Clause
131
Indemnity
schemes in connection with provision of health
services
Anne
Milton:
I beg to move amendment No. 68, in
clause 131, page 86, line 33, at
end add—
‘(11) A scheme
established under subsection (1) may only make provision to meet
expenses or liability to bodies or other persons as specified in
subsection (2) insofar as the expenses or liability arise from the
provision of publicly funded healthcare.’.
The clinical negligence scheme
for NHS trusts indemnifies members against losses and liabilities that
arise out of negligence occurring in NHS care. It is currently only
available to specific NHS bodies, under section 71 of the NHS Redress
Act 2006. When the schemes were first established, most NHS care was
provided directly by NHS bodies, but in recent years, non-NHS bodies
have started to deliver a considerable amount of NHS care. The
Secretary of State also procures some NHS services
directly.
There
has been considerable expansion in the use of private providers. We
have seen them in the independent sector treatment centres, about which
there has been some controversy, not only about the placing of the
treatment centres and the possibility of them undermining the local NHS
structures and trusts, but about them cherry-picking what are presumed
to be the easier cases and leaving the NHS with a bill to pick up for
the more complex ones.
There have also been issues
about independent sector treatment centres, because when it all goes
wrong, local NHS trusts pick up the bill. If ISTCs have been using, as
many of them have, a lot of doctors from places such as South Africa,
patients can be transferred in emergency circumstances into the care of
perhaps the local orthopaedic surgeon who has not previously been
involved with their care.
I am aware
that the Government are keen to increase private provision. I gather
that there has been some delay in the second wave of ISTCs, but the
Government were aiming for a target of 9 per cent. of all NHS care
delivered by private providers. We are now looking at an expanding
mixed economy of provision in the NHS. We have talked about pharmacies
delivering some care and undertaking some diagnostics. The amendment
would cover the liabilities that relate to people who are treated in
those private sector
organisations.
Amendment
No. 68 would prevent loopholes in the Bill, whereby expenses or
liability might arise from the provision of non-publicly funded health
care. I have been lobbied on the issue by, among others, Action against
Medical Accidents. I quote from what I think was a submission by the
organisation to the Minister that welcomes the move but
believes
“that the
provision of the Bill at the moment is seriously flawed in that it
makes this arrangement voluntary on the part of the
provider.”
The concern is
that if the arrangement is not compulsory, private providers will not
necessarily make it and that therefore leaves
the
“NHS patient who
suffers negligent harm from a private
provider”
without access
to
“the same system of
redress as an NHS patient harmed in an NHS trust.”
That is becoming increasingly
important.
I do not
have a problem with who provides the health care—whether a
voluntary, charitable, publicly funded or private body does
so—but what matters to me is that patients get the best care
that they need as and when they need it. However, we are still using
public money, so we must ensure that if the state—the
Government, the PCTs— commissions care from the private sector
the same safeguards are in place to protect and indemnify patients when
things go wrong.
Kelvin
Hopkins:
I do not expect a response from my hon. Friend
the Minister, but some Labour Members do not want to see the private
sector inside the public health service. I am sure that my hon. Friend
is aware of my views, but I want to make sure that they are on record
as not agreeing with private provision inside the national health
service. The service should be publicly provided, and I shall continue
to campaign on that
basis.
Mr.
Bradshaw:
I am sure that you would not welcome it,
Mr. Conway, if the debate were widened into a general debate
on the merits or otherwise of involving the voluntary and independent
sectors in providing health care. I take the point that my hon. Friend
made.
I have sympathy
with the hon. Lady’s amendment, but I will explain why it is
unnecessary. Subsection (1)(b) of section 71 of the 2006 Act limits
schemes to covering liabilities that arise out of carrying out the
functions of the member body. Under clause 131 (4) and (7), the
liabilities of the Secretary of State and non-NHS members will be
limited to those that relate specifically to their functions of
providing health services under the 2006 Act. Under our proposal,
schemes are limited to covering liabilities that relate to the
provision of publicly funded NHS health care with regard to those
members. However, the schemes cover not only such liabilities, but the
functions of health service bodies and expenses that arise from the
loss or damage to property that is not directly related to the
provision of publicly funded health care. An example would be malicious
damage to NHS property.
