Commons Sitting of 20 July 1990

Preamble
The House met at half-past Nine o'clock
PRAYERS
[MR. SPEAKER in the Chair]

Good Health
9.34 am
Mr. Roger Sims: I wish to call attention to the importance of promoting good health, and I beg to move,
That this House, noting that good health is to be valued and enjoyed, recommends the adoption of healthier lifestyles to help protect against major disabling and premature death causing conditions such as heart disease, stroke and cancer; and urges the National Health Service to increase its efforts to promote such good health, through increased use of preventive measures such as vaccination and immunisation, screening services and the widespread dissemination of advice and information.
This Session we have spent a good deal of time discussing the proposed reforms of the national health service. Inevitably, there has been a great deal of emphasis on the treatment of injury, illness and disease. This morning I am inviting the House to turn its attention to steps which can be taken to avoid the incidence of injury and particularly of illness and disease.
The concept of preventive medicine is not new. The House will recall that in 1978 the World Health Organisation in the declaration of Alma-Ata issued a challenge to the world under the heading:
"Health for all by the year 2000."
That involves a continuous programme of action. In 1985 the European office of the WHO defined 38 targets for the countries within its region. I have a copy of the booklet which summarises those 38 targets with me today, but the House will be relieved to learn that I do not intend to work my way through them all. Many of those targets concern aspects of preventive medicine.
The Government fully endorsed the principles underlying the "health for all" strategy, and issued a monitoring report covering the period 1985 to 1988. That report is available in the Library and I commend it to hon. Members as an impressive account of what has been done so far. When my hon. Friend the Minister for Health contributes to the debate, I hope that she will be able to assure us that there is a continuous programme aimed towards the targets of health of "Health for all by the year 2000", and tell us whether there are plans to issue another monitoring report to show what progress has been made.
I want to put two propositions to the House. The first is that each individual has a responsibility in deciding what to eat, what to drink, how to conduct his personal life—in short, to use the jargon, to determine his or her life style. The individual has a responsibility to use available knowledge to minimise the likelihood of disease and illness and to maximise good health. My second proposition is that it is a Government duty to introduce and to implement policies that will encourage healthier living and
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discourage harmful activities. The Government should issue advice and information as freely as possible so that people can make informed decisions.
I am not this morning—or, I hope, at any other time—preaching or advocating nannying. I am reconciled to the fact that I will be accused of both those things, and probably of trying to restrict the freedom of the individual. There is a certain amount of double thinking on these issues. If we tell people that smoking can kill them, that excessive alcohol is harmful or that too much fatty food is bad for them, they tell us that we are trying to interfere with their private lives. However, if salmonella or listeria come to light or a drug is found to be harmful, the Government are immediately criticised for not making more information available, for not taking action and for not taking action sooner.
Surely it is right, and the responsibility of Government, to alert people to the facts and to tell them the consequences of their actions. If people choose a life style that is harmful, that is up to them—it is a free country—as long as they know what they are doing and, of course, they are not causing harm to other people by their actions.
However, a healthy life style benefits the nation as a whole. Human misery apart, disease involves heavy cost in terms of the lost productivity of goods and services, and the cost of treatment. The cost to the national health service of treating smoking-related diseases, to take just one example, is £500 million per year. What could we do with that sort of money in the health service?
One way of promoting good health is through health checks. Some companies have schemes for their employees—we are fortunate in having a similar scheme in the House. In any event, an increasing number of doctors are now offering what my own general practitioner rather delightfully calls "MOTs". It is curious that we think it important that, after a certain age, cars should be regularly checked to ensure that they are roadworthy, but that we do not encourage such checks on their drivers. It is now the usual practice for GPs to carry out basic tests such as on blood pressure, when seeing patients, regardless of the reason for which the patient is attending the surgery.
This week I was interested to note that my right hon. and learned Friend the Secretary of State for Health has issued for discussion the report of the Standing Medical Advisory Committee on blood cholesterol testing, which has examined the cost-effectiveness of opportunistic cholesterol testing. That means that, whenever the opportunity arises, such as when a patient visits a doctor, the patient should be tested for blood cholesterol. The report is interesting, and suggests that such opportunistic testing would be well worth while. I hope that that idea will be pursued.
The new doctors' contract encourages doctors to provide health clinics and to give patients free yearly check-ups. The contract obliges doctors to carry out such checks on the elderly. I find that admirable, although it is difficult to reconcile it with deterring people from having eye and teeth checks by charging them. I have demonstrated my views on that issue previously both in speeches and in my votes, and I shall not labour the point now, although I live in hope that Ministers will come to see the inconsistency of their policies on that.
The new contract also encourages child immunisations and cervical screening. The Government are developing programmes for both cervical and breast cancer screening. The patient's involvement is voluntary, but one cannot

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over-emphasise the importance of women over 20 taking advantage of the cervical cancer screening facilities which are becoming increasingly available, and of women over 50 taking advantage of the breast cancer screening facilities. However, when a women is tested, she should know the results within one month. That is the deadline that has been laid down by the Government. A delay of three months is simply unacceptable.
The House will recall that, last year, the Public Accounts Committee drew attention to coronary heart disease and urged improvements to the campaign to prevent it. The Committee made some telling comparisons between the costs of that campaign and the costs of treating the disease. In the context of coronary heart disease, the blood cholesterol report to which I have referred emphasises the importance of other factors, especially smoking and diet.
The House will not be surprised if I say a few words about smoking, which is the largest avoidable course of illness and premature death. It is estimated that 110,000 people each year die before their time through smoking and that 90 per cent. of the deaths from lung cancer, bronchitis and emphysema are due to smoking. The evidence of the harm caused by tobacco products is overwhelming.
Happily, the incidence of smoking has declined, but as one third of the population still smoke, that proportion is still far too high. Especially worrying is the extent to which smoking is prevalent among young people, particularly girls. I commend the efforts of the organisation Parents Against Tobacco, with which my hon. Friend the Member for Ealing, Acton (Sir G. Young) is much involved. That organisation concentrates on ensuring that the law that makes it illegal to supply children with cigarettes is enforced. If the tobacco companies can encourage children to smoke, the chances are that they will have customers for life. There is no doubt that, if tobacco were invented now, it would never be allowed on the market.
We must be realistic: it would not be practical to ban the sales of tobacco products completely. But what are the Government doing to try to reduce the extent of smoking? The Government spend £5 million per annum through the Health Education Authority and ASH on persuading people not to smoke. The tobacco industry spends £100 million per year trying to persuade people to smoke.
Why do the Government allow smoking advertisements? I grant that the present advertising is subject to controls, but how are those controls decided? We are told that they are decided by voluntary agreement, but that means that the Government and the industry sit around the table and have a cosy chat. The Department of Health officials say what restrictions they would like and the tobacco industry suggests the restrictions that it is prepared to wear, and a compromise is reached. That is not a voluntary agreement; it is negotiated agreement. The fact is that the Department of Health is party to a negotiated agreement about how to promote the sales of a product that we know to be deadly in its effect.
I should like a complete ban on tobacco advertising and its promotion, especially when that promotion is associated with sport, which seems particularly cynical. I favour far stricter controls on advertising. I was sad that the Government opposed the EEC directive on health
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warnings. A draft directive is now under discussion, which involves strict controls on advertising. Only two Community countries are now opposing the proposals—West Germany and the United Kingdom. Why is the United Kingdom opposing the terms of that directive?
