Health

HC Deb 23 October 1987 vol 120 cc1023-92

Motion made, and Question proposed, That this House do now adjourn.—[Mr. Lightbown.]

9.34 am

Mr. Dennis Skinner (Bolsover)

On a point of order, Mr. Speaker. I wonder whether you have received any requests from Ministers or anyone else to make a statement regarding the proceedings that took place at Lambeth magistrates court yesterday, about which the Prime Minister refused to comment, in which the Government Chief Whip, an ex-Member of Parliament and the right hon. Member for Brighton, Pavilion (Mr. Amery) were involved, along with South Africans and others, in machinations and allegations about trying to take over members of the African National Congress in this country. There has been a lot of speculation in the press this morning and I would have thought that that is a matter for a statement. If Ministers are not available to make that statement today, they should be requested to do it at the next available opportunity, so that they can clear the air.

Mr. Speaker

Whether a statement is made is not a matter for me.

9.35

The Parliamentary Under-Secretary of State for Health and Social Security (Mrs. Edwina Currie)

This debate is taking place against the background of an increasingly healthy population. The population of this country as a whole has never been healthier. If we look back 100 years, we find that nearly half the people of this country died before the age of 40. Today, 70 per cent. of our people survive into their seventies. The little girl born today stands a very good chance of surviving into her eighties. Even looking back 40 years, to the start of the National Health Service, life expectancy at birth was only about 67 years for men and 72 years for women. In the last 10 years alone, two years has been added to life expectancy and perinatal mortality has shown a dramatic improvement, with the number of deaths per 1,000 births going down from 17.6 to 9.5. In human terms, that means that about 4,500 babies will survive this year who would not have done so 10 years ago.

Why has this quite dramatic improvement in public health come about? In my view, there are three main factors. The first reason is concerted action, often directly led by the Government and the House, to improve the environment. Proper sewage disposal and adequate supplies of clean water led to the elimination of killer diseases such as cholera. Nor has this effort stopped. It continues as part of the responsibilities of my right hon. Friend the Secretary of State for the Environment. Indeed, there is action right across Government to improve the conditions in which we live. Today, of all the major countries, we must be one of the best housed and have one of the cleanest environments, particularly since the Clean Air Acts of 1956 and 1968.

The second reason is improvements in medicine. Mass screening and immunisation programmes have eradicated other killer diseases that were once common. Smallpox has vanished altogether. Diphtheria and tetanus are now rare. Progress in the fight against tuberculosis and polio has been maintained. The antibiotic revolution means that pneumonia is no longer a killer of young people or, indeed, of older people, and that even feared diseases such as meningitis or complications such as septicaemia can now be treated. The establishment of child health clinics has had an important role in improving the health of mothers and children.

The third reason is that matters such as increasing consciousness of health and better diets, linked with an all-round rise in standards of living, have contributed to an overall improvement in general health. Today's school-children are taller and more robust than ever before. They enjoy better dental health. In 1983, only 48 per cent. of five-year-olds experienced some dental decay, compared to 71 per cent. 10 years previously. Well over half of all our children starting school have never known dental disease.

In the light of such success, why must we continue to give priority to preventing disease and promoting good health? There is a simple answer to that: prevention never ends. It is not just a one-off exercise. As we eradicate one group of diseases, medical science offers opportunities to tackle other candidates, such as the new vaccines that are coming out now for mumps or hepatitis.

Secondly, there are growing problems and new diseases which need attention. Heart diseases and lung cancer—the diseases of affluence— are rightly causing growing concern. These diseases were unknown in the last century. Many new problems arise as the result of addiction. Some, such as AIDS, appear to have come at us totally out of the blue.

Other countries are showing that prevention works and that many of these diseases can be tackled. Had we faced the prevention of heart disease with the enthusiasm that the Americans did some years ago, we might have been able to report much better results here. Over a 15-year period in America, they reduced deaths from heart disease by 40 per cent. and strokes by 50 per cent., and that improvement is still continuing.

Another reason why we should continue in this way is that it would cost us a great deal of money not to do so. The Health Service in England and Wales is spending over £20 billion this year, and a frightening amount is spent on curing illnesses that are preventable. Treating heart disease alone costs us £450 million a year. Treating lung cancer costs us more than £110 million. Treating kidney failure costs £100 million a year. It is a fact that 10 per cent. of kidney failure is probably caused by high blood pressure. I am told that control of blood pressure could contribute towards a postponement of the onset of kidney disease in about half of the cases that proceed to full renal failure.

It is not only money that is a consideration. In all humanity, we cannot stand back and let disease continue that we know can be avoided or postponed, or whose action can be mitigated or reduced. That is why we are in business. We are here to save lives and to improve the quality of the lives that we save.

I have been accused of being a killjoy when I advise people to cut out smoking and watch what they drink and eat, but I ask the House to consider where the joy is to be found in angina. Who would choose to have a stroke? Who would choose to have an amputation through vascular disease? Where is the pleasure in being breathless, in being unable even to walk to the front door, let alone in the street? Where is the fun in being dependent upon an oxygen cylinder? It is not being a killjoy to say that we should enjoy the good things of life but only in moderation, for by taking that course we are likely to enjoy them for much longer and live to tell the tale. We are probably not talking about saving money at all. We engage in prevention because it is right, and we can use the resources that are released to do other things.

Let us consider the main causes of death in England and Wales. We find that in 1985 about 140,000 men died of circulatory disease, 74,000 of cancer and 34,000 of other respiratory system diseases. Nothing else comes anywhere close. For women the figures are 147,000, 67,000 and 30,000 respectively. So our main killer is circulatory disease, which means heart disease and stroke. If we split the figures by age and sex, we find that disease patterns are different for men and women, and different for older and younger people. The main killer of men before their time is heart disease. The main killer of women prematurely is cancer, with breast cancer the leader in England and lung cancer the leader in Scotland. Indeed, lung cancer is rapidly increasing among women as a cause of death. The figures for women show a tragic 25 per cent. jump since 1979, whereas those for men are at last beginning to decline.

We will all die some day. Heart failure or pneumonia is often the last of a string of problems. We cannot prevent all disease. Some people do it all wrong and they survive to die eventually of old age. Others do everything right and still succumb in their 50s. Sometimes life seems so unfair. I have said before how important it is that we face death and care better for the dying so that they are relieved of pain and can die with dignity.

There are many who have a dangerously incorrect view of heart disease, our main killer. People sometimes think that they will have a heart attack and keel over and that that will be a good way to go. Against that, I offer these thoughts. When it happens, most people do not want to go; nor do their loved ones want to lose them. Secondly, for many it means being cut off not, in a sense, at the conclusion of business but in the prime of life. Last year in Britain about 37,000 people aged under 65 died of heart attacks. They left behind bereaved families, often with financial problems. Few would regard that as a good way to go, but when it happens, after years of smoking and eating a fatty diet, perhaps, it is too late.

For many with heart disease and circulatory disease the immediate result is disability, not death, for many heart attacks are not fatal. As a result, we have 300,000 sufferers from angina. Last year we issued 31 million prescriptions for preparations acting on the heart and for anti-hypertensive drugs. The numbers of heart bypass operations have been increasing steadily and we expect to be carrying out about 15,000 a year by the end of this Parliament. Every year more than 100,000 suffer a stroke. If we can do anything to reduce this appalling toll of misery and suffering, I believe that we have a duty to do it. I hope that the House agrees.

It is the same with cancer. We debated cancer in March and I do not want to deal with it at length now. I merely say that our scientists have considered the incidence of cancer in different countries, and it is very different from place to place. This has led them to think that as much as 80 per cent. of cancer is potentially preventable. Although there is a great deal of research taking place, we still do not know all the causes of cancer. However, we know some of them, and the main culprit is smoking cigarettes. Not only that, but cigarette smoking may raise the chances of getting all the cancers, so "Don't Smoke" has to be the message.

We know also that medical science in cancer is aided by early diagnosis, so screening for breast and cervical cancer, for example, is an important and valuable weapon in the war against cancer, which I believe will be conquered some day.

At the same time we face other problems, some of which seem to have appeared without warning. AIDS is the main one which concerns us now. To the end of September this year, 1,067 cases of AIDS, including 605 deaths, have been reported in the United Kingdom. There have been about 7,500 reports of people who are HIV antibody positive. Although it is not possible to know how many people are actually infected, it has been estimated that it could be between 30,000 and 50,000. Many of these people will go on to develop full-blown AIDS.

The treatment of those with AIDS is expensive, being about £20,000 per patient per year, and as yet we cannot save them. The implications for the Health Service are therefore very serious, and the Government are well apprised of them. We must remember the United States experience, where 43,000 people have AIDS and nearly 25,000 are dead as a result of it. In the United States, one person dies of AIDS every four hours. It is a most serious worldwide problem.

In the United Kingdom there is only minimal evidence of heterosexual spread other than to the partners of those such as drug misusers or homosexuals, who are most at risk. But the potential for wider heterosexual spread cannot be ignored. AIDS is spread by heterosexual contact and it is a problem for us all. In the absence of a cure or vaccine. Public education is the main weapon in the fight to counter infection. As part of the strategy to combat AIDS, the Government have embarked on a sustained compaign of public health education. A recent survey of what we have done shows a high awareness now and increased knowledge about AIDS and the ways in which the infection is spread. There is growing understanding of the ways of avoiding and reducing risks. We are hoping and praying that changes of lifestyle brought about by the campaign will have their effect.

We accept that the Government have a major responsibility and role in prevention, and we are approaching these responsibilities broadly in three ways. First, we are helping people avoid disease. Secondly, we are helping them by enabling early detection. Thirdly, we are promoting action across the whole of government. Helping people avoid disease is known as primary prevention. Our aim is to ensure that individuals understand the connection between the way in which they live their lives and the risk of disease, and that information is readily available about risk factors to enable them to make sensible choices and decisions in their everyday lives. It is all about understanding, information, choice and individual responsibility.

I do not like banning things if it is at all possible to avoid doing so. However, I have no doubt that during this debate the Government will be called upon to ban just about everything in sight. I do not like using the law if we can make progress in other ways. My attitude is at least partly pragmatic, for I look at other countries with tough laws and I see that if people do not agree they do not obey. If they agree, changing the law may often not be necessary. The key factor is to provide information and encourage people to make sensible choices. However, I will support changes in the law if I can see no other way of making progress or where is is clear that public support is so strong, or the public interest so paramount, that legal changes would be helpful. For these reasons, I have voted as a Back Bencher for seat belts, fluoridation and the abolition of dangerous items such as scented erasers. I will not put people's lives at risk for the sake of my principles, especially as my other principle is to keep down NHS costs.

The second part of the Government's role is to provide early detection. That is secondary prevention. As we know, not all disease is preventable and not everyone takes care to prevent it. It is important, therefore, to be able to detect disease as early as possible. The Government's role has been to set up surveillance and screening programmes such as those for breast and cervical cancer. We now have effective antenatal care for the early detection in pregnancy of foetal abnormalities or of problems such as toxaemia which would harm mother and baby. Those continue to he as important as ever. Just as important is the development of screening of children—for example, the PKU test — to detect potentially handicapping defects as early as possible.

We are interested in screening for the inherited blood disorders, sickle cell anaemia and thalassaemia that are found in people from Africa, the Caribbean, the eastern Mediterranean and Asia.

Mr. David Ashby (Leicestershire, North-West)

My hon. Friend will know of my great interest in and familiarity with familial lipidaemis. I asked my hon. Friend some time ago whether the Government would consider screening for those at risk in relation to familial lipidaemis. Will the Government consider extending screening, especially as machines are available for that work to be carried out very simply?

Mrs. Currie

My hon. Friend reminds me of an occasion when he set up an exhibition in the Upper Waiting Room for the Family Heart Association complete with the machines to which he has referred. If many people had their cholesterol tested, I would not be surprised at the poor level of the results. My hon. Friend put that point to me and the matter is under consideration. He should await the publication of the White Paper on primary care, which might answer some of his questions.

With regard to sickle cell disease and thalassaemia, we have pilot studies under way to advise us on the best method of screening, and we hope to make progress shortly. With regard to female cancer, it is worth reminding the House that no country outside Scandinavia is carrying out comprehensive cervical cancer screening, but by next spring we will have the entire system up and running. We were the first country in the world to announce a comprehensive nationwide breast cancer screening programme. We have a great deal to be proud of in the way in which we have set up secondary prevention.

I spent an interesting morning this week with the Maternity Alliance and that will be of interest to the hon. Member for Peckham (Ms. Harman). We discussed pre-conceptual care. There is some evidence that poor diet and smoking before conception has an adverse effect on pregnancy. I look forward to taking that work on, with he Maternity Alliance's help and advice. With an eye to the future, we are looking at detection systems for other cancers such as ovarian cancer which kills more than 3,600 women a year, although I must say that no system looks very promising at the moment. However, we take a close interest in that.

The third branch of Government action on prevention is the promotion of preventive action across Government and throughout Government Departments. Disease prevention and health promotion is not the responsibility solely of the Department of Health and Social Security. There are many aspects of this work, much relating to everyday life, going on across the whole of government. In the past few years, Government have responded to threats to the nation's health by setting up ministerial committees to take action forward in a co-ordinated way. There are now interdepartmental ministerial committees on AIDS, drugs and, announced only last month by my right hon. Friend the Home Secretary, alcohol misuse. I sit on two of these. We have also set up the Health Education Authority as an integral part of the NHS and it will carry forward a comprehensive health education scheme.

The work of many other Departments also, to a surprising degree, has a health promotion element. For example, guidelines on voluntary nutrition labelling were recently announced by my right hon. Friend the Minister of Agriculture, Fisheries and Food. All main nutrients of interest to consumers are within the scope of these guidelines, which follow an agreed international standard. However, because of European Community constraints, we have not been able to make nutrition labelling compulsory, as many here would have wished. However, a considerable step forward has been taken. Nor must we forget the work of my right hon. Friend the Secretary of State for Transport in his efforts against drinking and driving and the safety of vehicles to reduce the death and injury rates of road users.

To get an idea of the wide range of such activity, a survey was carried out by my Department which showed that there were nearly 300 projects of a "preventive" nature going on across all Government Departments. These range from accident prevention — road safety, safety in the home, fire safety — to environmental protection such as air pollution and waste disposal. It is a quite remarkable list and it surprised us and demonstrates our high level of concern and determination. I have arranged to put the list in the Library, and it will be updated from time to time.

I want to tackle one or two of the arguments that doubtless will be aired today. For example, I wanted to consider the argument about inequalities in health. Despite all the activity, there remains a higher incidence of ill health in certain social groups and in certain parts of the country. Much is made of the idea that the onus is all on the Government through their policies for example on unemployment, benefits and taxation of tobacco to bring about good health. People are often portrayed as helpless pawns of their circumstances with no capacity to take individual action to help themselves.

I ask the House to reflect that philosophies of that kind tend to make things worse. Surely people should accept responsibility at least in some part for their own health whatever their income; whether cigarettes are expensive or cheap; whether liquor is easily available or hard to get hold of; whether life in their neighbourhood is easy or tough; whether they live in Sunderland or Somerset, in Sheffield or Scotland or whether they live in the tough inner city, the affluent suburbs or a village in the country. There is a real health divide between those who know that their health is in their hands and they can do something about it, and those who do not and will not. Both groups are present throughout the country. The Government cannot compel people to be healthy, but they can help, and we are determined to do so.

We recognise that improvements in overall levels of national health are also linked to improving national prosperity. The Government want to see the general health of the nation to continue to improve. We are making that possible through economic policies which improve living standards for all through real economic growth. Family incomes after tax have risen by 16 per cent. in real terms under this Government. The average household now spends nearly £162 per week. Expenditure on social security benefits is up by 38 per cent. in real terms. In the end, however, individuals have an inescapable responsibility for their own and their family's health. Not to accept that ignores the capacity and willingness of individuals to choose healthier ways of living if they are given the information they need.

Nor is this simply a question of the Government spending more money on health. We have done that handsomely. Spending on the NHS is up; staffing is up; the number of patients treated is well up. The fact that far more are being treated as day and outpatients suggests that we are picking up conditions earlier; that the public are much more aware and willing to come forward. That may account for a 7.5 per cent. jump in out-patients treated in the past year or so.

We have allocated a lot more money to the regions with the most serious gaps in health provision and the worst disease figures. For example, in 1978 during the lifetime of the previous Labour Government, the northern region received £277 million. This year it is to receive £665 million. In 1978, the west midland region received £433 million and this year it will receive more than £1 billion —the exact figure being £1,050 million. The regions will receive large amounts of capital.

However, that is not the whole story. I challenge the assumption that endlessly putting more money into the Health Service will automatically produce better health or that that is all that the Government have to do. Some countries spend a greater proportion of GDP on health care, but that does not mean that their residents enjoy better health than us. We have better life expectancy than the United States and better infant mortality than West Germany. The inequalities in health between different social groups in the United Kingdom is far less, for example, than the United States, which spends more of its GDP on health than any other country.

Just as the improvement in dental health has occurred outside the dentist's surgery and the drop in lung cancer deaths among men has less to do perhaps with the chest surgeon's skills than to men giving up smoking since the mid-1970s, so the general improvement in health that I am seeking will come not from simply building more hospitals and employing more doctors, but from throwing away the frying pan and putting the cork back in the bottle. If we are successful, we will be able to use the magnificent NHS resources that have been voted to us to care for other groups, which perhaps as a society we have tended to neglect—such as the mentally handicapped, the mentally ill and the increasing numbers of old and frail.

Mr. Tony Worthington (Clydebank and Milngavie)

Why has the Minister totally ignored mental health in this speech'?

Mrs. Currie

I have not totally ignored mental health. I was just about to mention it as the hon. Gentleman rose to his feet.

There are major preventive elements in mental health and it is a matter to which I have asked my Department to give increasing attention. The hon. Gentleman is right; we tend to concentrate on acute illness because, when we look at how much preventable disease costs us, we can see that heart disease is still at the top of the list. [Interruption.] If it is Labour party policy to ignore heart disease, I would be sorry to hear it.

As I have said, if we are successful we will be able to use our Health Service resources to care for other groups such as the mentally handicapped, the mentally ill and the old and frail. However, it is sometimes said as an argument against prevention that if we are successful in prevention and in bringing about good health, fewer people will die in middle age and there will be many more old people and what will we do then? I hope that that is what happens. I look forward to my nineties and joining the ranks of the wrinklies and the crumblies.

It is already happening. We are expecting 4.5 million people aged over 75 by the year 2000. We are expecting them because they are with us now and are already joining the ranks of the retired. As I said earlier, most people do not choose to die in middle age, nor do they choose the risk of serious disablement. The elderly are not a separate species. They are citizens, and prevention applies to them too. There is not a cut-off point at the age of 65. Most people would choose retirement and a long life and they would enjoy it if they felt that they could enjoy good health, mobility, independence and be free from pain. It is just as important to watch one's weight at 70 as at 17 and it is just as important to take exercise, perhaps even more so.

It is worth reflecting that each major prevention success has had far-reaching social consequences of the sort we are now contemplating. The fall in child mortality leads us in the West to have smaller families because we know with confidence that our children will grow up and that makes it easier for women to have careers. The development of feminism, in my opinion, owes a great deal to disease prevention earlier in the century. In the same way, the increasing number of elderly people should help us to revise many of our attitudes to the old. I look to a time when, instead of people being written off as they reach retirement, the wisdom and experience of old age is once more respected in countries such as ours, as it is in others.

I have some announcements to make. As hon. Members know, we are faced with particular problems concerning AIDS. The Government are determined to press ahead with efforts to combat that disease. The Health Education Authority, which we set up earlier this year to undertake the important task of public education, has produced a strategy for the development of the AIDS campaign and is now ready to take forward its work. On 26 October, the Health Education Authority will, therefore, assume responsibility for the development of new work on the AIDS public education campaign. There will he a gradual transfer of work already in hand in the Department of Health and Social Services during the remainder of this financial year, with the exception of the current anti-injection campaign which will continue to be managed by the DHSS for the time being because of its links with the drug prevention work. The Health Education Authority will be working in close collaboration with its counterpart organisation in Scotland, Wales and Northern Ireland. An initial allocation of £4.1 million is being made to the authority in order to meet the cost of new work during the remainder of this financial year.

Of all the areas where prevention has a significant role to play, perhaps none is more important than smoking. It is still the biggest preventable cause of death and disease. It accounts for at least 100,000 premature deaths each year, that is nearly 300 deaths every day. It is a cause of prematurity and defects in the babies of smoking parents and it directly affects our hormones. A woman who smokes reaches menopause up to five years earlier and is more likely to suffer from osteoporosis afterwards.

Thankfully, people in this country have been successful in giving up smoking or not starting in the first place. The number of adults who smoke cigarettes has been falling steadily. There has also been a marked change in attitudes towards smoking. According to a recent EEC study, more smokers in the United Kingdom want to give up than in any other EEC country. People in the United Kingdom are also more likely to be disturbed by other people smoking. However, we are worried about the level of smoking among young people, particularly among girls.

We are publishing today the biennial survey carried out by the Office of Population Censuses and Surveys on smoking among secondary school children. There is some welcome news in it on boys smoking. In England and Wales only 7 per cent. of boys aged 11 to 15 were regular smokers—50 cigarettes per week—in 1986 compared to 13 per cent. in 1984. In other words, it has dropped from 13 per cent. to 7 per cent. in two years. However, there has been no significant fall in smoking among girls of the same age, which now stands at 12 per cent. in England and Wales. Young girls are smoking at nearly twice the level of boys. That comes on top of earlier information that smoking among young women aged 16 to 19 was not declining as in other age groups and is now roughly equal to the boys, if not slightly higher.

