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11 Dec 2008 : Column 720

Mr. Chaytor: My recollection of the shadow Secretary of State’s last visit to my constituency is that he was not allowed inside Fairfield hospital to look at the work being done in maternity care— [ Interruption. ] My recollection is that the photo was taken outside the building. The reorganisation of maternity services in Greater Manchester was necessary—

Mr. Lansley: On a point of order, Mr. Deputy Speaker.

Mr. Chaytor: It was necessary because—

Mr. Deputy Speaker (Sir Michael Lord): Order. That is an extremely long intervention—I think that the hon. Gentleman has more than made his point. I call Mr. Andrew Lansley to make his point of order.

Mr. Lansley: I do not want the hon. Member for Bury, North inadvertently to mislead the House, Mr. Deputy Speaker. I have visited Fairfield hospital twice. On the most recent occasion, I had a full visit all the way round the maternity services and a lengthy meeting with clinical staff.

Mr. Deputy Speaker: That is certainly not a point of order for me, but the hon. Gentleman has made his position clear.

Alan Johnson: What my hon. Friend the Member for Bury, North was about to point out is that we have got off second-stage complaints and the health innovation fund and on to the real meat and gravy of health services. The reconfiguration of maternity services in his constituency should have been carried out 40 years ago. Clinicians in the Manchester area say that they have been trying for 40 years to reconfigure maternity services to save babies’ lives. The Conservatives, in another failed campaign, have said that there should be a moratorium on closures.

Norman Lamb: The Secretary of State made an important point about dealing with under-doctored areas. It has long been a scandal that the poorest parts of our communities have far fewer doctors than the leafier suburbs— [ Interruption. ] I support what he is doing. However, will he please say what steps are being taken on the minimum practice income guarantee? I know that steps are being taken to eradicate it, so that payments to GP practices are based on need and population, but how long will it take?

Alan Johnson: My right hon. Friend the Secretary of State for Children, Schools and Families was saying that it was worth turning up to learn that the Liberal Democrats also oppose GP-led health centres. The hon. Gentleman asks about the MPIG. This year’s deal with the BMA begins the process of eroding the MPIG. We would have liked to have a multi-year deal, but that was not possible; instead, we agreed a one-year deal and we agreed on the principle of eroding the MPIG. If we continue to erode it on the same basis in future years—I see no reason why we would not—the proportion of practices that depend on the guarantee will decrease from about 90 per cent. now to about 20 per cent. in four or five years. That is a very important development and I praise the BMA—I do not praise the hon. Gentleman;
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that would be a first—for recognising the fact that, as he says, the MPIG militates against tackling health inequalities.

Mr. Barry Sheerman (Huddersfield) (Lab/Co-op): On his journey from his Hull constituency to Bury, my right hon. Friend will pass through Huddersfield, where we would love him to open something. However, may I remind him of the disgraceful campaign the Opposition waged in Huddersfield? The Calderdale and Huddersfield NHS Foundation Trust was angered by the time it took to guide their large party around the hospital and by the misleading press release that they issued afterward.

Alan Johnson: My hon. Friend should be gentle with the hon. Member for South Cambridgeshire (Mr. Lansley), who has already had to apologise for something he said earlier this week. If he had to apologise for all the mistakes he has made, he would be at the Dispatch Box for hours and I would never make progress on my speech.

Mr. Chaytor: Before we leave the topic of the reorganisation of maternity services and the development of much stronger community-based maternity services, is not the great irony for the Opposition that, if they had pursued their policy of listening to the medical profession without any interference from primary care trusts, acute trusts or the Department of Health, the changes would have been made many years ago, to the vast benefit of the overwhelming majority of women?

Alan Johnson: It took three attempts, but my hon. Friend has made his point well and eloquently.

As I mentioned earlier, significant improvements have been made to mental health services, in particular community-based and preventive treatment. Since 1997, an additional 740 community-based mental health teams have been introduced, providing early intervention and intensive support; the number of consultant psychiatrists has increased by 64 per cent., the number of clinical psychologists by 71 per cent. and the number of mental health nurses by 21 per cent.

Mrs. Madeleine Moon (Bridgend) (Lab): Does my right hon. Friend agree that one of this Government’s great successes has been their suicide prevention strategy, which has cut suicides in England to the lowest level since 1863? Unfortunately, the strategy is due to end in 2010. Will he assure me that the focus will not be removed from suicide prevention and that we will continue to put it at the forefront of our mental health strategy?

Alan Johnson: My hon. Friend makes a good point. I wish that I had not given way, because she has stolen my thunder; that point was in my peroration. I can give her the assurance she seeks. Of course, all these measures take money. Earlier this year, the shadow Secretary of State talked about £28 billion more going into health under the Tories, but we have not heard what will happen. We have not heard whether they would match the spending in 2010-11 that we announced on Monday. I would be interested to hear about that before the end of the debate, because the spending is important, if we are to do all the things that we want to do on mental health and other issues.

