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The Parliamentary Under-Secretary of State for Health (Mr. Ivan Lewis): I congratulate my hon. Friend the Member for Bolton, South-East (Dr. Iddon) on speaking in such a reflective and sensible way. He has highlighted an issue that frankly needs far more oxygen in order to have an impact on many families and individuals. I also congratulate my hon. Friend the Member for Derby, North (Mr. Laxton) on securing the debate and on his work as chairman of the all-party group on hepatology over a significant period.
It is always good to see my hon. Friend the Member for Norwich, North (Dr. Gibson). He has unique expertise on many of the issues that he brings to the House, particularly from a scientific point of view. The notion of needing to move the health service from a sickness system to a well-being system is at the heart of our vision for a world-class health service. It has been mentioned by the Prime Minister, the Secretary of State and Lord Darzi. When we publish the next stage review and the NHS constitution, we need to move from the rhetoric of moving from sickness to well-being and make it a reality. That must happen not only through our national policies but through the decisions, particularly commissioning decisions, made in every local health economy in every part of the country.
My hon. Friend the Member for Bolton, South-East referred to David Fielding. It is appropriate to remember that these issues involve human beingswe are talking about peoples families and their life expectancyand it is important that we hear stories of hope such as that of David Fielding. Many listening to our debate may be extremely anxious about their future because they have HCV, so it was important to hear about the David Fielding case. It was also right to pay tribute to the courage of the late Anita Roddick. HCV carries a significant stigma, and the fact that a prominent and successful member of society was willing to talk about it was itself a significant contribution. Her familys ongoing commitment to help with the issue is greatly appreciated.
The hon. Member for Romsey (Sandra Gidley) made a sensible contribution. She spoke about the Governments commitment, and that of international institutions, to the notion of a world hepatitis day. If such a proposal comes before a future world health assembly, we will consider it. I raise only a slight caution; I think that all hon. Members are aware of it. With so many days and weeks now focusing on a variety of specific issues, the danger is that the notion will become devalued. We need to think carefully about the idea, but in principle I think that it makes some sense.
The hon. Member for Hemel Hempstead (Mike Penning) made a non-party political, helpful and constructive contribution to the debate. I hope that he does not mind my saying so, but I wonder about the parenting skills involved in lecturing ones daughter about her behaviour during a Westminster Hall debate. None the less, the hon. Gentleman made a serious point about teenagers.
The hon. Member for Romsey and others spoke about childrens and young peoples perception of the dangers and risk of alcohol. Although we have concerns about drug abuseby no means have we won the argument over the danger of drugs; we still have a long way to goit is almost as if alcohol abuse is fashionable, has cachet, is trendy and is the norm for young people. We have failed to get across the message that if young people drink to excess it could have extremely serious consequences. It could affect their aspirations and the rest of their lives.
The hon. Member for Hemel Hempstead talked of scaring people. That has its place, but there needs to be a connection between explaining to young people why certain behaviour can have a detrimental effect and them seeing it as being relevant to their everyday lives and their future. The way in which we communicate those messages is crucial. If we are seen as a group of bland politicians lecturing the general public about what is in their best interests, we will not necessarily change behaviour. It is incredibly important for the Government to provide leadership on public health and health education, but the way in which we communicate the message has to be sophisticated and based on evidence of what works, and it has to be segmented to reach the different groups.
Mike Penning: I completely agree with the Minister that a bunch of bland politicians is not the answer. The best answer is the sort of support that was given to the all-party group when it first started by people such as George Best. He was a role model and a facesomeone that the kids could relate to. Some footballers may be bad role models, but some are good role models and we need to use the good ones to drive this forward.
Mr. Lewis: I agree with the hon. Gentleman. However, we must be careful not to glamorise the issue. We have to be careful when picking role models and celebrities. The late George Best was an important figure, who demonstrated the relationship between his excess drinking and the consequences for his health, and there are others in that position. However, it is important to think carefully about health education and health promotion. We recognise that sending the same messages to different groups does not work. We need to take a sophisticated and segmented approach. I do not speak only of the Government; it is also about society, parents and schools. We have not persuaded a significant number of children and young people that excess alcohol can have a direct impact on their health and life chances. We should therefore seek some consensus on how to tackle these issues more effectively.
Mr. Lewis: It is probably outside my portfolio to say so, but never mind. Adults who collude with young people who drink inappropriately should face serious consequences, whether they run off-licences or similar businesses or whether they are older brothers and sistersor even worse, parentswho sometimes allow children and young people to drink excessively. I have heard of parents of 13, 14 and 15-year-old young people hosting celebrations and parties within the family home, who preside over situations in which it is acceptable for children and young people to drink excessively. The argument is that they are doing so in a protected environment, but what sort of message does it send out? We all have a responsibility for the messages being sent to our children and young people. Equally, our long history of lecturing and hectoring young people is failing. We have to reflect on the most effective ways of getting the message across.