The position in the United Kingdom is apparently found in many other western countries. We are all finding it difficult to get across to young women the threat that smoking poses. My Department and the Health Education Authority held a two-clay seminar in Bristol this week on teenage smoking. There were experts on health education from France, the United States, Canada and Australia.

As a result of that conference, I am putting in hand immediately two studies. The first study will be to find out why the rate of smoking among young women remains obstinately high whereas young men seem to be aware of the health message. The second study will be on how to devise messages that will be accepted by the young rather than rejected, and how to deal with young people, especially women, who have not started to smoke regularly as well as those who have. I expect the first results by Easter and we will base further action on the findings.

I am alarmed at the apparent ease with which young people under the age of 16 are able to buy cigarettes. That is revealed in the study published today. Last year the House passed the Protection of Children (Tobacco) Act 1986 which made it illegal to sell any tobacco product to children under 16. Retailers should realise that it is not only immoral to sell tobacco to young people but illegal. I shall be discussing with my colleagues at the Home Office what can be done to tighten up the ways in which this legislation is enforced.

What also concerns me about women smoking is that a high proportion of nurses are still smoking. Doctors do not smoke, but nurses do. It is my intention to discuss that with representatives of the profession. I am meeting the general secretary of the Royal College of Nursing shortly. I hope to explore with the RCN and other bodies that might be interested how we can help nurses with the habit to stop.

Mr. Frank Cook (Stockton, North)

Does the hon. Lady care to indicate whether the Government are considering lending their support to proposals that would invert the legislative structure so as to create areas where smoking is permitted rather than areas where it is banned?

Mrs. Currie

I am grateful to the hon. Gentleman for that suggestion. We are awaiting the final report of Sir Peter Froggatt's independent scientific committee on smoking and health which was set up in 1973. It will report to us before Christmas on the issue of passive smoking and at that stage we will be able to give detailed thought to what measures might be required to carry out its recommendations. I am reluctant to say anything until I have seen what Sir Peter and his committee are recommending. We will take into account the point made by the hon. Gentleman.

I have to make one more announcement on healthy eating. Healthy eating out is as important as healthy eating at home. I can announce today that with that in mind, the "Look After Your Heart" campaign, launched earlier this year, is launching a new national award scheme—the Heartbeat award—in co-operation with the Institution of Environmental Health Officers. It is open to all hotels, restaurants and catering establishments. To qualify for the award, they must not only fulfil certain standards of hygiene but have no-smoking areas and offer healthy food choices on their menus.

The scheme is being piloted in 55 areas and will help customers to choose the best places to eat for their hearts' sake. The first 30 award winners announced this week show the wide range of restaurants and canteens wanting to take part. They include the British Gas staff canteen in Staines, Surrey; the Royal hotel restaurant in Weston-super-Mare; Rackham's rooftop restaurant and its staff canteen in Birmingham; and American Express in Brighton — that will do nicely! If they can win the award, why cannot our House of Commons restaurants? I leave that to the consideration of my colleagues on the House of Commons (Services) Committee, and I shall send them details of the award.

Mr. Paul Boateng (Brent, South)

All this talk of Heartbeat awards is all very well, and it is good to know that Mrs. Currie has the hearts of the nation so close to her own. However, the 56 elderly residents of the Wembley hospital and the 15,000 out-patients at the Wembley hospital, who are now threatened with being transferred to the Central Middlesex hospital as a result of the recent rounds of cuts in my constituency, are seriously beginning to wonder whether Mrs. Currie has a heart at all.

Mr. Deputy Speaker (Mr. Harold Walker)

Order. In the House we refer to hon. Members in the third person and do not use their names.

Mr. Boateng

I am much obliged to you, Mr. Deputy Speaker.

I am seriously beginning to wonder whether the hon. Lady has a heart at all, and, if she has, when she is going to stop wearing it on her sleeve and do something about the health crisis in this country.

Mrs. Currie

It occurs to me that if the Brent local authority, which has been the subject of much criticism — not least from its own director of social services— looked after its old people better, in its old people's homes and with its domiciliary services such as home helps and meals on wheels, we should have much less to worry about.

Ms. Joan Ruddock (Lewisham, Deptford)

Has the Minister given consideration to such awards being applied to food in hospitals? I have observed that, because of the budgetary cuts being imposed by the Government, it is extremely difficult for health authorities to provide food of the standard to which she has alluded.

Mrs. Currie

A number of health authorities, including the Oxford health authority, which I signed up last week, have joined the campaign. There is nothing expensive about providing a range of healthy eating, or about providing no-smoking areas — or, indeed, as the hon. Member for Stockton, North (Mr. Cook) suggested, smoking areas—in places where people eat. We would actively commend that, both inside and outside hospitals.

Ms. Joan Walley (Stoke-on-Trent, North)

rose——

Mrs. Currie

Perhaps the hon. Lady will forgive me if I continue my remarks. I have almost finished them.

I have hardly mentioned alcohol, which is an important issue. One estimate puts the cost of alcohol misuse in England and Wales as high as £1,800 million a year. Our concern was recognised last month with the setting up of the ministerial group on alcohol misuse, which has a remit to review and develop the overall strategy for preventing misuse of alcohol and to oversee its implementation. The group will be chaired by my right hon. Friend the Leader of the House, and will be able to look at any issue relating to the misuse of alcohol—ranging from young people, crime and drinking and driving to advertising and taxation.

Let me emphasis that my Department is not anti-alcohol. If used in moderation, alcohol does no harm to health. We welcome the active co-operation of the drinks industry in tackling the problem of alcohol abuse, and the funding that it gives for research and voluntary bodies.

The ministerial group will hold its first meeting in a few days. We intend to look first at the overall position on the misuse of alcohol, then at current preventive measures and whether we can make them work better, and finally specific ways of tackling alcohol misuse vigorously and effectively in the future.

Mr. Peter Rost (Erewash)

I welcome my hon. Friend the Minister's approach in promoting better health and creating a health service out of a sickness service. But will she say something about the contribution that could be made by alternative and natural medicines and therapies to that effort, acting—as they do in other countries—alongside, rather than opposing, orthodox medicine?

Mrs. Currie

My hon. Friend and close neighbour in Derbyshire is absolutely right. There is a tremendous role for all the therapies. We hope that, if people can take some of the advice that is being offered on life styles and good health, they may need neither kind of treatment, which would be all to the good. I have no doubt that during the debate we shall hear many suggestions about ways in which health can be promoted and illness tackled.

The health of this country has never been better. However that is a relative statement. Life can be made much more enjoyable for many people by the prevention of illness and premature death. Prevention is often more painless and always better than cure, and prevention of aviodable disease is a top priority. Our efforts are popular, wise and cost-effective. Our task is to promote the better health of the nation, and that we intend to do.

10.15 am

Ms. Harriet Harman (Peckham)

To be in good health a person needs a decent income, an adequate diet, good, warm housing and a safe environment. He or she also needs a health lifestyle. But inequalities in income, diet and housing mean that different people in different parts of the country, with different jobs or ethnic origins, have differing chances of life and death.

If the Government were seriously concerned about promoting good health, they would locate themselves right at the centre of a strategy for ending poverty, eliminating poor housing and cleaning up the environment. A Government with an effective strategy would be a catalyst for the proliferation of health promotion initiatives across voluntary organsiations — local councils, industry, schools and health professionals. That simply is not happening; but it should be.

The Minister has said that people cannot be compelled to be healthy. They can, however, be compelled to be unhealthy. The hon. Lady's Government are doggedly pursuing policies that positively promote ill health among some people, even when the link is clearly established.

The inequalities in health were once again clearly established in "The Health Divide", published by the Health Education Council earlier this year. I should like to quote briefly from that report, because the Minister's speech reflected no understanding of the important points that it mentions. The report states: Serious social inequalities in health have persisted into the 1980s. Those at the bottom of the social scale have much higher death rates than those at the top. All the major killer diseases now affect the poor more than the rich. Children in lower socio-economic classes are smaller and more sickly. The health of working class women is particularly poor. The report also points out striking regional inequalities. Death rates in Scotland are the worst, followed by those in the north and north-west of England. The south-east has the lowest death rate. However, evidence is now emerging that even within regions there are considerable inequalities of health. Even in the south-east, poverty and affluence live side by side, reflected respectively by poor and better health.

This week my own borough of Southwark produced a health profile which shows markedly worse health in the poor wards of Peckham than in the wealthier wards of Dulwich.

That health divide will not be tackled by anything that the Minister has spoken about today. The growing divide between the haves and the have-nots in our society—a divide starkly mirrored in health inequalities—is not something inevitable; it is a function of Government economic policies. The British Medical Association underlined that clearly in May of this year, stating: Increased resources for housing, work creation, income support, education, health and social services are needed. Although low cost initiatives are possible which might alleviate the health experience of some disadvantaged groups, the problem as a whole is so great and so entrenched within the structure of society as to be insoluble without significant diversion of public resources. We have heard nothing this morning about such a significant diversion of public resources, which would attack the health problems that the BMA has identified.

There is a growing and influential consensus on this matter, but the consensus appears to exclude the one body that is in the best position to act to prevent ill health, the Government.

The Government are also stifling local initiatives that seek to cut the link between poor housing and ill health. Again, this link is undisputed. All too often I see children with respiratory problems that have been caused, or made worse, by damp and poor housing. Why does the Minister not understand the heartbreak of the mother who not only has to see her child become ill but who knows perfectly well that, were it not for her poor housing conditions, her child would not have to be ill and suffering? All too often I meet mothers who are made ill by the stress of having to cope with young children in a cramped flat. They know that their chances of buying somewhere are remote, particularly in the south-east.

Mr. Julian Brazier (Canterbury)

The hon. Lady has taken an example from the lowest age band spectrum. To give her an example from the other end of that spectrum, a local authority in my constituency has decided to close an old people's home because it is old, damp and crumbling and much better facilities can be provided elsewhere for those people, yet the local Labour party has protested that, because we are closing this home and transferring the people in it to better and healthier facilities, a small number of jobs will be lost. I have received a large number of letters, including one from a Labour councillor, on the subject.

Ms. Harman

The hon. Gentleman did not say whether these people were being transferred to other council facilities or whether they were being shipped off, at public expense, to the private sector where inspection standards are insufficient to prevent ill treatment and to ensure a high quality of care. I am glad that the hon. Gentleman mentioned elderly people. I meet many elderly people for whom every winter is an ordeal as cold attacks their arthritis. They dare not turn on the fire because they fear incurring large fuel bills. Apart from those who live in council accommodation, elderly people who live in their own homes are affected by the lack of improvement grants.

The promotion of good health is an uphill task among homeless families who are condemned to live in a hotel room. The children of homeless families are more at risk from accidents if there is an electric kettle on the floor, or if there is no fireguard or stair gate. Children are not immunised when families are moved from pillar to post. Gastro-enteritis flourishes when a family has only one basin in the room, which they have to use for emptying the potty, washing plates and clothes and cleaning an preparing food.

Local councils are, for the most part, keen to house the homeless and to improve their housing stock. That would be a major contribution to good health. However, they are prevented from doing so by the Minister's colleagues in the Department of the Environment who have imposed spending constraints. Children are to be found in hospital paediatric wards because of poor housing conditions. The Minister referred to waiting lists being cut, but her colleagues in the Department of the Environment are driving people into hospitals and general practitioner's surgeries because of their poor housing conditions.

When the right hon. Member for Sutton Coldfield (Mr. Fowler) was Secretary of State for Health he recognised, albeit under duress, the link between unemployment and ill health. He said that he would not question the fact that unemployment may have negative effects on health, yet this message has not got through to the Secretary of State for Employment, and it is making no impact on the Chancellor of the Exchequer who, mildly regretting unemployment, think that it is an acceptable price to pay for low inflation.

The Government should be tackling unemployment as a priority, not just because of the waste of skills when people moulder on the scrap heap, and the waste of the potential of over 3 million unemployed people, but because of the tight interlink between unemployment, poverty and ill health.

A proper strategy for the promotion of good health would also address the working environment. Some 750 people die and 300,000 are seriously injured every year as a result of accidents at work. Many more people die and are disabled through diseases that are contracted in the work place. However, by undermining the Health and Safety Executive and reducing the ability of the trade unions to organise, the Government are bound to increase that toll. The Government ought to be strengthening inspection, they should be working with both employers and trade unions to encourage a reduction of accidents and disease and to encourage the work place to be seen as a useful place in which to promote screening and health promotion.

The message about health promotion is also lamentably failing to get through to the Department of Transport. Recent tragic motorway accidents have dramatically drawn attention to the carnage om our roads. We need to improve road safety, but why has it not dawned on the Minister that we could cut road accidents if there were a better rail network and better public transport on the roads, instead of cuts in the rail network and privatisation that will further undermine safety?

The Minister's message about healthy eating has not been taken on board by Minister's in her own Department, let alone by Ministers in the Ministry of Agriculture, Fisheries and Food. As she said, healthy eating should start before birth, with good preconception care. After birth, breast feeding is the healthiest for young babies. However, maternity wards still bristle with brochures and special promotions for powdered milk. What does the Minister intend to do about that? Midwives have no time to help mothers to establish breast feeding if they are rushing between emergencies in understaffed-wards.

Schools should play an important part in educating for health and healthy eating. What are the Minister's colleagues in the Department of Education and Science doing to ensure that health education is not marginalised by the introduction of the core curriculum? The Minister said that she hopes and prays that the message on AIDS will get across. In addition to hoping and praying, perhaps there should also be some education. Will there be a place for sex education after the introduction of the core curriculum?

With so much evidence linking fatty foods with obesity and heart disease, why is the Ministry of Agriculture still subsidising fatty meats? When shoppers, rightly, are becoming better informed and more choosy, why is there not more pressure for a mandatory standardised labelling code for sugar content, fat, fibre, salt and additives? Even a voluntary code should be standardised so that shoppers can compare like with like.

Will the Minister take action to stop her fellow Ministers in the Department of Health and Social Security from drastically reducing the number of people who are eligible for free milk? The Minister referred to visiting the Maternity Alliance. The Maternity Alliance is very concerned not only about the low take-up of free milk but also about the fact that the number of people who are eligible for it is to be drastically reduced.

Mr. Ashby

Will the hon. Lady tell us what the advantages of free milk are? Most people with knowledge of the subject are trying to persuade young people not to drink so much milk.

Ms. Harman

I was about to say that at the moment milk tokens can be exchanged only for full fat milk. I should like there to be an extension of the milk token scheme. People should be encouraged to have them, and it should be possible for them to choose between full fat, semi-skimmed and skimmed milk.

Mrs. Currie

The hon. Lady is aware that recently the Chief Medical Officer issued advice that young children and babies should be given not skimmed milk but whole milk and that skimmed milk is not suitable for them until they are older.

Ms. Harman

I was aware of that fact, but it does not alter what I said about the greater availability and the greater take-up of milk tokens, as well as greater choice when exchanging them.

Is the Minister not concerned about the diet of schoolchildren? The lunch box full of crisps and chocolate is increasingly taking over from school dinners. What is she doing to ensure that her fellow Ministers in the Department of Education and Science and in the Department of the Environment try to increase the take-up and the nutritional value of school meals, instead of reducing the take-up and privatising what is left of them?

The Minister hardly referred to any plans to reduce alcohol abuse. It was merely touched on, yet drinking is undoubtedly a major problem. It causes accidents both in the home and on the roads, it causes crime and violence and it is linked to heart and liver disease. Without properly thinking through the consequences, it seems that the Home Secretary is poised to allow pubs to open all hours, and the Chancellor of the Exchequer is allowing the price of drinks to drift down by failing to increase duty in line with inflation. The Government are being slow to tackle the problems of alcohol abuse and many people believe and say that that slowness is a direct result of the financial links between the Conservative party and the alcohol industry.

The Government should be making greater progress on smoking. Tobacco kills almost 100,000 people a year and is linked with coronary heart disease, lung cancer and bronchitis. The Minister mentioned initiatives taken on this and clearly there remains a major problem of young girls taking up smoking.

The Minister talked about competing with the public relations and advertising exercises of the tobacco companies. Instead of using valuable public money and wasting public resources on an advertising competition with enormous multinational tobacco companies, why does she not ban tobacco advertising and end tobacco sponsorship of events? She said that she did not like banning things, because it does not work without public support, but the public are ahead of her on this and there is public support for banning tobacco advertising. She should perhaps refer to the recent poll in this week's Health Services journal which, again, underlines that.

The Government are dragging their feet on the prevention of illness. Clearly, before a screening programme is introduced one must be sure that one will screen those at risk, that the screening will detect the disease and that the disease can be treated. That is the case with cervical cancer. Despite the Minister's clear assurance that by early next year we shall have a full screening programme, we are not beginning to have a national cervical screening programme. Again, there is an overwhelming consensus on the matter; only the Government remain outside it. We are failing to have that screening programme which would save many lives every year because of a lack of resources. The Government are not prepared to give district health authorities the additional resources that they need to develop the screening programmes which in the long term as well as reducing pain and suffering and saving lives will save the public purse money.

The Government are not sufficiently quick off the mark on immunisation. Wherever immunisation can be used to prevent disease, it should be. Will the Minister introduce immunisation for people, particularly health workers, who are at risk from hepatitis B?

Neither can we ignore the acute services. In promoting good health it is important to treat someone when treatment becomes necessary, not at the end of a long wait. If people are treated after a long wait, often their condition will have deteriorated and may be less amenable to treatment. An elderly person, for example, who must wait for a hip replacement often becomes accustomed to immobility, so it takes a greater effort to rehabilitate that person. The Minister talked about enjoying retirement and the important later years. That retirement is no fun or enjoyment if one is waiting for treatment on a seemingly endless waiting list.

The Minister spoke of Brent's responsibility to look after its elderly people. Perhaps she does not realise that local councils are being told by her colleagues in the Department of the Environment to cut their spending on social services. That means cuts in meals on wheels and domiciliary services. If she is thinking of mentioning that there has been a marginal increase in spending on social services, perhaps she will remember that that has come about despite and not because of the Government.

We await the White Paper on primary care. One of the major tests will be whether it encourages the family doctor together with nurses to adopt a greater role in health promotion and screening at primary level. Most people's contact with the Health Service is with their GP and there should be much more preventive and health promotion work carried out at that level. It is a worrying development that the Government appear to be happy to see screening and health checks develop in the private sector without introducing initiatives to ensure that those who use public health services have similar access to them.

It is important that the primary health care White Paper should also meet the challenge to improve mental health. One third of the people who go to their GP's surgery do so, not only with physical symptoms, but with stress, anxiety, trauma and other conditions which can lead to mental illness.

The great advances in improving the health of the British people have been organized—even the Victorians understood that. Obviously, it is right for individuals to understand their bodies and to make healthy choices, but the Government's preoccupation with exhortations to individuals smacks of blaming the victim. By urging individuals to take increasing responsibility the Government are seeking to distract attention from their culpability in promoting ill health and in failing to promote good health.

In the past great advances in health have come from research, resulting in drugs, from immunisation, clean water, better sewerage, slum clearance, clean air Acts and the establishment of the NHS. In future great leaps forward will be made when the Government develop a national strategy which cuts across all the Government Departments that I have mentioned and which energises amd enables health promotion initiatives at both national and local levels. Great leaps forward will also be made when the Government tackle poverty and end unemployment, when they deal with poor housing and homelessness and, for the sake of the people, when they free themselves from the interests of the food, tobacco and alcohol industries.

10.36 am

Mrs. Gillian Shephard (Norfolk, South-West)

I am grateful to you, Mr. Deputy Speaker, for calling me to make my first speech in this House during a debate on health matters which are of prime concern to my constituents in south-west Norfolk.

I am privileged to represent one of the most beautiful and certainly one of the most diverse of rural constituencies in my native county. I am no less privileged to follow in the footsteps of my distinguished predecessor, Sir Paul Hawkins, who won the seat in 1964 and whose wisdom, quiet courtesy and deep knowledge of all constituency and farming matters will be as much missed in Norfolk, South-West as in this House. In his maiden speech he described Norfolk, South-West as one of the finest farming contituencies, and, despite the many developments and changes since then, not least in boundaries, that fact remains true today.

The constituency covers more than 1,000 square miles of varied countryside. It stretches from productive fen land west of Downham Market, where crops include fruit and vegetables, where profitable holdings on the Norfolk county council smallholdings estate can be as small as 30 acres and whose inhabitants are extremely proud to be known as fen tigers, through the large Thetford forest to the unique area of Breckland, which was recently designated as an environmentally sensitive area. In the east of the constituency the farming pattern changes to large arable undertakings.

Such a large and diverse constituency is bound to have its problems, some of which I hope in due course to help solve. Obviously, there are current problems in agriculture: and there can be no part of my constituency which will be unaffected by policy changes. Indeed, the percentage of people statistically described as directly employed in agriculture masks a much larger number involved in haulage, mechanical and agricultural engineering, food processing and cider making. Their livelihoods depend on a prosperous agricultural sector.

My constituents are not afraid of hard work, nor are they unrealistic, but they will look to the Government to provide a clear framework for agricultural policy within which to work and plan. They want that framework soon in a year which has seen the worst harvest weather for decades, the threat of rhizomania, flooding and a hurricane.

