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2.32 pm
Mr. Andy Reed (Loughborough) (Lab/Co-op): It is a pleasure to follow the hon. Member for Wellingborough (Mr. Bone). I know that he takes preventive health seriously, because we have been in the gym at the same time twice this week, so I congratulate him on the efforts that he makes. I will focus on one small, specific issue to do with preventive health services, so as to allow other Members their full time allocation.
The debate is topical because of the structural changes to Sport England. One might wonder why on earth that was a matter for a topical debate on the health service. The Department for Culture, Media and Sport is rightly making Sport England concentrate on sport. That means that a vast amount of work is being done—work that is increasingly important to all of us who have campaigned on sports and physical activity issues over the past decade. We recognise that the Department of Health, through the PCTs working with agencies such as local government, will be vital to increasing participation in physical activity and sport. That is needed if we are to prevent problems arising from what is probably the most important issue facing the country—the levels of obesity that are likely in future.
The Foresight report demonstrated that by 2050, if no action is taken, or even if current levels of action are maintained, it is likely that up to 65 per cent. of men and 50 per cent. of women will be clinically obese.
That means that 40 per cent. of the national health service budget will be taken up by that issue. If there is a ticking time bomb, it is obesity.
My hon. Friend the Member for Dartford (Dr. Stoate) has been at the forefront of campaigning on the matter for a decade, and I follow. I am glad that he spoke on another topic today. If he had spoken about obesity, he would be the expert on it. We have talked anecdotally about the impact of obesity, but the Foresight report and some of the work that has been done by NICE, which is a well kept secret and does not seem to be in the public domain, has demonstrated that tackling physical activity levels and building in lifestyle changes to deal with obesity is one of the most cost-effective steps that we can take.
I have some figures. NICE works on the basis that it would recommend a drug up to a cost limit of £20,000 per life year. By contrast, the work that it has done on physical activity in the workplace and obesity, and the work that it is doing on physical activity and the environment, indicate a cost of just £1,000 per life year for the introduction of physical activity. So as most speakers have said, prevention is better than cure. If we spend £1,000 now, the likelihood is that we are helping to avoid the prospect of 40 per cent. of the health service budget in 2050 being devoted solely to tackling the problems of obesity.
I am one of those who has been going around saying that obesity will kill the present generation and our life chances will be reduced. We could be the first generation to see a reduction in our life expectancy. Foresight and some of the work carried out by NICE suggest that that is a myth. The reality and the problem is that obesity is an inefficient killer. That is not much consolation. Obesity makes us ill for a long time. It reduces our life chances eventually, but in the meantime we are an enormous burden on the national health service. More importantly for the individual, it is an enormous burden on their lifestyle. We need to make sure that obesity is at the top of the health agenda.
In this crucial period during which the future direction of Sport England is decided, the Department should make it clear that it is willing to work with PCTs in local partnerships including county sports partnerships and local authorities, to encourage physical activity and bring about lifestyle changes. The Department cannot shirk that responsibility.
Now that the importance of school sports is recognised, about 30 per cent. of those leaving school will take part in activities that we recognise as sport—team games and organised sporting activity. About 50 per cent., hopefully, will want to have a fairly active lifestyle and engage in other activities that reduce our chances of becoming obese. But 10 to 20 per cent. will require interventions, and that is where more work is needed—for example, among young girls aged 13 or 14, where there is a significant drop-off in participation rates, among young Asian women, who have cultural issues, and among those with disability and special needs, who are still missing out on sporting activity in schools. Those who are involved in school sport and even the Youth Sport Trust, in discussions this week, recognise that progress has been made elsewhere, but admit that it is lacking for those with disabilities and special needs at school.
Over the coming weeks and months, while Sport England is developing a strategy, it is crucial that the Department of Health offers guidance and support to PCTs to ensure that sport is delivered at a local level. Local partnerships exist already. I chair my own county sports partnerships. We are fortunate that the director of public health in Leicestershire is a triathlete. He is part-funded by the PCT and part-funded by the local authority. That situation represents a win-win, but it does not necessarily replicate itself around the country. In schools a decade ago, if there was a good head who was interested in sports, sport happened at the school. I want to make sure that for sport, there is no postcode lottery.