The increase in the tax on tobacco products was welcome, and one hopes that it will be steadily maintained. There is no doubt that increasing the cost of cigarettes dissuades people from smoking. Incidentally, it is worth reflecting that, at present, 1p on a packet of 20 cigarettes brings in about £40 million. In the next Budget, how about increasing the cost of cigarettes by at least the rate of inflation plus that extra penny, and devoting that £40 million to health education? While we are about it, would it not be sensible to take cigarettes out of the retail prices index, because it is illogical to include them?
Meanwhile, I welcome the increased adoption of non-smoking areas and, in some cases, of complete non-smoking policies in workplaces, restaurants, pubs and public places and such recent prohibitions on the underground and suburban trains.
Mr. Alex Carlile: Will the hon. Gentleman join me in commending the British Medical Association, which recently sent out an invitation to a large number of doctors to attend a reception? It said on the bottom, "Black tie, no smoking." Does he share my anxiety about the number of doctors in practice today who smoke?
Mr. Sims: Yes, I endorse both the hon. and learned Gentleman's comments, but particularly the latter one. Doctors do not set a good example.
The more organisations and places that have no-smoking policies, the better. I was delighted to learn that this week Air Canada decided to introduce a complete ban on smoking on all its flights.
Mr. Toby Jessel: Has my hon. Friend noticed that it is increasingly difficult for passengers who arrive comparatively late and check in perhaps only 40 or 50 minutes before take-off, to book a non-smoking seat? It seems that airlines are behind the public demand for smoking and non-smoking seats. Is not there a case for the Department of Health to suggest to Transport Ministers that they and their counterparts in other countries should discuss with airlines how airlines can keep ahead of the public demand instead of behind it and allocate more seats for non-smokers?
Mr. Sims: Yes, my hon. Friend is absolutely right. Another interesting example is the London surburban trains on which I travel daily. The trains used to have three non-smoking carriages and the fourth was a smoking carriage. Increasingly, one found that the only carriage in which one could get a seat was in the smoking carriage because more and more people wanted to sit in the non-smoking one. Now British Rail has recognised the very point that my hon. Friend makes and the train is completely non-smoking. I have not received any letters of complaint and I have not heard that any have been written. The arrangement has been generally accepted. Such policies discourage smokers. That must in itself be good. It certainly makes life more pleasant and healthier for others. There is increasing evidence of the harm that can be done by inhaling other people's smoke—passive smoking, as it is called.

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I also mentioned diet. That can be more difficult. At times it is hard to distinguish between advice from experts and advice from eccentrics. Fashions change. Different reports come from different quarters and can cause confusion. At different times we have been told that butter and sugar are either good or bad for us. The latest advice this week is that we should all eat garlic. That is an interesting suggestion but an anti-social one.
The Government have their own advisory bodies on foodstuffs. Perhaps we should consider a way in which the definitive, authoritative recommendations on food matters can be given wider publicity. Some basic principles have been established. As a general rule, we should limit our consumption of fatty foods, sugar and salt and eat plenty of fibre. The House will be pleased to note that porridge has now been established as particularly good for us.
The Food Safety Bill now going through the House deals with the marketing of food products. It is important that we should know what we are eating and its quality. It is equally important that in legislation from the House or in EEC directives the restrictions are not such that they prevent producers from making legitimate claims for their products.
The House will be familiar with the "Look after your Heart" campaign, which recently celebrated its third anniversary. I was pleased that the booklet about the health service, which has been put through every door and has caused some controversey, on which I shall not comment, includes the "Look after your Heart" pamphlet. The pamphlet incorporates some particularly useful and easily read quick-reference guides on matters such as eating, exercise, alcohol, smoking and so on. I hope that it will be widely read. Perhaps even those who are not completely in accord with the Government's NHS reforms will realise the value of inserting the "Look after your Heart" campaign pamphlet in the booklet.
I mentioned alcohol a few moments ago. The booklet to which I referred reads:
"Drinking can be enjoyable and safe, as long as you don't overdo it. But too much alcohol can be bad for your heart and liver and cause problems at work, with family and friends."
Perhaps I should declare my interest. The House will be aware that I am parliamentary adviser to the Scotch Whisky Association. I can say with every confidence that the association would wholeheartedly endorse that advice.
Moderate consumption of wines and spirits does one no harm. Indeed, it may do one good. I am sure that I am not alone in occasionally enjoying a whisky at the end of a busy day. But there is no doubt that excess is harmful. I also enjoy a glass of beer from time to time. I am glad to see the increasing popularity of the low-alcohol beers and lagers, which I now find quite palatable. It is encouraging to see the extent to which young people drink low-alcohol drinks and soft drinks, particularly if one of a party intends to drive.
Dr. Kim Howells: Does the hon. Gentleman agree that, increasingly, problems are surfacing among young people as a direct result of over-consumption of alcohol, often by people who are below the legal age to drink? Does he further agree that that is partly due to the continuing glamour and style of presentation of alcohol in advertisements? Young adults continue to believe that it is glamorous to drink hard drinks and that it makes them look like the glamorous people in advertisements. Does the hon. Gentleman agree that the rules on alcohol advertising should be tightened?
Mr. Sims: Yes. Of course, spirits are not advertised on television. Some of the drinks that are advertised on television or elsewhere are given a certain aura and glamour, which is not appropriate. It is a pity that some young people are influenced by those advertisements. Young men in particular seem to think that it is manly to drink far more than is good for them. It does them no credit. It makes them rather disagreeable socially and does a great deal of harm to the health.
I wonder whether we should consider doing more to support youth clubs and other facilities. I am sure that one of the problems in some areas is that pubs are the only place for young people to go. Of course, when one goes to a pub one has a beer, then another and then another. That is something that we should examine.
We must accept that, sadly, some people become addicted to alcohol. I commend the work of the alcohol advisory services, such as my local one, which are often started by volunteers. They merit support from the district health authority, which mine receives, because their work is saving national health service expenditure. The issues surrounding alcohol have been addressed by the ministerial group on alcohol misuse. Perhaps when my hon. Friend the Minister speaks she can tell us a little about its present work.
Another factor in health promotion is exercise. All credit to some of our parliamentary colleagues who take part in the London marathon. It is a little beyond most of us. Within the precincts of the palace we have a gym, which is a valuable facility used by many members of staff. There are an increasing number of private gyms in places such as the City, which are well used. There is an argument for giving some sort of financial incentive to employers to provide gyms for their staff. The extent to which private gyms are used suggests that the facility would be much appreciated. Indeed, it would be in the interests not only of the staff, but of the company to keep its employees fit.
Jogging is a simple form of exercise that appeals to some. I enjoy a weekly swim. The problem there, as with several other sports, is the limited number of facilities and the expense of providing them. Some of the best sports facilities are in our schools. Although some schools make their facilities available to the community, others lock their doors evening after evening and throughout the weekend, which is a pity. With the introduction of local management of schools, some governors may consider making the facilities on the school premises more available to local people when they are not needed by the school. In that way they would make a contribution to the community and to community health. They could reasonably make a modest charge, which would add to school funds.