The economy of my constituency is not now uniquely agricultural. Thanks to a productive partnership between English Estates and the relevant local authorities we have flourishing industries in our market towns; notably Thetford, where several large industrial companies are based.

There is no shortage of enterprise in the area, but if our companies are to compete on equal terms with those elsewhere we need improved road and rail links. The completion of the dualling of the A11 and A47 and the electrification of the Liverpool Street to Kings Lynn line is essential. I hope that it will not be too long before Norwich ceases to be the only connurbation of its size— 250,000 people — that is approached by a medieval network of single track roads. I shall continue to campaign for improvements, some of which are now in hand.

Much attention will rightly be paid in this Parliament, and no doubt in this debate, to the problems of the inner cities. No doubt we shall be hearing much of Watford and what lies to the north and south of it. From time to time, I shall remind the House that there are areas of the United Kingdom that lie to the east of it and that the particular concerns of scattered rural communities such as my constituency also merit attention. In an area such as Norfolk, South-West the delivery of services such as education and health requires a degree of ingenuity that is not needed in Bromley or Bradford.

Norfolk, South-West is served by three health authorities that have so far benefited tremendously from the recent RAWP allocations, which took account of our growing population and increasing numbers of elderly.

With regard to health promotion, I am delighted that East Anglia has experienced a 26 per cent. reduction in perinatal mortality since 1978 and a large increase in the numbers of children who have been vaccinated against whooping cough and measles. It is excellent that last July Norwich health authority introduced its computerised recall system for cervical cancer tests. The West Norfolk and Wisbech health authority is ready to start its breast screening programme. All those developments are particularly welcome to women of all social classes.

The delivery aspect of health education and promotion is all-important. Unless health promotion messages are comprehensible to the individual, acceptable and workable for the health professional and affordable for the public purse they are worthless. I am delighted that the point about the delivery of the health promotion message has already been raised in the debate.

I should like to commend to the House a scheme that has been devised by the Norwich health authority for localised community health care. Its main merit is the getting across to all sections of the community of the message of health promotion. The scheme is based on GPs' practices or groups of practices and it serves population groups of 25,000. It is therefore comprehensible to patients, because in Norfolk, South-West, as in other parts of the country, almost everybody is registered with a GP. Each population group is served by a multi-disciplinary team of professionals and that team includes the GP, thus spanning the somewhat artificial divide that is not perceived by the patient between health authority and family practitioner committee provided services. The team includes community and psychiatric nurses, midwives, health visitors, a speech therapist, a physiotherapist, a clinical psychologist, dietician and occupational therapist. It fosters links with social services and the voluntary sector. The contribution that such a group can make to health promotion within the community on diet, exercise and looking after one's heart can have an impact at local level, where it matters, by involving schools, adult education, commerce and industry, voluntary groups and the local media. It involves a group of health professionals as professional equals, so it can exploit and use to the full, in a way that amounts to more than the sum of the parts, the skills and knowledge of all members of that team to the enormous benefit of the community.

I should like to congratulate my hon. Friend the Minister on her enthusiastic and successful support of health promotion at national level. At the same time, I emphasise that it is the delivery at local level that will ensure that her policies reach people.

10.45 am

Mr. Sam Galbraith (Strathkelvin and Bearsden)

I congratulate the hon. Member for Norfolk, South-West (Mrs. Shephard) on her excellent maiden speech. I was particularly impressed by her description of her constituency. It is obviously a beautiful place to live and work. I took to heart her description of the problems in the delivery of health care over such a wide area. Those problems are, indeed, very difficult to solve and I am only too well aware of them in a area such as the Highlands and Islands. It is a matter to which we should direct our attention. I am sure that the House is grateful to the hon. Lady for her remarks, which were delivered in an excellent and articulate manner.

I pay tribute to my predecessor, Mr. Michael Hirst. Michael and I were at university together and I well remember him from the debating chambers of Glasgow university union, where he polished his skills in preparation for the day when he would be a Member of Parliament. I understand that he used those skills highly effectively in this Chamber. My constituents have mentioned my predecessor a number of times and remarked on what an excellent constituency Member he was. It is clear from what they say that he spared no effort to look after them and deal with their problems. I trust that I will be able to do even better than he did. I should like to thank him on behalf of my constituents for the work that he has done in the past.

I am glad to be able to make my maiden speech in this debate on health, for a number of reasons. Health is of particular importance to my constituents. Bearsden is often described in our national dailies as a leafy suburb. That part of Strathkelvin is made up of Bishopbriggs, Kirkintilloch and the villages of Lennoxtown and Torrance and lies beneath the Campsie hills and along the Kelvin river. My constituency has a small industrial base of under 2,000 jobs. The largest single employer is the Health Service. That is why health is of particular importance to my constituency.

I am also pleased to be able to speak in a debate on health because I have been employed in that sector for many years. I must warn the House to be wary of so-called experts such as myself and my large hon. Friend the Member for Kirkcaldy (Dr. Moonie). People such as he and I tend to peddle our prejudices and ride our hobby horses. My hobby horse is the acute sector, its inadequate provision and its inefficient method of delivering care. That is a subject to which I shall return in the ensuing months.

But to avoid peddling prejudices, I shall talk about the promotion of health. It is a subject that is not often dealt with by doctors in the acute sector. Doctors in the acute sector are concerned with the provision of services for the treatment of disease, not specifically the promotion of health, and there is an important difference. The treatment of disease is a proper and excellent end, but it is not the same as the promotion of health. If my specialty were to disappear overnight—let us not pretend that that will happen—and there were no neurosurgeons tomorrow, there would be no significant effect on the nation's health, although a significant effect on suffering.

The promotion of health is a separate subject. It is not necessarily about the acute sector, although that is an important aspect, or about the regular checkups advertised by private organisations offering services at highly inflated prices. In such cases, a number of investigations are carried out, blood pressure is checked, chest X-rays performed and various nondescript tests of no value performed. Promotion of health is not about measuring the serum cholesterol. It is about preventing it from going up—an important point to consider.

We must grasp the fact that the promotion of health is a political issue. I am disappointed that only the junior Health Minister — the hon. Member for Derbyshire, South (Mrs. Currie)—is present and that the Secretary of State for Employment, the Minister of Agriculture, Fisheries and Food and the Chancellor of the Exchequer are not here. Every one of them should be here, because they are more important in promoting health than anyone else.

When I started medicine, rheumatic fever was a common desease, causing abnormalities and valvular desease of the heart. Nowadays, a medical student does not have to waste time listening for opening snaps and mitral stenosis. Perhaps my hon. Friend the Member for Kirkcaldy will tell me about that later, because I have forgotten.

When I was a medical student, one could not even mention tuberculosis because it was such a terrible disease. In the town in which I was brought up, we all had relatives who had died of that disease. Rheumatic fever has disappeared and tuberculosis has become a minor disease. This has happened not because of doctors, streptomycin or penicillin but because political activity has changed our social structure and social environment. The change occurred in my town because the Labour-controlled local authority gave everyone a decent house. There were school meals, good education and mass campaigns. They are important in the promotion of health. It is not necessarily a matter of doctors treating disease.

The promotion of health is changing slightly. We now talk about changing lifestyles. I am pleased that the Under-Secretary of State talked about footballers taking alcohol. That is a political issue which requires political action. The hon. Lady cannot hedge away by saying that she wants to get us all to co-operate, although that is important. But she will have to take political initiatives.

The Under-Secretary of State would like us to co-operate and encourage people. One should not start in the way the hon. Lady did when she was appointed junior Minister and blame everyone, saying, "It is all your fault. It is a matter of what you eat. If you did not eat this food, you would not get this disease." She spoke as though she had just discovered some new great philosophy on health, whereas we had been campaigning for changes for many years. To get people to co-operate, we should not blame them. We should take them along with our ideas and make facilities available. I welcome the Heartbeat award, which is a useful innovation. Perhaps the Under-Secretary of State will get the Under-Secretary of State for Scotland—the hon. Member for Stirling (Mr. Forsyth)—who has responsibility for health in Scotland, to look at what is happening in some hospitals, particularly the one in which I worked, which had such facilities.

It was particularly noticeable that the Under-Secretary of State for Health and Social Security did not mention unemployment in connection with health. I can well understand why. There is no question but that there is a relationship between unemployment and health. All the evidence suggests that there is. What is that relationship? Is it spurious? Is it causal and, if so, in what way? Does unemployment cause ill health or does ill health cause unemployment? Some publications show that unemployment clearly causes ill health, especially in terms of mental health. A Sheffield study, which was reported in Psychological Medicine in 1982, investigated two groups of school leavers. Those who became unemployed showed a far greater incidence of mental disorders than the employed, whereas the incidence of mental disorders was the same for both groups when at school. That clearly showed a causal relationship between ill health and unemployment.

There is a causal relationship between unemployment and physical ill health. A 1984 Lancet publication of an article by Mosner et al, using information from the Office of Population Censuses and Surveys, showed that in cohorts people who became unemployed had higher standard mortality ratios than those who did not — a ratio of 136. That survey showed that unemployment caused early deaths. It showed that there was no significant increase in the first five years, which is what one would have expected. The survey showed that the wives of the men who became unemployed had higher standard mortality ratios than the wives of employed men, which is what one would expect if unemployment causes ill health.

We can no longer dodge the issue by saying that the evidence is inconclusive. There is a clear causal relationship between unemployment and ill health. Unemployment causes ill health. This requires political solutions. The promotion of health is a political issue which requires political action by every Department. No Department can shrink from this. Together they can promote health, add years to people's lives and life to those extra years. I call upon the Government to take this action.

10.57 am

Sir David Price (Eastleigh)

I welcome this debate and especially the excellent maiden speeches by my hon. Friend the Member for Norfolk, South-West (Mrs. Shephard) and the hon. Member for Strathkelvin and Bearsden (Mr. Galbraith). My hon. Friend spoke about her constituency and her experience of the Health Service in Norfolk. She is chairman of the Norwich health authority. The Select Committee on Social Services has been impressed on its visits to Norfolk by the improvement in health care. I was glad that my hon. Friend mentioned that her part of Norfolk had been a RAWP gainer. So often we hear of London RAWP losers.

I was impressed by the generosity of the hon. Member for Strathkelvin and Bearsden towards his predecessor, Michael Hirst. This bodes well for the hon. Gentleman's effectiveness in the House. As one who has been a Member for a long time, I am convinced that an individual Member of Parliament gets his ideas across better if he gives his, colleagues, especially those on the other side of the House. the benefit of the doubt in their intentions and actions. If the opposite view is taken, the House does not gain and one does not get one's views across. I regret the degree to which hon. Members' motives are being questioned in the House, because it is not good for Parliament. Furthermore, as I said, one tends to be more effective if one is generous. I like to be treated generously and I hope that I treat all hon. Members equally generously.

This debate goes very wide. I would not for one moment dissent from the views of those who point out that the concept of positive health promotion takes us very much wider than the confines of traditional medicine. I agree largely with the remarks of the hon. Member for Peckham (Ms. Harman) about the importance of environmental factors.

Mr. Frank Dobson (Holborn and St. Pancras)

On a point of order, Mr. Deputy Speaker. I am sorry to interrupt the hon. Member for Eastleigh (Sir D. Price). However, it would perhaps help the House if you could tell us whether you have been informed by the Attorney-General that he intends to make a statement on the extraordinary decision to drop the prosecution of those charged with conspiracy to kidnap members of the African National Congress. Does the Attorney-General—in line with what the Prime Minister said yesterday—intend to come to the House——

Mr. Deputy Speaker

Order. I can indeed help the hon. Gentleman and the House. I understand that there is to be a statement at 2.30 pm.

Mr. Skinner

Further to the point of order, Mr. Deputy Speaker. I appreciate what you have just said. But surely the important point is that it was the Prime Minister who attacked the ANC in Vancouver. Days later the magistrates' court at Lambeth was dismissing the case on the advice of the Director of Public Prosecutions. One is surely bound to reach the conclusion that the Prime Minister was in collusion on this matter. It should therefore be the Prime Minister——

Mr. Deputy Speaker

Order. The hon. Gentleman is sailing very close to the wind with his allegations. He will recognise that he is taking advantage of a point of order. I remind the House that many hon. Members have been sitting here since the start of business, eager to take part in the debate. We should get on with it.

Sir David Price

As I was saying, the hon. Member for Peckham was right to bring to our attention the importance of all the background environmental issues. It is the view of many social historians that more improvements have been made in the health of the nation over the past century and a half as a result of improvements in those factors than have ever resulted from straight medical advance. We are generally agreed on that. The House would also agree that it is not only physical environmental factors that matter; It is also the social and psyhological factors, which affect not only the physical quality of our lives but our whole personality. I draw the attention of the House to the steady increase in mental illness and in stress-related disorders to make my point. I hope that we could agree that the Romans had it about right. The House will recall that their ideal was mens sanum in corpore sano That means "a sound mind in a sound body", and it is the ideal that we should work towards today.

Taking that as the aim, I draw the attention of the House to the report of the Select Committee on Social Services on primary health care. We reported in February, although I regret that the matter has not yet been debated and that we have not yet had a reply from the Government. Our report on the promotion of health states that the next big challenge for the NHS, and one especially for primary health care, is to shift the emphasis of the NHS from an illness service to a health service offering help to prevent disease and disability. So far as doctors and nurses are concerned, health promotion takes two forms—the giving of advice on how to prevent illness and disability or to improve health by changes in lifestyle or diet, and explicit screening programmes for conditions such as cervical cancer or hypertension. The question arises, "How should we, as a nation, respond successfully to what the Select Committee called "the next big challenge"? To help the House I offer a 10-point programme for action now.

First, we should implement throughout the nation the concept of the multi-disciplinary primary health care unit, to which my hon. Friend the Member for Norfolk, South-West referred. As she said, it should be based on the group practice, and it would extend beyond the traditional boundaries of the National Health Service. I am extremely keen that it should be associated with the local social services and the voluntary services. As we discovered in our inquiry, that is already happening in some parts of the country. I want it to happen everywhere.

Secondly, the prevention of ill health and the promotion of good health should become mainstream objectives of the whole primary health team. Incidentally, I believe that it would be made easier if we merged the family practitioner committees with the district health authorities, as happens in Scotland at the moment. Paragraph 105 of the Select Committee report states: There is a considerable amount of evidence that people seek a doctor's help when they are ill, but given the choice, will seek to visit a nurse to discuss wider health care issues. Nurses have more time than doctors to listen and to offer health education advice. The most important point of all follows: All members of primary health care teams have a role in health education. That is the real message.

Thirdly, we must develop further the existing screening programmes and — very important — the consequent follow-up when necessary. It is no good having a screening programme unless one can act quickly on the results.

Fourthly, we must continue to encourage immunisation programmes. However, we must improve the monetary compensation given to involuntary casualties of a voluntary system. I have been pleading the cause for years on behalf of constituents who have suffered from vaccine brain damage. Although moves have been made in that direction, compensation of £10,000 simply does not stand up to the judgments coming out of the courts.

Fifthly, I believe——

Mrs. Currie

My hon. Friend may have missed the announcement earlier this year that the amount has increased to £20,000.

Sir David Price

I did, indeed, miss the announcement. I apologise. However, the sum is still not enough when compared with the awards that have been given by the courts.

Fifthly, we must increase and extend the scope of publicly supported health promotion campaigns. More emphasis should be placed on the positive aspects—on how to keep fit rather than on how to get ill. In other words, we should emphasise the "dos" rather than the "dont's". I am thinking particularly of diet, which I know my hon. Friend the Minister has very much in mind.

Sixthly, we should at the same time, press ahead with the very important warning campaigns to the public about the obvious and known dangers, such as smoking, drugs, alcohol, and sexual promiscuity. However, we should try to target such campaigns on high-risk groups rather than going for all-embracing campaigns. The Government were right to make the AIDS campaign general at first, but the evidence suggests that it should now be targeted on high risk groups—particularly on drug abusers or potential drug abusers.

Seventhly, we should encourage periodic medical check-ups for all those in identifiable risk groups. In some occupations—airline pilots are an obvious example—it is a condition of employment that one has regular medical check-ups. Regular check-ups would involve more and better information about all of us. The Select Committee report states: As part of health promotion work, more information is needed. Call and recall systems based on age-sex registers are now feasible and, using computers, could be extended to cover the whole population. As the Government says, 'Computer systems can be used to detect when patients are slipping through the net and to increase the effectiveness of preventive health care'. It would help us to bring about that aim if we brought together the family practitioner service and the district health authorities.

Eighthly, we must have more general practitioners and smaller lists. Paragraph 28 of our report makes this very clear. It states: With an ageing population, earlier patient discharge from hospital—particularly of children, increasing opportunities for diagnosis in general practice to reduce referrals to hospital, as well as greater responsibility for the management of chronic disease in general practice and a greater emphasis on a range of preventive services, the case for further reduction in the GP list size seems unanswerable. This must mean the employment of a greater number of GPs, and a significant sharing of care with nurses and other medical workers, together with the encouragement of prevention and self care by patients. We therefore recommend accordingly.

Mr. Galbraith

I cannot disagree with anything that the hon. Gentleman has said, but what method does he envisage to reduce general practice lists? Would he consider reducing the capitation fee when a list goes above 1,700 and reducing it still further above 2,500? Is he aware that the Government, in their most recent publication on this, suggested a system in which the capitation fee increased as the number of patients increased, which would lead to even larger general practice lists?

Sir David Price

The hon. Gentleman makes a fair point. I am making my speech in headline form in an attempt to be brief and I should detain the House too long if I developed my views on this, but I believe that the method of payment of GPs must change if we are to achieve what I have in mind. I think that it is sufficient contribution from the Back Benches to mark the fact that this must be done.

Ninthly, we cannot develop the National Health Service from being primarily a national illness service to a full and positive national health service without devoting more resources to it. One could argue that all that is needed is a bit of bridging money, but I do not accept that view. In the long run, one hopes that improved general practice and primary health care and better health promotion will ultimately reduce the number of referrals to hospital, but there are no secure figures on which to base a financial estimate. In my view, we have to accept that more resources must be devoted to this aspect of health.

Finally, we must involve the whole nation in health promotion if we are to succeed in our aims. We in Parliament should be careful not to attempt to impose what we regard as necessary for good health on a possibly reluctant people, on the basis that we in Westminster know best.

I end by cautioning the House not to follow the errors of our Puritan predecessors in the House who in 1652 banned the celebration of Christmas because they regarded it as pagan feasting and the house itself sat on Christmas day that year. No doubt that had something to do with the subsequent rejoicing at the restoration of Charles II. Let us, therefore, be very cautious before trying to ban burgers and chips or bacon butties.

11.13 am

Mr. Ronnie Fearn (Southport)

First, I congratulate the hon. Members for Norfolk, South-West (Mrs. Shephard) and for Strathkelvin and Bearsden (Mr. Galbraith) on their maiden speeches. Both have much to offer the House and I hope some day to visit both their areas. I have already visited Norwich.

I am delighted to take over the health and social security portfolio for the Liberal party as I believe that this is one of the most important issues, although it is accorded one of the lowest priorities by the Government. I pay tribute to my predecessors, my hon. Friends the Members for Southwark and Bermondsey (Mr. Hughes) and for Roxburgh and Berwickshire (Mr. Kirkwood), both of whom put an enormous amount of effort and skill into the job and harried the Government relentlessly on this issue.

I am pleased that today we have a chance to debate the important issue of health promotion. We have long taken the view that the National Health Service is geared far too much to being a curing service and does not concentrate enough on the prevention of ill health. In my view, ill health prevention is far from being a narrow DHSS matter. It should include diet, housing and social policies The alliance has said: To prevent ill health Government and people must attack and remove social deprivation. The most effective way to improve the health of people is to tackle unemployment, poor housing and poverty. That statement is the complete contrast to the comment of the previous Secretary of State for Social Services, the right hon. Member for Sutton Coldfield (Mr. Fowler), who replied to a question from my hon. Friend the member for Southwark and Bermondsey about inequality and health: I do not accept for one moment that there are horrendous inequalities and the report that the hon. Gentleman is holding— the Health Divide report— is no objective indication that there are." — [Official Report, 7 April 1987; Vol 114, c.146.] The right hon. Member must be the only person who believes that there is no connection between illness and inequality. The appalling nature of the inequality in good health between regions and social classes is clearly shown by the Health Divide report. For example, in the northern region death rates for men of working age are 88 per cent. higher among part-skilled and unskilled manual workers than among the professional and managerial classes, and the rates for women are 70 per cent. higher.

I am concerned at the inactivity of the Health Education Authority. Announced in November but set up only in April, that organisation has done next to nothing since then. I was therefore pleased to hear that the Minister intends to hand over responsibility for the fight against AIDS to that organisation, but the budget quoted today is far too small. What will be the remit, and why has there been an 11-month delay?

Mrs. Currie

That figure was for the rest of this financial year, which is only a small part of the year. Moreover, I do not know where the hon. Gentleman has been since the spring as the whole of the "Look After Your Heart" campaign, among many others, has been run, engineered and co-ordinated by the Health Education Authority.

