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Baroness Pitkeathley: My Lords--

Baroness Carnegy of Lour: My Lords--

Earl Russell: My Lords, it is the turn of the other side.

Lord Hunt of Kings Heath: My Lords, there are another 17 minutes. I believe it is the turn of this side.

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Baroness Carnegy of Lour: My Lords, I want to speak on fluoridation. Are noble Lords in agreement? The Government say that they will give local authorities power to force independent water companies to fluoridate water if the local community agrees. I agree with my noble friend and with the Minister that that is highly desirable, but as the Minister says, opinions differ. Does that mean that local authorities will be able to conduct surveys on the matter? If at present a water company fluoridates water, but the local community does not want its water fluoridated, will local government be able to force that company to stop fluoridating the water?

Baroness Hayman: My Lords, I may have preferred the question from this side!

It is important that we understand the different levels of consultation that will have to be gone through. First, we shall have to undertake a review and make sure that the evidence exists. Then we must make sure that local authorities rather than health authorities--they have not so far been a successful mechanism in this regard--have the powers to take forward fluoridation. Also, because the water company and local authority boundaries are not the same, we must discuss with the national body which represents water undertakers the technical implications of taking forward this policy in areas where, for example, the majority are opposed to it.

We need to break the deadlock that presently exists. Also, when we transfer from health to local authorities, the form of public consultation on fluoridating the local water supply will have to be decided. We intend to introduce a legal obligation on water companies to fluoridate where strong local support exists for doing so.

Baroness Pitkeathley: My Lords, does my noble friend agree that one of the most welcome aspects of this far-reaching and welcome White Paper is the extension of the age range that it covers to those who are under 75? Does she agree also that old people can benefit just as much from health education, from fitness programmes and better nutrition as younger people, but too often are ignored and expected to deal with their ailments as a consequence of old age? In her response, can the Minister also assure me that the provision of better health for older people will include their mental health as depression, leading to self-neglect and even suicide, is more common in older people than is currently acknowledged?

Baroness Hayman: My Lords, my noble friend is right to point out that we have extended the age range in terms of targets. We must recognise that there is not a sudden point in terms of age after which people can no longer benefit, either from health education--there are many important ways in which people can be given the information to enable them to improve their health--or from a range of services. Again, the extent of the importance of exercise and access to it in maintaining good health may differ in nature and scale depending on one's age, but exercise can be an important component for the elderly as well as for schoolchildren. My noble

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friend is also right to point out the mental health aspects that can affect older people. Targeting policies to reduce suicides covers all age groups.

Earl Russell: My Lords, the Statement was surely correct that low pay is a health hazard. Will the Government therefore consider the hypothesis that no pay is a greater health hazard? To that end, when they conduct their health impact assessment, will they collect information on the health of those disentitled to social security benefits?

Baroness Hayman: My Lords, the Acheson inquiry into inequalities in health showed that poor health is associated with low income; that is, low income whether from benefit or in terms of a low wage.

Earl Russell: My Lords, I said "disentitled" to social security benefit, not "on benefit".

Baroness Hayman: My Lords, I apologise to the noble Earl. That takes us into the area of looking at entitlement to benefit as a potential health hazard.

We have said that the health impact assessment programme will be carried out across the board, assessing major policies for their impact on health and health inequalities. We are already applying that assessment to policies assessing fuel poverty and the New Deal for 18 to 24 year-olds. I shall ensure that disentitlement to benefit and its potential impact on health assessment is taken into account by my colleagues in the Department of Social Security.

Lord Jenkin of Roding: My Lords, is the Minister aware that I share the distaste expressed by my noble friend on the Front Bench for the unpleasant "barbs" which the Secretary of State saw fit to include in his Statement, which was otherwise positive and forward-looking? Can the noble Baroness point to any other Statement by any former Secretary of State for Health in which it was argued that health inequalities were the fault of the poor? That is a monstrous accusation to address to anybody.

Is the noble Baroness also aware that I regard the Acheson report as a great improvement on the rather unfortunate Black report which I had to receive a good many years ago? Its research was sadly flawed and its remedies, I was advised, appeared to involve the spending of billions of pounds on abolishing the class system. Is the Minister aware that I regard the detailed proposals in the White Paper as a great deal more practical than the Black report and that I hope that they will succeed? If the Minister is right in arguing that it will take many years, I am sure that is wise. In the mean time, can she describe to the House what measures the Government will put in place to monitor the targets she announced?

Baroness Hayman: My Lords, we need to monitor progress. We are setting ourselves interim targets and every health improvement area will contain specific targets. There were targets in the tobacco White Paper

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for reducing the number of people in this country who smoke. We shall be evaluating progress at a regional and local level in regard to the different targets.

I do not want to enter into a spat across the Dispatch Box in relation to the relative commitment of individuals to good health. We made explicit our commitment not only to improve the health of individuals across the board, but also to reduce the existing inequalities--not a phrase that was popular or acceptable in the Department of Health for many years. Those inequalities have increased rather than reduced over the past 18 years.

Lord Bruce of Donnington: My Lords, the Government are to be congratulated on reasserting the undoubted experience of society as a whole. The health of the individual, while depending in part on the efforts to maintain good health made by the individuals themselves, is fundamentally dependent on society as a whole; and society as a whole is fundamentally involved in the health of the individual. At last, after many years of experiments--no doubt conducted in good faith--into the way in which the health service should be organised, we have an examination of the fundamental causes which reside in society. Aneurin Bevan himself pointed that out in much detail in that very great work of his, In Place of Fear, which was published in 1952.

We now have the opportunity to reassert the priorities in the nation as a whole as regards maintaining good health. Plans to relieve poverty and the fundamental causes of poverty and ill health are now matters for our consideration. I am very proud to be on the same Benches as a government who are now going to make this effort to emphasise the real priorities and give people some purpose in living again; indeed, to give them a fundamental sense of security in place of fear.

There will have to be a reassertion of priorities. One will not have to pay too much regard to private interests which are inevitably involved in the provision of, for example, pharmaceuticals or even ordinary diets. All these things will have to be reassessed. I am very glad that we have reasserted this. I am also very glad, as I am sure we all will be in due course, that perhaps some purpose in life has been restored.

Baroness Hayman: My Lords, I do not think that I need answer the specifics of my noble friend's contribution. However, I believe that the whole House recognises that he has perhaps a longer time-frame and perspective on the National Health Service through personal experience; and, indeed, as I remember, through being in Parliament with Aneurin Bevan when the original legislation to establish the National Health Service was introduced. We are now 51 years on from that time, but it has transformed the social landscape of this country in many ways. It has transformed the way in which we think of ourselves as a society.

The challenge that this White Paper and the inequalities that still exist give to this Government goes beyond the provision of service to the question of access to good health for all our citizens. It is an enormous challenge and one which demands action covering a wide range of people from the individual, through local

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communities, to government. But there are enormous prizes to be won because there is much deprivation to be fought.

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