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Mark Simmonds:
My hon. Friend makes a very good point, which touches on the issue that I was trying to emphasise at the beginning of my remarks—one must look carefully at what this Government do, not what they say. Their record on the health service since they came to power in 1997 has been very much about central control and disempowering patients and those
who use the NHS, rather than about empowering both individuals and groups. Conservatives want such empowerment to be a central part of the development of the NHS when we form the Government, as we hope to do after the next general election.
I want to make some additional points about what the Prime Minister said on Monday. There is no timetable for delivery of the screening. He said that it would occur at some point between April 2008 and 2011, but could not say at what point in the spending round the money would become available.
The House will also not be surprised to learn that some of the announcements made on Monday were not new. Conservatives have been calling for “triple A” screening for years, and the Government have promised to roll it out for at least a year. In the White Paper of January 2006, they recommended something called “life check”, which was supposed to include a mid-life health check, including checks on weight, blood pressure and cholesterol. That is remarkably similar to what was in Monday’s announcements.
Furthermore, no consultation on those proposals has taken place. Neither the National Screening Committee nor the British Medical Association were consulted on the screening plans. It is beyond belief that the Prime Minister did not consult the very groups set up to provide him with expert advice on screening, nor the doctors expected to implement those policies.
Mr. Stewart Jackson: Does my hon. Friend agree that the Prime Minister has form in that area? Last September, he told the Labour party conference that every hospital in the country would be deep cleaned. Figures recently released show that a tiny minority of hospitals and trusts have been deep cleaned, and many have no plans for a deep clean in place with their strategic health authorities.
Mark Simmonds: My hon. Friend is right to make that point, although that is not the specific area of debate for today. He is right to re-emphasise the point that, with this Government, one has to look carefully at their actions, not at what they say.
Not only have there been the criticisms that I have highlighted, but it is peculiar that the Prime Minister is announcing policy at the same time as a detailed policy review is being conducted by Lord Darzi. I suspect that it is because the Prime Minister is being reactive, rather that proactive.
Mr. Quentin Davies (Grantham and Stamford) (Lab): The hon. Gentleman spoke with approval a moment ago about those who criticise whole population screening and prefer selective screening based on risk-factor selection. Does that mean that under a future Conservative Government, if people want to be screened but have not been selected by the bureaucracy on the basis of some risk factor, their only hope is to go to the private sector and pay?
Mark Simmonds:
That is not exactly what I said. The health service needs to take into account the clinical evidence base that supports the recommendations from the professionals. The Government need to look carefully at what the National Screening Committee recommends, which is not whole population screening.
I understand that the Department of Health is starting to resile from what the Prime Minister said on Monday. I shall set out what we intend to do later in my remarks.
Not only have there been criticisms, but there are significant and glaring omissions. I just wish to give two brief, but representative, examples. First, despite what the Minister of State, Department of Health, the hon. Member for Exeter (Mr. Bradshaw), said inaccurately on “Newsnight” earlier in the week, pharmacists were not mentioned at all in the Prime Minister’s speech, despite their vital importance and the potentially significant contribution that they can make to preventive health care. The Government claimed that the new contract would lead to exactly these types of checks in the community, but only 1 per cent. of pharmacies have been commissioned by PCTs to do that screening.
We also critically require primary prevention to improve nutrition. The estimated overall cost to the NHS of failing to treat under-nutrition is £7.3 billion per year, but measures to alleviate this burden were not announced in the Prime Minister’s speech on preventive health care. Recent figures detail that the number of patients being admitted to hospital in an undernourished state has increased by a staggering 85 per cent. since 1997, to more than 130,000 last year. Failing to prevent under-nutrition in patients leads to longer hospital stays, delayed recovery, an increased risk of contracting health care-associated infections, and poor respiratory function. In some studies, undernourished patients are estimated to have a mortality rate up to eight times higher than well-nourished patients.
The Opposition believe that policies on such important issues as preventive health must be carefully and fully considered and appropriately resourced. We have consulted widely and made a number of proposals in that vital area of health policy.
We have pledged an independent ring-fenced budget for public health, allocated through a new public health structure, overseen by local directors of public health jointly appointed by PCTs and local authorities. We want to see a strengthened chief medical officer’s department, made more independent of Ministers. We will use the public health budget to enhance significantly the impact of health awareness campaigns, both for primary prevention, to convey an understanding of the impact of lifestyle especially on cancer risk, and for secondary prevention, promoting awareness of symptoms and encouraging early presentation. We would make greater use of the skills and expertise of health care professionals, such as pharmacists, who are close to their communities and well placed to provide information about medical conditions, lifestyle choices and medicine management.
Sadly, we have seen no such policy rigour from the Government, and the Prime Minister’s recent announcements have left health care professionals and patients confused over exactly what services will be provided, where the resources are coming from, and when the checks will begin.
