail. Issues such as screening and vaccinations come up all the time. The new pneumococcal meningitis vaccine for children has been introduced in the last six months and I understand that that has gone well.
All these issues raise important points for the Government in terms of what we can afford and provide for, and their impact. There has been a lot of talk this afternoon about what we should be doing. There is a price tag attached to everything. The Opposition refused to vote for the increase in funding for the NHS andin relation to some of the other points that have been madeare refusing to change the NHS in a way that will make it fit for the future and allow space for public health to flourish.
The hon. Member for Southport (Dr. Pugh) seemed to have a reasonable approach. I did not hear much about what the Liberal Democrats would do that would be different from what the Government are doing, but we welcome him on board.
My right hon. Friend the Member for Rother Valley (Mr. Barron) talked about the challenges of the 21st century. Physical activity is not just about facilities; it is about engaging people so that they use those facilities. We cannot just say that we will build facilities and people should come to them. We have to think about what sort of activities young people want to be involved in. For example, what gets in the way of Muslim women using swimming pools? The issue is usually that they want to be able to swim without the presence of male lifeguards. Some areas, such as Brent, have tackled that and the rate of women and girls from the Muslim community who go swimming has gone up enormously. The issue is about listening to people when it comes to the ways in which we can break down barriers. My hon. Friend also made an important point about GPs. When it comes to health inequalities, some of our poorest communities have not had the services that they deserve. Giving PCTs the power to challenge that is important.
On the speech made by my hon. Friend the Member for Kingston upon Hull, North (Ms Johnson), I have visited Hull and seen the importance of the school meal programme. I attended an international conference where that was leading the way. The people of Hull will have to judge for themselves whether the Liberal Democrats in Hull have got their best interests at heart.
The UK, often portrayed as lagging behind the rest of Europe in terms of hepatitis C management, has dramatically increased the number of new cases identified in 2004 and 2005 compared with previous years.
Regarding the budgets of the NHS, there will not be the space for public health, and the point raised quite rightly by the chief medical officer about the raiding of public health budgets is not new. We need a better balance in the NHS to ensure that hospitals and secondary care have their place and that, rightly, public health and primary care in communities have a fair slice of the cake. That is why I am looking at [ Interruption. ] No, not ring-fencing, because that does not offer a solution
Sir John Stanley (Tonbridge and Malling) (Con): During the summer recess Adjournment debate that was held on 25 July last year, I raised the key issue for virtually all my constituents of the dire consequences of the Secretary of State for Healths policies for both the acute hospital trust in my constituency, the Maidstone and Tunbridge Wells NHS Trust, and my constituencys two community hospitals at Tonbridge and Edenbridge. I make no apology for returning to the same subject just six months later.
I want to raise two key issues about the acute hospital trust. The Department of Healths treatment of the trusts £16.9 million-worth of so-called accumulated debt is frankly indefensible. The trust has already paid off the debt once, yet the Department is insisting that it is paid off a second time by means of the creation of a surplus, which, in my book, means making a profit out of the needs of patients. The situation is simply unacceptable.
I appreciate that the process is being carried out under the resource accounting and budgeting Government accounting system. However, as the Minister and her Secretary of State know, the Audit Commission has made a categorical recommendation about applying RAB to NHS trusts. The recommendation, as it was stated by the then Health Minister, Lord Warner, in his letter to me dated 26 July, said that the Department
should moderate the future application of the RAB regime, in particular by no longer applying the RAB carry-forward rules to NHS Trusts.
Last year, my three colleagues from west Kentmy right hon. Friend the Member for Maidstone and The Weald (Miss Widdecombe) and my hon. Friends the Members for Sevenoaks (Mr. Fallon) and for Tunbridge Wells (Greg Clark), both of whom are in the Chamberand I wrote twice to urge the Secretary of State for Health to accept the Audit Commissions recommendations. So far, she has stubbornly refused to do so, so we wrote a third time on 31 January. We are earnestly hoping that our persistence will be rewarded. If it is not, and if the trust is forced once again to find £16.9 million, there can be only one absolutely certain consequence: a diminution in patient services and a loss of jobs for health service workers. It is wholly unreasonable that that should be the consequence of frankly ridiculous accounting rules.