The amendment would prevent the
existing schemes from providing cover to the NHS for such expenses and
liabilities. I am sure that that is not the hon. Lady’s
intention, but it would be an undesirable outcome. In response to her
question about compulsory or voluntary participation, we cannot make
participation compulsory, because we cannot compel foundation trusts,
but in the contract with the independent provider, we can and will
require liability—we cannot specify, but the scheme will be much
cheaper for them.
2
pm
Anne
Milton:
That was very fast, and I did not entirely follow
the Minister. Will he confirm that the same cover will be available for
patients regardless of whether they are treated in NHS or in private
provider settings?
Mr.
Bradshaw:
There will still be liability, yes. We cannot
force providers to take part in the scheme, but I suspect that they
will, because it will be cheaper for them.
Anne
Milton:
I shall withdraw the amendment, although I am
slightly hesitant. The Minister presented some very technical details,
which I am in no position to question, although I am sure that his
advisers know exactly what they are talking about. I would not want to
undermine any current situation, but I put on record a slight caution
about such people being treated with public money, because of the
concern about whether
they will get the same cover. However, I beg to ask leave to withdraw
the amendment.
Amendment, by leave,
withdrawn.
Clause 131 ordered to stand
part of the Bill.
The
Chairman:
I remind the Committee that, although we can
consider the Bill until 7 o’clock tonight, the House may divide
up to seven times at 5 pm, which will cut into a hour and 20
minutes of that time allocation. I am sure that hon. Members will bear
that in mind when they seek to make their
contributions.
Clause
132
Weighing
and measuring of children:
england
Sandra
Gidley:
I beg to move amendment No. 168, in
clause 132, page 86, line 41, after
‘the’, insert
‘annual’.
The
Chairman:
With this it will be convenient to discuss the
following amendments: No. 169, in
clause 132, page 86, line 41, leave
out ‘junior’ and insert
‘primary’.
No.
170, in
clause 132, page 87, line 3, after
‘the’, insert
‘annual’.
No.
171, in
clause 132, page 87, line 3, leave
out ‘junior’ and insert
‘primary’.
No.
176, in
clause 132, page 87, line 32, at
end insert—
‘(1A)
Information authorised in accordance with sub-paragraph (1)(c) shall
include information relating to a child’s body mass
index.’.
No.
172, in
clause 133, page 88, line 7, after
‘the’, insert
‘annual’.
No.
173, in
clause 133, page 88, line 7, leave
out ‘junior’ and insert
‘primary’.
No.
174, in
clause 133, page 88, line 11, after
‘the’, insert
‘annual’.
No.
175, in
clause 133, page 88, line 11, leave
out ‘junior’ and insert
‘primary’.
No.
177, in
clause 133, page 88, line 40, at
end insert—
‘(1A)
Information authorised in accordance with sub-paragraph (1)(c) shall
include information relating to a child’s body mass
index.’.
Sandra
Gidley:
This is a timely debate, given that we had the
paper on obesity yesterday. The obesity problem could be tackled in
part by keeping a closer eye on schools, so that children who were
developing patterns of obesity could be identified at an early stage
and appropriate action could be taken, whether that involved educating
the parents or whatever.
Currently, as a function of the
national child measurement programme, children have their height and
weight measured in reception and in year 6. The Bill appears to give
the Secretary of State the power to increase the frequency of
those measurements, but the Minister is not being bold enough, so these
amendments are an attempt to provide something more
meaningful.
Amendment Nos.
168, 170, 172 and 174 would provide for annual measurements of weight,
so that weight could be tracked. I have also tabled amendments that
would change the designation of junior school to primary school, so
that the clause covered all children between 4 and 11 years
old.