Some PCTs have demonstrated the good practice of GP referral schemes, physical activity co-ordinators, creating the built environment and workplace activity. We should recognise that people’s lifestyles are changing dramatically, particularly from a sports perspective. By 2010, 65 per cent. of people will be working an atypical working week, so working 9 to 5 or a 3 o’clock kick-off for a football or rugby game will no longer be the norm. Sport, physical activity and recreation must take account of that shift in balance. That is why the workplace will be increasingly important. Governing bodies of sport and others need to try and work out what form sport and physical activity will take in the next 10 to 20 years. It will be very different. Everyone knows how difficult it is after a long day at work to come home and motivate oneself to go back out to do something physical.
We know that 20 per cent. of people will always be keen to do sport and physical activity and another 20 per cent. can be encouraged, but the couch potatoes and others in the middle should not be put off or frightened by the prospect of having to take up a sport or to do something really dramatic such as joining a gym, because we can build a lot of activity into our daily lives. The World Health Organisation target of five times 30 minutes of moderate activity a week needs to be explained to people. We may be at the slightly difficult level of talking about active hoovering, but moderate exercise such as gardening and walking is enough to meet the WHO definition.
We need to ensure that in our social marketing, which will probably be one of the most important things that we do, we sell the idea of building physical activity into our daily lives. I do not envy the Government because I have seen the Parliamentary Office of Science and Technology paper on changing behaviour, which says that that is one of the hardest things to do. The problem is that everyone recognises the need to change their behaviour in order to reduce the potential for obesity, but as with new year resolutions, we may do well until the end of January but come February all resolve goes out of the window. We must change the whole way in which we lead our lives.
I know that my right hon. Friend the Minister met the premier rugby clubs recently who have been working on behalf of the Department on the five-a-day campaign. I visited Saracens rugby club to see its community programme and went to some of the schools with the players. The motivation that results from being told by a leading sports star to eat five portions of fruit or vegetables a day is far greater than
when a politician, someone in a white coat, or even—with all due respect—a doctor says so. I saw the motivation created as a result of the programme being delivered by sportspeople throughout the country, and I would urge that there should be a connection between sport and more moderate levels of physical activity.
This is a topical debate because the next few weeks, or possibly the next couple of months, will be crucial to delivering what most of us in sport have wanted for a decade or so, and that is for the Department for Health to take a real interest in increasing physical activity and changing lifestyles to tackle the obesity time bomb that is heading our way.
2.42 pm
Dr. Richard Taylor (Wyre Forest) (Ind): I thank those hon. Members who have spoken recently for accelerating to give me nearly my full time. I understand that the Minister will also be very generous and has said that she can manage with four minutes. I shall try to give her a little longer, but I am grateful for this opportunity.
I always enjoy following my friend on the Health Committee, the hon. Member for Dartford (Dr. Stoate), the only other doctor. I can cap his years in the NHS by quite some time, and I remember the terrible things that we used to do. We carried around hatpins with red knobs to test visual fields, and the sharp end we used to test for sensation from patient to patient to patient. Can you imagine it? Things have moved on tremendously.
I shall be slightly pedantic and separate prevention from screening, because they are quite different and I do not want us to lose sight of the well-established preventive techniques that are essential because we are rushing to screening, which may not be so evidence-based. I do not need to mention stopping smoking because obviously the effect of not smoking in public places is already showing benefits in the reduction in heart attacks. That is absolutely incredible.
Tackling obesity, as the hon. Member for Loughborough (Mr. Reed) said, is crucial. I am sure the Minister is aware that one of the recommendations in the Health Committee report in 2004 on obesity was that there should be a specific Cabinet public health committee, chaired by the Secretary of State for Health, but bringing together Ministers with responsibility for health, education, sport, transport, trade and industry, environment, food and rural affairs and work and pensions—the whole shooting match. When the Government responded to the report they said that such a Committee had been set up and I should like to know whether it is still active and what it has achieved, because that was important.