I have a few brief questions for the Minister and I hope that she will respond when she winds up. Will the Minister confirm that it is the Government’s intention to fund fully any future recommendation from the National Screening Committee? Where are the resources coming from to fund the triple A announcement, which was first made in June 2004? What is the difference
between the “life check” announced in January 2006 and what the Prime Minister announced on Monday? The Prime Minister said that everyone had the right to these check-ups
“when you want and need them, and where you need them.”
Is it the Government’s intention to apply that to screening and, if so, where is the clinical evidence and analysis of the importance of risk profiling? How can this be reconciled with the advice from the National Screening Committee, which does not recommend whole population screening? Could the Minister clarify whether the Prime Minister is really promising screening for everyone at any time?
The NHS is one of the country’s greatest assets, and the Conservative party’s No. 1 priority. Under a future Conservative Government, the NHS will have a greater patient focus; it will be based on outcomes, not centrally driven targets; it will be properly resourced; it will be free at the point of delivery; and, most importantly, it will focus on the key to our long-term health—better public and better preventive health care.
Madam Deputy Speaker (Sylvia Heal): Order. I remind all hon. Members that Mr. Speaker has imposed a 10-minute limit on Back Bench speeches.
1.56 pm
Mrs. Sharon Hodgson (Gateshead, East and Washington, West) (Lab): It is a pleasure to be able to speak in this debate on the subject of a more preventive health service. I apologise for my croaky voice, but I have a bit of a cold. Perhaps if I took more preventive health care decisions, I might not be suffering as I am today. [ Laughter. ] The topic is a worthy one and, of course, we would not have been discussing it without the new time made available for topical debates, which I warmly welcome.
I have lost track of the number of conversations I have had in my time as a Member of this House with health care professionals and constituents that have stressed the importance of taking a more preventive approach to health care in this country. I am sure that other hon. Members are no strangers to that topic either. The speech given by the Prime Minister earlier this week should be welcomed on both sides of the House as a step towards creating an NHS that is seen to be adapting to the new challenges and opportunities of the 21st century.
There has been an increasing focus in recent years on the impact of our lifestyles on our health. Lifestyle choices and the plethora of products available to support them are no longer a niche conversation or a niche market. The continued emergence of research that identifies risk factors associated with different diseases cannot be ignored. That is why a new focus on preventive health care is so timely. We now have the information available to support health professionals in seeking both to educate and protect our constituents. I am sure that I will not be the first or last Member today to utter the words “prevention is better than cure”, so I will get that one out of the way.
I would like to discuss briefly three aspects to the approach. It is necessary to raise the importance of both awareness and screening in increasing prevention
of cancer and other killer diseases, and I would also like to ensure that Ministers are reminded of the continuing need to address health inequalities in the north-east. I would hope that long-term thinking and preventive health care will be able to make real inroads into health problems in Gateshead and Washington, and I will return to that issue.
The recent cancer reform strategy made clear the need for greater attention to be paid to raising awareness of rarer cancer symptoms and also began to set out improvements in screening that will continue to save lives throughout the country. If we are to see more preventive health care, we need better education of symptom awareness. Ovarian cancer is the fourth most common cancer in women, but all too often symptoms go unnoticed by GPs and patients alike. England and the UK were recently revealed to have among the lowest ovarian cancer survival rates in Europe, with just over 30 per cent. of women surviving for five years. The figure has not changed significantly in more than 20 years. Most women—75 per cent.—are diagnosed once the cancer has spread significantly, making successful treatment difficult. If our rates could match the best in Europe, an extra 800 women a year would survive beyond five years.
I welcome Professor Mike Richards’s statement that ovarian cancer will be included in the early awareness initiative that was announced as part of the cancer reform strategy. I welcome the active steps that are already being taken on better prevention through symptom awareness. The ongoing “TLC” campaign that encourages woman to “touch, look and check” their breasts for any signs of change also does valuable work in raising awareness of the risks of breast cancer. It is vital that Ministers continue to work with campaigners such as Breakthrough Breast Cancer to achieve the results that we all wish to see.
Alongside working to increase awareness, it is vital that access to screening continues to improve for those most at risk of developing cancers and other deadly diseases. I have been in touch with Cancer Research UK about that, because I know it takes screening seriously. The launch of the parliamentary phase of the “Screening Matters” campaign will be co-ordinated in partnership with other charities including Jo’s Trust and the Breast Cancer Campaign. The message is incredibly simple: screening matters because it saves lives. Hon. Members will have an important role in spreading the word and I encourage them to attend the launch event, which will be held in the House during February.
Breast cancer screening is estimated to save 1,400 lives a year. Bowel cancer screening for those at risk is also playing a role in detecting cancer early and increasing the chance of survival. The message that I continue to hear from organisations such as Bowel Cancer UK is that the steps being taken by the Government are hugely ambitious. Labour Members should share a sense of pride at having helped to support those changes.