Mr. Fearn

I accept that, but last November it was regarded as sufficiently urgent to announce the authority of the centrepiece of the Government's AIDS proposals. Who is to be the public's advocate? Does the Minister accept that any worthwhile promotion programme is bound to come up against vested interests, whether they be the interests of tobacco companies or those of other Government Departments worried about their budgets? Does she regard the HEA as a tool of Government or does she expect it to have the power and independence to fight against the vested interests of other Departments? I am reliably informed that in its first flush of enthusiasm the HEA decided to import an American idea — the prevention index. A list of factors was sent to a series of experts and pressure groups, who were asked to rank them in order of precedence as causes of ill health. The results were not published because, I am told, unemployment came second on the list. Will the Minister confirm that and will she publish the results?

We welcome the "Look After Your Heart" campaign as the only significant thing that the HEA has done so far. The campaign is vital because heart disease kills 160,000 people per year—one every three minutes—costs £458 million per year in grants, surgery and hospital beds, and is responsible for one in nine working days lost. I agree with the Coronary Prevention Group that it is ironic that in 1987, the first year of the campaign, taxes on tobacco were not increased despite the well-documented effect of such increases on smoking. Electoral popularity triumphed over health promotion.

We support regular tax increases above the rate of inflation, on smoking, and a ban on all promotion of tobacco products. We also support a more comprehensive health warning about tobaccco and non-smoking as the norm in public places.

The prevention group points out that the Government suggest, and ostensibly support, greater use of exercise, but the Sports Council's budget has been reduced. How can the Government justify that?

We support the prevention group's call for a mandatory format for nutritional labelling which would include saturated fat levels and sugar, fibre and salt content. It is no good telling people to have a healthier diet if we do not provide sufficient information to allow them to make sensible decisions about what they eat.

The Under-Secretary said at the launch of the Government's campaign: Heart disease is not a Tory disease; it is not a Government disease. We do not suggest that it is, but there is a great deal that the Government could and should be doing. If it is not to appear that the campaign is little more than a publicity wheeze for Ministers, rather than a realistic and effective campaign, a number of questions need to be answered.

How long will the campaign last? Ministers are saying different things. Will the DHSS ensure that GPs and others involved are aware of practical solutions so that they can advise their patients? We do not want a campaign aimed merely at the problems. If increased screening for cholesterol is not matched by proper counselling it will be next to useless. Will the Under-Secretary increase the number of community dieticians and restore nutritional standards for school meals? The Government abolished those standards and I do not believe that their restoration would cost money. Will the Under-Secretary also draw up a mandatory code on food labelling?

In the fight against AIDS, with no cure and even a vaccine many years away, health promotion is the only answer. It is vital to have a national co-ordination strategy to fight AIDS which will lay down guidelines and allocate resources for at least 10 years and, thus, involve all-party discussions.

The all-party Select Committee on Social Services produced a report in May, but there has still been no exact Government response. The Government have seriously underestimated the cost of treating AIDS patients; by 1992 about 3.2 million people are liable to be infected. Clearly, we cannot afford more delays.

Many of the measures necessary to combat AIDS are potentially embarrassing to the Government, dealing, as they do, with sex and drug abuse. However, the situation is far too grave for us to be squeamish. The problem is serious enough for the Government to take the bold step of making condoms available free of charge in GP's surgeries and chemist shops.

The pilot schemes involving syringe exchanges must be extended and the Government should consider the desirability of selling sterile syringes across the counter in chemist shops. The problem of AIDS in prison must also be tackled.

The Government or the HEA must plan now advertising campaigns for the next few years. They need to be explicit, but to be careful to avoid blame or to stir up unnecessary fears. More resources are urgently needed for counselling and testing or renewed advertising will swamp the system, as happened previously.

AIDS has overshadowed hepatitis B which can lead to cancers and acute illness, and we must note that there are 200 million carriers of hepatitis B throughout the world. It is different from AIDS, because vaccination is possible and the Government should issue guidelines to health authorities to ensure that health care workers and others at risk are immunised.

The Green Paper on primary health care essentially restricts itself to the family practitioner services. In contrast, the Cumberlege report on community nursing provides a comprehensive and imaginative set of proposals for developing the role of nursing in health promotion. We support the concept of the nurse practitioner and believe that it should be introduced in all areas to complement the services of GPs and to contribute to a more effective primary care service in the community.

The Government should do all in their power to enforce in industry, including agriculture, strict standards to restrict harmful pollution in food, air and water.

The Government make much of the fact that resources are scarce. Rather than cutting hospital provision, they should be investing across all Departments to tackle poor housing, poverty and unemployment, while campaigning against poor diet and, through taxation, against smoking and alcohol. They must also ensure adequate screening systems for women.

Finally, action against vested interests is vital and would be more effective than pretty pictures and words.

11.26 am

Mr. Christopher Gill (Ludlow)

Thank you, Mr. Deputy Speaker, for providing me with the opportunity to make my maiden speech in the debate on the promotion of good health.

May I first pay tribute to my predecessor, Eric Cockeram, who succeeded Sir Jasper More as the hon. Member for Ludlow in 1979. I am sure that the House will wish Sir Jasper a full recovery from his recent illness.

During Eric's second term at Westminster, he was a prominent and effective member of the Public Accounts Committee and of the Select Committee on Trade and Industry. While the hon. Member for Bebington between 1970 and 1974, he had been the Parliamentary Private Secretary to the Chancellor of the Exchequer. Eric was a capable, concerned, loyal and conscientious Member, who enjoyed the respect of his colleagues. On behalf of his constituents, I thank him for the manner in which he so assiduously represented their interests for the past eight years.

Perhaps I may be permitted to say a few words about my beautiful constituency, which is known to more than a few hon. Members as a very lovely and unspoilt part of rural England. I would describe it as an ideal place in which to live, to work, to holiday and ultimately to retire.

Living in the middle of this predominantly agricultural constituency, I am able to cast my eyes to the east, to the arable areas which have profited so much from our membership of the European Community, and to the west, where the farmer dependent upon livestock has, sad to say, been less advantaged. While the majority of the House believes that a reform of the common agricultural policy will resolve that dilemma and many others, I believe that circumstances and events will ultimately prove that majority to have been wrong in its judgment. I say that, because differences between individual member states of climate and weather, geography and topography, history and traditions, and, not least, markets are too disparate to permit a common solution — quite apart from the obvious political difficulties of achieving a consensus.

We are witness to the absurdity of bureaucrats in Brussels making or amending rules about farming, the practicalities of which are as Greek to them, and a plethora of organisations, to which I shall refer later, seeking to control or stultify the environment in which that industry must operate.

The environment in rural England today is the direct result or consequence of farmers tending their crops, husbanding their resources and producing food, that most essential prerequisite of good health. There is no such thing as bad food, only bad diets. We need to do more as a nation to improve people's knowledge in that regard.

I applaud the statement attributed to my hon. Friend the Minister: the Government is determined that people should get accurate information to help them make sensible choices about healthy eating It is indeed high time that the public were given the facts. For most people, moderation in all things and a properly balanced diet is the most appropriate advice. As a master butcher and a practical livestock farmer I should like to draw the attention of the House to other facts. Meat, for example, essential protein, vitamins and minerals, and good old-fashioned meat and two veg, is in itself an ideally balanced meal.

It is a fact that less than a quarter of all saturated fats are derived from meat and meat products. Even that proportion can be reduced simply by leaving the fat on the side of one's plate, and that is more than can be said for any other foods, very many of which inevitably contain a much higher proportion of saturated fats. Beef and lamb, much of which is produced in my constituency, is the most natural, unadulterated food in the world.

These same animals, which provide us with good, wholesome, nutritional and healthy food, also help to maintain the balance of nature and keep our countryside so attractive that in my constituency we have attracted the attention of at least half a dozen either statutory or voluntary bodies intent upon its protection and preservation. Those bodies are the Countryside Commission, the Forestry Commission, the Development Commission, the Nature Conservancy Council, the Council for the Protection of Rural England, and the Shropshire Trust for Nature Conservation.

In this one, admittedly large, constituency which it is my pleasure and privilege to represent I have conservation areas, rural development areas, intermediate assisted areas, environmentally sensitive areas, agriculturally less-favoured areas and areas of outstanding natural beauty. However, for anyone living in this idyllic environment who is unfortunate enough to be taken ill, there is but one body to which he can turn—the Shropshire health authority. Even as I speak, that authority is planning closures for want of a few hundred thousand pounds. What consolation, indeed what relevance, is it to the sick and dying, to be told that they live in an area of outstanding natural beauty?

Where is our sense of priority when we spend so much time, effort and cash on preserving the environment but deny the very people who tend that environment the basic right to be treated or, indeed, to die in their own surroundings?

Is there any realisation that the environment which has attracted so much "dogooding" cannot be maintained without people, and that without adequate schools and proper health provision it is the people, not the trees, that are at risk?

If I am conspicuous by my absence from this place, it is because I am manning the barricades in south Shropshire to fight the attempts to close the rural hospitals. Without schools and hospitals we are left with no more that a nice view. I do not believe this Government, who have already done so much to ensure that available resources are targeted towards those in greatest need, will countenance that.

Since 1979 we have had an expanding health budget, but at the same time the demands on the NHS have been growing, not only because of the age structure of the population but also because of improvements in medicine. Against this background I welcome the forthcoming debate on the evolution of the National Health Service. Doubtless this will consider the potential for developing the partnership between insurable health care and that which must inevitably continue to be funded by Government. Meanwhile, real problems exist and in Shropshire the major one is perceived to be the level of resource available. I very much hope that Government commitment to resolve these difficulties will soon be revealed.

11.34 am

Mrs. Audrey Wise (Preston)

I congratulate the maidens who have given us such fluent speeches, the hon. Members for Norfolk, South-West (Mrs. Shephard) and for Ludlow (Mr. Gill). I agree with the strictures by the hon. Member for Ludlow about the closure of hospitals in rural areas. He will gain much support from the Opposition if he pursues that line of thought and action. Later in my speech I shall take issue with the hon. Gentleman on one or two of his other statements. I also congratulate my hon. Friend the Member for Strathkelvin and Bearsden (Mr. Galbraith) and associate myself with his remarks. In his eloquent maiden speech he pointed to the close link between the improvement in social structures and conditions and the improvement in health and the conquest of disease.

I am grateful to you, Mr. Deputy Speaker, for calling on me to make a maiden speech for the second time in my life. That seems to make me an experienced maiden, which is rather a contradiction in terms. At least it is a more interesting description than "retread". I am glad to be back in the House and especially glad to represent Preston.

I am privileged to follow Stan Thorne, who represented Preston so well for the 13 years during which he was a Member of this House. I know Stan very well. We came into the House together in 1974 and during those first five years I worked closely with him on the many issues in which we have a shared interest. I saw his work at close quarters then and lately I have seen the high regard in which he is held in the constituency of Preston. I am proud that he was pleased to introduce me to his constituents and I am grateful to him for the help that he has given me. I hope to achieve in the representation of the people of Preston, the high target that Stan Thorne has set for me.

I am also pleased to represent Preston because it is a fine town with a strong sense of its own identity. Indeed, it calls itself proud Preston. It has many problems, not the least of which are those associated with the closure of much manufacturing industry. I have no doubt that in the House I shall draw attention to those problems many times. Despite its problems it is a good town, a friendly town, and overwhelmingly a Labour town. I am proud to represent proud Preston.

I am less pleased to have to tell the House that people in Preston suffer higher premature death rates than the national average or even the average in the north-west. They also have a higher perinatal death rate than the national average. I assure the Minister that this is not because Preston people choose to die sooner than their fellows in the rest of the country. Premature deaths in Preston follow closely those areas with the most poverty and the worst living conditions. A recent report was produced by the director of community medicine in Preston, but perhaps the Minister has not yet had a chance to study it. I shall send it to her and ask for her comments. Directors of community medicine have an important role to fulfil and I regret that recent changes in the management of the National Health Service have reduced the influence of community physicians.

I listened with incredulity to the Minister when she said that the health divide is between those who know that their health is in their own hands and those who do not. I cannot understand in what world the hon. Lady lives when she can make such an amazing statement. They are cruel remarks directed at people who are forced to live in conditions that are emphatically not of their own choosing. She scoffs at us for appearing to think that "people are helpless pawns of their circumstances." I do not believe that people are helpless pawns of their circumstances. I believe that the common people of this country, over many years and generations, have fought to improve their circumstances, but that their task is made ever harder by the cruelty and inhumanity of the Conservative party. The way that it conducts this country's affairs is designed to reduce people to being pawns. It steadfastly takes away their rights and their opportunities to defend themselves.

The Minister interestingly talked about the fact that the United States of America spends more on health care than we do, yet we do better. I am only sorry that the hon. Lady does not listen to her own words rather more carefully and draw some conclusions from them. Surely the great difference between this country and the United States of America in the field of health care is that it spends twice as much, it has no national health service and over 30,000,000 people have no health insurance cover. It is a disaster to be ill in the United States of America and, if one is poor, it is an impossibility to be well.

Those are the conclusions that the hon. Lady should draw. When she does draw them, she should draw her Government back from their endeavours to make this country a poor imitation of the United States of America. While she is studying the problems, she should also compare Sweden with the United States, because Sweden has imcomparably better figures for perinatal mortality than the United States. They are both rich countries. The great difference between Sweden and America is that in Sweden there is much less inequality and far more social justice, which is reflected in better lives for babies and more chance for those babies to survive.

The hon. Lady willingly gave divisions by sex and age on health factors in the population, but figures relating to social class were noticeably lacking. I commend to her the British Medical Association Paper on deprivation and ill health. It is a very careful study and it comes to some striking conclusions. If the hon. Lady, who is concerned with the promotion of good health, were to take to heart the statements in the BMA paper, she might manage to convince her Government to cease increasing ill health and to act to improve good health.

I am in favour of changes to our lifestyle. I am not just a non-smoker, I am a positive anti-smoker. But it is idle to harangue people, especially to harangue women in the vulnerable state of being expectant mothers, about their smoking habits. The Government should examine the kind of stresses faced by women in their everyday lives. They should examine the poverty faced by so many women, the lack of power held by so many women and, in particular, the isolation of women. Has the hon. Lady never heard women say, "I must get out of these four walls."? What is her Government doing to reduce isolation, whether in inner cities or in rural areas?

The best way to reduce isolation is to give more social support. Items such as nursery care can make an enourmous difference to the lives that women lead. More opportunities for employment, whether full-time or part-time, would reduce the stress on women by increasing their opportunities for independence and for better incomes. Let us have less emotional blackmail of women and a good deal more help for them.

We are told that people make bad choices. I will tell the hon. Lady some of the bad choices that apparently people in Preston make. They make choices apparently to live in rotten, damp houses in areas that need a good deal of work done on them. These are not free choices.

My grandfather stood for election to a local council in a deprived area in Newcastle-upon-Tyne in 1932, 55 years ago. In his election address, which is a valuable possession in my family, he made the connection between ill health and had housing. Everybody who is interested in health must make that same connection today.

There are many factors besides simple overcrowding or lack of facilities. For example, in Preston the borough council is unable to put fences around gardens so that women can allow their children to play in those gardens in safety. There are all the design factors and realities of life on estates where councils are thirsting to make improvements but are prevented from so doing by the Government, even when they have the money in the bank. Preston has over £7 million which it longs to spend on improving its housing stock, yet it is prevented from so doing by Government Ministers.

The hon. Lady said that she is surprised that nurses continue to smoke. Once again, I draw her attention to the stress factor. The nursing staff at the Royal Preston hospital spend a good deal of their time arranging the movement of patients from ward to ward. A stroke patient was moved seven times in three days, and patients are moved because of the closure of surgical beds. I appreciate that the debate is not about the acute service, but those nurses are part of the community who should be in a position to give an example when it comes to stopping smoking. However, their lives are so stressed and their morale so low that they need not lectures but assistance.

Nurses also need less harassment in relation to their residences. To save money, it is the policy of health authorities to dispose of nurses' homes and to harass nurses living in those homes in order to empty the buildings. That is disgraceful. Our nurses have neither peace and tranquillity in their working lives nor in their homes.

Last year the Government abolished the £25 maternity grant. Yet the link between ill health and poverty is so clear, and never clearer than in 'relation to expectant mothers. The Government said that £25 is a small amount. Anybody with a grain of logic would have increased it, but the Government decided that, since it was so small, they would dispose of it altogether, thus robbing the poorest mothers even of a miserly £25. The Government propose to go further along that path with changes in social security and the introduction of the cash-limited social fund next April.

I am in favour of better food. I take issue with the hon. Gentleman the Member for Ludlow, who said that there is no such thing as bad food, only bad diets. I suggest that good food cannot be the product of factory farming. If food is produced by cruel and inhumane means, we are diminished. I believe that one is endangered by what one puts in one's stomach because of the medication that factory farm animals require to prevent them from suffering epidemics. It does them no good, it does us no good, and it is an insult to our status as human beings.

What about the lettuces that are full of nitrates? I believe in eating a good deal of fresh produce, but I know that my best hope of getting it is to grow it in my own garden. I am lucky enough to have a garden, but my position would be better still if there were more opportunities for motorists to buy lead-free petrol, which would result in my garden being less polluted.

The British Medical Association's paper has much to say about food. It refers to the importance of individuals changing their diet to include fresh vegetables and fruit. It states: Superficially, this advice appears inexpensive to follow. For example, skimmed milk is cheaper than whole milk; red meats are expensive while green vegetables are cheap. However, this cursory analysis ignores the calorific value of the foods. To obtain the same energy intake, a person needs to drink more skimmed than whole milk, at greater expense. Green vegetables and fruit are not very filling and hence even their low cost can seem hard to justify for somebody on a low income. When the BMA referred to a "cursory analysis" it must have had in its mind's eye a clear picture of the Under Secretary of State.

The London Food Commission has estimated that a diet in accordance with current guidelines costs 35 per cent. more than the amount which poorer families actually spend on food. It detects no relationship between the supplementary benefit rates paid for children and DHSS estimates of energy needs at different ages. Similarly, the Maternity Alliance concludes that a healthy diet in pregnancy would cost a third of the income of a couple on supplementary benefit and half that of a single woman. So, one lectures a single woman about a better diet only if one has a brass nerve. The Under-Secretary of State does lecture her, so she must have that sort of nerve.

I believe in choosing organically grown food. I believe in healthy diets, and I want to know what the Government are doing to help organic growing even so that those who can afford to make the choice have the opportunity of obtaining organic foods.

I believe that the Lady's advocacy of healthy living tends to bring the concept into disrepute. Fewer words, less haranguing and more action would be a more proper approach.

I assure the hon. Lady once again that my constituents do not choose early death. Nor did they choose a Tory Government, and they can make the connection between the two. I shall continue to bring their problems forward and suggest solutions to them. I look forward to the day when a debate like this will be accompanying real action instead of being a substitute for it.

11.53 am

Mr. Michael Shersby (Uxbridge)

First, I thank the maiden speakers who have contributed to the debate, especially my hon. Friend the Member for Norfolk, South-West (Mrs. Shephard). It was delightful to hear her speaking about the lovely county of Norfolk and the interests that she has in it and her remarks about her predecessor, Sir Paul Hawkins, who was much loved and respected in the House.

The hon. Member for Strathkelvin and Bearsden (Mr. Galbraith) served the best traditions of the House in the way in which he paid tribute to his predecessor whom he defeated at the general election. It is welcomed generally when Members observe the conventions of this place.

My hon. Friend the Member for Ludlow (Mr. Gill) made an extremely interesting speech which found echoes in all parts of the House. He reminded us of the beauty of his constituency. If I were a hunter, I think that I would go quango-hunting in Ludlow. We must investigate the vast increase in the number of quangos that appears to have taken place in that part of the country.

My hon. Friend the Member for Ludlow spoke about food being an essential prerequisite to good health, a note which I shall pick up later in my speech. May I also welcome the hon. Member for Preston (Mrs. Wise) who on her return to the House made a typically robust speech. I have one thing in common with the hon. Lady in that I am a dedicated non-smoker. Unhappily, I cannot agree with the rest of her remarks, although I had the pleasure of visiting Preston briefly recently en route to another town in the area. Every time I pass through Preston I find it a very interesting historic town. I want to join the hon. Lady in paying tribute to Mr. Stan Thorne, who represented the constituency of Preston very effectively for many years in this House.

I want to declare an outside interest—that I am a member of the council of the Food and Drink Federation and other food industry bodies as declared in the Register of Members' Interests. Because the food industry in this country is very responsible and highly regulated, producing food of very high standards, I believe that it has an important role to play in the promotion of good health. I have no reservations in speaking about it today.

My hon. Friend the Member for Ludlow said that good food is essential for good health. So also is a varied and balanced diet. Fortunately, most people in Britain today have access to good food in sufficient quantities throughout the year, irrespective of the rigours of the seasons. However, not all of them necessarily have the benefit of a sufficiently varied and balanced diet. One of the principal reasons for that is a lack of knowledge about human nutrition. Another reason is that the consumer today is becoming increasingly confused by the conflicting advice received from a variety of bodies, some official and others unofficial.

It is virtually impossible to turn on the radio or television without hearing or seeing some new expert on diet telling us what we should or should not eat. I thought that that situation was described very well by Digby Anderson in the first chapter of a recent book entitled, "A Diet of Reason", published by the Social Affairs Unit. In that he said: The British housewife, her husband and their children are currently bombarded with messages telling them what to eat to become, or stay, healthy. The point is also made in the book that there is a group of activists in the healthy food debate who claim to have some conclusive evidence about healthy eating. It is time, the group states, for its opinions to be imposed on the population by specific Government policies such as nutritional guidelines and through the intervention in the composition of meals served in schools, hospitals and other institutions. These activists claim to have conclusive evidence on what they say, the population now agrees constitutes a healthy diet. We have heard echoes of that in the House today. Such people are quite sure that we all eat too much of certain foods and too little of others and that our current eating habits cause major killing diseases like heart disease.

