§ 2.30 a.m.
§ Mr. Michael McNair-Wilson (Walthamstow, East)
This is the first time the House has debated the work of the Health Education Council since its inception in January, 1968. Why I cannot say, because the Council, whose task is to promote research into the science and art of healthy living and the principals of hygiene, clearly has objectives of nationwide importance for which its annual budgets of £455,000 for England for 1971–72 and for Wales of £7,000 do not seem excessively large.
Bearing in mind that the Milk Marketing Board spends £1 million a year and the National Coal Board £2 million a year on publicity, we may consider that £500,000 spent on health education for England and Wales and Northern Ireland is fairly paltry, in particular because of the importance of the task which faces the Council. Be that as it may, the Council's present budget is very close to the half million pounds which Lord Cohen suggested in 1964 when he produced his report on health education from which the Council is derived.
Either he and his committee were particularly accurate in their assessment of the likely cost of the Council or the Council has in turn assumed that Lord Cohen's figures would be acceptable as its target and it has therefore moved towards that target. However, because of the Supplementary Estimates which we are debating, the Health Education Council's budget for 1971–72 will be £586,000, and it seems reasonable therefore to question how this 1284 money is being spent and, in particular, to ask whether the Council is fulfilling the task set for it by Mr. Kenneth Robinson when, as Minister of Health in 1968, he launched it and it took over the responsibilities of the Central Council for Health Education. In a Press release issued at the time the Council's aims were stated as being to plan and promote national programmes of health education to assist in the development of local programmes in co-operation with local authorities, professional organisations, voluntary bodies, industry and commercial firms. It was also to undertake research into health education techniques, evaluate results and foster training of staff to engage in health education.
These are worthy aims, and it set out on an enterprising programme. It has certainly, in that programme, fulfilled the aims and aspirations of Lord Cohen and his Committee which were to give health education a new and more professional look. Under the distinguished chairmanship of first Lady Serota and now Lady Birk and with a body made up of medical men, advertising experts, educationists, dentists and local government experts, the Council seems to have the right mix to perform its work effectively.
Certainly it is much better equipped than was its predecessor the Central Council for Health Education to fulfil that public health strategy which Miss Anne Lapping, in the magazine New Society, described in 1967 as being:how to stop people from wantonly falling victim to sicknesses like lung cancer, coronary thrombosis, V.D. or drug addiction.Indeed, as she proclaimed in that same article:The fastest spreading killers in advanced societies are diseases people can be taught to avoid.The question is therefore how well the Health Education Council is now measuring up to that task. In attempting to estimate its work, I have to admit to being at the disadvantage of having only one annual report and what the Council describes as an interim report to rely on. I understand that another annual report is due in the very near future, but I cannot wait until that report and therefore if any statements I make are in accurate I apologise for the inaccuracies since I have no way of putting them right.
1285 However, from the two reports I have mentioned, it is clear the Council is constrained by the size of its budget from tackling as it would wish the task it sees itself as having been allotted. After all, it is a national task.
However, on the basis that one must cut one's cloth according to one's cloth, I find it surprising that in its income and expenditure account for the year ended 31st March, 1970, it stated that it had spent £107,550 on a campaign about smoking and health; while only £9,463 on a dental health campaign; £2,846 on an anti-V.D. campaign; £2,078 on a food hygiene campaign; £878 on a cancer campaign; £763 on sex education and contraception; £563 on accident prevention; and £475 on child health. It spent nothing on campaigns about immunisation and vaccination.
I cannot help wondering whether that order of spending shows the right priorities. It seems incredible that the Council should wish to spend £107,000 on a campaign about smoking and health and only £878 on a cancer campaign, in view of the enormous amount already spent on smoking and health, and in view of the publicity it has received from so many services, I wonder whether it was wise to spend its money in the way it has rather than giving it a greater spread over the other subjects, all of which require expenditure, particularly such subjects as immunisation and vaccinations, which are surely two of the most effective means of maintaining the health of the community. In passing I notice the Council spent nothing on drug prevention, which I believe to be a serious threat to the health of the community. It does not even refer to the subject.