I have just one quick point to raise on inoculation. The absolute value of inoculation is dramatically demonstrated when we hear about the greatest cause of death among children on the African continent—it is not HIV, malaria or tuberculosis, but the pneumococcus. We have virtually eradicated that here.
Prevention of sexually transmitted infections is vital. In the Health Committee report on that, we recognised the huge importance of sexual and relationship education, or SRE, at schools and recommended that it should become a core part of the national curriculum.
The Government response, just three months later, stated that SRE was a statutory requirement; I was never clear about whether it had been all the time or we had achieved it. The Government also said that they had asked Ofsted to report specifically on the progress of SRE teaching. Is that being done?
The Parliamentary Office of Science and Technology drew attention to the other alarming thing about HIV/AIDS in its recent note about the condition in the UK. People are less scared of HIV/AIDS than initially because it is now controllable, but the salutary warning is that the fastest increase in HIV/AIDS is happening among men who have sex with men. They are white men, who in the vast majority of cases acquire the disease in this country. The horrifying figure is that about one in 20 men between the ages of 15 and 44 who have sex with men are HIV-positive. The problem is huge; as we rush to screening, we must not forget the well proven bits of health prevention.
I was delighted that the Minister mentioned the National Screening Committee because when I heard the Prime Minister’s comments I wondered whether he had taken that into account. Certainly, aspects of cancer screening and screening for sexually transmitted infections are well established. However, as many hon. Members have said, blanket and not necessarily targeted screening for a wide range of conditions has not yet proved worth while.
I turn to screening for abdominal aortic aneurisms. My search on the website is obviously a few months out of date because I did not know that the National Screening Committee had got to the stage of recommending it. I found its draft studies on the issue and was horrified by the extent of the problem—the number of people who would have to be screened and of staff who would have to be trained to do the screening. After that, there would have to be many people in vascular surgery departments to mend the aneurisms that had gone beyond certain limits. Once an aneurism is above a certain size, it has to be followed regularly, which involves more scans. I would love to know from the Minister that all that has been taken into account.
I shall end by quoting something from that bible for doctors, the Merck manual. It emphasises some of what the Minister has already said:
“The premises of screening are that early detection of disease can improve outcomes in patients with occult disease and that the false-positive results that often occur during screening do not create a burden that exceeds the benefit of early detection.”
“If 12 different tests for 12 different diseases were done, the chance of at least one false-positive result is 46 per cent.! This underscores the need for caution when deciding on a panel of screening tests and interpreting the results.”
2.49 pm
Dawn Primarolo: With the leave of the House, Mr. Deputy Speaker. I am delighted briefly to respond to the debate. I thank all hon. Members for their thoughtful contributions on this subject. I strongly support the remarks by my hon. Friend the Member for Dartford (Dr. Stoate) and others about the excellent work that is going on throughout the national health service and the debt of gratitude that we owe to the dedication of the staff in delivering these services. I am sure that we would all want to reinforce that point.
My hon. Friend the Member for Gateshead, East and Washington, West (Mrs. Hodgson) made an excellent speech in which she made two points. First, she drew attention to health inequalities and the importance of the role of prevention and strategies linked with public health policies to ensure that we reach out to hard-to-reach groups. As my hon. Friend the Member for Loughborough (Mr. Reed) noted in his important contribution, that must go much wider than just the health services themselves. The most important aspect of public health policy is the combination of understanding the risks and the causes and bringing together the public services, the voluntary and community sector and organisations such as Sport England to bear down on the particular issues that we need to address.
My hon. Friend the Member for Gateshead, East and Washington, West is absolutely right as regards her second point on the importance of symptom awareness and early detection leading to treatment. As she and the hon. Member for Wyre Forest (Dr. Taylor) said, screening matters. We must understand clearly the distinction between prevention strategies for ill health and all the various strategies that we can deploy, and use screening when necessary, when proven and when it gives the required outcome, quickly followed by the appropriate treatment.