However, as the Social Affairs Unit has said, the group urges a radical change in national diet so that we can all reduce the risk of such diseases and live longer and healthier lives. They see that being achieved through the funding of Government propaganda on healthy eating and the banning of the production and advertising of certain foods which that group decrees to be unhealthy. In their different ways, a number of expert authors of the papers contributed to "A Diet of Reason" have completely rejected that position. They make clear that the evidence relating to diet and health is not conclusive.

Much of what is presented to the public, even in reports published by unofficial bodies such as the former National Advisory Committee on Nutritional Education or the Health Education Council is not strictly scientific. There is no single, clear, simple message about the foods that we eat. There is no guarantee that if we change our diet in particular ways many of us will enjoy better health, let alone live longer. The Social Affairs Unit has done a service for the country by bringing those facts to our attention.

What should be the role of the Government in promoting good health through our diet? My hon. Friend the Minister has made it clear in a number of speeches that there will be no national diet and that individual choice is the theme of the Government's food and health policy. I am sure that that is the right policy and I am also sure that the majority of people in this country will be relieved to learn that there are to be no national dietary guidelines and no DHSS cook book, perhaps the worst horror that some of us could contemplate. My hon. Friend has also made it clear that the key to ensuring good nutrition is education, better food labelling and the ability of the consumer to make up his or her mind as to what is best suited to their individual diet. I agree with her views but I hope that she will go further.

Nutrition is a subject that should be part of the course of every medical student. I hope that I may have the support of the hon. Member for Strathkelvin and Bearsden, as he has a special knowledge of these matters. I feel that if doctors are well informed about human nutrition they will be better equipped to give expert advice to their patients when they have a particular problem, be it obesity or heart disease. I hope that my hon. Friend the Minister will discuss with my right hon. Friend the Secretary of State for Education and Science the need to include the teaching of human nutrition in the school curriculum as soon as possible. Perhaps it should be called the apple-core curriculum. It is certainly an important subject. Far too many people today do not enjoy a good balanced diet simply because they do not have the knowledge to make that possible.

Better food labelling and informed choice will not, by themselves, lead to an improvement in health. We must also ensure that our farmers and the food industry are encouraged to continue to provide the widest possible choice of food and drink products. In a society such as ours, where more women than ever before are at work, processed food is now providing a major part of the diet. In fact, about three quarters of the food we eat in Britain is processed and there are more than 50,000 food and drink products from which to choose. The average supermarket now carries about 10,000 products and the average family buys about 300 different products a year.

It is worth noting that about 80 per cent. of our population now live and work in urban communities and it would clearly be impracticable for everyone to grow, store and preserve their own food. In fact, without food processing it would be impossible to feed our population of 56 million. Therefore, safe, nutritious and high-quality food makes a major contribution to the promotion of good health and provides an important addition to the availability of fresh food and vegetables.

I was particularly glad to hear my hon. Friend the Minister talk about the work of the new Health Education Authority. She told the House about the programme of health promotion to be undertaken and she made specific reference to the authority's campaigns on AIDS, smoking and heart disease. Those are all national initiatives and they are most welcome. However, a great deal more can be done at local level and I would like to give a few examples of what is happening in the borough of Hillingdon in which my consituency is situated.

Hillingdon health authority is making certain that people know what is available in terms of health care; it is doing that by producing a quarterly newsletter which is now being distributed to over 90,000 residents in the district. One quarter of the newsletter is devoted to health promotion. Trying to deal with the problem of AIDS locally, the health authority runs a helpline, which is available between 10 am and 5 pm and provides free syringes and condoms for drug addicts. Hillingdon also has a cervical cytology call and recall scheme introduced in April last year for women aged between 35 and 60 and for those who have had three or more pregnancies. It has also introduced cervical cytology screening for health authority staff.

We in Hillingdon are participating in the "healthy hearts" and "look after your heart" campaigns, and we have an annual healthy heart run at Harefield hospital. Most people have heard of Harefield, because it is one of the two great centres in this country providing the expertise to enable people to have heart transplant and bypass operations. The local health authority has restricted smoking on all its premises, as has the borough council. Those are some examples of what one borough is doing; I am sure that others are making similar moves in the right direction.

A tremendous drain on national resources is caused by the treatment of some major diseases. The latest figures for expenditure on the anti-AIDS programme show that resources of about £50 million will be expended in the forthcoming year. Heart disease is costing £400 million, smoking-related diseases another £400 million. But I was staggered to hear my right hon. Friend the Secretary of State for Social Services say in his Blackpool speech that alcohol-induced illness now costs £2 billion. That is a substantial sum, and a massive drain on the resources of the National Health Service.

When the Minister winds up, I hope that she will say a word or two about measures that may be taken, either by her Department or by the Health Education Authority, to deal with that major problem. The scale of the resources demanded to deal with it makes the expenditure on heart disease pale into relative insignificance. I do not say that in any light-hearted way, and every hon. Member will surely agree that something must be done to tackle such an enormous problem. Two billion pounds is a lot of money out of a health budget of £19 billion this year, rising next year to £21 billion. Anyone who feels that we are not spending enough on health should bear in mind that £21 billion is a pretty massive sum by any standards.

My hon. Friend the Minister referred to the improvements in the lifespan of people in this country. In my own lifetime of just over 50 years, life expectancy at birth has increased from 58.7 to 71.6 years for men, and from 62.9 to 77.4 years for women. As my hon. Friend said, that is due in part to the elimination or control of major infectious diseases such as smallpox, tuberculosis, diptheria, cholera and poliomyelitis. However, it is also due to better nutrition and a better standard of living.

I accept that, as Opposition Members have said, many homes still fall below the standards that we would wish to see. There are still too many damp homes, in particular. Every hon. Member has the problem in the winter months of dealing with the complaints of constituents living in damp homes. Through our housing programmes, I am sure that we shall continue, both nationally and locally, to tackle that problem.

The principal activity in which both the DHSS and the Health Education Authority should be involved is that of tackling the major diseases to which I have just referred and securing their elimination. They are the areas in which the maximum loss of life is taking place. They are the major drain on scarce resources. If we could eliminate the expenditure of £3 billion on those diseases alone, we should have more money to spend on the improvement of the inner cities, on better housing and on ensuring the promotion of good health. Anyone who has travelled around the world knows that we are very privileged to live in a country where health standards are high and where every citizen has access to health care. That should not be lost sight of in this debate. I wish all power to the Minister's elbow. She should keep up the good work. We shall all give her our full support.

12.10 pm

Dr. Lewis Moonie (Kirkcaldy)

I join other hon. Members in congratulating those hon. Members who have made their maiden speeches today. The hon. Members for Norfolk, South-West (Mrs. Shephard) and for Ludlow (Mr. Gill) eloquently described the problems that are faced in rural constituencies in an effort to maintain access to health facilities. That is often overlooked by those with less rural constituencies such as myself. My hon. Friend the Member for Preston (Mrs. Wise) is an experienced parliamentarian and does not need my congratulations, but I welcome what she said and the polemical way in which she said it. At times like this it is good to introduce a little controversy on to the Floor of the House. I congratulate also my hon. and small Friend the Member for Strathkelvin and Bearsden (Mr. Galbraith). We worked closely together for many years, and I hope that we shall do so again in this House.

It would be remiss not to say something about the speech of the hon. Member for Eastleigh (Sir D. Price). lt was very impressive. I have rarely heard a speech from Conservative Benches to which I listened with such interest and with which I was in such agreement. I welcome the report, and I hope that it will be acted on promptly.

Today's subject is one of the most important that we shall be discussing during this Session of Parliament—the means by which a relatively wealthy nation like ours can foster the health and well-being of its people. Good health is not just a matter of ensuring that the NHS is adequately staffed and funded. Nobody would disagree that that is important. It is not just a matter, either, of another advertising campaign in an attempt to market good health like any other commodity.

Today, alas, the Minister has shown that she has learnt very little during the period in which she has been in office. What are we to say if people are unhealthy? Do we say that they are to eat Flora instead of butter, or that they should eat muesli instead of cornflakes? That is fine, but can we really expect them to take advantage of the advice that we give them? It cannot, surely, be the Government's fault if people are too foolish, or ill-educated, or live too far north to take advantage of the good advice that is given to them, can it?

Mrs. Currie

Would the hon. Gentleman join me in advising people to eat porridge?

Dr. Moonie

But of course. One can tell by the size of the hon. Member who is standing opposite the Minister that it is a most excellent food, particularly when it is eaten with cream washed down with whisky. But that is only on very rare occasions—usually on 31 December. There is only one thing that is wrong with porridge. For it to be palatable, it needs a fair amount of salt, and there is some evidence that the consumption of salt is bad for us. Perhaps, therefore, porridge is not quite so good for us as we may think.

Governments must promote good health. It cannot be left just to the individual. Individual behaviour is ultimately responsible for much ill health, but it is only ultimately so. Healthy choices can be made only in the context of a society which gives everybody a fair chance of making them in the first place. That is something which we in Britain have so far manifestly failed to provide. Death and disease arise because Governments fail to prevent them — not just this Government, but all Governments. Is the Minister asking the House to believe that a person living in poverty, in damp, overcrowded, ill-heated housing, in a bedsit with young children with no prospect of employment and miles from decent shops and, possibly, from health facilities can make appropriate choices about his or her health? I am certain that the Minister has read the reports of Sir Douglas Black and that she must have listened to the medical profession, nurses, social workers and others.

We live in a society which makes illness much easier to achieve than health, and it is up to the House and the Government to create the conditions which will make good health a reality, not just a dream. What, therefore, should our priorities be? Members on both sides have touched on general priorities—the abolition of poverty must be a prime consideration, the provision of good housing, the chance of a decent well-paid job for everybody, access to warmth and comfort and a well-funded Health Service with its objectives clearly defined and monitored by the Government to ensure that they are met.

I shall give the House an example of one way in which we fail to monitor objectives. I am from Scotland, as hon. Members can undoubtedly tell from my accent. I am sorry that the Scottish Minister with responsibility for health is not present. It was obvious that Scottish Members would speak today, and our Health Service is differently organised from that of England and Wales, as it is organised through the Scottish home and health department. When the Labour Government were in power, they commissioned a report which was published in 1980 and accepted by the then Government. It was entitled SHAPE, "Scottish Health Authorities' Priorities for the Eighties". The main priorities in the report were health promotion and the provision of services, especially community services for elderly, the mentally ill, mentally handicapped and disabled people. The money for them was intended to come from other services which were being provided.

Over the past eight years, I have worked in the Health Service in preventive medicine and I am sad to say that those priorities have not been met. Even the monitoring has not been carried out effectively, because in many cases health boards have been unable to give the Government the information that they sought. What do we have now? We have failed to meet the priorities, so we have another report called SHARPEN — the name has obvious connotations — "Scottish Health Authorities Revised Priorities for the Eighties and Nineties". It is intended to focus our attention more accurately on the priorities of the day. Sadly, the priorities have been reduced in number and the report has not yet been published, despite the fact that it was completed six months ago. Instead of concentrating on the well-being of the elderly, the mentally ill and handicapped people, only elderly people will be a priority. The others have been downgraded — not, I suspect, because we have answered their needs and developed the services that we were supposed to, but because we cannot meet the objectives set.

There are many reasons for that. Government reports tend to be unrealistic. The supposition that resources can be transferred from acute services to services for those who are chronically sick and disabled is ill-founded if acute services are underfunded in the first place. The length of waiting lists throughout the country suggest that that is so. Our acute services are underfunded, so we cannot transfer money from them.

It is difficult for authorities to work together and to plan effectively. That is perhaps a further reason why the initiative failed. Above all, it has failed because of the abysmal lack of quality in the Home and Health Departments' monitoring and control. The Government must get to grips with the problem of the inability of their Departments to do what they want them to. I hope that the SHARPEN report will sharpen our performance in Scotland.

Community care will, alas, be something of a joke unless it receives the resources that it needs. Health promotion is about promoting good care for people as well as preventing illness. It is no consolation for someone who is waiting for a hospital bed or an operation to be told that the Government are spending money on promotion. More resources must be found, but the Government will probably disagree with me as to the best method of doing that.

I have mentioned a few of the general priorities that the Government should have, and in conclusion I shall touch on some matters that have already been mentioned. I have already mentioned funding for the care of elderly, mentally ill, handicapped and disabled people. Some 100,000 death occur every year as a result of inaction on smoking. We should ban tobacco advertising and ban smoking on public transport, restaurants, public buildings and shops. We should be looking at areas where smoking is permitted rather than those where it is forbidden.

If we are to believe the Goverment's philosophy that advertising is an effective means of promoting good health, surely we must accept the corollary that it is also an effective means of promoting bad health. Some 100 times as much is spent on advertising bad health through tobacco advertising as is spent on promoting good health by advising people to avoid it.

Mrs. Teresa Gorman (Billericay)

Does the hon. Gentleman agree that, by banning things that we disapprove of, we would be on a very slippery slope? Is he aware of a book called "Pure, White and Deadly", which is all about sugar and sweeties? Would the hon. Gentleman ban sugar, which is also a tremendous health hazard? The hon. Gentleman is embarking on a very slippery slope when he is talking about banning things with which we disagree.

Dr. Moonie

I have not once mentioned banning smoking or stopping people smoking altogether. I am speaking as a smoker my pipe is in my pocket. I am not speaking as a puritanical Member or as a killjoy who is trying to deprive others of their pleasures. I know that smoking is bad for people, but the fact remains that I enjoy it, as do others. I am saying that smokers should be prevented from harming other people. Those who manufacture killing products should be prevented from advertising them. It has been demonstrated in other countries that banning advertising is effective and it makes it less likely that young people will take up smoking. Non-smokers should be allowed to exist without being polluted by those of us who smoke. Our young people should be prevented from taking up a habit that will probably lead to a life-long addiction. Tobacco is the most addictive substance known to man. It is worse than heroin, cocaine, or alcohol.

Some hon. Members have mentioned alcohol and its enormous social cost. Again, I am a drinker and I do enjoy it, but fortunately I do not drink to excess. The Government would be well advised to take careful heed of the overall experience of Scotland since the relaxation of licensing laws before attempting to do the same thing in England and Wales. There is no evidence whatsoever that that relaxation has been beneficial in Scotland. The best that can be said is that the effect has been neutral: it may not have been a good thing. I know that the Government intend to introduce legislation to relax the licensing laws, but I urge them to take careful heed—I am sure that many Conservative Members will agree with this—of the experience elsewhere before they do so. Alcohol ingestion causes thousands of deaths each year on our roads. The time has come for us to introduce random breath testing in an attempt to stamp out this curse. That is the only way to give the police the means to take effective action against it. Advertising alone will not he enough.

Health promotion depends on collective action, not just on individual behaviour. It depends on Government action. Let us remember the World Health Organisation definition of health: a state of complete mental, physical and social well-being and not merely the absence of disease or deformity. Let us have action, not words.

12.25 pm

Mr. Alastair Goodlad (Eddisbury)

I add my voice to those of hon. Members who have congratulated the maiden speakers. The hon. Member for Strathkelvin and Bearsden (Mr. Galbraith) spoke with great knowledge and authority, and I hope that he will participate in many more health debates. He succeeded Michael Hirst, who was a popular and distinguished Member. I hope that the hon. Gentleman will not take it amiss if I say that we miss Michael Hirst and hope to see him back here.

The hon. Member for Preston (Mrs. Wise) has been very much in our thoughts during her temporary absence, partly because those amendments to the Finance Bill which bear her name and that of the hon. Member for Birmingham, Perry Barr (Mr. Rooker) were frequently on our lips. She made a characteristically robust speech and her return is welcome on personal grounds. She is welcomed back by all those who believe that a robust and healthy democracy needs a robust and healthy Opposition.

My hon. Friend the Member for Ludlow (Mr. Gill) has made a great impact in his constituency, as I know because I represent a constituency in Cheshire, the county next door. My hon. Friend's speech had much meat in it, and I know that he will have a great impact in the House, as well.

As my hon. Friend the Under-Secretary of State said, an important aspect of good health is the promotion of better mental health. In that context nothing is more important than the problem of schizophrenia. Sufferers from schizophrenia occupy one in four of our hospital beds. About one person in 100 suffers from the illness at some time during his life. About a third have a single attack; about a third go through a cycle of attack followed by recovery; and about a third are reliant for the whole of their adult lives on health and social security provision.

The symptoms of schizophrenia are heartbreaking for family and friends and appalling for the patient as he or she suffers delusions and hallucinations, perhaps hears voices, withdraws from family and society, loses the will to work and suffers acute mental stress. I am sure that all hon. Members have come across sufferers among family, friends and constituents. I saw schizophrenia at first hand in the mental illness hospital of which my late father was the medical superintendent and which was my home throughout my childhood and early youth.

The problem is massive. In this country there are about a quarter of a million sufferers and in the world at least 17 million. Schizophrenic patients occupy one in four of our hospital beds, although more than 67,000 inmates of mental illness hospitals have been sent into the community since 1959. About a third of our prison population suffers from the illness, many in prison for minor offences committed while under its influence. A number of sufferers live at home. Others live in various forms of accommodation in the community. Many live rough.

Beyond the statistics lie two things. First, there is human suffering on an enormous scale by schizophrenics and their families whose lives can be dominated and ruined by the effects of the illness. Secondly, there is the massive economic cost of hospital provision, community care, prison resources and the wasted lives and talents of otherwise healthy people.

What is the solution? There is no cure for schizophrenia nor is it know what precisely causes the condition. Neuroleptic drugs, such as Largactil, are used to control the acute symptons of schizophrenia by blocking the messages passing between the brain cells. Some people think that the illness is caused by the interaction between a person and his environment, but most researchers believe that it is a disturbance in the biochemistry of the brain. It may come about by the triggering of an inherited predisposition by stress or hormonal upsets. It may be associated with viral or other infection, which may be genetically transmissible. Nobody knows.

Research is being carried out to determine, first, what, if any, is the inherited factor of predisposition, secondly, to identify the triggering factors, and, thirdly, to discover more about the biochemistry of the brain, in the hope that more effective drugs can be developed. Recent developments in molecular genetics are such that it may now be possible to analyse the genes of sufferers. The PET brain scan now makes it possible to see what is happening in the live brain. There are about 20 teams in the world using the machine. There is only one in Britain. The machines cost £2 million and the one in this country is at Hammersmith hospital. I understand that it has been out of action for some time and is rarely available for research on schizophrenia.

There is a massive task for schizophrenia research if money and enthusiasm are available. Hitherto the disease has been unfashionable and underfunded. The Medical Research Council spends over £100 million a year. Just over £5 million of that is spent on mental health and only about £500,000 on schizophrenia. It is obviously difficult for outsiders to challenge the priorities of the council, but the amount devoted to schizophrenia seems small when measured against the scale of the problem. While research into the neurobiology of the normal brain may appear more important than specific research into schizophrenia, it would be an inexcusable tragedy if suitable and promising projects failed through lack of finance.

Research into some "fashionable" diseases, for want of a better word, is funded by other means — through charities for example. However, here — as in other countries — very little extra money is available for schizophrenia research. The National Schizophrenia Fellowship of Great Britain, MIND, the Richmond Fellowship and SANE — Schizophrenia — a National Emergency, established last year—are carrying out vital work, not only in seeking to raise money for research into the cause, treatment and eventual cure of the illness, but by seeking to raise public awareness of the problem. Their efforts, and those of The Times and Marjorie Wallace—the winner of last year's British Campaigning Journalist of the Year Award for her work on the subject—are of major importance.

There is an unanswerable human and economic case for the Government stepping up their efforts—including the Health Service research programme — to support research into finding a cure, and I hope that my hon. Friend the Minister will co-ordinate efforts to ascertain what more can he done.

In the absence of a cure for schizophrenia, I fear that, despite the dedication of those involved, the needs of schizophrenic people in the community are not being met as well as they could be, and must be. At a time when mental illness hospitals are being emptied of many of their patients but still kept open, there is an urgent need for adequate resources, co-ordination and planning so that the community can cope.

Community psychiatric nurses, day centres, voluntary organisations and so on are under desperate pressure to look after former psychiatric in-patients. Of the thousands of people discharged from mental illness hospitals, a tiny proportion go into local authority residential care. Many areas do not have a home or hostel to care for the mentally ill. It is not acceptable to run down mental hospitals before the planned network of hostels, workshops and day centres are built. It is estimated, for example, that 60 per cent. of the homeless are discharged mental patients, mostly schizophrenic. They have a crying need for sheltered employment. Sufferers are taken by the police under section to mental illness hospitals and refused admission. People accommodated as "vulnerable homeless" become "voluntary homeless" under the influence of the disease and become ineligible for council accommodation. We must not stand by and watch the creation of a new lost tribe of destitute homeless people who are abandoned without treatment and end up without care in bad lodgings, in prison or underneath the arches. That is in danger of happening.

Community care of the mentally ill is a massively complex operation, involving not only finance and dedication on the part of those involved but a readiness on the part of society to welcome mentally ill people into the community.