I come now to the substance of the debate. The Government recognise the importance of liver disease as a public health issue, and the need to ensure that we have appropriate services in place to prevent, diagnose and treat its various forms. As we heard, liver disease is the fifth most common cause of death in this country, for both men and women. It is the only one of the big killers for which the mortality rate is steadily rising. The United Kingdom is the only major developed nation with an upward trend in mortality and we need to understand why.
In principle, as my hon. Friend the Member for Bolton, South-East said, liver disease is almost entirely preventable. The Government are concerned about the increasing incidence of and mortality from liver disease. A substantial programme of work is already ongoing to
tackle liver disease and its main causes, which have been spoken about at length. They are alcohol, viral hepatitis, and obesity. In addition, as my hon. Friend is aware, we are considering the development of a specific programme of work on liver disease to cover health promotion as well as the full range of health services. To inform those decisions, officials have undertaken preliminary work on a range of things, including commissioning a rapid critical review of existing evidence on liver disease epidemiology, treatment and services; asking an ad-hoc group of experts chaired by Professor Ian Gilmore of the Royal College of Physicians to produce an overview report of clinical issues; and holding a series of informal meetings with key stakeholder individuals and groups.
That preliminary work culminated in a one-day workshop last week that was attended by health service commissioners, clinicians and representatives of patient organisations. The participants were asked to identify and prioritise areas for future action. It will be no surprise to my hon. Friends that the top suggestion was for an action plan or national strategy for liver diseaseall contributors to the debate mentioned that.
Dr. Gibson: Does my hon. Friend agree that liver disease as a cancer is part of the reformed cancer strategy? It is sometimes described as a rarer cancer, but, nevertheless, prevention is part of the reformed strategy. It should be inclusive and there should be joined-up thinking about the causes that lead eventually to cancer.
Mr. Lewis: I agree entirely with my hon. Friend. The cancer strategy would be less than effective if we did not recognise the direct links between the two. If we develop a national liver disease strategy, a relationship between those two things would be essential.
We must also consider how such a strategy will fit with the next stage review, which we are working on, and how we can ensure better commissioning generally, throughout the country, of liver services. We are considering those things and will say more about what we intend to do in the near future.
I should like to clarify something that the hon. Member for Romsey said on the national plan for liver disease, because there is clearly some confusion. The 2004 national plan for liver disease was produced by the British Liver Trust and the British Association for the Study of the Liver. It is an important documentit is informing our consideration of a national strategy for liver diseasebut it is not a Government or Department of Health document, so we have certainly not updated it, nor are we aware that anybody else has done so.
That clarification is important because I would have shared her concerns had the situation turned out to be as she described. We should be clear on where the plan originated and why it is impossible for the Department to update a plan that is not ours. She may need to speak to her colleagues to find out what specifically they were referring to.
Mr. Lewis: I would be happy to write to the hon. Lady and other hon. Members, but I suspect that the appearance of the plan on the website does not necessarily mean that it was a Department or Government production. I shall seek clarification on the matter.
It is essential that we keep the all-party group informed of our intentions. My ministerial colleagues have a commitment to meet directly with my hon. Friend the Member for Derby, North in the near future, and he will be welcome to bring his colleagues with him to debate the matter.
More generally, we are concerned about the increasing incidence of, and mortality from, alcohol-related liver disease, and we are committed to tackling the problem. Identifying harmful drinkers as early as possible will help to avoid the serious damage that harmful drinking has on the health of the individual. Drinking also has a major impact on the wider community and society. We are all concerned about antisocial behaviour, which is increasingly fuelled by alcohol abuse, in our local communities.
The Department of Health launched only this week a much-expanded, £10 million sustained public health and education campaign to raise general awareness of units and the health risks of drunkenness. There will also be more help for those who want to drink less. A £3.2 million investment will establish a series of intervention and brief advice trailblazer projects in health and criminal justice settings. Those projects will identify people who drink at harmful or potentially harmful levels and offer them help and advice. As we know, there is a direct relationship between people who end up in the criminal justice system and alcohol abuse.
The Government are also investing £650,000 in training which could, within 10 years, produce 60,000 new doctors trained to identify and advise or treat people who are drinking too much. Independent reviews into evidence of the relationship between the pricing and promotion of alcohol and harm, and unit labelling, including advice to women on alcohol and pregnancy, are under way. The reviews will form the basis of a public consultation later in the year and may require legislation in future.