While I appreciate that it is up to the Council, and not me, to say how it should spend its money and what the priority for that expenditure should be. But from conversations I have had I have the impression that many medical officers of health do not feel that the Council is sufficiently in touch with them or understands their problems, and that generally there is a feeling that it spends too much money on researching subjects in which it is interested and not enough on getting out leaflets and posters for public consumption. Many of the leaflets and posters it produces, and particularly the posters, have had a mixed 1286 reception. I think particularly of its sex education posters of Casanova and the pregnant man, which caused a good deal of distaste.
It has also had problems with its anti-V.D. campaign. That is how I became interested in its work. Comparatively recently I put down a Question to my hon. Friend the Minister about the incidence of V.D. in this country. The Question was seen by a national newspaper, which asked me the reason behind it. I stated that I wanted to persuade the Government to mount a national education campaign to make young people aware of the danger of the disease and how it was contracted, since gonorrhoea is now the second most infectious disease in the country, next only to measles. Its incidence, as shown by the figures my hon. Friend announced today, is increasing quite considerably, particularly among young people.
As a result of that statement being printed in a national newspaper, I received a letter from the Diocesan Council for Family and Social Welfare, Exeter, which said:You may be interested to learn that the above Council has been involved in a publicity drive for the Health Education Council's posters on V.D., and its Executive passed the following resolution recently:'The Executive Committee of the Diocesan Council for Family and Social Welfare is informed that some local authorities have displayed little enthusiasm for the Health Education Council's poster campaign, warning young people of the dangers of venereal disease.'We understand that only 38 of the 64 County Councils and 11 of the 85 County Boroughs are displaying these posters.I think these figures are serious because they show that county councils and county boroughs are not particularly concerned with or attracted by the posters produced by the Health Education Council. Therefore, one is forced to ask whether the fault lies with the H.E.C. or with the borough and county councils. It is too simple to suggest that the fault must necessarily lie with the H.E.C, but if it is seeking to produce posters which are aimed at nationwide circulation and it gets such a poor response, as these figures suggest, one wishes to know rather more why it has been so unsuccessful. Perhaps they suggest straight away that the H.E.C. has as big a job on its hands to win the support of local authorities as it has in getting 1287 its message over to the public. On the other hand, I also received a letter from a church group in Belfast which is concerned about social problems. It too came after the newspaper report to which I have referred. It said:With regard to venereal disease one difficulty is to obtain suitable posters. The Health Education Council posters appear to treat the matter too lightly; a course of treatment and everything will be all right. We need posters aimed at prevention. We would be grateful for help and advice.That letter raises the same question as the previous one, namely whether the H.E.C. is really producing material required by local authorities and by other groups concerned about health within the community.
I do not suggest that these two letters or the comments I have made about medical officers of health and their views of the H.E.C. are in themselves definitive. Indeed, a handful of conversations and two letters do not constitute a body of evidence which is worth very much. But the fact that the House of Commons Library had to send out for the Council's annual report for 1969–70 when I asked for it suggests to me that the Council is not perhaps communicating even with those of us who should be informed about its activities as we might hope.
As one whose profession is public relations. I can only say that I am amazed that the Council got by during the year 1969–70 with spending only £127 on public relations and £13 on Press releases. I should have thought that if it was really to communicate in the way it must if it is to do the job, it could not do so on such paltry expenditure. I must also add that as a Member of Parliament, I am not aware of having received anything from it.
I do not wish to seem from these remarks to be denigrating the very real achievements of the Council. I appreciate that it has had to build itself up very nearly from scratch and that although it was launched in early 1968 it did not really get under way until early 1969. As I have said, it has been lucky to have had as its Chairman the noble ladies Lady Serota and, in particular. Lady Birk, whose untiring efforts have done so much to make it effective. But at a time when society is faced with health and population problems as often 1288 as not caused by ignorance, it is clear that the work of the Council is of first importance in disseminating in a relevant and contemporary way the facts which can enable as many people as possible to live a full and healthy life.