Understanding and, indeed, consent by the public to the community care of the mentally ill, can be achieved only with adequate resources and careful co-ordination. Mental hospitals must not be run down more quickly than psychiatric support facilities in the community are ready to take their place. The objective of returning mental patients to the community is not to save money but to provide better care and service. I understand that some regional authorities have set up bridging funds for the purpose. All should do so. The Department must be alive to the need to provide bridging finance while institutions remain open but not full and community care is under pressure. Local authorities are not consistent in the provision of more services for the mentally ill any more than they are consistent in other matters. Channelling bridging money through the joint consultative committees of local and health authorities, together with local voluntary organisations, can help to ensure that money is well spent.

Health authorities must be encouraged to contract with local authorities and voluntary organisations. Social security should be able to meet the board and lodging costs of discharged mentally ill patients in local authority homes or in NHS-run residential facilities as well as in private accommodation and voluntary homes. I should like my hon. Friend the Minister to institute and co-ordinate an interdepartmental review of the care of the mentally ill in the community to ensure that all that can be done is being done.

Until the causes of schizophrenia are known and a cure found, the responsibility for coping with this great problem lies with the Government, with local authorities, with voluntary organisations and charities, with families and with individuals. We must ensure that the burden is borne humanely, fairly and ever more effectively.

12.36 pm

Mr. John Battle (Leeds, West)

I, too, congratulate all those Members who have made their maiden speeches in the debate. I thank them and wish them well in their service to the House. If it is not invidious to single out one of them, I should thank the hon. Member for Ludlow (Mr. Gill), who gave a portrait of a constituency which contrasts totally with my inner city area. To empasise one point in his contribution, I support him in urging the Government to obtain accurate information before making decisions about health provision.

I wish to present a case study of a hospital visit. The Minister recently visited Leeds to open a charity-built bungalow for families visiting Killingbeck hospital, and to look at NHS provision in the city. Many people in Leeds reman deeply sceptical about the purpose and result of that visit in terms of the Government's promotion of good health and wonder whether the Minister took back to the Department a searching concern to tackle the real and increasing health needs not just in Leeds but throughout the country.

Crucial to this debate is the context in which the Minister's message of good health promotion is promulgated. The Minister has received representations from the Leeds western health authority, which faces a budget crisis this year. In September it announced a budget deficit of about £750,000 in the current financial year. The chairman has spelt out what that crisis means. He says that it is the result of Government underfunding for agreed national pay awards for staff, which absorb any notional budget growth, and of the fact that there was no extra provision in the budget for growth to meet increased needs such as AIDS treatment and child abuse. Moreover, there was no recognition in the setting of that budget of the fact that technology needs updating in a teaching hospital and that such hospitals receive many tertiary referrals. As the Minister commented on her visit to Leeds: What my visit has taught me is that we have in Leeds one of the greatest teaching hospitals in the world and we must not lose that. The practical implication of that statement is surely that there must be proper budgets to back up the hospital and its provision.

As a result of the budget crisis, health authority managers have had, in their words, to lower the budget ceiling of the service. That has meant the closure of wards. It is predicted that one ward at the Leeds general infirmary will be closed for the next eight years. A surgical ward has been reduced to five-day working and there are insufficient resources to cope with child abuse. Support services to handicapped children in the community have been reduced and there are cash limits on orthopaedic and rheumatology appliances and on the purchase of the newly developed drugs to which the Minister referred at the start of the debate. There has been no progress in promoting good health policies, which are being reduced to no more than lip service.

When the Minister made her fact-finding visit to Leeds, child cancer victims were queueing for beds. Surely the health of our children is the key to the future good health of the nation. One of my constituents, three-year-old Danielle Wilson, is a cancer victim. The Leeds children's cancer ward, which covers the whole of Yorkshire and Humberside, is desperately overstretched and underfunded. About 85 new cases are diagnosed each year and more beds are urgently needed.

The Leeds cancer centre is one of 90 in Britain and I understand that only the Bristol centre is anywhere near adequately funded. Charities have to raise funds to pay the wages of doctors working in the Leeds centre. The Yorkshire Evening Post is supporting a campaign for the extension of provision to cover child cancer victims. A report on the problem is with the Minister and it would be helpful to hear from her what immediate steps the Government intend to take.

When the Minister was told about the crisis facing the children's cancer unit in Leeds, she said: It tears my heart out. That is not an adequate response. She has a responsibility to demand practical action from her Department. Her responsibility includes challenging the Treasury which is pressing for reduced NHS provision. Treasury-dominated budget reductions are translated by the new managers of health authorities into the language of "productivity and throughput". Patients are being regarded as units of production; people's needs are being written out of the equation.

My local health authority treasurer told me that Treasury-led budget planning was not sufficiently sophisticated to take account of people's needs and of matters such as the demographic evidence of the increasing number of elderly people in certain areas. In that case, we need to ask why health authorities are not budgeting for the increased health needs of our people.

I should like to ask the Minister to take action on what she learned as a result of her ministerial fact-finding visit.

In the present context that must mean challenging Government budget attitudes and increasing budget provision for the National Health Service. The Minister must challenge the Treasury limits because people need to be convinced that NHS provision is not being reduced to ministerial media events. The Minister's contribution to this debate will simply be regarded as cosmetic in the context of the popular experience of reducing National Health Service provision.

Mr. Nicholas Bennett (Pembroke)

The hon. Gentleman says that he is giving us a case study, but in the intellectually valid case study one must give all the facts. The hon. Gentleman is giving us a catalogue of facts which do not include the increase in staff in his health authority, the increase in the number of patients being treated and the increase in the budget over and above inflation. Nationally, all three of those things have happened. Is the hon. Gentleman telling the House that Leeds has been singled out by the Government for a decrease in those things and is he giving us only part of the story?

Mr. Battle

I shall continue to present the case study in detail, as the hon. Gentleman has requested it. The facts and figures are there and have been put forward by the health authorities to the Government. Those authorities have asked for action to increase their budgets and they are still awaiting a reply. The Minister gave the clear message to Leeds to stop smoking, but in her wake she left an uproar because of her off-the-cuff and casually insensitive attitude. The Minister was made aware that premature babies in the city were being turned away from the Leeds intensive care unit because of a lack of facilities to cope with all the babies in need of treatment. Worse, during her visit the Minister said that Leeds women probably had a higher than average rate of premature births because they smoked a lot. Her comments hit the headlines and that evening the Yorkshire Evening Post carried the headline: "Parents' fury at 'insensitive' Edwina". For the interest of the hon. Member for Pembroke (Mr. Bennett), I shall read the article: Dr. Dear confirmed he had spoken to Mrs. Currie about further funding for the unit and had pointed out to her that premature births in the area were above the national average. 'She implied that might be because women around here smoke a lot. I explained there were other factors but she did not seem keen to discuss the whole issue. I also told her we had to rely on charities to provide life-saving equipment and she seemed to think this was a good thing."' The editorial headline in last week's newspaper said, Arrogance that calls for an apology".

Mrs. Currie

I am sure that the hon. Member for Peckham (Ms. Harman), who is on the Opposition Front Bench, would join me in saying that it does the hon. Gentleman's constituents and particularly those tragic babies no service whatever to ignore the fact that smoking has a great deal to do with prematurity and with, the incidence of handicap during pregnancy and afterwards. It is a simple matter of fact and we help no one if we ignore it or deny it.

Mr. Battle

I am grateful to the Minister for her intervention, because it prompts me to go further and press the case made by the editor of the Yorkshire Evening Post. In his editorial the editor spelt out in detail what he meant. He said: It could almost be a chapter out of a Dickens novel. Young mother gives premature birth to twin daughters. She turns up at hospital for the vital intensive nursing care they need and is told there is no room for them. The nearest help is over 100 miles and two hours' travelling time away. This is an actual case and if any hon. Member wants further details he will find them on the front page of the newspaper which gives the name of the family concerned.

The editorial goes on: But this is 1987 not 1887. And the traumatic story is fact not fiction. Fortunately the little girls survived. We arc not sure about 12 other similar cases where premature babies have been turned away from St. James's Hospital, Leeds. An experienced doctor involved in intensive care at St. James's makes a chilling point: 'Long distance travel can be detrimental and we are not only talking about death but about the quality of survival and reducing the risk of handicap'. The hospital is short of funds. Although it is equipped with eight intensive care cots it is so short of staff it is often reduced to operating only four of them. Meanwhile with a characteristic turn of arrogant alacrity, Health Minister Mrs. Edwina Currie dismisses the whole crisis by inferring that if mothers did not smoke there would be no premature-baby problem. That facile remark deserves an immediate apology. Not only to the caring mothers themselves, but to the devoted medical staff who are fighting to provide a vital service on a shoestring budget. This newspaper has already exposed the need for more facilities at St. James's paediatric unit, where the treatment of child-cancer sufferers is nearing breaking point. In conclusion, the article states: The Government may continue to crow about a healthy economy, Mrs. Currie may continue to hog the public eye with her advice on healthy diets; but how long can they ignore the fundamental problem of the health of a health service which can no longer care for its patients? In the light of that article, what are the Minister's real objectives in the debate? Is it to have a do-it-yourself Health Service? In reality, do Ministers visit constituencies but not listen? What we are hearing from the Minister is a merciless counsel of despair — "sick people, heal yourselves".

Mr. Deputy Speaker (Sir Paul Dean)

It will be evident to the House that many hon. Members still wish to speak in this important debate. I appeal for short contributions. If hon. Members were able to restrict themselves to 10 minutes, there would be fewer disappointed hon. Members at the end of the debate.

12.51 pm

Mr. Roger Sims (Chislehurst)

The hon. Member for Leeds, West (Mr. Battle) is perfectly entitled to describe the situation in his own constituency and to put his own interpretation on it. However, I am sure that he will excuse me if I do not pursue his line of argument. We in the House of Commons are accustomed to being both misrepresented and misunderstood, but one of the grossest misrepresentations is often when we see a cartoon showing rows and rows of uniform figures. Whatever else we may be, we are not that. This morning we had a further demonstration of the wide range of abilities, backgrounds and expertise that are represented in the House. I join with other hon. Members in extending congratulations and good wishes to the hon. Members who made their maiden speeches this morning. We shall look forward to hearing more from them.

I am glad to see that the hon. Member for Preston (Mrs. Wise) has returned to us—with, if anything, renewed vigour. I was glad that she was able to find an alternative to the inelegant expression of "a retread", although I was slightly surprised that she preferred to call herself an experienced maiden, with its sexist overtones.

Illness and disease can affect us all at any time, unpredictably and inexplicably. We also know that there are some illnesses and diseases that can be minimised and avoided. The very fact that we are debating today not treatment but prevention, demonstrates the increasing realisation that there is scope for policies to promote positive steps to promote good health. Some 10 years ago I sat on what was then the Expenditure Committee that investigated, and produced a report on, preventive medicine, in which we made a number of recommendations. We have come some way since then, but if one rereads the report, one realises that we still have a long way to go.

As my hon. Friend the Minister quite rightly said in opening the debate, we each ultimately have responsibility for ourselves—to use the current jargon, for our own lifestyles. It is up to us to decide how and what we eat, whether or not we drink sensibly, whether we take adequate exercise, whether we organise our lives so as to least minimise stress, and whether we have medical checkups from time to time. However, we can all be influenced by Government, by the agencies of Government and by those whom we come into contact with in the medical sphere — doctors, nurses and chemists.

The conversion of the Health Education Council to an authority has given the whole sphere of health education a higher profile, and I was glad to hear this morning of further responsibilities being transferred to it. It has a formidable task, and I shall give only brief illustrations. Its admirable document entitled "Broken Hearts" sets out an analysis of the figures for coronary heart disease and reveals that in one year 146,813 people living in England died from coronary heart disease. It appears that 17.2 per cent. of all these deaths came before the age of 55. That represents the loss of about 26 million work days a year. On average, nearly 6,000 hospital beds are occupied each day by patients with coronary heart disease, and the cost is about £450 million a year. Only yesterday my hon. Friend the Under-Secretary of State produced figures in a written answer on alcohol-related road accidents and revealed that the cost of alcohol misuse is £112 million in patient treatment and general practitioner services alone. If these figures could be reduced, more money would be available for the treatment of the unavoidably ill.

Reference has been made already to smoking, the largest avoidable cause of illness and disease. I have spoken on the topic previously and made my case, and on this occasion I confine myself to say that prohibition would be impracticable. However, there is no denying that if tobacco had been only recently invented, its introduction and marketing would have been forbidden. The extent to which people are still smoking, especially the young, is extremely worrying, and there are two steps that the Government could take. One step would be to increase the price, as is being urged by the British Medical Association, which would reduce the sale of tobacco products to the young. The second step would be to invite my hon. Friend the Minister, as the hon. Member for Peckham (Ms. Harman) did, to reflect on the sum that the tobacco industry spends on the promotion of its products and to compare that sum with the resources that are made available to organisations such as the Health Education Authority and ASH for advertising and education.

Alcohol is often described as a problem, but let us be clear about the issue. The problem is that there are some who consume and abuse alcohol—in other words, the problem does not lie with the product itself. When we talk about alcohol-related road accidents, we could refer to petrol-related road accidents. After all, both elements are involved. The issue is how the product is used by consumers. I must declare an interest as I am the parliamentary adviser to the Scotch Whisky Association. I became so involved through my interest and its interest in alcoholism. The association is much concerned about alcoholism and does much to promote sensible drinking as well as putting the problem in its perspective. I am interested in the establishment of the ministerial group to which my hon. Friend the Minister has referred and I hope that she will be able at a later stage to tell us rather more about its remit. It certainly has a wide area of study, including the control of under-age drinking, the need for education and information on the drinking habits of the young, the effect of alcohol and the relative strengths of measures of different forms of alcohol.

There is a need for workplace schemes to recognise and help those who have drink problems. There is a need also to support local counselling services. I am involved in one in the borough which comes within my constituency, which is doing its best to offer a counselling service on a shoestring budget. There is a need for more training for doctors, nurses and social workers to ensure that they recognise alcohol problems when they come across them.

I have no doubt that the study group will be addressing itself to pricing. Alcohol is already highly taxed in the United Kingdom compared with other countries, and to increase the tax here would penalise the majority of alcohol consumers who drink the product properly as against the 2 per cent. of users who abuse it. There is also some evidence that the real alcoholic will still buy the product whatever the price and if the price is beyong him, he will turn to an inferior form of alcohol which will do him ever more harm.

I have mentioned areas where the Government can act. However, the people most able to promote good health are those who meet the population face to face—chemists, nurses and doctors. The Green Paper on primary health care visualised a larger role for chemists. As the chemists point out, there are 6 million daily visits to pharmacies. Therefore, pharmacists have more contact with the public than any other public health professional. They are qualified professional people who see healthy people. The pharmacy is the ideal place to impart information verbally and through the distribution of health education literature.

We look forward to the White Paper on primary care shortly. In a speech which the Secretary of State for Social Services described as lifting the corner of the veil on such care, he listed one of the four objectives as the aim to boost health promotion. He hinted at a chance in doctors' contracts to encourage high performance. I hope that that high performance will include work on prevention. There could be a special role for the general practitioner. 'That is certainly the view of GPs in my health authority in Bromley, an area that has developed strategic proposals for health care and has a plan for improving vaccination and immunisation rates.

A group of which my GP is a member has taken as its starting point the World Health Organisation programme "Health for All by the Year 2000", which the United Kingdom is supporting. The aim is to reduce the incidence of certain diseases by specified percentages by the year 2000. That can be done and is being done in some countries.

Some diseases have not always been with us. The group to which I have referred states that heart attacks were virtually unknown earlier this century, yet it is estimated in my health authority area that 31 per cent. of deaths last year were caused by heart attacks. At the turn of the century, medical test books referred to angina as rare and something which a GP might come across once a year but which did not occur in women. Now, alas, it is all too common, particularly among women.

If these diseases gradually increase, they can he gradually diminished, as is the case in some countries. Alas, the United Kingdom still has the highest rate of heart disease in the world. We can and must reduce those figures.

The group to which I have referred has taken local mortality and morbidity figures and proposes to specify local rolls of percentages by which cardiovascular and circulatory diseases can be reduced by the year 2000. The group's programme includes encouraging, motivating and helping those who do not smoke not to start and to help those who smoke to give up; to assess the smoking status of all those aged 18 to 64 every five years; to encourage the avoidance of overweight and obesity; to promote a diet lower in fat, saturated fatty acids, salt and alcohol and which is higher in carbohydrates and fibre, and to assess the level of overweight and obesity in the 18 to 64 age group every five years. Similarly, the group aims to encourage the taking of sensible and regular exercise; to reduce blood pressure and have regular surveillance of the adult population's blood pressure every five years and encourage the avoidance of alcohol abuse. There is an interesting additional feature in the programme, as the group is trying to encourage a proportion of the population who feel reasonably confident to carry out cardio-pulmonary resuscitation. That would certainly save lives.

I do not suggest that that group of practitioners is unique, but I suspect that they are not entirely typical. Many doctors need persuading to adapt to treating and advising healthy and fit people as well as those who are ill. I hope that my hon. Friend the Minister will agree that that is an initiative which is to be commended.

However, it is not only doctors who are in contact with people. Nurses in hospitals, district nurses and midwives have such contact and could perform a similar advisory role—indeed, the Royal College of Nursing is anxious that they should do so — but they will need some training and instruction. My hon. Friend the Minister commented on the extent to which nurses smoke. It is worrying to note that 64 per cent. of student nurses are smoking and that 40 per cent. of district nurses are smokers. Something will have to be done.

Mr. Jeremy Corbyn (Islington, North)

Has the hon. Gentleman ever thought that one of the reasons why nurses are such heavy smokers is the tension under which they have to operate, and their difficult working conditions? I am totally opposed to smoking by anybody in any place but, before we hear sanctimonious lectures about nurses and their smoking habits, there should be more action by the Government to increase their wages and improve their working conditions.

Mr. Sims

I hope that nothing I said was sanctimonious or preaching. I was simply making the point that nurses could do a more effective job by example. However, I accept the hon. Gentleman's point. They do have a stressful job. They are not the only people with stressful jobs and I appreciate that some people find that taking a cigarette relieves that stress. I am simply suggesting that there are other ways of relieving it.

In the light of your admonition, Mr. Deputy Speaker, I shall conclude. I was hoping to say a little about dentistry, which I believe is a success story for prevention.

This is a wide area and I have touched on only a few aspects. I urge my hon. Friend the Minister to press on with the "Look After Your Heart" campaign and her own personal campaign on subjects such as diet. I hope that she will develop them. Her manner is sometimes considered controversial, but if she stirs up controversy and brings about more discussion of these issues, it will be better for the health of the country and for its economy.

1.7 pm

Mr. Andrew Smith (Oxford, East)

I welcome the fact that we are having this debate on the promotion of good health. One of the advantages of sitting here since the debate started is that I have been able to see the extent to which there are common points of focus on both sides of the Chamber. However, it grates a little to hear the Minister, quite rightly, refer to the role that clean water and the sewerage system have played in improving the nation's health over the years at a time when half the nation's sewers are collapsing under our feet for want of the necessary infrastructure investment. It also grates to hear her refer to the value of good nutrition for our children's development and growth when her party has done so much damage to the school meals service, which provided such an essential element of nutrition for many poor people in this country.

However, I welcome the degree to which there is a drawing together in promoting effective strategies for health. We have to be clear as to what those strategies require. They require co-ordination, sensitivity and accountability to local needs. They require adequate resources and they need to be set in a framework of social and economic policies for jobs, houses and social justice. There is wholly insufficient evidence to date to show that the Government properly understand, and still less intend to respond to, those requirements.

It is important, and it would be a mark of good faith, for the Government seriously to consider the role of local authorities in health promotion. Some local authorities, in partnership with health authorities, are beginning to develop cost-effective and efficient health promotion programmes. Those initiatives have the advantage of being local, sensitive to community need, inter-sectoral — involving partnership with the voluntary and private sectors — and effective in terms of delivery of services and health information to local schools and work places where the needs are greatest. I am pleased to say that in those respects Oxford city council has shown something of the potential of partnership and genuine joint planning. A joint healthy city strategy has been developed, bringing forward action on many fronts in a way that involves the local community. A monthly health promotion strategy group is held to guide forward the policies, involving a medical officer and his team, and the city environmental health officer and his staff.

There are several good examples of the progress that has been made through this approach of closely involving the local council: the development of an AIDS strategy and the appointment of Britain's first local authority AIDS officer; the joint facilitation of the "Look After Your Heart" campaign; the 13 health contracts with local industry, representing 40,000 workers, which the Minister saw when she was in Oxford recently; and the action on home heating, with the appointment of a home heating officer, and on home safety, with a home safety officer. All that has been achieved by the local council working together with the health authority to take action at the grass roots. It has been possible for the city council and the health authority to work jointly with neighbourhoods and the voluntary sector, and to link with the commercial and industrial sector.

I feel that the Oxford model has national implications. But, for that model to work successfully, we need support in the following respects.

The Health Education Authority and other national health bodies must link with local authorities, as well as with health authorities. As with the links with the Health Education Authority, Oxford has made progress on that. We also need many more pump-priming resources to help to finance joint work on health promotion, and to supplement the somewhat cumbersome machinery of joint consultative committees. Flexibility and speed are often essential — witness the lead-in time for the AIDS awareness programmes. Local effort needs to be backed by health promotion initiatives nationally, as with the "Look After Your Heart" and AIDS campaigns. National campaigning and local networking and delivery of services and health information are a powerful combination. One without the other seriously impairs the effectiveness of the effort.