Concern about the number of alcohol-related hospital admissions and the rising trend led the Department to put in place a new national vital signs indicator for the NHS from April to measure change in the rate of alcohol-related hospital admissions. That is the first national commitment to monitor how well the NHS is tackling alcohol-related health harm.
On viral hepatitis, hepatitis B and C are relatively uncommon in this country, with fewer than 0.5 per cent. of the general population being chronically infected with either. We are far below the global prevalence rate for hepatitis B or C of one in 12, as quoted by the World Hepatitis Alliance. That said, we cannot be complacent. The absolute numbers are significant and there are effective ways in which to prevent infection and treat those infected to prevent serious liver disease, as my hon. Friend the Member for Norwich, North pointed out.
In recognition of that, a comprehensive range of measures is in place to prevent and control hepatitis B and C infections, including screening of blood donations and viral inactivation of blood products; immunisation against hepatitis B for groups at increased risk of infection;
antenatal screening for hepatitis B; services to prevent the spread of sexually transmitted infections; harm reduction services for injecting drug users, including needle and syringe exchanges; and drug treatments for chronic hepatitis B and C infection, as recommended by the National Institute for Health and Clinical Excellence.
The hon. Member for Hemel Hempstead referred to immunisation. An expert committeethe joint committee on vaccination and immunisationis reviewing the hepatitis B immunisation programme to see whether it ought to be altered. Advice on that is expected later this year. He also referred to the problem of obesity. We have a constant struggle to educate and raise awareness among parents and young people on the impact of obesity. We need to look at how to get our message across more effectively than we have been able to do thus far.
Those are some of the new challenges facing the health service. In 60 years of the NHS, we have never been able to stay still because there are new and constant challenges. How can we spot difficulties before they explode and spiral out of control? The fact that we began focusing on obesity from a significant public policy point of view only recently begs some questions of our capacity to anticipate diseases, conditions and challenges far earlier than we do. Intervention and prevention at an earlier stage would be a far more effective way in which to tackle the problems than dealing with them once they become epidemics.
We recognise the importance of liver disease as a major public health issue and we have a range of measures in place to tackle it. However, we are concerned about the increasing incidence of, and mortality from, liver disease. Therefore, we are considering the need for an acceleration of our approach to the issue and the creation of a national strategy. It is difficult if every time we have a problem we reach for a national strategy rather than local solutions. However, the issue is so serious that there is a strong case to be made for a national strategy that influences commissioning and provision decisions at local level.
Margaret Moran (Luton, South) (Lab): I am here to talk about the NATS proposals and plans for the airspace over Luton. It is a supreme irony that we are discussing the proposals just after an announcement by the Department for Environment, Food and Rural Affairs, relayed on our local radio, about noise maps for Luton. The noise maps form part of the national ambient noise strategy, which has an EU basis and whose purpose is to consider ways to manage noise issues and effects, including road, rail and air traffic noise, and to make noise reduction proposals as necessary. That is some timing: my constituents are being asked how their lives could be made more tranquil when we are in the middle of the biggestand, I hope, the noisiestrow about noise and environmental impact that Luton has ever seen.
NATS proposes to change the flight paths over my constituency and swathes of Bedfordshire and Hertfordshire. According to NATSs own estimate, the number of households adversely affected will increase by 111 per cent. under the plans. Let me make it clear that we are not discussing proposals from London Luton airport. I support the airport: it is our major employer, and it brings direct and indirect economic benefits to our town and the region. Like the rest of us, the airport authorities are consultees to the plans. I hope that as good neighbours, they, like my constituents and many colleagues and fellow MPs, will reject the plans. To do otherwise would alienate the local community, which broadly supports the airport, and scupper any good will for growth.
The NATS plans came as a surprise to many. Looking at the proposals, many of my constituents asked how NATS could possibly be mandated to create a detrimental environmental impact on Luton and the surrounding areas. NATSs stated objective is airspace safety, but it also has a requirement to minimise impact on residential areas. NATS itself says:
NATS has aimed to position routes to minimise the noise experienced by people and in particular to avoid centring routes over more densely populated areas.
An innocent reading of the NATS leaflet on the Chilterns and Luton suggests that the good folk of my constituency and the surrounding areas will sleep soundly in their beds, in more ways than one. Many in Luton have not been able to lay hands on that leaflet, but it says that the noise preferential routes for Luton
would be changed to minimise the population overflown, reduce future delay
Many of my constituents feel that we have been duped and dumped on, and we demand an alternative. We have been duped because the press releases and leaflets that NATS has issued have been wholly misleading about the impact on my constituents. When NATS launched the proposals in February, it claimed that the new routes would reduce the number of people overflown by 20 per cent. That is not the case. The real impact is a massive shift of aircraft noise from some areas to Luton and the surrounding areas.
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