One of the themes of my motion and my remarks is the need for our fellow citizens to be well informed about health and how to promote their own good health. One source of advice is one's general practitioner and another is the local pharmacist. He or she is always ready and willing to play a part in promoting good health in the community and to give advice and information. Chemists are also a valuable means of disseminating a whole range of good material produced by organisations such as the Health Education Authority and the British Heart Foundation, whose pamphlets are reflective, well presented and readable. I am sure that hon. Members will be familiar with the publication "Pharmacy Healthcare".

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It is the report on a scheme to provide freely information on health care issues through community pharmacists. It has done well and is worth expanding.
Whatever steps are taken, injury, illness and disease will occur and sometimes unexpectedly, for example, an accident in the home or on the road or a heart attack. If someone who happens to be on the spot can render first aid, it may literally make the difference between life and death. The July issue of Which? carries an interesting article on first aid. It explains how easy it is for people to take a variety of courses in first aid. People should be encouraged to do so. Again, perhaps employers could give employees time off for a course to ensure that several people within the company are well trained and able to carry out first aid, should the need arise, as is happily the case in this building.
I have had some correspondence with my local director of education on the matter and I was rather surprised to learn that
"there is no statutory requirement for a First Aider to be present at Schools.".
He did go on to say:
"We do obviously feel that this is beneficial and we encourage both teaching and non-teaching staff to participate in the First Aid training."
I had asked him to what extent first aid training was available to pupils, to which his reply was:
"There is not a lot of time to encourage First Aid with pupils."
With the new curriculum, that is understandable, but I should have thought that it would be valuable if first aid training was made available to pupils immediately after school. I am sure that many youngsters would be interested in it. Certainly, St. John Ambulance or Red Cross would be happy to provide instructors.
I have taken the advantage of having won first place in the ballot of private Members' motions to address the House for longer than should normally choose. I am aware that even then, I have not touched on a whole range of issues that are relevant to health promotion. Acquired immune deficiency syndrome, for example, almost merits a debate on its own. On the whole, the Government have conducted a good campaign in an extremely sensitive area. Whatever they said or did, they were bound to be criticised.
I have not mentioned housing, which is relevant to health, or pollution. In the past day or two we have seen some of it and the figures show the frightening amount of pollution over London because of the present weather conditions. Family planning is an important part of health promotion. All those are relevant factors and perhaps later in the debate some of my hon. Friends will address themselves in greater detail to those topics.
Mr. Jessel: I have agreed with almost all of my hon. Friend's speech until now. Can he explain why family planning is relevant to health promotion? It is not a disease for a woman to give birth to a baby.
Mr. Sims: How long do we have? I should have thought that plenty of examples spring to mind, where the general standards of health of a family and its individual members are lower than they might have been, had the mother been able to take family planning advice and restrict her family. Any health visitor could answer my hon. Friend's question in great detail. He may well wish to pursue the point later.
Mrs. Teresa Gorman: I intervene so that we can have a woman's voice in this, as family planning generally concerns women more than men. Before we had family planning, the most frequent cause of death for women was from illegal abortions. Just one statistic is that 5,000 women a year died in that way. Dr. Marie Stopes and other pioneers introduced family planning because such deaths were the cause of misery and large families had difficulty raising their children. That is how the family planning movement began. For women, it is one of the most beneficial developments in preventive medicine that I can think of.
Mr. Sims: I am obliged to my hon. Friend for that intervention, which confirms my point that family planning is an aspect of health promotion. Other hon. Members may deal with that issue later in the debate.
I hope that I have demonstrated that, as I suggested in opening, there is much that the individual can do to enjoy a healthy life and to minimise calls on the national health service, that there is much that the Government are already doing, but that there is plenty of scope for them to do more. That is the message that I endeavour to convey in my motion, which I hope commends itself to the House.
Mrs. Audrey Wise: I agree with the statement:
"The best prescription for good health is decent housing, pure water and clean air—all of which need a government committed to good public services and high standards for the environment."
That is a quotation from the Labour party document entitled "Looking to the Future", which will be the basis of the policy of the next Labour Government. During my remarks I shall refer to some of the points made in that document.
The hon. Member for Chislehurst (Mr. Sims) was right to refer to housing. I appreciate that he could not deal with the issue at length because, as he said, he has raised a many-sided subject and time is limited. But I wish to emphasise that many families are desperate because they are homeless. I refer not simply to the young homeless but to those who are statutorily homeless, people with children and pregnant women. It is impossible to be healthy and homeless. It is a contradiction in terms. Yet the capacity for local authorities and individuals to tackle the problem of homelessness is constrained at all points and made virtually impossible to resolve because of the squeeze on local government finances.
Many families suffer from overcrowding. Again, one cannot be healthy, physically or mentally, if one is living in overcrowded conditions. Many people's homes are in a bad state of repair. Repair and improvement grants have helped, but they have never been easy to obtain. They became even more difficult to use when the Conservatives removed tax relief from loans for improvements, which made it harder for people to make the necessary contribution to the cost of repairs, which they must make in addition to any grant that they obtain. It is impossible for people to be healthy if they are living in poor, and perhaps damp, conditions.
Let us not forget those whose homes are satisfactory but whose health is affected because they are stressed by the fact that the amount they must pay to live in their homes has increased almost beyond recognition through increased mortgage rates. In other words, even people who thought that they had solved their housing problems are facing difficulties and stress.

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There are so many facets to the subject that the hon. Member for Chislehurst has raised that it is difficult to know where to draw the boundaries. For example, I recall a discussion with a group of women members of my trade union, the Union of Shop, Distributive and Allied Workers. Although the discussion was about health, particularly women's health, it soon developed into a discussion of wages.
They decided that a major cause of ill health among them and their fellow workers was stress, caused mainly by the fact that they did not earn enough. Because they were working arid were also poor, they were suffering from the poverty of low income and the poverty of time. In other words, they were suffering both material deprivation and stress. Clearly, a discussion of health can easily develop into a discussion of low pay.
Coupled with the stress of low pay is stress caused by working conditions and employer attitudes. I have spoken previously in the House about the conditions of supermarket check-out operators, and I do not apologise for raising the issue again. I have observed that occupational health, injury and disease is usually regarded with the male stereotype in mind, and, for example, accidents in mines and on construction sites. But the health of many women workers doing ordinary jobs, such as supermarket check-out operators, is impaired because of their conditions and hours of work. They suffer back strain and repetitive strain injury from the sheer spread of the operation and the fact that employers are determined never to allow them a moment even to glance round. The supermarket owner allows his customers to build up into large queues rather than risk a check-out operator not having a queue waiting to be dealt with.
When I last raised this subject in the House I spoke of the time stress imposed on supermarket check-out operators. Even in a well-organised trade union shop, they may be expected to work to a norm of processing 20 items a minute. A target such as that is incredibly stressful, mentally and physically. It is positively bad for a person's health and the members of my trade union suffer, especially after doing that type of work for several years.
That state of affairs could be corrected by supermarket owners easing up on the speed, by offering more variety of work to the staff and by providing more reasonable working hours and better wages, enabling employees to take advantage of the better hours. A shop worker recently told me, "The employer thinks he owns you body and soul." People who are driven to feel like that may be prevented from enjoying a good state of health, mentally or physically.
