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Mr. Secretary Hutton, supported by the Prime Minister, Mr. Chancellor of the Exchequer, Secretary Jacqui Smith, Secretary Hilary Benn, Secretary Hazel Blears, Secretary John Denham and Malcolm Wicks, presented a Bill to make provision relating to gas importation and storage; to make provision in relation to electricity generated from renewable sources; to make provision about the decommissioning of energy installations and wells; to make provision about the management and disposal of waste produced during the operation of nuclear installations; to make provision relating to petroleum licences; to make provision about third party access to oil and gas infrastructure and modifications of pipelines; to make provision about reports relating to energy matters; to make provision relating to gas meters and electricity meters and provision relating to electricity safety; to make provision about the security of equipment, software and information relating to nuclear matters; and for connected purposes.: And the same was read the First time; and ordered to be read a Second time on Monday 14 January, and to be printed. Explanatory notes to be printed. [Bill 53].

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Topical Debate

Preventive Health Services

1.26 pm

The Minister of State, Department of Health (Dawn Primarolo): I beg to move,

I welcome the opportunity to debate preventive medical services. We often debate issues involving the national health service and the treatment of ill health, and it is important for us to be able to focus also on the prevention of illness and the promotion of good health.

The NHS has been engaged in preventive health services since its inception in 1948, and some preventive health services even predate its establishment. Wartime posters reminded mothers not to forget babies’ cod liver oil and orange juice to prevent rickets and scurvy, and photographs of child health clinics with lines of children waiting to be vaccinated are emblematic of the early days of a service that is unique in its offer of health care free for all at the point of need, liberating all of us from fears of unaffordable treatment and untreatable illness: comprehensive health care, publicly funded by taxation.

The announcement made on Monday by my right hon. Friend the Prime Minister builds on that tradition by offering health checks where they will improve our ability to predict and prevent certain conditions in the people at greatest risk, including abdominal aortic aneurism in men over 65, which currently kills over 3,000 men a year. The screening programme is expected to halve that number. There will also be a mid-life test to identify vulnerability to vascular diseases that currently affect the lives of 6.2 million people, causing 200,000 deaths a year, and are responsible for a fifth of all hospital admissions. We announced last month that we would make available a vaccine to prevent the human papilloma virus, a major cause of cervical cancer. We have also made it clear that we support the implementation of further screening programmes when the National Screening Committee advises that the evidence base is sound.

Some of the greatest improvements in the health of the population have been secured through preventive programmes. As a result of vaccination, once-dreaded diseases like diphtheria and polio are extremely rare in this country, and smallpox has been eradicated worldwide. Those campaigns have been so successful that we can easily become complacent about their worth. There used to be 500,000 cases of measles in Britain each year, but they can now be measured in hundreds. In other countries, however, measles remains a major childhood killer. We have seen how dependent we are on prevention to keep it at bay in this country when, as a result of vaccine scares, immunisation rates have fallen, leading to needless infections, complications and death.

Mrs. Ann Cryer (Keighley) (Lab): On children and the prevention of illness, will my right hon. Friend comment on the need for advice to be given to some of our communities who practise first-cousin marriages? That has a detrimental effect on any ensuing children in terms of genetically transmitted disorders, which cannot be prevented by vaccination or immunisation.

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Dawn Primarolo: My hon. Friend touches on another important dimension of having a national health service that treats ill health, advises and supports, and ensures that information and evidence is clearly provided to individuals. That is the national health service at its very broadest. My hon. Friend has raised an important issue, but, given the shortness of the debate, my response must be brief. Her comments reveal the broad role of the national health service and its professionals as stewards of good information and advice for all individuals in this country.

Mr. Philip Hollobone (Kettering) (Con): That role is most applicable to tooth decay, which is almost entirely preventable. Does the right hon. Lady share my concern that there are not enough NHS dentists in constituencies such as Kettering? Does she also share my concern about the large number of young children who do not regularly visit an NHS dentist and receive the preventive health advice they need?

Dawn Primarolo: The hon. Gentleman is assiduous in his work in this Chamber, and I congratulate him on how he represents his constituents. I am sure he knows that we have some of the best standards of health care and healthy teeth in Europe, which is in large part due to fluoridation. The Government have invested a huge sum in dentistry, and the profession is expanding. Our training colleges are full, and our dentists are trained to the highest standards. I have no doubt that the hon. Gentleman will continue to make sure that his constituents get the very best of what they need from dentistry.

Mr. Stewart Jackson (Peterborough) (Con) rose—

Norman Lamb (North Norfolk) (LD) rose—

Dawn Primarolo: I shall give way to both hon. Gentlemen, and then I shall try to make some progress.

Mr. Stewart Jackson: I thank the Minister for her generosity in giving way. Among the most significant preventable conditions are the neural tube defects, hydrocephalus and spina bifida. Is the Minister able to advise the House when a decision will finally be taken on the fortification of foodstuffs with folic acid to prevent those distressing conditions?