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Before I gave way, I was going to say, “And the suicide rate has fallen to its lowest level since records began in 1848.” That will teach me. One in four people will experience an episode of mental illness at some point in their life. Mental illnesses such as depression are one of the leading causes of disability in this country, and 42 per cent. of people on incapacity benefit are on it because of a mental health problem. Until recently, access to psychological therapy was limited, even though, as the hon. Member for South Cambridgeshire said, it is widely acknowledged as the most effective way of treating mild to moderate depression.

As recently as seven years ago, only 9 per cent. of people with depression or anxiety were offered psychological therapy by the NHS. In October 2007, I announced that there would be a rapid expansion of access. The 13 new psychological therapy pilots that I launched a year ago have treated 17,500 people. This month, 35 primary care trusts launched their services; that is 15 more than we had anticipated. By 2011, we will have recruited 3,600 therapists, who will have helped to treat 900,000 people. Those are just some of the many developments that led the World Health Organisation in October to describe mental health services in this country as the best in Europe. In schools and children’s services, there has been similarly dramatic progress.

Rob Marris: Will my right hon. Friend give way?

Alan Johnson: I will make some progress, if my hon. Friend does not mind. There has been a significant expansion in child care and early years education, and greater achievement by pupils at all key stages. More young people than ever before are going on to study at university. Far from variable tuition fees discouraging poorer people from going to university, the social class gap in higher education is narrowing; it grew in the 40 years after the Robbins report. I point that out to my hon. Friend the Member for Norwich, North (Dr. Gibson), who, I remember, engaged in the debates on the issue.

One of the defining moments of this Government came when we pledged to eradicate child poverty by 2020. That has been one of the most important catalysts for improving the life chances for children in this country. In October, the OECD reported that there had been faster growth in income equality in the UK than in any other developed country, and that the poverty rate had fallen well below the international average. It described the achievements in this country as “remarkable”. There are now 600,000 fewer children living in relative poverty than when we took office, and the number of children living in absolute poverty has halved, yet we need to do still more. The measures set out in the Gracious Speech will strengthen children’s trust boards, so that they can lead on local improvements to services. There will be a Bill to raise standards in schools and improve education and training for 16 to 19-year-olds and enhance the skills of those already in the workplace. We will also introduce a Bill that will convert our pledge to eradicate child poverty altogether by 2020 into a legislative commitment.

On health, we need to adapt to meet new challenges. An ageing population and the prevalence of lifestyle diseases such as obesity bring different pressures on health and on social care. Smoking, poor diet and lack of exercise account for most of the disease burden in
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this country. The next stage review, led by my noble Friend Lord Darzi of Denham, set out how we would ensure that the NHS promotes good health and well-being as effectively as it detects and treats illness.

Rob Marris: On health, a major cost to the NHS is diabetes, and recent research suggests that there may be a link between diabetes and coeliac disease. I am a member of the all-party group on coeliac disease and dermatitis herpetiformis. Will my right hon. Friend, or one of his Ministers, meet the group to discuss the disease, which, as my right hon. Friend will know, has a prevalence of about one in 1,000? With the right diet, the adverse symptoms of that disease are entirely preventable, but coeliac disease goes undiagnosed in many carriers for years, and costs the NHS dear while those people are undiagnosed. That is aside from the devastation to those people’s lives. Will he agree to meet the group?

Alan Johnson: My hon. Friend raises an important point about coeliac disease, and of course I, or one of my fellow Ministers, will meet the group. The next stage review set out how the NHS will ensure that it promotes good health and well-being effectively. It also set out how the NHS will further improve quality of care and give patients greater choice.

Mrs. Moon: Will the Secretary of State give way?

Alan Johnson: One more time.

Mrs. Moon: I thank my right hon. Friend for giving way. One of the big problems for people with Parkinson’s disease is simple to address. When they are required to go to hospital, they should have access to the same medication that they were taking at home, at the same time as they took it at home. All too often, however, their health deteriorates in hospital because they have to fit in with the nurse’s medication rounds, rather than getting medication as and when they need it. Is there any way in which that can be addressed in the current review?

Alan Johnson: The current review is all about the issue of personalised care. It is about how we move away from a regimented system and look at the needs of individuals, not least for the important reasons that my hon. Friend raised. There are many other ways in which a stay in hospital could be much more beneficial if the routine were changed. We are finding that out in an initiative called “The Productive Ward”, in which we give nurses and clinicians the ability to organise how the ward works, having listened to the patients on their wards. My hon. Friend makes a profound point.

The health Bill will introduce several measures that will support the implementation of the next stage review, including measures to enable the NHS to explore the potential for personal budgets by piloting direct payments to patients with long-term conditions, and provisions requiring all NHS providers to measure the quality of their services and make that information available to the public. The Bill will also propose several measures to support the health of young people and, in particular, to promote health and well-being. We have already set
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out a groundbreaking strategy to tackle obesity; it is the first of its kind in the world. An essential component is “Change for Life”, the social marketing campaign that brings together community groups, retailers, employers, the media, schools, health services and national and local government to encourage people to lead healthier lives.