§ 2.45 a.m.
§ Mr. Michael Cocks (Bristol, South)
I am grateful to the hon. Member for Walthamstow, East (Mr. Michael McNair-Wilson) for giving us this opportunity to speak briefly about the work of the Health Education Council. He referred to the rather meagre budget it has and the need for greater expenditure. The whole tenor of his remarks about how the general public is in need of help and advice allows me to bring before the Minister tonight a particular aspect which is becoming of increasing public concern.
As a nation we are becoming more health conscious, and hand in hand with this there has been an increase in the number of advertisements for health insurance schemes. The Health Education Council can play a great part in enabling the public to arrive at an assessment as to what value they get from those schemes. I quote as an example an advertisement in the Sun newspaper on 15th November by the London and Edinburgh Insurance Company which had the heading:These are the only exclusions",which then goes on to list a number of conditions not covered by the policy.
Prompted by this, I put a Question to the Department of Health and Social Security which was answered by the Minister on 6th December. In his Answer the Minister showed that the things described in the advertisement as the only exclusion in fact accounted for over 50 per cent. of beds in National Health Service hospitals.
It seemed to me that the general public were not in possession of the medical statistics to enable them to make a realistic appraisal of advertisements of that sort. This is the sort of work which the Council could do. So misleading did I think the advertisement, that I wrote to the Chief Inspector of Weights and Measures in Bristol asking whether an advertisement couched in those terms was an infringement of the Trade Descriptions Act. He replied that 1289 it was not. Frustrated in this direction, I then wrote to the Department of Trade and Industry drawing attention to the advertisement and received a courteous, but unhelpful reply that the Insurance Companies Act did not confer any power on the Department to control the methods by which insurance companies issued policies, but the Department went on helpfully to say that it was considering selling methods.
I turned to the Law Commission, which sent a letter in reply with a report, but suggested that I should contact the Advertising Standards Authority. I did so and received a reply to the effect that the average person in the street should be able to deal with this matter. It said:We do not, however, think it unreasonable to assume that the average person is capable of assessing, from his own experience and that of his family and acquaintances, whether he is sufficiently likely to undergo hospitalisation for those conditions which the policy does not cover as to make it worth his while to invest in it.This is where the Health Education Council could help. I do not think that what the Authority says is a fact. Prompted by the answer I received from the Authority, I put another Question to the Minister about the length of stay of various age groups in hospital: ages 0 to 17, 18 to 39 and so on. The Minister said that information in the form requested was not available. If the Minister has not got information in that form it is difficult to see how the general public can have any sort of idea of what are their chances of staying in hospital at a particular age. The Minister kindly gave me information in another form, for different age ranges. Even so there is a lack of information and there is a gap here which the Health Education Council could fill.
I put my dilemma to the statistical division in the Library to see whether we could arrive at some assessment of whether these schemes were worth investing in. The division gave me a full reply, listing a number of reasons why it was not possible for it to make any sort of realistic assessment of the schemes. These included:The actual monthly premium paid depends on the age structure at enrolment of the family: this figure cannot be directly related to the expected average length of stay in hospital of any one member of the family; the monthly premium does not change when the members of the family move into different age groups; 1290 the age groupings are not the same as those quoted in reply to the Parliamentary Question. In making the required calculation one would have to introduce a risk factor based on the chances of any member of the family being in hospital in any one year. One can say that the chances are 1 in 13.6 for those under 14 and 1 in 5.4 for those over 75, but the incorporation of such probabilities into the calculation is a job for an actuary.One could not adequately take account of the provisions relating to accidents whereby £400 per month is paid when both husband and wife are in hospital together after an accident. …Nor could one take account of the provision excluding the first two years of sickness of those who are already sick with a given condition at the time of taking out a policy.For these reasons it was felt impossible to give any sort of realistic assessment as to whether the scheme offered value for money. There is a job here for the Health Education Council. I have gone to various sources to get something done about this. I asked the Secretary of State on 21st December whether he would seek powers to enable him to control the advertising of private health insurance policies and he replied "No."