Dawn Primarolo: The Department has revisited that issue and we are now running a large campaign based on guidance, leaflets and advice to parents on folic acid. Rather than use up time now, I am more than happy to write to the hon. Gentleman detailing those developments, because he is right that it is an important issue.

Norman Lamb: To follow up on the point about NHS dentistry, is the Minister not concerned that the evidence suggests that the system of units of dental activity does not in practice incentivise NHS dentists to offer preventive dental health care to their patients, and also that, almost universally, dentists say that the system must be reformed to incentivise that preventive work?

Dawn Primarolo: As I am sure the hon. Gentleman knows, those are matters of great importance in the negotiations on the dentists’ contract, the terms of
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which are being revisited quite a long time after their inception. Dentistry is moving away from “extraction and fill” to a policy of prevention of tooth decay, but his comments will be looked at closely.

All the points that have already been raised make it clear that while we are, of course, concerned that we should have a national health service that is free at the point of need, treating people with illness, it also has a huge task to prevent ill health and to support individuals to have more control of their health in partnership with their clinicians. The NHS has discharged that role in the past 60 years, but it will need to do more in the coming years to empower people to monitor their own health. Screening programmes play a crucial role in that, such as the revolutionised child health care screening programmes, including hearing tests for new-born children, screening for sickle cell anaemia disorders, and the secured screening for cystic fibrosis, which will avoid lengthy diagnostic delays and minimise frequent hospital admissions for affected children. Those programmes play an important part in ensuring that people are able to stay healthy and fit and have a good quality of life, as well as treating them under the insurance policy that the NHS provides for all of us—the very best treatment when we need it.

Mr. Peter Bone (Wellingborough) (Con): Will the Minister give way?

Dawn Primarolo: I will be happy to do so after I have made a little progress.

Preventive health services are, of course, not the exclusive preserve of the NHS. An increasing range of commercial screening services are advertised, and there must be a degree of caution—the health service certainly has that—in considering the use of such programmes. Any screening service has the potential to harm people as well as to benefit them, because finding illness in a whole population who have no signs of illness is like looking for a needle in a haystack. Often, unnecessary concerns are raised, which can result in treatments that carry a higher risk of complications. Therefore, preventive health services in the NHS are designed to deliver the greatest benefit to both the individual patient and the population as a whole, and to ensure that the outcome of a screening programme is net benefit and not net harm. Those important issues need to be borne in mind. I have a feeling that the hon. Member for Wellingborough (Mr. Bone) wants to raise this matter, so I shall give way to him now.

Mr. Bone: I entirely agree with the Minister about screening being a good idea, but the initial costs must be extraordinarily high. First, the screening must be done, and then the illnesses are found and must be treated. Any screening programme will represent a huge additional cost. Has that been budgeted for?

Dawn Primarolo: If any screening process is recommended—I will discuss this later—consideration will be taken of the risks and the interventions and assessments, as I said a moment ago. Of course, such considerations are made all the time by the national health service in terms of screening and preventive interventions. That is why the outcome must be net benefit and not net harm. We must ensure that screening
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is effective and that it produces the greatest benefit for the health of the population. We must not conduct interventions that just reassure but actually offer no benefit.

Improvements in public health have been achieved by what the Nuffield bioethics report refers to as “quite interventionist public policies”. As we move forward in the 21st century, we cannot rely solely on that approach. No one person or policy will solve the complex issues in our modern-day society, such as childhood obesity or the need to stop binge-drinking and inform people of the associated risks.

Philip Davies (Shipley) (Con): Will the Minister give way?

Mark Pritchard (The Wrekin) (Con): Will the Minister give way?

Dawn Primarolo: I am very short of time and I would like to make some progress. I am sure that the hon. Gentlemen will make their points incredibly powerfully in the debate.

What I have said goes right to the heart of the issue: the balance that must be struck between state responsibility and individual choice—individual empowerment and responsibilities and the provision of services. As my right hon. Friend the Prime Minister said, the future of the health service must be about building partnerships between patients and the NHS, and ensuring that patients are empowered to monitor their own health and to exercise real choice. Crucial factors in that approach will be advice on diet and physical activity. Policy on smoking cessation has been crucial in making serious qualitative strides on high quality interventions to improve the health of the nation.

Philip Davies rose—

Dawn Primarolo: Time is short and I have been very generous in giving way, so I am afraid that the hon. Gentleman will have to speak in the debate.

Primary care has, of course, played a central role in the development and implementation of preventive health services, but the primary care team contains many different professions and expertise, all of which need to be utilised, from the house visitor to the practice nurse and pharmacist. In taking forward strategies to prevent ill health, the health service will need to rise to the challenge of ensuring not only the provision of a personalised service that supports the individual, but the appropriate use of all the skills that exist in our national health services.