We also tabled
amendment Nos. 176 and 177, which would specify that the information
that is provided to parents includes
“information relating to a
child’s body mass index”.
That is important because height and
weight in themselves are not accurate enough measurements. They give a
picture, but some children have growth spurts, for example, and any
problem would be less easy to identify. The American Academy of
Pediatrics has placed frequent measurement as its first priority in the
identification and management of obesity. The academy’s research
stressed to every doctor the importance of a yearly assessment for
children. If body mass index were tracked from year to year, it would
be easier to identify any early deviation from the normal, expected
growth
curve.
Body
mass index is not something that most people can calculate off the top
of their heads, but there are easy sliding scales and mini calculators,
so it can be done at the touch of a button or the turn of a dial. Once
a school nurse, say, has the height and weight measurement, it would be
easy for them to provide the extra information. People could plot the
information on hand-held growth charts so that they had a history over
time. A one off measurement of height, weight or BMI is, in fact,
fairly useless—all one can do by measuring that trend is to get
an overall picture of whether 11-year-olds are getting larger and
fatter. That may help to provide national statistics, but we are trying
to produce something that will help to identify children who are at
risk so that appropriate action can be
taken.
I
hope that the Minister will look kindly on the amendments. He has not
looked kindly on any amendment so far, but I live in hope—I am
eternally optimistic. I do not think that we should get too bogged down
in whether people understand the concept of BMI; it is a fairly simple
idea and can be explained to people. They do not need to know the
calculation or anything else, but it is important that they are able to
track the trends. My children are too old to benefit from such a
measure now, but perhaps I will be a grandmother one day, and I would
like to think that someone would keep an eye on my
grandchildren.
Anne
Milton:
I congratulate the hon. Lady on finally using the
word “fat”—it is not used very often these days.
My issue with the word is that “fat” is something for
which a person might feel that they have responsibility, whereas they
might think that “obesity” simply happens to them. I feel
like a victim because of the extra stone and a half that I carry, but
if I thought about it as “fatness”, I might take more
personal responsibility for getting rid of
it.
I appreciate the
hon. Lady’s sentiments. I do not know about the use of the words
“junior” or “primary”, but I dare say that
there is a legal definition. We could use numbers or simply a term such
as 9 to 10-year-olds. I do not believe that inserting the word
“annual” would be terribly useful because, in fact, it
might be useful to weigh and measure people monthly. There needs to be
quite a lot of leeway for those who would be involved in the
programme.
Sandra
Gidley:
I intervene to clarify the use of the word
“annual”. It would ensure an annual weight check for
everybody—for all children. I fully accept that there may be a
need for more frequent measurements in some individual cases, but
specifying a more frequent measurement would be over-prescriptive on
the health service.
Anne
Milton:
I thank the hon. Lady for her intervention. I will
not prolong the discussion but I look forward to a stand part debate on
the matter. There is much more to be said about the weighing and
measuring of children.
Mr.
Bradshaw:
Amendments Nos. 168, 170, 172 and 174 make
explicit provision for weighing and measuring to be carried out
annually. In England, the National Child Measurement Programme is
currently run on an annual basis, with children in the reception year
and year six being weighed and measured at any time during the school
year. I am happy to confirm that we have every intention of continuing
to collect that data annually. However, we do not think that the
frequency of the programme needs to be specified in the Bill, indeed,
that could cause potential confusion as existing guidance already asks
primary care trusts to weigh and measure the children in reception and
year six each year. PCTs are able to carry out that task over the
course of the school year, which allows for the local health care
professionals involved to be used most effectively, spreading their
duties over the year and visiting schools at the time that best fits in
with school activities and causes least
disruption.
Sandra
Gidley:
I am not sure why that would cause confusion. The
Minister mentions a scheme in which, at some stage during the school
year, children in reception and year six are measured. This measure is
an entirely different proposition and suggests that each year all
children will be measured. It is not so that they can be measured at
any random time, the aim is to provide an annual health check for each
child in Britain.
Mr.