The hon. Member for North Norfolk (Norman Lamb) talked about human papilloma virus and vaccinations up to the age of 26. We are following the advice that has been given to us by the scientific bodies about where it is best to use such vaccination. This is about prevention, not treatment; that has been a theme throughout the debate. He also made an important point about financial incentives in the health service and how we can ensure that they are not skewed only to ill-health treatment. I assure him that the operating and outcomes framework issued to the national health service this December has many public health objectives within it and seeks to address exactly the point that he raised.
My hon. Friend the Member for Dartford, eloquently using his experience, as ever, talked about the transformation in the health service and the enormous possibilities that exist to intervene speedily in cancers and other areas given early diagnosis and the crucial importance of screening, with a balance across all the fields. I entirely agree with him about pharmacies. They are a great untapped resource which will expand access in the NHS and ensure that we all get the appropriate treatment at the right time, and that we are able to be involved in and control our own health and well-being and to understand much more about the causes of ill health and therefore how we, as individuals, have a role to play in preventing it.
I was sorry to hear the comments of the hon. Member for Wellingborough (Mr. Bone) about wet-eye macular degeneration. He, with others, has been a great advocate in that regard in this House. We are talking specifically about a certain treatment. Although the National Institute for Health and Clinical Excellence has not made a final determination, I have been clear in this House and in correspondence that until that happens the primary care trust should not refuse treatment in this area for any other reason than on a clinical basis—that is the clear guidance given to PCTs. I am happy to consider the matter further and pursue it for him if he will send me the correspondence.
My hon. Friend the Member for Loughborough has been a fantastic advocate in this House in ensuring that people understand the complexities of issues such as obesity and the importance of using all the available opportunities and levers to tackle them and to understand the roles played by the built environment, transport, activity and food, as well as health care. I absolutely agree with him about the fantastic scheme that the Saracens are running, and about the importance of a comprehensive approach. On the question of a partnership, under the operating and outcomes frameworks issued to the NHS we require primary care trusts to work with local authorities, organisations such as Sport England and the voluntary and community sector, through local area agreements, to bring to bear all the policy opportunities to tackle the problem.
I defer to the enormous experience of the hon. Member for Wyre Forest, and to his knowledge of this area. I am glad, however, that he did not have his pin with the red head on him, so that he was not able to stick it into everyone in the Chamber. He is right: we have to be clear about the difference between prevention and screening, and about when it is appropriate to deploy measures relating to either.
This has been an excellent debate and our proposals to expand a preventive health service, linked, crucially, with screening programmes where appropriate, mean that we intend to ensure that, as we look forward to the 60th anniversary of the national health service this year and the celebration of that huge achievement, we go forward with confidence to improve the range and quality of services, both for treatment and—
It being one and a half hours after the commencement of proceedings, the motion lapsed, without Question put, pursuant to Temporary Standing Order (Topical debates).
The Leader of the House of Commons (Ms Harriet Harman): On a point of order, Mr. Deputy Speaker. Earlier, I announced the business of the House for the next two weeks. I overlooked to announce the business that will take place in Westminster Hall. I sincerely apologise to the Leader of the House— [ Interruption. ] I am sorry; I apologise to the shadow Leader of the House for the fact that she has had to return to the Chamber unexpectedly.
I would like to inform the House that the business in Westminster Hall for 17 and 24 January will be:
Thursday 17 January—A debate on extending participation in sport.
Thursday 24 January—A debate on the report from the Foreign Affairs Committee on “Global Security: The Middle East”.
Mrs. Theresa May (Maidenhead) (Con): Further to that point of order, Mr. Deputy Speaker. In relation to matters raised at business questions today, I wonder whether I might seek your guidance as to how I can ensure that the record is put straight. There was an exchange at business questions about—
Mr. Deputy Speaker (Sir Michael Lord): Order. I do not want to interrupt the right hon. Lady too soon, but all she can comment on is the matter that has been raised by the change of business.
Mrs. May: This is a separate point of order.
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