I agreed with much of what the hon. Member for Chislehurst said, particularly about smoking. Stressful conditions encourage people to smoke, in that they seek escape from stress by smoking. I myself believe that it adds to life's stresses, but that is not the way in which many people see it on a day-to-day basis, so they make a wrong decision and smoke. The hon. Gentleman was right to say that at least a part of the answer would be to ban advertising and sports sponsorship and promotion by tobacco companies. We do not simply need exhortation, and we certainly do not need to spend large quantities of taxpayers' money on a counter-advertising campaign. As a non-smoker, I resent my taxes going on counter-advertising when it would be easier, simpler and more effective simply to ban advertising in the first place. I agree with the hon. Member for Chislehurst about that.
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As long ago as 1986, in a Labour party document called "Women and Health", the Labour party committed itself to prohibiting the advertising of tobacco except at the point of sale. That is one item that receives some cross-party support. I guarantee to put pressure on the Labour Government, after the next general election, to stick to that pledge. I am pleased that the hon. Member for Chislehurst is trying to persuade the Conservative Government to have a similar policy—albeit unsuccessfully.
Child health is also adversely affected by poverty and bad housing. It is an uncomfortable fact that at present in our society people with children are relatively worse off than those without children—that applies whatever the level of income. I am not talking about the most poverty-stricken people, although their problems are the greatest. At all levels of income, having children makes people less well off than others with similar jobs and salaries.
Although I think that children bring a great deal of joy, the logic escapes me as to why children should be regarded as necessarily having to bring with them a poorer lifestyle, which affects not only parents, but the children themselves. It means that, in families with children everyone involved is relatively worse off than others from the same social background, without children.
I am pleased that, within its first year of Labour government, my party will increase child benefit at least to make up for its loss of value since 1987. It is disgraceful that increasing child benefit has not been a priority—indeed, it simply has not occurred; child benefit has been frozen. If we are really concerned about wanting children to live in healthy families, we must improve families' incomes. Child benefit is the way to do that throughout all levels of society. If anybody is worried that child benefit also helps the rich, we can increase taxation on the rich and get the money back that way. We should not destroy the universality of such a splendid benefit. I commend Conservative Members to pressurise their Government to lose no more time in restoring the level of child benefit. They should not leave it to Labour. We shall do it and so reap a great deal of credit. I shall be pleased about that, but I do not suppose that Conservative Members will be.
The provision of well woman centres is particularly important in the provision of health services generally. I call them "centres", not "clinics" because that is a less clinical, more welcoming name, which suggests a blurred edge to the function of such centres. That is important because women can be deterred from seeking medical help if their anxieties are vague or they are not sure that their complaint is a matter for the doctor. They might have a worry that is impinging on their health and could be helped by some other means, for example, other professional advice, or a self and mutual-help group. Well woman centres are important because they can serve that function, and the woman does not feel that she is "wasting the doctor's time"—a phrase that is often heard when people, especially women, are wondering whether they should go to the doctor, but fear that they might be wasting his or her time. Most doctors would probably agree that patients who worry about that are precisely the ones whom they would like to see and are least likely to waste their time. The provision of informal well woman centres, where women can go if they have worries that are

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vague and anxieties that straddle medical and other problems, is an excellent idea. There is no doubt that there is a huge demand for such centres from women.
As long ago as 1986, in our document "Women and Health", we talked about the promotion of well woman centres and made pledges to enable women to see women doctors. Such a policy could not be brought in overnight because there would have to be changes in training arrangements and in doctors' career structures to enable there to be large numbers of women doctors at all levels and in all specialties of the profession. That objective will need some work, but it is necessary because many women are deterred from seeking medical advice as they find it difficult to locate a woman doctor to see. That is intolerable.
It is also important for people to get a good start. I believe that preventive medicine begins even before conception. The Labour party "Women and Health" document states:
"Pre-conceptual advice, pregnancy testing and parent craft classes should be provided and ante-natal discussion groups and post-natal support groups encouraged by group practices of midwives based in the community."
Pre-conceptual advice and thought is one of the new, valuable advances in preventive medicine that should be encouraged, and we are pledged to do so.
The maternity care that the mother receives after conception, the birth and post-natal care also have a great effect on the start given to the baby and the family unit. We want such care to be greatly improved. It is wrong that women and babies should have unnecessary hurdles to overcome because they have had a bad start. The Opposition believe that more research is needed into post-natal depression. A baby cannot have a good start if it is born to a mother who becomes deeply clinically depressed as a result of the baby's birth. There is not half enough research into that problem. As with many factors affecting women, it is neglected.
The Opposition also believe that continuity of care should be provided for expectant mothers. Starting with anti-natal care, and carrying on through the birth into post-natal care, every women should have a midwife with whom she can identify. The midwife would have the opportunity to exercise her professional skills to the full because she could watch that woman's progress and the birth of her baby from the beginning of pregnancy to the end of the post-natal period. That would be a vast improvement on the present, hopelessly fragmented approach to maternity care.
I was somewhat disappointed that the hon. Member for Chislehurst did not mention the need for free eye and dental checks, which I know he supports—
Mr. Sims: But I did.
Mrs. Wise: In that case, I apologise to the hon. Gentleman: I must have missed it. So we agree. The Opposition find it a paradox that the Government claim to favour prevention, yet put a financial hurdle between people and two of the most proven preventive procedures. I should have thought that people face enough discouragement from consulting a dentist through their own fears. They do not need charges to make matters worse.
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My son is an optometrist, and a week or so ago he saw a lady who, he discovered, was suffering from a detached retina. He feared that it had been detached for some time. Detachment does not necessarily happen in one fell swoop, obvious to the patient. It can commence, then worsen. My son referred the woman for immediate hospital treatment, and I am pleased to say that she was operated on within a day—but the hospital did not have any great expectation that it could save her sight. So she was given expensive operative care, which the hospital is duty bound to carry out as long as there is any hope—but how much more sensible it would have been—and how much better a use of resources—if the woman had been seen several months earlier when her problem was only beginning. Then, the operation would have saved her sight.
The lady told the hospital that although she had been worried about her sight she had worried even more about her capacity to pay for an eye examination. It was the cost of the examination that had deterred her until her anxiety became so acute that she decided to seek advice. At that stage it was too late. That is tragic for her and it is a waste of the resources of the national health service. It is also distressing for the professionals who have to care for such patients. It upset my son that he had not had a chance to see her earlier and it undoubtedly upset the surgeons too. We should not burden our health professionals with extra stress of this sort. I look forward to the election of a Labour Government and the fulfilment of our commitment to restore free eye and dental checks.
A couple of days ago an interesting press release about the conditions in which food should be kept emerged from the Department of Health. The Government propose to introduce temperature controls to food retailing and delivery—a good step. I am sorry to have to criticise that good step, but I must do so because the Government are also acting as a brake on the speed of introduction of their own new controls. They are phasing in the temperature controls to ensure that retailers can bring their equipment up to standard. Fair enough, but the time scale is outrageous.
The first requirement is that from April 1991 food must be kept at no more than 8 deg C; so far so good. However, much perishable food should really be kept at 5 deg or less, as the Government acknowledge. They are laying regulations to that effect, but they will not come into force until April 1993. It is one thing to say that retailers need time to bring their equipment up to standard, but it is disgraceful to allow them nearly three years during which people, including pregnant women, may continue to eat food contaminated with listeria organisms, which can keep growing at 6, 7 or 8 deg.