Bradshaw:
I beg the hon. Lady’s pardon, I
misunderstood. I have explained why we believe the amendment to be
flawed, but I misunderstood her reasons for tabling it. We do not take
the view that it is justified or proportionate to measure every child
every year. Measurements from these two different years will give us a
pretty comprehensive database without imposing disproportionate burdens
either on PCTs or schools.
Sandra
Gidley:
It would be interesting to know if the Minister
has any data so far. The scheme has only been going for four or five
years, so he may not have any, but we do not yet know how far adrift
children have been allowed to go in six years. It is a considerable
period of time during which a child may have picked up bad
eating habits. Yesterday we discussed how children do not always get the
best food at home and how lunch boxes are not always healthy. Despite
efforts being made with school meals and cooking, a lot of damage could
have been done during that time. It is not about recording data, it is
about identifying early problems.
Mr.
Bradshaw:
That implies that the only way of identifying
those problems is through weighing and measuring. As the hon. Lady
knows, there are a range of measures taken by schools and by doctors
and nurses so that they are able to intervene in this. Our advice
suggests very strongly that, as things stand, annual weighing and
measuring would not be justified in terms of the benefits compared to
the costs.
Amendments
Nos. 169, 173 and 175 would make the scope of the provisions in clauses
132 and 133 apply to primary pupils instead of junior pupils. There is
a technical reason why we have used “junior”. It goes
back to the Education Act 1996, where
“junior pupil” means a
child who has not attained the age of
12”.
Primary pupil,
however, is not defined, and unless accompanied by a suitable
description, the amendment would use a term in statute without a clear
definition. The main difficulty with that approach is that it risks
excluding those children aged 10 or 11 who attend middle schools rather
than primary schools.
On amendments Nos. 176 and 177
on the body mass index, as the hon. Lady will appreciate from the
letter I sent her at the end of November last year, we have not ruled
out providing parents with their child’s BMI but we believe that
further work is required before we can be certain exactly what should
be prescribed. That will be debated again when we come to discuss the
regulations. An important reason why we may decide not to include BMI
information is that recent research suggests a lack of understanding
about it. We need to be sure that the information we provide is in a
form that can be most readily understood and used by parents. Research
commissioned as recently as 2007, from the British Market Research
Bureau, on parental attitudes to the current weighing and measuring
programme in England suggests that most parents do not understand BMI.
Some parents said that they had never even heard the term used before
and others, who had heard the term, said that they did not understand
what it meant.
2.15
pm
Angela
Browning:
While the debate has focused on weight gain, in
terms of a child’s health, I wonder what thought the Minister
has given to girls approaching puberty. We know that increasingly, some
of them suffer from anorexia and bulimia at quite a young age and the
idea that suddenly their parents are going to start encouraging them,
as a result of a statistic, to dramatically lose weight would give me
some cause for concern. Although in terms of children’s health
weight gain is a problem, so too is the increasing problem of how we
handle young girls who become much more fashion conscious, even at
primary school level, and for whom getting the balance right in how
that information is given will need to be sensitively handled.
Mr.
Bradshaw:
The hon. Lady is absolutely right. Sometimes we
are better to talk about a healthy weight, because she is right to
point to the problems of anorexia among teenage girls in particular, at
a slightly later stage than the one we are discussing now. We agree
that we need to move away, over time, from focusing solely on obesity
to focusing on a healthy weight and healthy
lives.
Angela
Browning:
May I say to the hon. Gentleman, I do not think
that we must assume that this is a problem just in the teenage years?
Increasingly, it is younger and I know of many nine, 10 and
11-year-olds who are fans of the Sugababes and others, who are now
fashion conscious even at primary school level, and for whom the
argument would apply.
Mr.
Bradshaw:
Yes, indeed and as part of the national child
measurement programme we will advise school nurses or other health
professionals who are concerned about a child’s health or weight
that whether the child is overweight or underweight, they should take
action accordingly through the local care and support that is
available.