In the absence of action by the State we need some sort of body such as the Council to provide this information to enable the public to know whether it is getting value for money. This is daily becoming more urgent.
In the Evening Standard of 8th February the following headline appeared over an advertisement:With every passing year you know your chances of going into hospital are increasing all the time.I asked the Secretary of State about the average length of stay in hospital and the Under-Secretary was kind enough to give me a very full answer on 6th December. From that it can be seen that it is not true that with every passing year one's chances of going into hospital are increasing. I referred this advertisement to the local Weights and Measures office under the Trade Descriptions Act, and again action was refused.
In the Committee considering the Local Government Bill I have raised the whole question of standardisation of decisions by Weights and Measures inspectors who are now being asked to make subjective judgments whereas before they made objective judgments, analysis of samples and so on. We should now be thinking in wider terms of what the Council can do. 1291 I apologise for raising this matter without giving notice. I do not expect an answer tonight, but I should like the Under-Secretary of State to think about whether it is possible to assist the general public, who are being pummelled and bombarded by these schemes, to reach a rational judgment.
§ 2.55 a.m.
§ The Under-Secretary of State for Health and Social Security (Mr. Michael Alison)
It is a matter of congratulation to my hon. Friend the Member for Waltham-stow, East (Mr. Michael McNair-Wilson) and the hon. Member for Bristol, South (Mr. Michael Cocks) that they should have the distinction of contributing to the first extended debate we have had on the Health Education Council.
§ Mr. Deputy Speaker (Miss Harvie Anderson)
I remind the hon. Gentleman that he requires the leave of the House.
§ Mr. Alison
I apologise. For the second time of asking, I request leave to speak again.
The hon. Member for Bristol, South, used the phrase "a courteous but un-helpful reply" of an answer given in response to an inquiry he made. I trust that I shall retain my courtesy even at this late hour, but I hope he will allow me not to make a full reply to his points for the reason he himself forecast, namely, that he was not able to give notice of the points he intended to make. I assure him that we shall carefully read and note what appears in the Official Report, as no doubt will the members of the Health Education Council without having to be referred to it by my Department.
In turning to the helpful, well-informed and encouraging remarks of my hon. Friend the Member for Walthamstow, East, it might be helpful if I filled in a little of the background of the Health Education Council. The Council was set up in 1968 to take over the health education functions of the then Ministry of Health and the Central Council for Health Education, following a recommendation by a Joint Committee of the Central and Scottish Health Services Councils that a national health education organisation should be established. The Council is financed from central and local government funds. My hon. Friend commented 1292 on the financial aspect, and I shall come to this later. The Council is required to obtain the approval of the Secretary of State to its budget and programme of activity, but, in keeping with the recommendations of the Cohen Committee, not to the detailed ways in which it carries out its functions. The raison d'etre of this type of body is that it is wholly free to concentrate on health education without the possibility or the danger of its energies being diverted to other subjects. It is also likely that it will feel freer to experiment and try to break new ground than would a Government Department.
The Council's legal status is that of a limited liability company. The objects for which it is established are to promote and encourage in England and Wales and Northern Ireland education and research in the science and art of healthy living and the teaching of such living, and to assist Government Departments, local authorities and other statutory and voluntary bodies to pursue the same end. The Council has a valuable co-ordinating and disseminating rôle and a responsibility to give advice on the development of a professional approach to health education.