Services work best when they are based on evidence and on expert guidance on the benefits to individuals and the whole population. We are fortunate to be guided by the National Screening Committee and the Joint Committee on Vaccination and Immunisation. I would like to take this opportunity to pay tribute to the work that those two committees, and others working in the field of preventive medicine in the NHS, have done.

As the NHS moves towards its 60th birthday, we are seeking to place even greater emphasis on the importance of preventive health services, which save and improve lives. That will be a key feature of the NHS next stage review, which is being led by Lord Darzi and is expected
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to report in the summer. We have much to be proud of from the first 60 years, and we intend to ensure that the next 60 years of the NHS builds on prevention and need, and celebrates everyone’s life and quality of life.

1.42 pm

Mark Simmonds (Boston and Skegness) (Con): No one in this House or this country would deny the importance or significance of preventive health care, nor would they criticise the Government for, at last, shining a light on public and preventive health care. Conservative Members recognise the benefit of prevention and earlier detection, diagnosis and treatment in improving the overall health and well-being of the population, particularly as preventive health services are key to combating health inequalities.

Let us begin by discussing where we agree with the Prime Minister’s statement on Monday. We agree with devolved decision making and with greater emphasis on prevention. We want greater accountability, a more patient-focused NHS and greater individual empowerment, and a larger involvement for the charitable, voluntary and private sectors. We also want extended diagnostics in surgeries and greater access to screening, which all have the potential to save many lives. I am sure that the Minister will acknowledge that Conservative Members have called for all that repeatedly. However, the message delivered by the Prime Minister on Monday is in stark and direct contradiction to this Government’s track record. Over the past decade the NHS has been overseen by the Prime Minister, who has presided over a command-and-control, top-down, centralised and process-driven system, and certainly not over a patient-centred NHS based on outcomes.

The key to preventive health care is public health. Under this Government, our public health service is fragmented and there are few clear lines of accountability. Primary care trusts have no incentive to pay for public health interventions that will be costly in the short term as a result of additional demand. Public health budgets have been raided to bail out deficit-ridden trusts, and it is clear that, especially in London, there is an inverse relationship between socio-economic deprivation and public health expenditure.

Dr. Howard Stoate (Dartford) (Lab): Before the hon. Gentleman extols the virtues of his party on public health and preventive medicine, perhaps he would like to reflect back to the 1990 general practitioners contract, which contained 27 targets for GPs to meet on so-called preventive medicine, not one of which was evidence based and all of which fell quickly into disrepute because they were completely ineffective.

Mark Simmonds: The hon. Gentleman will not be surprised to learn that I do not share his analysis. Let us consider what has happened since 1997. Rates of obesity, sexually transmitted diseases and substance abuse are all increasing, and progress on reducing smoking has stalled. Levels of infectious diseases, such as tuberculosis, are rising in the United Kingdom, and the UK has a higher prevalence of drug misuse than any other European country. That is not a record of which he should be proud.

Philip Davies: I think that we all agree about preventive health, but the thing about this debate that worries me is the talk that we sometimes hear from
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Labour Members about denying treatment to people who happen to smoke or who eat junk food and are overweight. Will my hon. Friend confirm that the next Conservative Government will not deny people any treatment that they need because of their lifestyle choices? If we went down those lines, anyone who got pregnant would not be able to have an abortion on the NHS, because that would have been preventable too.

Mark Simmonds: My hon. Friend makes a good point, and I can confirm from the Dispatch Box that that is not the policy of the party that I represent from the Front Bench, nor, to be fair, do I suspect it to be the policy of the Government.

Urgent action must be taken to prevent a public health crisis. On Monday, the Prime Minister promised everyone in the country a check-up for heart disease, strokes, diabetes and kidney disease. Of course, it is right that such checks are available to those who need them, yet instead of this being the initiative-seizing new start for the Prime Minister, the proposals have been criticised by the very people who are charged with implementing them.

Let us be clear that the Minister was right to mention and congratulate the National Screening Committee, but it has not recommended whole population screening, which was announced by the Government. Instead, it recommends a narrower programme of risk assessment that could include measurement of risk factors such as blood pressure, cholesterol and glucose, alongside assessment of the all-important family history. Will she detail the clinical evidence for such whole population screening, which could divert finite, financial resources away from deprived areas and ethnic communities, where it is vital to reduce health inequalities?

Tony Baldry (Banbury) (Con): Before we get on to the detail, I think that my hon. Friend can help me with the mystery that all this involves. We are debating just one aspect of the speech that the Prime Minister gave on Monday, because the Government have chosen to select just one part of it. What confuses me about that speech is that it contained numerous messages about patient power, concern about a health service that was driven by the needs of providers rather than those of patients and the phrase “empowering patients”. That all sounds hollow in my constituency, where people see NHS services being closed down, taken away and reduced—they do not see how that reconciles with patient power. What does my hon. Friend understand the Prime Minister to mean when he talks about patient power? Does the fact that the only bit of the speech that the Government are focusing on today is a dissertation on preventive medicine mean that all the other things said by the Prime Minister were simply hot air?

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