As I was
saying, one of the reasons why we think that BMI may not be the
appropriate way to give information to parents is that they do not
understand it. Another reason is that as a single measurement, it may
not as accurate in young children as it is in adults and I am advised
that there are a number of reasons for that. Unlike adults, children
are still growing and therefore one single measurement may be skewed by
a particular growth phase, in particular BMI may vary with puberty.
Secondly, evidence linking children’s BMI to health outcomes is
not as strong or well established as it is for adults. We will be
consulting parents, professional groups and other relevant
organisations over the next few months, to develop the best system and
format for providing children’s results to their parents. That
will include determining what level of detail parents would find most
helpful. In due course, we will consult further on the regulations
around this measure, so all who have a view will be able to contribute
to that debate. I have already sent the draft of the regulations to the
Committee. I hope that in the light of those assurances, the hon.
Member for Romsey will feel able to withdraw her
amendments.
Sandra
Gidley:
I listened with interest and disappointment to the
Minister’s remarks. To return to the point about BMI, it is
slightly different in children but I think that the Minister
was being uncharacteristically feeble when he said that parents do not
understand it—whatever happened to education? We do not have to
call it a body mass index, we can call it something else, such as a
healthy weight index, but it is a cop out to say, “Oh, this
looks a bit difficult, we won’t do it this way” if it
does prove to be the most effective
measurement.
Anne
Milton:
Moving away from BMI, has the hon. Lady considered
the use of centile charts, which can be terribly useful and slightly
less complicated to use? What does she feel about
those?
Sandra
Gidley:
Yes, I have considered the use of centile charts
and, having been reduced to a nervous wreck by a health visitor because
my child was at the bottom of the curve, am not terribly enthusiastic
about them. The BMI gets round some of those problems. I was interested
to hear what the hon. Member for Tiverton and Honiton said because I
have a naturally-skinny daughter who has always been slim, although she
ate like a horse and has a healthy body image. She was constantly being
asked by school nurses if she felt that she looked fat. Clearly, they
thought that she was potentially underweight. If that had been tracked
for a longer period, they would have realised that that was just her
and that some people fall at the extremes of those measurements quite
naturally.
An
obsession with weight can be unhelpful for a fit and muscly child who
will always be at the top of the scale, and it is a difficult one to
judge. However, annual weighing would help to pick up early signs of
decreasing BMI, which can also give cause for concern. Obviously, that
would be treated in a different way. I shall turn my attention to the
regulations and beg to ask leave to withdraw the amendment.
Amendment, by leave,
withdrawn.
Question
proposed, That the clause stand part of the
Bill.
Anne
Milton:
I could not help but notice the Minister’s
eyes go up to heaven when I mentioned the possibility of a stand part
debate. We started this morning’s sitting with everyone feeling
a little tetchy, but I think that the mood of the Committee has
improved. I would hate to see the Minister’s emotional state
regress as a result of a stand part debate because this is
important.
Obesity is
probably one of the most important public health issues that we face. I
understand that we are the first generation of adults whose children
are likely to have a lower life expectancy than us. In this century, it
is absolutely appalling to think that what we are doing will shorten
our children’s lives.
I have a few issues that I
would like to raise. I am not entirely sure why there has to be
legislation on this matter. I saw the regulations and would like to
thank the Minister because, although they are neither lengthy nor
exhaustive, they give some idea of the thinking on that. They
state:
“An
important effect of the Regulations is to protect the position of the
young children participating in the NCMP in compliance with the
European Convention on Human Rights and data protection
legislation.”
I assume,
therefore, that that has to be placed in legislation simply to allow
the PCTs to relay the information to the parents, but I would like the
Minister’s clarification because at the moment that is already
ongoing. I have had contact with all the strategic health authorities,
which are all advancing well towards meeting their targets for that
programme.