The Prime Minister’s announcement of a new vascular screening programme has been warmly welcomed by many, including health charities such as HEART UK, the Primary Care Cardiovascular Society, the National Obesity Forum and the British Heart Foundation. However,
we must ensure that that ambitious programme is properly supported. We need to stick to well-founded examples of best practice, such as those established for vascular screening. We will not succeed unless we have appropriate treatments and expertise available for those who are identified through screening as suffering from a potentially terminal illness.
There is huge potential in the increased screening programme and it will make a real difference for many in my constituency. The introduction of the smoking ban, the success of the “five a day” campaign and improvements in the quality of school meals all add up to show the Government’s strong and continuing commitment to public health in Britain. We now have more than 32,000 more doctors and 85,000 more nurses. Waiting times for operations are shorter than ever and screening projects are becoming more and more effective.
I do not believe that we would have seen anything like the same degree of financial support or policy commitment under a Conservative Government. All the local authorities in Tyne and Wear are in the top two fifths of the most deprived areas of the UK. Gateshead and Sunderland, which cover my constituency, are both in the top fifth. I know from talking to staff at Gateshead Queen Elizabeth hospital and at Sunderland royal hospital that they are doing all they can to address the health inequalities that affect my constituency so badly.
Those inequalities are prevalent despite the excellent care that my constituents receive at those hospitals and across the wider north-east from skilled and dedicated staff. In the Sunderland metropolitan area, life expectancy is 18 months below the national average. Death rates from smoking, heart disease, strokes and cancer are all above the national average. The mortality rate for cancer is 136 per 100,000 compared with a national average of 119. Almost a third of children are dependent on means-tested benefits. That can be compared with a wealthy London Borough such as Kensington and Chelsea, where the cancer mortality rate is only 81 per 100,000.
In Gateshead, life expectancy is almost two years below the national average. Again, deaths from smoking, heart disease, strokes and cancer are all above the national average. In fact, mortality rates for heart disease and strokes are at 110 per 100,000 compared with a national average of 90. The statistics create a compelling argument that cannot be ignored. It is a common-sense recognition that the more we can prevent killer diseases through medical progress and lifestyle change, the more savings we can make on health budgets.
Progress will be achieved only if primary care trusts and social care services work closely together to educate the public. Therefore, it is even more vital that we do not push the two services into a battle for funding so that gains for one only lead to losses for the other. That is why I am delighted about the recent provisional funding announcement, which will go some way to ending the problems that have been caused by the double damping of funding.
In constituencies such as mine, health services need extra support to tackle ingrained public health problems. Many of us know the old sayings such as “an apple a day” and “go to work on an egg”, but in the current environment there is a risk that such simple messages can get lost in the myriad information and warnings about the impact of our chosen lifestyles.
I hope that ministers will acknowledge the issues facing constituencies such as mine in the north-east and will endeavour to address them as a priority when moving towards more preventive health care.
2.5 pm
Norman Lamb (North Norfolk) (LD): It is pleasure to follow the hon. Member for Gateshead, East and Washington, West (Mrs. Hodgson). I immediately had a sense of affinity with her when she made her comments about her rough throat. I failed to take the preventive measure of a flu jab for the first time in 10 years, and the result was a miserable Christmas. I have a great deal of sympathy for her.
The debate concerns an issue for which there is no doubt universal support. No one objects to or resists the idea of preventive health care. It is in every citizen’s interest that the NHS should focus on that. It is also in the NHS’s interest. As Derek Wanless said when he advised the Government on NHS funding, unless we help people to care better for themselves, we will bankrupt the NHS; it is simply unsustainable.
The real debate is about whether the Government have delivered on preventive health measures and are likely to do so in future, as well as about the real meaning of the Prime Minister’s speech on Monday. Like the Conservative spokesman, I was left with a degree of suspicion. It seems extraordinary that the announcement could have been made without discussion with the National Screening Committee or the involvement of clinicians or the British Medical Association. One is inevitably left with the sense that it is part of the big political battle over health and the Prime Minister’s determination to recover lost ground on the health service.
In a spirit of new year generosity, I will acknowledge that the Government have made some progress. For example, QOF—the quality and outcomes framework—introduced the idea of incentives to encourage primary care to engage in preventive measures. As the hon. Member for Gateshead, East and Washington, West said, the screening programmes for breast cancer and bowel cancer have made progress. That should be acknowledged. I absolutely support the introduction of ultrasound screening for triple A, or abdominal aortic aneurysm, provided that it happens and is properly funded. As we have heard, the announcement was originally made some time ago and we are still waiting.
The decision on vaccinations against cervical cancer was also absolutely right, and it will save lives. The debate is now about whether the programme can and should be extended to cover older age groups within the licence. It is licensed for those up to the age of 26, and yet women in the older age bracket will not get vaccinations under the programme. Will the Minister undertake to look into that?
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