I am sorry that the Government are spoiling their initiative that way. Of course retailers need time, but not three years. The application of technology and of money—there is plenty of that in the grocery trade—could ensure that the process is carried out in much less time, given the will to do so. I shall regard the Government as being directly to blame for cases of listeria that occur between now and 1993 because food is not kept below 5 deg. The Government know what should be done and are wilfully allowing too long in which to do it.
The Government's move is also an insult to large sections of the retail trade. If the equipment of some retailers is in such a bad state that it needs three years to bring it up to a scientifically reputable standard, I am appalled at the lack of thought that those retailers have

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given to food storage. However, I believe that the best retailers could meet a much tighter deadline, and it is unfair to them to allow their competitors to get away with inadequate food storage arrangements for close to another three years.
The reported figures of cases of listeria infection may represent only the tip of the iceberg. It is not an easy disease to diagnose or to trace back to its causes. But it is scientifically accepted that listeria organisms can grow under refrigeration, and that food must be stored at less than 5 deg C to protect us from this common organism. Precautionary action should certainly be taken before April 1993.
The promotion of good health is a many-sided subject. Of course people must make good personal decisions about their life style. It is sensible not to smoke; it is sensible to take exercise and to try to eat as healthy a diet as possible—although that is sometimes ruled out by a lack of income. But individual decisions in the matter, although important, are by no means the whole story—they are not even the main story. Without collective action and provision it is impossible for people to protect their health to the extent that we should all wish. In food storage, for example, we rely on Government regulations on retailing. We can make our own decisions in some ways; I have decided that I do not want to buy anything stored at more than 5 deg C, but how do I know it has been? I must make another decision—to cut out of my diet a whole range of foodstuffs that are perfectly healthy in themselves, provided that they have been stored properly. But I cannot make a personal decision that can cover that—just as we cannot make personal decisions that satisfy the housing needs of the population or ensure that we will all have adequate incomes. We rely on trade unions, employers and Governments to do those things.
The promotion of good health is the responsibility of all of us; however, it is especially the responsibility of the House and of Governments not only to encourage but to facilitate good health, through the provision of improved standards in all the areas that we are discussing this morning.
10.40 am
Sir George Young: I congratulate my hon. Friend the Member for Chislehurst (Mr. Sims) on both his choice of subject and his speech. The non-sermonising "Jimmy Young" note that he struck was exactly right. I also commend him on the large number of subjects that he managed to cover. As he hinted, his choice of subject is timely.
For much of this year, the health debate has revolved around the role and structure of the national health service and how it should respond to changing patterns of demand, changing types of illness, new treatments and changes in medical technology. This morning my hon. Friend has righly switched the spotlight away from the national health service, and back to the role that the individual must play in improving standards of health.
I strongly believe that we have reached the point of diminishing returns in trying to secure improvements in the nation's health through investment in traditional curative medicine. Of course we must maintain that investment, but the improvements in health that all hon.
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Members want to see are far more likely to result from changes in individual life styles than from an increase in throughput in our hospitals.
What does that mean to a party whose traditions might suggest that it should not intervene in individual life styles, and whose instincts might lead it to the view that, if people do not wear seat belts, or if they want to smoke, that is a matter for them and not a matter in which Government should intervene? I do not agree with that view. One does not have to be a socialist to appreciate that, if the resources available to the National Health Service are finite and if those finite resources are used to treat avoidable illnesses, there will be fewer resources left for unavoidable illnesses.
A consultant at St. George's hospital—before it moved from Hyde Park corner—summed up the position very well. He was about to operate on a patient who suffered from a serious but not acute illness, and who had a rare blood group. The consultant had assembled, with some difficulty, sufficient quantities of blood of that group to enable the operation to proceed. However, just before the patient was anaesthetised, there was an accident on Hyde Park corner and a motorist who was not wearing a seat belt was rushed into the hospital, critically ill. He had the same rare blood group as the consultant's patient; and, inevitably, the supplies were diverted towards the motorist and away from the patient.
That graphically illustrates the point that my neighbour's life style is of consequence to me. We live in an interdependent society, and when health care resources are rationed, we all have a stake in how they are spent.
I do not regard it as tenable for any party to claim that it should be neutral on the question of individual life styles. How a party then discharges its legitimate interest in individual life styles is another matter. An individual should be encouraged to make sensible decisions about his or her life, but it cannot be left to the marketplace, although many of my hon. Friends might like to do that.
Let us take the issue of smoking, which was touched on by my hon. Friend the Member for Chislehurst. If it were left to the marketplace, the information that an individual received would be wholly one-sided, and any decision based simply on that information would inevitably be wrong. For an individual to reach a relevant decision about his life style, he must have all the relevant information. As the tobacco industry will not provide that information, inevitably the Government are drawn in. They can either do what was suggested by the hon. Member for Preston (Mrs. Wise) and simply ban the advertising of tobacco—with which suggestion I have some sympathy—or they can make available to the individual the contrary information, so that he has access to both sides of the equation before he reaches a view.
The same is true of the promotion of alcohol. The Government have a legitimate interest in ensuring that the information on which an individual bases his decision is well balanced. The notion that the Government should be neutral and stand back on those issues is not one that I can support.
The Government set the parameters for many of the decisions that are made. It is the Government who decide by whom alcohol should be consumed, at what age, where and at what times. The Government fix the price for both alcohol and tobacco: that is another reason for them to take a sensible and coherent approach to these issues.
As was implied by my hon. Friend the Member for Chislehurst, this is not just a matter for the Department of

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Health. All Government Departments have a stake in many of the issues that he touched on. The Department of Trade and Industry may have a policy on helping firms that happen to manufacture tobacco to set themselves up to manufacture something else. How does that relate to the Department of Health's interest, which is perhaps aimed at reducing the consumption of tobacco? The Department of the Environment has a role to play in sports sponsorship, to which I shall return in a moment; the Treasury has an interest, in relation to its fiscal responsibility for setting the price.
My hon. Friend the Member for Chislehurst rightly prioritised some of the issues surrounding smoking when he drew attention to the 110,000 premature deaths that occur each year. This is the area where investment in health promotion can produce the best returns. I hope that my hon. Friend the Minister will draw on the reserves of good will that she has at her former Department—the Department of the Environment—to secure a passage in the White Paper on the environment about passive smoking.
For millions of people, pollution is not acid in rain, lead in petrol or the hole in the ozone layer; it is other people's smoke. If we as a Government are to be credible on the macro-issues we must be credible on the micro-issues, of which passive smoking is one.
People with asthma or chest complaints find that other people's smoke makes their condition worse. For millions of people it is an irritant. In the immortal words of Frank Sinatra, smoke gets in your eyes; but it also gets in your clothes and hair. I applaud Air Canada's decision—mentioned by my hon. Friend the Member for Chislehurst—to ban smoking on all transatlantic flights, but the White Paper should sketch out the Government's role in establishing space in public offices as non-smoking areas.
Mr. Alex Carlile: The hon. Gentleman is right to praise Air Canada's policy. Will he join me in deploring the policy of Lufthansa, the German airline? One tends to find smokers on one side of the aisle and non-smokers on the other, effectively sitting alongside one another.
Sir George Young: That is a wholly unreasonable approach for any airline to adopt. I think it would be best not to book tickets with that airline, and I am grateful to the hon. and learned Gentleman for giving me notice of which airlines to avoid.