One of the
issues that we should start with is just how fat we all are, and the
figures are absolutely dreadful. The Department of Health’s
website advises that the proportion of children in England aged two to
10 who were overweight or obese in 2005 was 31 per cent., compared to
22.7 per cent. in 1995. The proportion of children who are overweight
increased
from 12.8 per cent over that period to 14.2 per cent, while the
proportion of obese children rose from 9.9 per cent. to 16.8
per cent. over the same period. In 2005, the prevalence of obesity for
boys and girls aged two to 10 was similar: for boys, obesity rose
from 9.6 per cent. in 1995 to 16.9 per cent. in 2005, while
for girls, obesity rose from 10.3 per cent. to 16.8 per cent. I also have some figures from
Yorkshire and Humber. In fact, I congratulate the strategic health
authority there on giving me such a detailed breakdown of what is going
on. This will distress my hon. Friend the Member for Tiverton and
Honiton, but it suggests that young people in the region eat only half
the recommended portion of fruit and vegetables. It is projected that
33 per cent. of boys and 30 per cent. of girls will be overweight by
2010.
The figures for
those aged 11 to 15 are even more stark. The projected level for boys
is 33 per cent., and the projected level for girls is the highest in
England. Some 28 per cent. of girls are projected to be obese, with a
further 16 per cent. being overweight by 2010, which means that almost
half the children in that region aged between 11 to 15 will be obese.
That is truly shocking.
My hon. Friend raised the issue
of anorexia. It is important to note that the flipside to obesity is
anorexia. She is right to say that the issue affects younger and
younger children. Sadly, though, that issue and the issue of obesity
cannot be addressed simply by weighing and measuring
them.
Mr.
O'Brien:
I would like to reinforce the points made by my
hon. Friends the Members for Guildford and for Tiverton and Honiton.
Because of the increased evidence of obesity and anorexia appearing at
a much younger age, the clues that one gets for the trend starting are
that much smaller. The sooner that the trend lines can be picked up,
the sooner one can get the evidence, which will lead to better health
advice and hopefully to a better outcome. That is another reason for
saying the younger the better when it comes to applying this
measure.
Anne
Milton:
My hon. Friend raises a crucial point. It is all
about picking up the trend. Early intervention is important for
children suffering from anorexia and bulimia. It is not nutritional
advice that such children need but psychological help. Looking at the
figures on what is being spent on obesity drugs, one can see that they
are now the fastest growing item being prescribed. Prescriptions for
obesity drugs increased 28 per cent. with a total cost of nearly
£50 million. I know that the Government are keen to address the
drugs budget. In some ways it is a shame that we are having to treat
such conditions with drugs because we have not acted at an earlier
stage and tried to treat the condition with a lifestyle
change.
The burden of
the proposed measure will largely fall on school nurses from primary
care trusts. The nurses will oversee the weighing and measuring.
Schools will be asked to provide the PCT staff with a list of children
to be weighed and measured and to inform the PCT if the parents have
chosen to opt out of the programme. Information about individual
children’s weights or heights will not automatically be given to
parents,
although they may request the child’s information. The records of
children’s heights and weights will be anonymised and the data
used in the NHS for the analysis of trends in obesity and overweight
and underweight children. I have to
flag up to the Minister the concern that exists in my own constituency
and across the country as a whole about the need for security of this
data. We had quite a lot of discussion yesterday about obesity
following the Secretary of State’s statement. I appreciate that
this measure is only one aspect of the Government’s programme to
tackle obesity. Again, if anyone wants to get to sleep tonight and is
failing to do so, the current arrangements are described at length on
the Department of Health’s website. Such reading is a guaranteed
cure for insomnia. The Department of Health has issued a leaflet for
parents called “Why your child’s weight matters”.
It is probably an indication of the state of affairs that we have got
to, that we have to say that.
There is guidance for PCTs and
arrangements for measuring. Some of the regulations are highly specific
about what machines are used and so on, which is important. If we are
going to lump the data together, we need to ensure that data sets mean
something. As I said, the guidance also sets out the legal basis for
the current programme, the responsibilities of PCTs, the role of
schools and local authorities, the schools covered, and lists of data
collected and how they are stored and used. Separate guidance will also
be issued for schools. That is a considerable burden on schools and
PCTs.