The Council's activities include the mounting of national campaigns and the use of research methods in planning such campaigns. The application of knowledge from the science of epidemiology, economics, and the communication and behavioural sciences is essential to planning. Its activities also include liaison with the Department of Education and Science, the Schools Council, Her Majesty's Inspectors of Schools, local education authorities and individual heads of schools with a view to developing an educational pattern for young people which will allow for more fundamentally healthy living in the future. Other activities include organising training courses for family doctors, local authority and hospital staff; producing publicity material, posters, leaflets—about which my hon. Friend had a word to say—films, and so on; and a library service.
The Council, through its Medical Research Division, carries out research into health education needs and the approaches and methods which are most likely to achieve maximum effectiveness. Within its resources, the Council must 1293 necessarily plan its activities by allocating priorities on its own initiative and responsibility. These must be determined among areas of possible health activity. The areas of health education activity which are currently being given greatest priority are smoking and health, family planning and venereal disease.
The Council during its short life has established itself as a source of advice and help on health education matters to local and central government, to voluntary organisations and to the mass media. It has become a focal point for everyone involved with the planning and development of health education on a rational scientific basis.
The Council recognises that its objectives can be fully met only if all who are or should be involved in health education—for example, doctors, nurses, dentists, social workers, health visitors, midwives, and teachers—are properly educated and trained about the relevance and techniques of health education in their particular fields. The Council accepts a responsibility for stimulating the development of training facilities for these people, and during the last year in particular has been actively pursuing this policy by organising courses, regional seminars and other functions, by conducting a survey of local authorities to determine their views and requirements, by establishing contact with all medical schools in England, Wales and Northern Ireland, and by submiting evidence to the Committee on Nursing.
It is also in close touch with the Department of Education and Science and the Schools Council regarding health education in schools. In addition to all these activities, the Council continues to develop its training courses for health education staff of local authorities and voluntary bodies, partly with the aid of its mobile training unit which travels extensively throughout the country; it also publishes the quarterly "Health Education Journal" and half-yearly the "Health Information Digest", both of which disseminate views and information about the practice of health education.
My hon. Friend spent a good deal of time in his speech in dealing with the subject of venereal disease. The Council considers education about the dangers of sexually transmitted diseases to be one of its first and most important priorities. 1294 The Council has conducted national poster campaigns aimed at informing young adults, the age-group at greatest risk, about sexually transmitted diseases and their treatment. The Council has also produced a leaflet which has been widely distributed among local authorities and elsewhere and features this topic prominently in talks, discussions and training courses which it organises.
Last November the Council drew the attention of local authorities to the increase in the incidence of gonorrhoea. The Council reminded them of the avail ability of posters and leaflets and asked for information about any successful approaches authorities had made to the problem. This resulted in some additional requests for posters and created interest in some areas; but unfortunately for a number of reasons many local authorities appear to be unenthusiastic about mounting public education campaigns on this subject.
There are many difficulties here, some of which my hon. Friend knows. Elected representatives and their officers may be apprehensive about appearing to condone loose sexual morals about sexually transmitted diseases, and educationists are understandably no less apprehensive. Indeed, it must be recognised that the subject is offensive to some people; my hon. Friend has knowledge of possible counter-productiveness in this regard in terms of hostility. Nevertheless, the Council's poster campaign has raised the whole level of discussion about sexually transmitted diseases. There has been a noticeable broadening of concern in young people's magazines; the Press and radio have given space and time to news and features about V.D., and television has produced some instructive programmes about the problem.
The Council has included the sum of £50,000 in its estimates for 1972/73 for V.D. health education and this amount has been set aside by my Department for this purpose. The Council is actively planning and experimental intensive health education and contact tracing campaign which will be held in two London boroughs, Lambeth and Wandsworth.
§ Mr. McNair-Wilson
May I ask my hon. Friend one other question? Will he also see that there are sufficient centres to which people can go? At present, we 1295 are about at full stretch as regards treatment.
§ Mr. Alison
I take my hon. Friend's point. Certainly if I find that there is anything specific that I can give my hon. Friend, I shall drop him a line about it.