The canteens in Government Departments would be nicer if non-smoking were established as the norm. The Government have a role to play in helping to promote a society where non-smoking is the norm, and where there is a presumption that a public area is somewhere one does not smoke. People should not have to wait for the no-smoking sign before knowing that they are in a no-smoking area. The whole debate has to be turned around now that non-smoking is the majority activity.
It also makes good business sense for pubs, restaurants and other areas of public entertainment to develop non-smoking areas, because that is what the majority of their customers want. I hope that the Government will look at a code of guidance for employers who want to know how to tackle these sensitive issues, especially where some employees want to smoke while others do not. There
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is now a threat, under the Health and Safety at Work etc. Act 1974, from those who suffer from passive smoking. The Government have a role to play in this.
The hon. Member for Preston mentioned sports sponsorship. When the advertising of tobacco on television was banned, the tobacco industry, in a cynical move to get round the restrictions placed on it by Parliament, began sponsoring sport. It is sad that sport is as addicted to tobacco as many smokers. We have to do more to find alternative sponsors for some of the sports that get sponsorship from the tobacco industry. We also have to look carefully at the rules. If tobacco manufacturers want to sponsor sport, rather than using the brand names of cigarettes, they should use manufacturing names, which would weaken the association. It is cynical to link sport, which is essentially healthy, with smoking, which is essentially unhealthy.
My hon. Friend the Member for Chislehurst mentioned the voluntary agreement with the tobacco industry and implied that discussions about it were cosy. When I conducted those negotiations, they were far from cosy. However, if the tobacco industry knows that the Government will not legislate, what it volunteers is the voluntary agreement, because the Government have no negotiating power. We should allow the House a free vote on the advertising of tobacco and sports sponsorship by the tobacco industry. The Government resolved libertarian issues such as the use of safety belts and crash helmets through a free vote on a Government Bill. I hope that, in the next Session, there will be a Bill with a provision that will allow a debate, such as this, that can end with a free vote on whether we should phase out the promotion of tobacco, save at the point of sale.
My hon. Friend the Member for Chislehurst spoke about the problem of doctors smoking, but the problem among health professionals is not so much with doctors, among whom the consumption is declining, as among nurses, among whom the incidence of smoking is high. I hope that the NHS can do a little more work on why it is that those who must be aware of the consequences of smoking, smoke disproportionately.
Mrs. Wise: Stress:
Sir George Young: It may be stress. I welcome the initiative of Parents Against Tobacco, which has valuable support not only from my hon. Friend the Minister but from my right hon. Friend the Prime Minister. It is endeavouring to shield children from the pressure to smoke until they have grown up and can take a rational decision of their own. Members of Parliament had a helpful meeting with my hon. Friend the Under-Secretary of State for the Home Department, who said that he was planning legislation to tighten up the regime that controls the sale of cigarettes to children. Perhaps the House of Commons can do something in this. It has always seemed crazy that the House should validate an activity of which, by and large, it disapproves by selling its own brand of cigarettes in the kiosk downstairs. I hope that the Services Committee will have another look at this to see whether we should validate this activity by putting the insignia of the House of Commons on cigarette packets.
Cycling has a role to play in promoting good health. There has been a substantial increase in cycling over the past 15 years. My hon. Friend the Member for Chislehurst said that some activities are inaccessible, because the

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facilities are not there, but this argument does not apply to cycling. Some 90 per cent. of men and 67 per cent. of women can bicycle and there are now over 15 million bicycles in the United Kingdom—as many bicycles as cars.
A growing number of Members of Parliament use bicycles to get to and from their places of work. I claim some credit for this, because I established the House of Commons bicycle pool, way back in 1975, to promote this activity. I am not sure what happened in 1979, when this Administration came into office and I lost track of it. I think that it was privatised and that the assets were sold to the Members in accordance with the principles of that Administration.
Mrs. Wise: Will the hon. Gentleman mention the need for more cycle tracks?
Sir George Young: Yes, but there is no point in installing cycle tracks if all that happens is that motorists park in them, which is what tends to happen in London. I am all in favour of cycle tracks and routes through Royal Parks to make cycling more attractive and easier, but there has to be more observation of the cycle tracks once they have been painted, because otherwise the motorists assume that they are delineated places in which to park their cars. That is what has happened in the Uxbridge road in my constituency, where we have a cycle track that is no longer visible because of parked cars.
Cycling has great health benefits. It is a form of vigorous exercise in that, in the words of doctors, it is dynamic aerobic activity involving free movement of large muscle groups—larger in the case of some people than in others. Some interesting research was done by Dr. Tuxworth, who analysed 1,394 middle-aged factory workers. He discovered that cyclists in general enjoy a level of fitness equivalent to being five years younger, and for regular cyclists, the level of fitness was equivalent to being 10 years younger.
It is estimated that the training effect of cycling four mile each way to work at 12 mph is the same as 10 minutes wrestling, 30 minutes of squash, 50 minutes of singles tennis or 24 holes of golf. The effect is doubled if one increases the speed from 12 to 17 mph. Cycling has the advantage over jogging, swimming or some of the other activities mentioned by my hon. Friend the Member for Chislehurst, in that it is easier to incorporate into one's daily routine without it being a time-wasting chore that eats into valuable time. For those who are worried about the constraints on cycling and who think that it rains all the time, I can say that, on average, it rains between 8 am and 9 am on 12 days in the year.
Dr. Kim Howells: I am not sure whether those figures refer to Wales. I am interested in the statistics that the hon. Gentleman has given us. However, given the dangers presented by traffic, especially in great cities such as London, could not cyclists be prematurely 20 or 30 years dead as a result of cycling on some of the busiest roads?
Sir George Young: The hon. Gentleman is right. The statistics for cycling accidents are far too high—I think, about 300 deaths a year. However, when these cycling statistics are compared with those for other forms of transport, they are somewhat misleading in that cycling statistics include children, whereas motoring statistics do not. Once one isolates that and looks at adults on bicycles as opposed to adults in cars, the statistics are not so disadvantageous.
When one then allows for the fact that much of the motoring is on motorways, where the cyclist cannot go, and then looks at cycling in cities as against driving in cities, the statistics become more reassuring.
It is safer to bicycle from home to the station, take the train and then bicycle the other end than to drive a long way, so the bicycle, taken in conjunction with public transport, is safer than it may seem. However, as the hon. Gentleman emphasises, we must make cycling safer and reduce the constraints.
A combination of the NHS reforms that have just reached the statute book and the emphasis on the role of the individual given by my hon. Friend the Member for Chislehurst should ensure that we enter the next decade, at the beginning of the year 2000, a fitter, healthier and happier nation than the one that entered the 1990s.
10.59 am
Mr. Alex Carlile: As I lay in a hot bath this morning trying to unravel an episode of backache, as, a little later, I looked in a mirror—the credibility of which I doubted, and have done for some considerable time—and as I opened my post and looked at it with ever-wearying eyes, I reflected on the fact that perhaps hon. Members are not especially qualified to teach the nation what it should be doing about its state of health.
There can be few jobs that are as unhealthy as that of hon. Members—too much hot air and too many free meals are hardly a recipe for a healthy life. Indeed, I suspect that even those like the hon. Member for Ealing, Acton (Sir George Young)—
It being Eleven o'clock, MR. SPEAKER interrupted the proceedings pursuant to Standing Order No. 11 (Friday sittings).