2.30
pm
There is
concern about school nurses. The Royal College of Nursing—I
declare an interest in that I am a member—supports the proposals
that help school nurses to share information with parents on the
well-being of their children. It sees it as a positive step that PCTs
and the Government will work together to ensure that every child has
access to a school nurse by making the adequate resources available.
However, it is concerned that progress to achieve the
Government’s target of one qualified school nurse in every
secondary school and its cluster primary schools is slow, with evidence
indicating that many school nursing teams have been adversely affected
by the impact of NHS deficits, which I mentioned
earlier.
The 2006
joint report by the National Audit Office, the Healthcare Commission
and the Audit Commission entitled “Tackling Child
Obesity—First Steps” indicated that head teachers
reported that their ability to tackle health issues, such as obesity,
was seriously inhibited by the lack of access to health professionals
within schools and other educational settings. I am sure that I am not
alone in saying that schools are increasingly worried about the burdens
and responsibilities place on them for looking after an aspect of a
child’s growth and development that they do not feel is their
responsibility and that, in many cases, they do not feel well equipped
to deal with. The presence of school nurses, therefore, will be crucial
to the success of the programme.
The other point I want to raise
relates to what we do with the information. In the light of some of the
responses from strategic health authorities around the country, my
concern is that it will be yet another box-ticking exercise. Their
letters had an air suggesting that what mattered was that they reach
the target for weighing and measuring children, and that was
it—their job was done. But, of course, that is only a way of
benchmarking health improvements put in place afterwards. What is
crucial is the follow-on that we are able to provide and the
resources.
Mr.
O'Brien:
I am sure that the Minister would be the first to
accept that the weighing and measuring of children is important in
public health. In any village in any developing country, the first
thing that one sees is a sling on which babies are weighed. It is the
first means of establishing, in those cases, the presence of
malnutrition, and in general the state of young people’s health.
That applies quite a long way up the age scale.
We ought to
learn from the public health agendas of such developing countries,
because we are in grave danger of losing out as a result of our more
sophisticated approach to health care provision. We should issue the
mother with a little booklet recalling over time all the weights and
heights of her children—most of us of a slightly older
generation will have experienced that. That would be a very powerful
tool, because that information would be owned by the mother, which is
more important than the broad statistical measurements in SHA or PCT
measuring units. That is one way in which we could use such
information. It would give the mother ownership of the health of her
child.
Anne
Milton:
My hon. Friend raises a very important point about
ownership. I opened by talking about fatness and obesity, with one
being something that happens to me and one being for which I am
responsible. That endorses his point. The ownership by parents of their
children’s health is extremely important. I must raise again the
issue of hard-to-reach groups. Parents can withdraw their children from
the programme, and I dare say that the child could withdraw themself.
Even if a parent gives permission for their child to be weighed and
measured, if the child on the day refuses, the school or school nurses
could not insist otherwise. My concern is that the fat kids will
withdraw.
Often,
particularly with very obese children, there are huge issues about
self-esteem. We have talked about anorexia and bulimia, and in relation
to severe obesity there are many similar psychological overlays making
children fat. This has a great deal to do with self-esteem. It is
important that when we introduce the programme there is a safety net to
pick up the children at that stage and to give them counselling,
because there are other problems in their life. It gives us an
opportunity to deal with those children and their psychological
problems at a very early stage. Withdrawal from the programme is in
itself an indicator that there are other problems.
Obviously, we
would support anything that could be done to tackle the problems with
obesity. If you will indulge me for a minute, Mr. Conway, I
will return to the health in pregnancy grant and say that this issue
starts with maternal health, foetal health and having enough midwives
to support and encourage breastfeeding. In this day and age, women are
not in hospital long enough to establish breastfeeding, and the problem
starts from that point and goes right the way through.
The work is quite resource-intensive; it costs quite a lot of money.