This contact tracing campaign is due to start shortly and to last at least a year. A research assistant has been carrying out the necessary preliminary work and a steering committee, which includes senior doctors from my Department and the local authorities, has been established.
The main aims of the campaign are to increase the proportion of contacts of patients with either gonorrhoea or early syphilis who are traced and persuaded to receive treatment at a special clinic, and to make the local communities more aware of the V.D. problem in their area and of their general responsibility to prevent the spread of these diseases.
Health education will be mainly directed at the sexually most active, that is those in the age group 18–24, and a variety of education methods will be used ranging from face-to-face interviews to publicity material in clinics and exhibitions open to the general public.
Extra welfare officers for contact tracing will be attached to St. Thomas' Hospital and other major clinics in the area. It is hoped that local family doctors will participate and have access to laboratory services and contact tracing teams.
The Council hopes that the campaign will demonstrate how contact tracing methods can be improved and throw some light on the question as to which groups should be subjected to the main health education effort.
The Council considers that it is necessay to give serious consideration to the drug problem. However, we recognise the need to tread warily before embarking on publicity on drug abuse. There are two basic reasons for this cautious approach. First, there are still gaps in our knowledge of the precise size and nature of the drug problem in Britain and secondly, and more importantly, there is a very real risk that ill-chosen educational methods might encourage an interest in drugs in people who had not previously felt it. Other Governments are also well aware of the dangers of 1296 national campaigns and share the fear that this type of activity might be tantamount to advertising drug abuse. However, it does not necessarily follow that a carefully designed programme of public education could not have a valuable part to play in helping to combat the growing problems of drug abuse.
With this in view, the Government have sponsored a survey into public attitudes towards drug taking with the aim of finding a much firmer basis than has existed so far for assessing the full need for education about this subject. The survey has now been carried out and the draft report is currently being evaluated.
The Council features the topic of drug abuse prominently in its training courses and during recent years many local authorities have been actively engaged in promoting health education on drugs. A variety of methods has been used, for example, talks, discussions, film shows and pamphlets.
The Advisory Council on the Misuse of Drugs held its first meeting on 7th January, when it decided, among other things, to explore the area of education and information to see whether it could contribute any advice to the Ministers concerned.
The Council and my Department are collaborating closely with the Department of Education and Science about education on the dangers of drug abuse, particularly in schools. As my hon. Friend will know, health education in schools is a matter which my right hon. Friend the Secretary of State for Education and Science is weighing carefully.
Since its inception in 1968 the annual expenditure of the Health Education Council has increased from £163,000—some expenditure was also incurred in this year by the Central Council for Health Education and the Health Department—so it was not entirely the limit of the budget at that time—to an estimated £720,000 in the financial year 1971–72. A large part of this expenditure has been devoted to producing publicity material and mounting campaigns in areas considered to merit special priority, such as those which have been pinpointed tonight. For example, smoking and health expenditure increased from £28,000 in 1968–69 to more than £200,000 in 1971–72, V.D. expenditure 1297 has increased from £4,000 in the base year to £22,000 in the last financial year, dental health from £1,000 to £18,000 and family planning from nil to £129,000 during the same period.
Local authorities' contributions to Health Education Council income have risen from £37,000 in 1968–69 to about £85,000 in the current financial year. Apart from a small income from the sale of some materials, the remainder of the Council's income is provided by my Department.
The total increase of about £128,000 in the Supplementary Estimates for the Council is almost wholly accounted for by the additional sum of £118,000 which was made available to the Council towards last Autumn's television campaign on smoking and health. It is our intention to make up to £½ million available for the financial year 1972–73 for smoking and health and provision has been made for this in the Council's budget estimates for 1972–73.
I make no apology to the House for giving some of these details in minute form, because I believe that it is the first chance we have had to give widespread publicity to the Council. I believe my hon. Friend will see from the figures of a dramatically escalating scale of expenditure that we take the Council, its scope and its importance seriously, and we demonstrate this in the most convincing and sincere form possible, namely, in terms of hard cash.