If we are serious about moving towards a national health promotion strategy, it must be recognised that at present the nation lacks a systematic approach. Ministries do not address themselves sufficiently to the health agenda relative to their area of responsibility, whether it be in agriculture, energy—think of the nuclear power stations — or transport. There is insufficient co-ordination of effort in their promotion of health. Except in regard to AIDS, political will seems to be lacking, and even in that respect it has been misdirected.

I think that it would be useful to extend the Cabinet working party on AIDS to encompass health promotion generally, and to require the Health Education Authority to produce a national health promotion strategy in line with the World Health Organisation targets—to which, after all, the United Kingdom is a signatory. It would also be useful to begin a health audit of Ministries with the adoption of health targets, progress towards which could be reviewed annually, and to publish a popular and annual national health assessment.

Such an analysis should contain a considered analysis of the causal factors in what is monitored, rather than covering up, as Governments in the past have covered up, the Black report and other, subsequent reports. Above all, local councils and health authorities should be given the tools with which to get on with the job, in terms of freedom and resources to respond to local needs. I am sorry to have to say that nothing could be further from that goal than present local experience. I shall give a couple of examples from my constituency.

Mention has already been made of the fact that the quality of housing is universally acknowledged to be a very important factor in standards of health, yet in Oxford there are 3,000 families on the waiting list, while 70 families are in bed and breakfast accommodation. The Government are piling on pressure to cut the building programme and to force up rents. The Minister for Housing and Planning has promised to end council building altogether and to drive rents still higher. It costs the same in Oxford to keep a family in bed and breakfast accommodation as it does to provide a perfectly good, new, three-bedroomed house. That brings home just what a waste of resources bed and breakfast accommodation is. One wonders whether there is a predilection among Conservatives to shovel money towards the profiteers in the private sector and to deprive those in the public sector who are in the greatest need.

Homelessness, and all that that means, makes you sick. We are not referring, as the Minister did, to the helpless pawns of their circumstances. We are dealing with people who are the victims of circumstances that are the result of the Government's policies, and they can be altered.

If the Government want to be taken seriously on health promotion, they must take to heart the lesson that health cannot be built up with the one hand if housing programmes are demolished on the other. The Minister said that there are major preventive elements in mental health, but she failed signally to suggest what she thought these were. There are, indeed, major preventive elements. They are called homes, jobs and a safe and secure environment.

As for health cuts, yesterday the Oxfordshire health authority announced options on the £1.75 million of cuts that, even on the most optimistic assumption, will be needed to balance its budget next year, as it is required to do by law. The cuts will result in the closure of 140 hospital beds, sharp cuts in the ambulance service and a £100,000 raid on the joint finance budget. What price health promotion then? Where will the money be to follow through the breast cancer screening initiatives? It is all very well to set out these initiatives in a great fanfare of publicity, but they are no use whatsoever if the resources are not there to undertake diagnosis and carry out treatment thereafter.

Cuts on the scale that Oxfordshire health authority is now thinking about will hit local people, especially the elderly, very hard. Waiting lists will shoot up and old people will suffer and die. Some will risk a fate even worse than death. They will be stuffed into the kind of brutal, private residential establishments that were exposed a couple of weeks ago in a film about what is happening in Kent. Places of that kind are bad for people's health.

Mr. Brazier

The matter to which the hon. Gentleman referred is sub judice, so I cannot say very much about it. However, it should be stressed that the home upon which that thoroughly unbalanced film concentrated was removed two years ago from the ownership of the people involved, because of the action that was taken by the social services.

Mr. Smith

I cannot comment on the details of any particular incident in that film. The film pointed to examples of good private residential care as well as to bad ones, but the good examples were very few and far between. It referred to circumstances that the elderly are being forced to endure. According to the statements of care assistants, old people are lying in urine and are tied down at night. Lights are turned off on upstairs landings to save electricity and to boost owners' profits. The conditions were so scandalous that the makers of that film did a service to the whole country by exposing what is going on in such terrible places.

I shall meet the Parliamentary Under-Secretary of State in the near future to make the case for funds to stave off the crisis which faces the Oxfordshire health authority.The people of Oxfordshire will undoubtedly do their bit on health promotion by saying in no uncertain terms that the cuts must be stopped. I can promise Ministers that they will run into a solid wall of opposition to the damage that they threaten to inflict. I have no doubt that the public, health authority members, consultants, nurses, trade unions and our community health council will be as one in demanding Government action to divert this crisis and if the Parliamentary Under-Secretary of State is interested in preserving and promoting her good health, she should listen.

Oxfordshire has had not one, but three visits from the Parliamentary Under-Secretary in as many months and I am sorry that she is not present to hear what I have to say. Each visit has had as much to do with promoting the Minister as with promoting good health, but it has not worked. Each visit has upset more people than the previous one. Even for someone evidently operating on the maxim of "There is no such thing as bad publicity", it is a dangerous preoccupation.

The front page of a local newspaper stated: Heart of Ice! Another rap for the minister 'who couldn't care less …'", and followed it up with "Ice-cold Currie" items. When asked whether old folk would die this winter because of NHS cash restrictions, the Minister said that we must all die some time. As has been suggested, perhaps it is her style to stir things up and catch the headlines, but Conservative Members have no idea of the damage being done to their party by these off-the-cuff remarks on visits. Perhaps they do.

We in Oxfordshire do not want any more public relations visits or stupid complaints, such as when the Minister was last there and complained to the health authority because it did not give her a hot lunch. We want not promotional floss but some understanding of the structural underfunding historically present in Oxfordshire's budget. Most of all, we want funds to stop the cuts and the deaths that will otherwise inevitably occur. That is the best contribution that the Parliamentary Under-Secretary of State can make to the real promotion of good health.

If someone is taking notes for the Minister, may I ask for two clear assurances when she replies? First, will she give an assurance that the important contribution that local authorities must make is not only recognised but that the Government will match words with action and press for the damaging restrictions on local councils' spending to be eased so that they can play their full part in promoting good health through both housing and services, and co-ordination and publicity? Secondly, will she give an assurance that the immense financial pressure under which most health authorities work will be lifted through a commitment now to examine carefully the regional and sub-regional problems which will otherwise be created by the sorts of revenue allocations which are being talked of for next year?

If, as I fear, the Government are not prepared to give either commitment, today's debate unfortunately will be seen as no more than a smokescreen for their real policies of cutting public provision, eliminating local democracy and condemning more people to genuine suffering. The matter is made all the worse by the fact that so much ill health is avoidable. While health promotion and prevention are better than cure, they are not cheap options. Neither of them is a substitute for cure for those who need care and curing now or who needed it last year but are still on the waiting list. The Government's attempt to have their cake and eat it is not only implausible but downright unhealthy.

1.24 pm

Mr. David Tredinnick (Bosworth)

There are two key aspects of the promotion of good health that are grossly underrated — alternative, or complementary, medicine and preventive medicine. I wish to bring to the attention of the House my personal experience of complementary medicine and the vital preventive work of an association in my constituency that is fighting, almost single-handed, a vicious killer disease.

Interest in complementary medicine is increasing at a phenomenal rate. The 1986 report of the Institute for Complementary Medicine revealed that the number of people interested in natural therapies is increasing at the rate of 15 per cent. a year; that is on a 1984 base figure of 2.5 million people living in this country. A "Which?" magazine report of October 1986 on complementary medicine found that one in seven people had consulted an alternative practitioner in 1985 and that 80 per cent. had claimed to have been cured or improved; further, that over 70 per cent. of them would definitely use complementary medicine again and that over 70 per cent. would recommend it to others with a similar complaint.

I must declare an interest, because I am very much part of that 70 per cent. who have used complementary medicine and who would use it again. I want to share my experience with hon. Members, because about 10 years ago I suffered a very bad fall. It was so bad that I cracked three vertebrae in my back. I was paralysed in one leg for a time and I had to lie flat for three and a half months, which gives plenty of time for contemplation. I will always be grateful for the excellent medical treatment that I received from my general practitioner. I was also seen by a surgeon. In the end I had to decide whether to have an operation that might have been risky and not 100 per cent. successful. I decided not to and I turned to alternative or complementary medicine. I saw a chiropractor and he said that he thought that he could stop the pain in my back. Over a period of six months of gentle realignment he did just that. He stopped the pain and managed to straighten my spine again. However, I still suffered from massive knotting of muscles in my back, so I turned to another alternative medicine practice—osteopathy. An osteopath was able to loosen my muscles and again my back improved.

A couple a years later I went a stage further when I heard of the Alexander technique. That has been described as applied engineering for bodies. It is all about getting balance right and getting muscles in equilibrium. I went through its discipline and as a result I am completely cured. One of the side effects of that technique is that it loosens tension in the back and gets one to relax. One often grows one inch or half an inch, changes shape and expands across the chest. I have never been fitter than I am now and I owe it to complementary medical techniques. But for complementary medicine I do not think that I would be here today.

I should like to bring to the attention of the House one other aspect of complementary medicine of which I have experience. When I first met my dear wife, who I am glad to say is today sitting under the Strangers Gallery, she suffered from severe migraine. Over the years, her doctors had not been able to find a solution to the problem. We agreed to see an allergy specialist. Currently such a service is on the fringe of medicine. We carefully looked at my wife's diet and analysed certain foods, to which she was found to be allergic, and the migraine was eventually cured completely. Although my wife cannot talk here, as she is not a Member, I think that she would agree that this made her life easier, although she is married to me, which does not help.

All these therapies have helped in different ways. Different people respond differently to the various techniques. There are horses for courses and there are benefits from these techniques, which I commend to hon. Members. There is no question but that the treatment works.

I pay tribute to the Council for Complementary and Alternative Medicine, which has done much in recent months to establish codes of professional conduct and to set standards for the different complementary medical groups. My hon. Friend the Member for Stafford (Mr. Cash), who has done so much to promote the cause of complementary medicine, is here to support the debate.

In this debate, we have heard much talk about AIDS and ways of alleviating the problem. In August, a report in the Sunday Telegraph magazine showed that the use of complementary medicine in conjunction with conventional medicine can double the life expectancy of some AIDS sufferers. If ever there was proof that complementary medicine gets results, surely it is there.

It has always been held that prevention is better than cure. I congratulate my hon. Friend the Under-Secretary of State for Health and Social Security — the hon. Member for Derbyshire, South (Mrs. Currie)—on her efforts to increase preventive medical care. Under this Government such care is greater than ever before. I draw attention to the preventive medical work of Combat, the association to combat Huntington's chorea, which has its headquarters in my constituency. Huntington's chorea is one of the most horrific of hereditary diseases. It drives sufferers insane and kills them. Whole families can be affected. Sufferers' children have a 50/50 chance of catching it. Two years ago, the genetic marker of the disease was found. A predictive test has been derived to help sufferers. Combat provides family support officers who arrange for those needing tests to get them from the authorities, thus preventing further heartbreak in those families. Combat's officers support the DHSS carers and the families of the afflicted. They help families stay together. That is why I was so pleased to receive the letter written on 14 October by my hon. Friend the Under-Secretary of State for Health and Social Security—the hon. Member for Enfield, Southgate (Mr. Portillo) — assuring me that Combat's application for funding for next year will be given sympathetic consideration and that a decision will be reached as soon as possible.

Mr. Ashby

My hon. Friend will know that in my constituency, which adjoins his, there has been a number of cases of Huntington's chorea. In a particularly sad case, someone was severely at risk as a result of the disease. Will my hon. Friend join me in making representations to the Home Office for sympathetic secure provision for people who may be suffering from the disease and who put themselves and those around them at risk? There are problems because the Home Office will not provide secure provision for these people, who may be put in prison when they should not be.

Mr. Tredinnick

I am grateful to my hon. Friend, who also represents a Leicester constituency, and of course I shall support him in his application to the Home Secretary. As I said, my constituents and I greatly appreciate the concern of my hon. Friend the Under-Secretary. Combat has been very grateful for previous grants and I assure my right hon. Friend the Secretary of State for Social Services who has joined my hon. Friend on the Front Bench that Combat has put those grants to very good use. My constituents, Combat and I will be most grateful if my hon. Friend the Under-Secretary will comment further today on Combat's grant application for the forthcoming year.

In conclusion, good health would be better promoted were greater attention paid to the great benefits of complementary medicine, and if there were an increased commitment to preventive medicine.

1.35 pm

Mrs. Alice Mahon (Halifax)

My hon. Friends the Members for Strathkelvin and Bearsden (Mr. Galbraith), for Peckham (Ms. Harman) and for Preston (Mrs. Wise) have put a most convincing case to the House on the correlation between ill-health and social deprivation. There can be no doubt that the connection is especially marked in respect of preventable illness, including mental illness, some cancers and heart disease. The Minister's contribution, in what some would call doublespeak, flew in the face of the expert opinion of eminent bodies—opinion expressed in the Black report, which looked into inequalities in health, the British Medical Association's paper, and the study by the now abolished Health Education Council, entitled "The Health Divide", which proved conclusively that bad housing, inadequate diet and low incomes damage health.

In a recent report, the Child Poverty Action Group concluded that, overall, those now living in poverty or on its margins increased in number by 42 per cent. between 1979 and the mid-1980s. More than 16 million people now live in poverty. That is a shameful record for any Government to contemplate. No Opposition Member doubts that the Government's economic and social policies have led to the growing divide. If present policies continue, the divide will widen.

I shall concentrate on one aspect of policy: the Government's attack on the school meals services. That attack will lead to further deterioration in health for some social classes. At the beginning of the century, school meals were introduced because even the most ardent free marketeers were shocked to discover that members of the working classes recruited to fight in the African wars died like flies from dysentery and other poverty-related diseases. Men at the front died before they could be used as cannon fodder. Physical deterioration was endemic among certain classes. A pamphlet published by the Labour party in 1905 spoke of the nation being awake to the danger of physical degeneration. A 1902 Royal Commission looked into the problem. The report was clear. It recommended that children who suffered from lack of food should be fed, if necessary by the local authorities, and the Provision of Meals Act 1906 was passed as a result of pressure from Labour Members. I warn the Government that Labour Members today recognise the signs of physical deterioration again and that we are just as committed as were our forebears to ending the injustice.

After the dreadful poverty of the 1920s and 1930s, the Education Act 1944 fully recognised school meals as a valuable method of alleviating poverty, improving nutritional standards and therefore the health of children. The 1944 provisions made it clear that on every school day there shall be provided and on every other day there may be provided for every pupil as a midday dinner a meal suitable in all respects as the main meal of the day. That statement was accepted by all Governments until 1979. Since then, it has been downhill all the way for this vital service and for thousands of innocent children, victims of a savage and pitiless ideology which makes virtues of greed and selfishness and puts self-help as a serious option to the five-year-old child and the single unemployed parent.

One is left with no alternative but to conclude that the Government are determined to end the school meals service for good. The attack began in 1980 when nutritional standards were abandoned. Since then, prices have risen steeply, in some instances to as much as 70p per day. A further report from the Child Poverty Action Group reveals that the proportion of children taking meals has dropped from 64 per cent. to 49 per cent., largely due to price increases, and that the number receiving free meals has risen from 18 per cent. to 37 per cent.—a clear indication of the growing poverty in our society.

The House should bear in mind that the school dinner is often the main meal of the day and that for some children it is a vital meal. The Minister said in her opening remarks that she was against too much legislation. If that is so, perhaps she will persuade her right hon. Friend the Minister for Social Security and the Disabled to repeal that part of the 1986 Act which will mean that 500,000 children will be disqualified from entitlement to free school meals in 1988. In Halifax, free school meals are provided at the discretion of the local authority to children from families on supplementary benefit, on family income supplement or on low incomes. The entitlement to free school meals is a passport to other benefits and thus a vital element of benefit to low income families.

In April 1988 the discretionary powers to provide free school meals will be removed from local authorities. My local authority estimates that this will reduce the number of free school meals served by up to 6,000 per day, so the size of the problem is clear. About 35 per cent. of the total meals served will be lost and 3,000 children will lose free meals worth up to £3.50 per week per child.

The cash compensation on the new family credit system may be as little as 44p per day and will in no way compensate for the loss of a vital service. Moreover, the viability of the school meals service itself is threatened, which could mean damaging job losses for people in my constituency and others. I hope that no Conservative Member will try to lecture the House about good management as a way of stretching totally inadequate benefits and scandalously low pay. That would be the ultimate hypocrisy in view of the recent pay award to Members of Parliament.

In the past three or four years, towns and cities in west Yorkshire have experienced epidemics of dysentery. We all know that damp housing, lack of services to repair bad drains and many other external conditions contribute to diseases of this kind and it is no coincidence that children from families on low incomes are the most vulnerable. The Minister for Health must take note of the comments and recommendations of the Black report, which states that any reduction in the provision of school meals or in eligibility for free meals would mean putting further at risk the development of significant numbers of children. Even before the massive increase in the number of people living in poverty, a study showed that children receiving free school meals were significantly shorter than their wealthier peers. The Black report's recommendations were unequivocal. The committee recommended that local authorities should be required to provide nutritional meals at all schools and that the service should be extended in areas where there is underprovision. It also recommended that there should be regular consultation between local authorities, communities, dieticians, parents and teachers about the provision of those meals, and that the meals should be free.

The Lancet said in 1980 that the school meal was the principal source of nutrition for many poor children. In view of the Minister's campaign on heart disease, I hope that she will note that the Coronary Prevention Group said this year: In the face of long-term unemployment and current levels of state benefit, the school meals service is as important now as it was in 1890. My hon. Friend the Member for Holborn and St. Pancras (Mr. Dobson) put the case movingly in a recent report when he said: A hungry child cannot learn. A child who does not have an adequate diet will be stunted physically and mentally. Children who do not learn what food is good for them will feed poor food to themselves and their families.

The Minister will rightly be accused of the most outrageous neglect of the health of the nation's children if she ignores the plea to save the school meals service. I believe that we are again in a serious period of physical deterioration. The process is not inevitable and it is an obscenity that diminishes us all. We should be ashamed of ourselves as a nation that we are not prepared to help those on very low incomes. The Minister can see the evidence. She and the Government have the power to reverse the decline, and they could start to reverse the attack on this vital service by repealing the relevant section of the Education Act.

1.46 pm

Mr. Peter Rost (Erewash)

I join this excellent debate with hesitation because I have never claimed to be an expert on health. However, I know something about alternative medicine and, like my hon. Friend the Member for Bosworth (Mr. Tredinnick), I and my family have benefited from it. I also declare an interest as the parliamentary adviser to the Natural Medicine Society and because the major manufacturer of herbal products in this country, Weleda UK, is situated in Ilkeston in my constituency.

I have studied the contribution that natural medicine makes alongside orthodox therapies abroad, especially in Switzerland, Germany and France, where alternative treatments and herbal medicines are more widely accepted by Governments and medical professions as having a useful contribution to make alongside and complementary to orthodox treatments.

The health establishments in those countries are modest enough to acknowledge that, despite the enormous advance in technology, modern drugs and treatments may not have all the answers or always offer the best solutions.

It seems in this country that those radical enough to admit that there may be more in homoeopathy and the holistic approach to illness and preventive medicine are still too often derided by the medical mafia as cranky outsiders.

From what I have seen from those who have benefited from alternative medicine and in countries that have a more enlightened approach and a less conservative, entrenched medical establishment. I am convinced that our nation's health would be a great deal better if we listened more and accepted more readily the growing concern about modern drugs and if we did more to educate the nation about better health instead of running a national sickness service.

Too many drugs are being prescribed by the NHS and its practitioners to too many people. Too many patients have become overdependent or addicted to certain drugs, especially to drugs such as tranquillisers, and there are too many deaths and adverse reactions. The United Kingdom has one of the worst health records in the western world, not because the NHS is under-financed but because it is badly managed, not enough resources are allocated to health care, prevention and education and there is too much prejudice in the DHSS and in those who run it against those who offer contributions from alternative therapies.

Orthodox medicine has become the dominant feature in our philosophy over the past 100 years and is supported, of course, by the enormous financial muscle of the pharmaceutical industry. Many of the products from that industry have worked wonders in making progress against disease. However, I suggest that perhaps we have become a little over-confident and over-entrenched in the accepted modern orthodoxy. We have become over-dependent on pills to cure everything to the point where we have, perhaps, been blinded by prejudice against the contribution that herbal, natural alternative health medicines and therapies have to offer.

The Minister's advisers are dominated by experts in orthodox medicines. Three, or perhaps four, early-day motions that I helped to sponsor and which were signed by over 200 hon. Members, urged a stronger recognition of these alternative therapies and, especially, the establishment of a special advisory committee on alternative medicines. Such a committee is provided for under the Medicines Act 1971 and such committees exist in other countries. Despite those early-day motions, the DHSS continues to obstruct what could be a constructive contribution to a wider debate and to better health in Britain.

Instead of encouraging a broader debate about whether, for example, we need to shift the balance of power and influence a little bit away from orthodoxy back to an emphasis on the holistic or homeopathic approach of preventive, healthier living natural medicines, the DHSS is harassing the producers of herbal products. Under the current review of medicines, products are expected to prove their safety. That is fair enough and we all agree with that. Natural medicines have been proved safe over many hundreds of years. It would be good if all modern synthetic drugs could claim the same record.

The review currently being undertaken also demands that all products prove their efficacy. This completely misunderstands the different philosophy of those who prescribe or wish to use herbal products or practise alternative therapies. It is almost impossible to finance the huge cost of the long clinical trials that this directive demands. Of course, the large drug companies finance such trials. They then have patented products and recoup their large capital investment when the drug is marketed.