However, if we really believe in joined-up government and want to make
a difference, we have to see that investment up front in the areas that
I have described will save—if we want to consider this purely in
financial terms—a great deal of money in the long term, because
we will prevent at an early stage all the diseases associated with
being both underweight and
overweight. I think
that the Minister finds these clause stand part debates slightly
tedious, but the issue is important. He is shaking his head to show
that he enjoys every minute of them, but he did not feel happy to
respond to the points raised on the health in maternity grant. I hope
that he will address some of these matters. The problem concerns us
all, and the Government can make a difference if they apply themselves
not to the headline figures or to the figures on children’s
weight going down, but so that we see children at a more healthy
weight, eating more healthily and living more healthy lifestyles to
prevent the implications for the health service that we are storing up
for the
future.
The
Chairman:
I cannot imagine why Mr. Hood and I
were appointed to chair this
Committee.
Mr.
Bradshaw:
May I put it on the record that there is nothing
tedious at all about clause stand part debates? What I always try to
avoid is repetition —particularly when I am given direction by
the Chairman, who has asked specifically for brief contributions
because many of the arguments have been explored and illustrated in
debates on the amendments. I think that most members of the Committee
find that tiresome and it is exactly what I was trying to avoid
earlier. However, the hon. Lady has made some very important and new
points and I will endeavour to respond to them to the best of my
ability.
The hon. Lady
asked first the most fundamental question: why is the legislation
necessary? There are three reasons why we need to legislate. First, we
need to give a legal basis to the existing programme. Secondly, we need
to allow feedback to parents. She will be aware that at the moment
people have to opt in to obtain the feedback, whereas this provision
will mean that people have to opt out. We hope that it will mean that
more parents receive the feedback. Thirdly, we need to legislate to
allow the data to be used for performance management for local primary
care trusts on their obesity
strategies.
The hon.
Lady has said, and I acknowledge, that this provision is a small part
of our overall strategy against obesity, which was launched, and very
well received, yesterday. I do not intend to broaden the debate out to
that in general, because we are talking about a specific programme of
weighing and measuring of children. She may not have mentioned it, but
it is worth putting it on the record that another reason why we are
legislating is that two Select Committees—the Health Committee
and the Public Accounts Committee—specifically recommended that
we did so.
As the hon.
Lady will know, our target for 2006-07 is 80 per cent.
coverage—that is the percentage of eligible children weighed and
measured. We are confident that improvements to the programme will have
resulted in
much greater coverage and that there will be a vast improvement on the
48 per cent. participation that we achieved in the first year, 2005-06.
We do not have those figures yet for 2006-07, but the hon. Lady might
like to table a parliamentary question every few weeks and as soon as I
can I will put them in the public domain. She is right to point out
that the child would have the freedom to refuse. I do not think many
people would suggest that we should force children, particularly given
the self-esteem issues and the sensitivity that she rightly described,
but we have developed a DVD and a flyer for children about the
programme to help to reduce any concerns that they might have about
participating. PCTs
will upload the data electronically to the national child management
database, which will be developed and maintained by the Information
Centre for Health and Social Care. The centre will not have access to
child-identifiable data. When the data is uploaded to the database, it
will be anonymised by removing or converting all identifiable data,
including the name of the child; the postcode will be converted to
lower super-output area, whatever that means; and the date of birth
will be converted to age and month. Although the information centre
will not have access to any patient-identifiable information, there are
robust information security measures in place to ensure that the data
is held and accessed securely.
Individual children’s
results will not be shared with school staff or other pupils, and
suppression and disclosure controls will be implemented when the data
is set and publication released. That means that when the data is
published, small numbers that could allow individual children to be
identified will be suppressed. For example—someone must know
what this means—at super-output area level, or even at PCT
level, if numbers between one and five appears in any data cell, that
number will be replaced by an X; so will any corresponding total
relating to that number.
Question put and agreed
to.
Clause 132
ordered to stand part of the Bill.
Clause 133 ordered to stand
part of the
Bill.
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