Britoil (Special Share)
Mr. Speaker: Statement—Mr. Morrison.
Mr. Frank Dobson: On a point of order, Mr. Speaker. Is it not usually the case that statements on a Friday must be exceptional, urgent, or agreed through the usual channels? It is not true that the making of a statement today has not been agreed through the usual channels? The statement is not urgent and it does not require any exceptional treatment.
Britoil is a Scottish company and the bulk of the people employed by it work in Scotland. Most people affected by the statement are Scottish. To have such a statement on a Friday in July makes it especially difficult for Scottish Members of Parliament. When the last statement on Britoil was made, no fewer than 15 Scottish Members of Parliament, of all parties, raised points. They are now being deprived of that opportunity by this shifty means of making a statement today.
Mr. Alan Williams rose—
Mr. Graham Allen rose—
Mr. Speaker: Order. I think that I can deal with this matter. The Standing Order provides the opportunity for statements to be made at 11 o'clock. I am not informed of the contents and I have no idea whether they are urgent. However, it is perfectly in order for a statement to be made at this time on a Friday.
In relation to what was said by the hon. Member for Holborn and St. Pancras (Mr. Dobson), I can say from experience that I very much hope that the business of the House can, in general, be arranged through the usual channels. We proceed in good order if there is the consent of both sides of the House.
Mr. Alan Williams: Further to that point of order, Mr. Speaker. I appreciate your ruling. As it is virtually the last week before the recess, there will be no opportunity to debate the matter before October unless we can do so next week. Is it not true that virtually the only opportunity for debate next week would be the Consolidated Fund (Appropriation) Bill? Is it not also true that, because this statement is being made without notice, it is now too late for any hon. Member to table this matter for debate under the Consolidated Fund procedure?
Mr. Speaker: Of course, in addition to the Consolidated Fund—the ballot for which has already been held—there is a three-hour debate on the summer Adjournment motion on Monday. Furthermore, there is still time for the right hon. Gentleman, if he so wishes, to apply for a debate on the Adjournment on the last Thursday.
Mr. Allen: Further to that point of order, Mr. Speaker. I very much hope that you have a long and relaxing recess. During that time, would you consider the way in which the Government, not only on this occasion, but on a number of occasions during recent weeks—this is becoming more and more evident to hon. Members on both sides—have sought to use the opportunity to gain television coverage to manipulate and extend the boundaries that hitherto were agreed by all sides? Would you consider how Parliament could recapture some of its lost time?
Mr. Speaker: There was an interesting debate last night on the televising of the House and since it is now agreed that the House will continue to be televised. I can now come clean and say that I think that it has been a considerable success. However it is not for me to speculate on how time is used when the cameras are on. Our Standing Orders allow the opportunity for statements to be made on a Friday, and Friday is of course, a working day.
Mr. Dennis Skinner: Further to that point of order, Mr. Speaker. Last week and the week before, there were discussions in the House, in which you were involved, about the way in which the House was being used, without the usual negotiations between the usual channels. You made a statement to the effect that the practice of using the House of Commons in that way was not good enough. The Government do not listen to your words. They think, "It doesn't matter now; a week or two has passed so we will do it again."
There comes a time when you, Mr. Speaker, must use some authority. Unfortunately, your recent words were not good enough, because the Government have decided to treat them with contempt. At some time, you must make it abundantly clear to the Government—especially as they are now using the opportunity of television—that this sort of business must stop. Never mind about Back Benchers, never mind about the Opposition—you must make that clear to the Government. You know that there are occasions when some hon. Members are present but others are not.
It is clear that those hon. Members whose constituencies are 300 or 400 miles away and who have an interest in this matter, face more difficulties than someone like me, whose constituency is only 150 miles away. I have always recognised the fact that some hon. Members, who are up in the Shetlands and elsewhere—[Laughter.]
Mr. James Wallace: The Outer Hebrides.
Mr. Skinner: Yes, and the Outer Hebrides. Some of our people actually live in Scotland. I suggest that you, Mr. Speaker, make it clear to the Leader of the House, no less, that this sort of business must stop, and follow that with a report to the House on Monday. The Government are railroading through the business and treating the Opposition, Back Benchers and yourself with contempt.
Mr. Speaker: Not at all. The hon. Gentleman is here regularly on a Friday and he well knows that it is a full working day in the House of Commons. However, undoubtedly it would have been for the convenience of hon. Members with Scottish constituencies if they had known that the statement was to be made this morning.
Mr. Nigel Spearing: On a point of order, Mr. Speaker.
Mr. Speaker: I do not think that I can take any more points of order. What can I say about it?
Mr. Spearing: I shall explain that, Mr. Speaker.
Is it not true that, habitually, Ministers making statements, of whatever importance and with whatever agreement, preface their remarks with the words, "With permission"? Is it not also true that those words are nothing but a courtesy and that, in fact, they are empty of meaning? When I investigated, I discovered that not even

1305
you, Mr. Speaker, or the House has to give permission. Therefore, I suggest that it is inappropriate that it be sought.
I am a London Member, and I resent my Scottish colleagues being treated in this way. Should we not refer the question of statements to the Select Committee on Procedure? For the time being at least, should those words that are empty of meaning be not uttered by the Minister? He does not have the permission of the Opposition.
Mr. Speaker: If the hon. Gentleman wishes to refer that matter to the Procedure Committee, he should certainly do so.
11.7 am
The Minister of State, Department of Energy (Mr. Peter Morrison): With permission, Mr. Speaker—
Hon. Members: No.
Mr. Speaker: Order. In the light of what has been said, I am not sure that that is helpful.
Mr. Morrison: I should like to make a statement on the Britoil special share. A number of substantial benefits to Scotland and to the development of the United Kingdom's oil and gas resources have been secured as a result of BP's compliance with the assurances that it gave to the Government when it acquired Britoil in 1988.
The reserves of Britoil's producing fields have been upgraded by 67 million barrels, a 24.5 per cent. increase, and well over the 5 per cent. that was promised. The drilling rate on Britoil acreage increased significantly in 1988, and again in 1989, and this year is expected to be approximately double the 1988 level. British Petroleum has confirmed to me that its plans for drilling in 1990 are designed to secure that 87 wells are drilled on acreage held by BP or Britoil at the time of the acquisition, and that it is confident that £310 million will be spent. A further £30 million is being spent on exploration-related research and development.
British Petroleum is pressing ahead with the development of a number of major fields, including Miller and Amethyst, and has made detailed proposals for the development of Bruce. In Scotland, Glasgow has now been established as the head office for BP's upstream business throughout the whole of Europe. This year alone, BP Exploration will be spending approximately £1 billion, more than half its worldwide spending, on activities run mainly out of Scotland.
The numbers employed by BP Exploration in Glasgow and Aberdeen have risen significantly, mainly as a result of the enhancement of Glasgow's role. In addition, the expansion of Kinneil is expected to generate an extra 2,500 jobs and the Bruce project 500 jobs—all of them in Scotland. BP's commitment to Scotland has been underlined by its establishment of a Scottish advisory board chaired by the chairman of the BP group.
When BP gave the assurances, the Government undertook that after a period they would review, in the light of the way that they had operated, when the special rights preference share in Britoil should be redeemed.
BP has fully implemented the assurances, which have now been working satisfactorily for some time. They have also been the subject of an inquiry by the Select Committee on Energy.