Companies like Weleda which market several thousand natural herbal products cannot prove the clinical efficacy of the products because they affect different patients in different ways, and in any case they are not synthetic but natural products. As a result licences for some of these natural products are already being removed, although the licensing system is the same as that which applies in other parts of the European Community where such products remain on the market. This will cause a major public outcry. Governments in countries such as France and Germany which have the same EC directives are overcoming this problem by accepting that natural products have to be assessed differently from laboratory-made products such as drugs. Why cannot the DHSS accept the same system?

If a fraction of the research and development finance that goes into the orthodox medicine and drugs industry were made available to improve the scientific data base about the efficacy of herbal products and alternative therapies, we might make greater progress in the prevention and cure of illness. The Natural Medicine Society has this week published a most interesting pamphlet entitled "The Health Crisis". It should be compulsory reading for all hon. Members and I hope that the Select Committee looks at it and considers an investigation into the status of alternative medicine and the contribution it could, and should, be making to our Health Service.

I shall make one or two suggestions to my hon. Friend the Minister because I know that she is sympathetic. I enjoyed and support her opening remarks in the debate. If the Government are really serious and concerned about improving the health of the nation, as I believe they are, first, we should take urgent steps to encourage the integration of orthodox medicine with complementary and alternative medicine, as happens in other countries. It should not be an either/or situation; we should have both together.

Secondly, the Medicines Commission should be restructured to allow for more balanced advice on how this can best be achieved. Thirdly, mainstream complementary medicines and medical treatment should be available under the National Health Service. There should be greater priority in education given to health care and particulary to the more holistic approach to illness and its care. There should be fewer drugs administered to fewer people. We should encourage and finance more education and training within our medical schools for alternative medical treatments and their holistic approach. There should be more research and development supporting whatever contributions complementary medicine can make.

Finally, the Government should fund the establishment of holistic centres in major towns, staffed by qualified orthodox and alternative practitioners working together. The National Health Service is inefficient and too costly because it has failed to promote good health adequately enough, which would have reduced, and would reduce in the future, the demand for its resources in disease management. We have failed to incorporate cheaper, safer and often more beneficial alternative therapies and medicines within the Health Service. Unless the Government accept those fundamental failings, given complementary medicines proper recognition and accept their useful role, we shall get more dissatisfied customers and, above all, we shall not get a healthy nation. I hope that today's debate will at least lead to a change 'An attitudes and policies.

1.59 pm

Mr. Tony Worthington (Clydebank and Milngavie)

A realisation is spreading throughout the House that illness is not something that is afflicted by nature. We are beginning to understand that it is a product of our way of life, but the developing appreciation of this must be taken much further. One of the major challenges of the next few years is to change the way in which we think about health. Unfortunately, there have been some major omissions in the thinking of some of hon. Members today, and it is intriguing that the Under-Secretary of State appears to have read the first few chapters of books on the prevention of health but ignored the final chapters, which draw attention to the significance of the social structure of a country and the impact that that has on care within it. As I said in an intervention in the Minister's speech, the text which was prepared for her was directed almost entirely to physical health, ignoring mental health almost totally. With the exception of the hon. Member for Eddisbury (Mr. Goodlad), who made a fine contribution on schizophrenia, the entire debate has been skewed towards mental health.

Mrs. Currie

I think that the hon. Gentleman means physical health.

Mr. Worthington

I am sorry, towards physical health. I am relieved to know that the Minister is listening to me. It was clear that she was not listening to many of the earlier contributions of my hon. Friends.

I think that it is generally accepted that we now know much more about epidemiology and the different incidences of diseases in different parts of the United Kingdom and in other countries. In the greater Glasgow area there is great awareness now about the shameful record of the health board area, it being a cancer capital of the world, and the regrettable rates of heart disease. We can now identify the self-damaging aspects of life such as smoking, drinking and fatty foods.

The Government would like to think that everything rests with the individual, but we know without fear of contradiction — source after source can be quoted to support this contention—that unemployment is a causal factor of ill health. We know that poor housing is a similar factor. Mental health conditions such as clinical depression are a reflection of the life that we lead. One of the most interesting studies undertaken since the second world war was that carried out by George Brown and his associates on the social causes of depression. It showed that in an area such as Camberwell clinical depression was endemic among women, and that in an area such as the Outer Hebrides it was not. That is a reflection of the lives that women lead in some parts of our country.

Every society makes decisions about the extent to which it will allow the people to die or suffer, and the present Government choose by lack of attention to the health of the nation that more will die or suffer. They have chosen to have a high level of unemployment to discipline the work force. They have chosen also to have a low-wage policy, and everything that they introduce is geared to that approach. Examples are the community programme and the Government's claim that young people are pricing themselves out of jobs. The Government are to introduce a poll tax, the effect of which will be to withdraw resources from poor areas. The effect of the DHSS cuts that they are imposing will be to withdraw resources from poor areas. The Government are introducing school meals cuts. What will be the effect of that? They are to privatise many council jobs, and the effect of their hidden agenda will be lower wages in the local authority sector. They are introducing reduced housing resources, which will have an impact on the fabric of houses. At the same time they are deliberately causing rates to increase. What will be the impact of these policies?

We know that unemployment and poor living conditions are a cause of ill health, and yet these are elements of Government policy. This suggests that the Government are deliberately pursuing policies that will worsen the health of the British people. This is demonstrated by a report that appeared this week from Edinburgh, which reveals that those living in the smart suburbs of that city are more than twice as likely to live to retirement age than those in the poorer areas. That is not essentially because of the behaviour of these people but because of the lives that they have to lead. A minority of the population has the majority of ill health, and by the Government's choice of priorities they are deliberately imposing poor health on our poorer citizens. The Government have made that choice.

Health has been over medicalised. We have attributed to doctors magical powers and we must now withdraw that attribution. The medical model of health in the 19th century is now inappropriate. It is clear that high-tech medicine is not resulting in longer lives. Research undertaken in 1970 by John Powells, for example, indicates that middle-aged men nowadays are living longer not because of the presence of high-tech medicine but because of what happens to them earlier in their lives. The disease theory of illness is no longer appropriate. The idea of the body as a car engine which can occasionally go wrong and be put into hospital to be restored does not now apply.

The type of problems that people take to doctors is ludicrous. They go to doctors with marital problems and in the west of Scotland with that ubiquitous problem of nerves. Indeed, they go to doctors because they are suffering from sleepless nights, sexual and alcohol-related problems. Doctors do not have the answers for those conditions in the boxes of tricks. The resources, skills and the answers must come from other areas, some from other parts of the health industry, through social work or other counselling services. We must consider that area and abandon the pharmaceutical industry with its addiction to psychotropic drugs. We must have more appropriate answers. We have grossly overmedicalised our lives and we should consider the real issues.

The real issues include such questions as why more women than men are admitted to mental hospitals. There is nothing about the nature of woman which shows that that should happen. The answer lies with the importance and self-esteem of women——

Mrs. Teresa Gorman (Billericay)

Will the hon. Gentleman give way?

Mr. Worthington

I would be delighted to give way when I reach the end of these comments.

Why are progressively more and more members of the ethnic minorities admitted to mental hospitals and why are poor people more likely to be admitted when we consider their proportion of the population? The reasons lie in the style of life that is inflicted upon them.

Mrs. Gorman

Is the hon. Member for Clydebank and Milngavie (Mr. Worthington) aware that women in the age group of 50 and over are afflicted to a greater degree by Alzheimer's disease or senile dementia? Is he also aware of the strong connection between that and their loss of hormones which happens to all women as they pass childbearing age? One of the most effective and growing forms of preventive medicine in that area is the replacement of those hormones and I hope to address my remarks to that matter if I have the opportunity to speak later. The high incidence of women in mental hospitals is not due to social deprivation to which the hon. Gentleman referred. There is a physical cause which I hope that we can address.

Mr. Worthington

That is not true. I regret that the hon. Lady has just taken the opportunity in my speech to make points that she wanted to make but which she probably will not be able to make today. However, I had been looking forward to her valued contribution on those matters because that is an interesting subject.

All the research shows that more women are in receipt of treatment for mental illness at all ages than men. We must ask serious questions about that. It cannot be due to diet, cigarettes or alcohol. The reasons must lie with social factors in society.

The factors that predispose us to health lie with areas of social change, social isolation, lack of social networks, unemployment, housing conditions and life events. We must look at more effective ways that are not centred on the medical profession which lacks such skills, to help people to cope with stresses in life.

When we have another debate on this subject — shortly, I hope—I trust that more attention will be paid by the Government to the impact of Government policies upon ill health and the fact that the Government are seizing on individual causes and ignoring social structure. Next time I hope that the Minister will remember that a huge amount of the misery and suffering in this country is related to mental illness. I hope that attention will be paid to that in future.

2.9 pm

Mr. Simon Coombs (Swindon)

I am grateful for the opportunity to address the House in this debate. I speak as the secretary of the all-party parliamentary food and health forum. That is a Back-Bench Committee which looks forward to seeing many of the contributors to today's debate at its future meetings. One welcomes the interest in health promotion that has been demonstrated by some, if not all, speakers in today's debate.

Britain has been governed over the past eight years by a Government who have succeeded in making the country a more wealthy one. It is now important that we turn our attention to making this country a more healthy one. Therefore, I welcome the Government's initiative to bring about the campaign entitled "Look After Your Heart". I want to address my brief remarks to that campaign and what lies beyond it.

The campaign is a useful first step towards creating greater awareness of the links between coronary heart disease and the diet enjoyed by the people of this country. I do not agree with some hon. Members who have spoken who have suggested that the link is not yet an established matter of fact. There is now widespread consensus about the fact that there is a link between heart disease and aspects of our diet. It is time that the Government went beyond the existing campaign to hammer home the lessons that need to be learned.

Expert committees for some time, including the National Advisory Committee on Nutrition Education and the Committee on Medical Aspects of Food Policy sub-panel have emphasised the need to change the balance of the British diet—less fat, more fibre and no increase in sugar and salt intake—and to provide the people of this country with the information necessary to enable them to make a judgment about what they buy and consume. That can be done only by providing helpful and clear food labelling. The current guidelines have been before us for a brief time and have been the subject of intense consultation in the past. I hope that the Government will move swiftly to introduce a mandatory, statutory basis on fats and clear voluntary guidelines on other aspects of nutrition. There is no further reason for delay. In the House yesterday I asked the Minister responsible whether there was any reason under the laws of the EEC why that should not be done. He was at pains to assure me that there was no such reason.

Some people have deduced that the Treaty of Rome makes it impossible for this country to introduce food labelling ahead of other members of the Community. However, article 36 of the treaty makes it clear that where a matter of public health is concerned a member of the Community can act independently for the benefit of its people. I urge the Government to do so. We need to see the labelling of fat, sugar, fibre and salt content. We need pictorial representation on items wherever that is possible and we need an education campaign for the entire country to tell people what they are seeing on the labels and how they should react to them.

Exercise has barely been mentioned in the debate. No one has mentioned the importance of a regime for all the people of this country which involves as much exercise as they are physically capable of. Regular exercise helps weight loss and reduces blood pressure and cholesterol in the blood stream. It is also useful in coping with the aspects of stress, about which the Opposition have made great play. The advertisements on that aspect of health in the "Look After Your Health" campaign may be an ad man's dream and they may lead to the sale of a few more bicycles, but they do not address the central issue, that all people would benefit from a much greater amount of exercise in their daily lives than the majority enjoy at present.

We now have the technology to undertake the screening of blood pressure and blood cholesterol levels. Indeed, there is much happening in that area which leads one to be hopeful that it is on the increase. However, screening must be accompanied by practical advice on what to do when problems are identified. The trouble is that far too many of the people responsible for our health—general practitioners and others — are as yet not adequately aware of the consequences of identifying problems with blood pressure and, in particular, blood cholesterol. Part. of the campaign must involve the provision of more detailed information to general practitioners and others. involved in primary health care on how they should react when faced with a patient who presents such problems. The amount of training that has so far been made available to general practitioners is inadequate, and something must be done very soon.

A number of hon. Members have referred to school meals, and I agree broadly with much of what they have said. The Department of Health and Social Security published a survey in April 1986 entitled "The Diet of British Children". The survey highlighted the fact that many schoolchildren have a poorly balanced diet, high in fat, sugar and salt and, conversely, low in fibre and in the vitamins and minerals that children need if they are to develop satisfactorily. It has already been said today that, in many instances, school meals provide a substantial proportion of children's daily nutritional requirements. However, they can do more than that. A good, balanced school diet will increase children's awareness of the nutritional standards which the Government, in their wisdom, decided to do away with in 1980, and which are now needed more than ever.

I hope that the message that both sides of the House have been putting forward in this debate attended by my hon. Friend the Parliamentary Under-Secretary of State will be heard in other Departments. They, too, are responsible for the health of the nation. Let me refer particulary to the responsibility of the Department of Education and Science for the nutritional well-being of school children. I find it very strange that when questions are addressed to that Department, the answers sometimes seem wofully lacking in understanding of nutrition. That may be the fault of the structure of Government, rather than of individuals in the Department, in which case we should address ourselves to the problem in the near future.

I also think that we must press the DES to examine the national core and foundation curricula. The matter of physical education, on which I touched earlier, needs to be addressed. I see from the consultation document that 5 per cent. of the core curriculum is suggested as being appropriate, but I hope that physical education will not be brushed aside or put at the bottom of the list. I also hope that a place will be found for nutritional education in the core curriculum, and that it will not be treated merely as a part of chemistry, biology, home economics, cooking or any of the other convenient pigeon holes in which it could be placed. The national curriculum is an important aspect in the discussion of education; it must also be an important aspect in the discussion of health, as it impinges on the well-being of our children.

I hope that the Minister is thinking ahead from the present "Look After Your Heart" campaign to what will happen in phase two, which must address itself to evaluating the results of phase one. Here we have a problem: the Government, properly in my view, have targeted income groups C2, D and E for their campaign. Many hon. Members have referred to the health problems caused by a low income. As far as I am aware—I hope that the Minister will put me right on this—there do not appear to be any plans to collect statistics on mortality and morbidity in order to assess the effectiveness of the "Look After Your Heart" campaign. I hope that the Office of Population Censuses and Surveys will be invited to provide data and statistics on the effectiveness of the campaign. More research is needed into effective means of promoting health care among the low income groups.

As for the Government's overall strategy, it is noticeable that this debate has been attended by only one Minister. I recognise that the Minister in question is the one who is most concerned with health promotion, but no representative of the Department of the Environment has attended this debate. The Minister for Sport ought to have been here to answer questions about the Sports Council's budget having been cut at a time when we are trying to promote good health. No representative of the Department of Education and Science has been here, to whom we could have put questions about school meals and the importance of nutrition in children's education. No representative of the Ministry of Agriculture, Fisheries and Food has been here to whom we could have put questions about nutritional labelling and the Common Market's common agricultural policy.

All these matters are closely concerned with the promotion of good health. When they return from their many and varied activities around the country today—I do not criticise them because they all work very hard—I hope that my right hon. and hon. Friends will read what has been said in this debate and that they will act upon it.

The Government, rightly, reacted quickly to the Hungerford tragedy, but the tragedy of loss of life through poor health, because of the lack of good health promotion, is far greater. It kills more people than a single gunman could kill in one tragic and crazed incident. It behoves all of us to ask the Minister to take even more vigorous action than she has taken so far. I commend her on what has already been done, but rapid action needs to be taken to reverse the worrying trends in our society.

2.22 pm

Mrs. Currie

We have had an excellent debate. There were 20 speakers, and I imagine that another 20 have been disappointed. I cannot possibly answer in detail all the points that have been made, but I shall write to those hon. Members whose speeches I do not mention. I have listened to nearly all the speeches. Indeed, that was the purpose of having this debate in Government time. I wanted to know what hon. Members feel about what the Government are trying to do.

There have been four excellent "maidens" today, and I am delighted to join hon. Members in paying tribute to them. My hon. Friend the Member for Norfolk, South-West (Mrs. Shephard) was the chairman of the Norwich district health authority. For many years she was also a mental health commissioner and a member of the national council of MIND. She will bring those talents and that experience to this House. My hon. Friend the Member for Ludlow (Mr. Gill) is a butcher. He told us very effectively about meat. I understand that he is a member of the Rare Breeds Survival Trust. He will be joining a rare breed here. He will obviously be a Member who looks after his constituency with great determination and courage.

I heard what my hon. Friend said about the Shropshire health authority. I merely point out to him, as I did to my hon. Friend the Member for Shrewsbury and Atcham (Mr. Conway) in an Adjournment debate, that for many years the occupancy rate of available hospital beds in Shrewsbury has been around 75 to 76 per cent., so there are probably a few areas in which the Shrewsbury health authority could make some improvements. The Shrewsbury health authority has 26 hospitals. It is about to have another one—the brand new and marvellous Telford district general hospital. With the best will in the world, I do not think that Shropshire needs 27 hospitals. How that question is resolved, however, will be a matter for that area.

I join colleagues in thanking the hon. Member for Strathkelvin and Bearsden (Mr. Galbraith) for the generous tribute he paid to his predecessor, Michael Hirst. I understand that when the hon. Gentleman came to the House he had to give up a substantial chunk of salary, about £10,000 a year. I hope that simply proves that we look after our doctors in the Health Service, if no one else. Whatever he has given up, he has clearly gained a platform which will benefit not only his constituents but health matters in this House and we welcome him.

I had not heard the hon. Member for Preston (Mrs. Wise) speak in the House previously as she left the House before I came. In a typically robust speech she developed one or two important themes, but perhaps I may point out to her some slight inconsistencies. She is worried about the cost of a healthy diet to her constituents, yet she is keen to get rid of what she calls factory farming. The alternative can be expensive. One of the reasons why chicken is now cheap and not a luxury is because of modern forms of farming. That must be taken into account.

I listened with interest to another doctor, the hon. Member for Kirkcaldy (Dr. Moonie), who is no longer present, but is perhaps in the Tea Room. He is an extremely rare breed, being a smoking, drinking and eating doctor. He finished his speech with a demand for action, not words and the hon. Member for Strathkelvin and Bearsden and I will watch him in future to see if he means it. We now have six doctors in the House and, of course, the most well known of them did not turn up.

I was pleased to hear my hon. Friend the Member for Bosworth (Mr. Tredinnick) back Combat. I know that other hon. Friends take an interest in Combat and in the appalling disease of Huntington's chorea. The application of Combat for section 64 funding is with my hon. Friend the Minister for Social Security and the Disabled and I know that he is giving it urgent and sympathetic consideration. It will be for him to make announcements and I know that he will take into account what has been said.

I am ever so sorry for the upset I have given to hon. Members, such as the hon. Members for Oxford, East (Mr. Smith) and for Leeds, West (Mr. Battle), but if Labour Members are against it, obviously it is worthwhile and I shall go on doing it. Perhaps I should do a little more of it. I learn a great deal on these visits and find them extremely useful.

The hon. Members for Peckham (Ms. Harman) and for Halifax (Mrs. Mahon) are concerned about school meals and milk vouchers. It is worth pointing out that when we had nutritional guidelines for school meals they were not a fat lot of use because a great deal of food was thrown away. About 30 per cent. of children entitled to free school meals do not take them now. Many local authorities are doing much better than that and with good health education we think that we can make progress. Supplementary benefit claimants will still receive free school meals and milk tokens. That is about 80 per cent. of claimants for milk tokens. Probably twice as many families will qualify for the new family credit and will receive cash in lieu, so the new system will be much more generous than the old.

Several hon. Members mentioned mental illness and I listened with interest to the words of my hon. Friend the Member for Eddisbury (Mr. Goodlad) on schizophrenia. I entirely accept the criticism that we are not giving as much attention to the preventive side of mental illness as we could and we shall try to take that on board.

Much has been made of the difficulties of those in hard circumstances. But the inequalities of health and social class can be tackled and the changes in perinatal mortality show what can be done. Perinatal mortality is down for all social classes. The death rate for social class 5 is roughly where it was for social class 1 when the Labour party was in Government. [Interruption.] I hear the Opposition bleating, but I refuse to write off whole groups of society as beyond help. Many of the examples of illness we have had from Opposition Members are caused by heavy smoking among the poorest members of society. I would ask them to bear in mind that each packet of cigarettes smoked a day takes £500 a year out of a family's pocket. Therefore, we shall make some sort of achievement if we can persuade those people to give up.

My hon. Friend the Member for Eastleigh (Sir D. Price) commented on targeting. The point that has been made by such people as Professor Rose is that most people are running risks, particularly of heart disease. It would be a mistake to concentrate on small groups to the exclusion of others. If we can make small changes for large numbers of the population that will have the most effect.

I am a little hesitant with regard to the point that was made by my hon. Friend the Member for Swindon (Mr. Coombs) about screening for blood pressure. Screening is not enough; it must be accompanied by good advice and follow-up.

We have had a marker debate. It is the first proper debate that we have had on prevention and health for many years and I welcome the points that have been made by many hon. Members. We have a healthy country and we are lucky to be living in this country, with its National Health Service. We have a better housed, better fed and more prosperous population than ever before and certainly more so than under any previous Labour Government. We intend to keep it that way and see prosperity spread.

It being half-past Two o'clock, the motion for the Adjournment of the House lapsed, without Question put.