We need to do more to tackle smoking, which still accounts for 87,000 premature deaths in England. Two thirds of smokers start before they are 18. I am genuinely perplexed by the approach taken on the issue by both the Conservative and Liberal Democrat Front Benchers—by the “nanny state” allegation from the Liberal Democrats, and by the other criticisms that we have heard today. The hon. Member for South Cambridgeshire started his speech by talking about the importance of consultation. He said that there had been a derisory response on the NHS constitution, but a very big response—86,000 responses—to a consultation on something or other; I forget what it was.

Mr. Lansley: On pharmacy.

Alan Johnson: Yes, pharmacy, on which there will be a report very soon. The response on the smoking issue is the biggest that we have ever had on any consultation. If the hon. Gentleman believes that one should simply follow the result of consultation—that is a rather dangerous belief, if taken to its obvious conclusion—he will support the measure in question. The overwhelming response from 100,000 people consulted was that we should remove tobacco from display.

The hon. Gentleman talked about a lack of evidence, and having evidence-based measures. We have found that in other countries where such a measure has been introduced, smoking has reduced among young people. The number of young smokers in Canada, for instance, was reduced by 32 per cent. among 15 and 19-year-olds as a result of the implementation of the measure. There was a 26 per cent. fall among 15 to 16-year-olds in Iceland. That is why Australia, New Zealand and many other countries are taking that route, and why we must do so, too. We should recognise that a youngster who starts smoking between the ages of 11 and 15 is three times more likely to suffer a premature death than somebody who begins smoking at 20. Given the efforts over the years to reduce the number of smokers, with the figure down to 22 per cent., and given the recognition of what a huge public health issue smoking is, and the fact that it is the biggest health inequalities issue—in manual occupations, 29 per cent. still smoke, compared with the overall figure of 22 per cent.—I am perplexed why responsible politicians in both Opposition parties should oppose the measure. I believe that they will be on their own, without public support, when the measure is introduced.

We will take measures, too, to ban vending machines, which provide only 1 per cent. of the overall cigarette market, but provide 17 per cent. of the cigarettes sold to 11 to 15-year-olds. We will take steps, first, to restrict access to vending machines, but if that does work, we will ban them. The steps that we will take to promote health and well-being will have a significant impact on the health of our society.

The NHS is the proudest achievement of a Labour Government. Massive investment and greatly improved
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services mean that in the 60th year of the NHS, the case for a national health service that provides universal health care, free at the point of need, is supported as strongly by the public as it was at its inception. By 2011, investment in the NHS will have trebled. On Monday, I announced an average increase of funding of 5.5 per cent. for primary care trusts over the next two years, representing a £164 billion investment in the NHS over the next two years. That will mean a rise in local spending on health from £426 per person when we came into government in 1997 to the grand total of £1,612 by 2010.

Rob Marris: Say that again.

Alan Johnson: When the Opposition were in government the figure was £426 per person, but under this Government it is £1,612. As a result of extra investment supporting the skills and abilities of its dedicated staff, the NHS has reduced the rate of premature deaths from heart disease by 50 per cent., from stroke by 44 per cent., and from cancer by almost 20 per cent.

Mr. Fraser Kemp (Houghton and Washington, East) (Lab): If that spending was not matched by other political parties, has the Secretary of State made any estimates of the impact on the health and well-being of my constituents and those of many other hon. Members?

Alan Johnson: My hon. Friend is absolutely right. Up to now, the Opposition have sought to suggest that they are as dearly attached to the NHS as the Labour party, abandoning their patient passport scheme, on which every single Opposition Member was elected. They have sought to say that they will invest more. The hon. Member for South Cambridgeshire got into trouble in February for saying that his party would put £28 billion into the NHS. Now we know that it is going to spend less overall and less on public services. We know from the hon. Member for Runnymede and Weybridge (Mr. Hammond), the shadow Chief Secretary to the Treasury, that it will spend less on the NHS. We have not heard it from the lips of the hon. Member for South Cambridgeshire, so I would be perfectly willing to accept an intervention from him, as we need to know whether the Opposition will match our spending in 2010-11. [ Interruption. ] Okay, he does not wish to do so.

The constitution that we published alongside the NHS next stage review set out the key principles and values of the NHS, reaffirming our commitment to a service for all our people, with the finest medical treatment available, based on need, not on wealth. It enshrines the rights and responsibilities of patients and staff, bringing together existing legal rights with pledges and commitments about the standards of service that the NHS will provide. It establishes patients’ legal right to choose where they are treated for certain services, and it sets out a patient’s right to all NICE-recommended drugs and treatments.

The health Bill will place a legal duty on the NHS, its regulators and any independent or voluntary sector bodies that provide NHS services to have regard to the constitution. It will also commit the Government to renewing the constitution every 10 years. I believe that by building on the solid foundation established over the past 11 years, the NHS constitution and the measures that we have set out in the Gracious Speech will accelerate
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further progress, improve quality and intensify the focus on prevention. That will further enhance the huge progress made in health and education, and I commend the Gracious Speech to the House.

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