The second issue relating to the acute hospital trust is the future of the proposed private finance initiative hospital at Pembury. The hospital, on a PFI basis, was conceived and taken forward substantially by the previous Conservative Government. The present Government have been in office for 10 years, but during that period, there has been a huge amount of delay on the hospital. Indeed, I have to say to the Minister that some of my constituents are even doubting that the Government are committed to the hospital and think that they may at the last moment rat on constructing the hospital at all.
whether there is a firm Government commitment to have a new private finance initiative-funded hospital at Pembury; and if she will make a statement.
The Department has reviewed the proposed private finance initiative scheme for Maidstone and Tunbridge Wells National Health Service Trust on value for money and affordability grounds. An announcement is expected shortly.[ Official Report, 5 February 2007; Vol. 456, c. 724W.]
I must say to the hon. Lady that this is having an extremely debilitating impact on the whole of the NHS in our area, particularly in the Maidstone hospital, where there is great uncertainty about the future of services such as accident and emergency. It really is high time that the Government made it clear that they arehopefullyfirmly committed to allowing the new Pembury hospital to go ahead.
I turn now to the equally important two community hospitals in my constituency, at Tonbridge and at Edenbridge, where again we have a very sorry state of affairs which is essentially of the Secretary of States making. At both hospitals, half the beds, which were supposedly closed temporarily in January 2006 in order to reduce the primary care trusts deficit, are still closed over a year later. As the Minister knows, because she gave the answers, I recently tabled two further parliamentary questions to the Secretary of State. I shall read to the House the questions that I tabled and the answers that I received from the Minister.
I asked the Secretary of State if she would take steps to ensure that the closed beds at Tonbridge hospital and Edenbridge War Memorial hospital were reopened, and if she would make a statement. I shall read in full the reply that I received:
This is a matter for West Kent primary care trust...NHS South East Coast has advised that the West Kent PCT is currently undertaking a review of all its community hospitals to ensure that they offer high clinical care as well as value for money. Until the review is completed, which is likely to be in the spring, all beds that are temporarily closed will remain closed. If there are any proposed changes to services in this area there will be a formal consultation with the public.[ Official Report, 5 February 2007; Vol. 000, c. 723-4W.]
I have to say to the Minister that that answer, which was supposedly an explanation of why the beds have been closed, isI am bound by the conventions of parliamentary language, Madam Deputy Speakerfactually an absolute travesty of the reality.
I offer the Minister my answer to my question. This is what the answer should have read: The West Kent primary care trust has been thrown into deficit by the
Secretary of State for Healths decision to make a massive transfer of funds from community hospitals to acute hospitals in order to achieve the Governments politically driven target of 18 weeks for admission to acute hospitals by the time of the next election. The West Kent PCTs deficit has been substantially increased further by the Secretary of State for Healths wholly unnecessary and financially wasteful primary care trust reorganisation of last September. However, notwithstanding her two financially calamitous decisions for the West Kent PCT, the Secretary of State agrees with the right hon. Member for Tonbridge and Malling that both Tonbridge and Edenbridge hospitals provide high standards of clinical care and excellent value for money and has instructed that the beds closed at both hospitals should be opened forthwith. Frankly, to be silent about the real causes of the deficit in the West Kent primary care trust is outrageous. It is equally outrageous to cast doubt on the standards of care at Edenbridge War Memorial hospital and Tonbridge Cottage hospital.
I would like to give the Minister the opportunity of dispelling any doubt that she has about the standard of care at the two hospitals. In all seriousness, I extend an invitation to her. I will scrub my diary, and I invite her to come to my constituency tomorrow, or if that is not convenient, on another date. I will meet her at Tonbridge station, and we will walk together up and down the High street, and ask the good people of Tonbridge what they think about the standard of care in Tonbridge hospital. Then I will drive her to Edenbridge, where we will walk together down the High street and ask the good people of Edenbridge what they think about the standard of care at Edenbridge War Memorial hospital.
I tell the Minister what the response will be: my constituents will be flabbergasted that that question should even be asked. They are in no doubt whatever about the excellent standard of care at both hospitals, because they know what the reality is from their own experience, and from the experience of their families. They know from the experience of their grannies and granddads, mums and dads, husbands or wives, and children. They know that when they go to the Tonbridge or Edenbridge hospital, they receive outstanding care. It is a wholly fictional justification to suggest that the review has anything to do with the standard of care at the two hospitals.
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