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My right hon. Friend the Secretary of State for Energy and my right hon. and learned Friend the Secretary of State for Scotland and I are satisfied that BP has lived up to its word and that the Government's objectives in obtaining assurances have been met. I am therefore taking immediate steps to arrange for the special share to be redeemed.
Mr. Frank Dobson: As there were at least 10 references to Scotland in that statement, the protest by my hon. Friends and myself was entirely justified.
The statement is the last nail in the coffin of Britoil, which the Government privatised as an independent oil company and which used to be Scotland's largest publicly quoted company. When Britoil was originally put up for sale, the then Minister of State for Scotland, Mr. Hamish Gray, now Lord Gray, said that the arrangements that the Government had arrived at would contain effective safeguards for Britoil's independence. The golden share was a vital part of those arrangements. In 1988, Britoil was bought up by BP. The then Chancellor of the Exchequer, the right hon. Member for Blaby (Mr. Lawson) said:
"The existence of the special share has enabled the Government to secure from BP these wide-ranging, valuable public assurances."—[Official Report, 25 February 1988; Vol. 128, c. 150.]
Those assurances covered the amount of exploration and development work to be undertaken and the level of employment in Scotland to be provided by both companies, the sale of assets of former Britoil property, and the structure of the board.
The Minister told the House today that those assurances have been kept, but that is simply not true, He said:
"they have also been the subject of an inquiry by the Select Committee on Energy."
They have, but the Minister forgot to mention that the Select Committee recommended that the golden share should be retained for the time being. The Committee also said that it was not convinced that BP had acted in the spirit of the assurances given about employment in Scotland. It is simply not true that the assurances have been kept.
The Minister's carefully worded statement, obviously drafted by a first-rate Sir Humphrey, said:
"British Petroleum has confirmed to me that its plans for drilling in 1990 are designed to secure that 87 wells are drilled on acreage held by BP or Britoil at the time of the acquisition?".
Some of that acreage is no longer held by BP or Britoil but has been disposed of. How can the Minister accept an assurance from BP that it has kept its promise when the company is counting in assets that it no longer owns? That is a preposterous concept.
Will the Minister confirm that if the acreage sold off is excluded from the calculations, the expenditure commitment on exploration and on wells drilled has not been kept? Will he answer that specific question?
Will the Minister confirm also that BP's plans for work next year will mean that its activities will be cut by half., and that the Government's surrender of the golden share will allow the company to dispose of Britoil assets exactly as it wishes and to invest the proceeds abroad, rather than in North sea activities? Will the Minister confirm that both may happen if he gets rid of the golden share?
What are the tax implications of today's statement? Is it not true that BP will be able to shift assets around from

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one company in the group to another? BP itself calculates that this development will help to reduce its tax liability by between £75 million and £100 million this year. Is that counted in the current public expenditure round, or is it just another of the privatisation sweeteners that the Prime Minister seems happy to hand out?
The golden share existed to enforce the assurances that BP gave. They were given partly to the Scottish people, but they have not been honoured. Surrending the golden share will give BP an entirely free hand to do what it likes with Britoil's assets and staff. Frankly, for the Minister to give up the golden share at this moment is like throwing in the towel before he has even climbed into the ring. There should be much more resistance to the action that BP is covertly trying to take.
If the Minister does not know what BP is up to, he should resign for being incompetent. If he does know, he should resign for collaborating with it. His announcement will harm the ecnonomy, our efforts in the North sea, and the people of Scotland. It has one saving grace—it will also harm the Government.
Mr. Morrison: The hon. Member for Holborn and St. Pancras (Mr. Dobson) and I are at variance about the reason why the golden share existed in the first place. If the hon. Gentleman examines the original wording on that subject, I think that he would find it impossible to use the share in the way that he wants, for intervening in the running of BP or Britoil, or both. I do not believe that it is right to intervene in any company. The North sea has prospered substantially since 1979, for the simple reason that we have allowed companies to get on with running their own businesses, rather than interfering.
The hon. Member for Holborn and St. Pancras said that my statement was
"the last nail in the coffin of Britoil",
but that is utter rubbish. As my statement pointed out, there are now 500 more jobs than would have been the case in 1988. The hon. Gentleman also talked, perfectly fairly, about the acreage—
Ms. Marjorie Mowlam: My hon. Friend can talk about whatever he wants.
Mr. Morrison: I agree with the hon. Lady.
The hon. Gentleman referred to the acreage that is now not owned or operated by BP. I can give him precise figures. Of the 87 wells to which I referred, 39 will be operated by BP, 28 will be partner-operated, 10 will be farm-outs, and 10 will be Oryx. The sale of some Britoil assets was carefully examined by my right hon. Friend the Secretary of State for Energy and myself several months ago.
The hon. Member for Holborn and St. Pancras will be pleased to know that, where a well is not to be operated by BP, we have received a categorical assurance that the wells will be drilled—so that assurance has been honoured.
The hon. Gentleman referred to BP's tax situation. I have not paid any attention—on reflection, nor should I—to that aspect, because it is a matter for BP and the Inland Revenue. I considered carefully the letter that Sir Peter Walters, the then chairman of BP, wrote to Sir Peter Middleton, permanent secretary to the Treasury, to determine whether the company's assurances have been
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honoured. That was a long and detailed letter, and it was a tough negotiation at the time, and I assure the House that they have all been carried out.
Mr. John Hannam: Can my right hon. Friend confirm that the targets set for the company two years ago were extremely tough and that all the Government's expectations have been exceeded? Is it not true that, in general, the North sea has seen tremendous success in its exploration and development over recent years?
Mr. Morrison: I can confirm that the targets set were tough. For example, in 1988 52 wells were drilled between BP and Britoil and that figure is now just under 90. I can also confirm that the level of activity in the North sea was, I am glad to say, of a high order. New investment is at an all-time record of £3.7 billion this year, and the exploration and appraisal of wells is of a high order. As a result, the number of jobs—good jobs, too—created in Scotland is much higher than two years ago, and I am delighted by the progress of the oil and gas sector of the Scottish coast and on the United Kingdom continental shelf.
Mr. Wallace: I am sure that the Minister will accept that there has been a number of job losses since the take-over of Britoil by BP, particularly in the constituency of my hon. Friend the Member for Gordon (Mr. Bruce). There has also been a significant number of job losses in my constituency with the withdrawal of BP from its oil supply base at Lerwick, about which I have seen the Minister. Many people will wonder whether the golden share is worth anything at all when a Government who proclaimed the independence of Britoil when it was privatised and believe in competition were unable to use it to stop the takeover of Britain's largest independent company by one of the biggest companies in the United Kingdom as a whole.
In the Select Committee report there was a suggestion that BP had brought forward oil drilling into 1990. The Select Committee specifically recommended that his Department should monitor BP drilling in 1991 and beyond. What powers does he now have to take action if that level of drilling in 1991 and beyond falls far short of what would have been expected from the assurances given by BP at the outset of the take-over?
Mr. Morrison: I fully accept, as the hon. Gentleman said, that there have been some job losses. However, as I have said, there have been some job gains, and just over 500 is the net figure of the increase. I am sure that he will agree that the proper structure of the organisation—the way it balances its labour force and so on—is a matter for BP. The net figure has more than met the assurances.
The hon. Gentleman said that he does not believe that the special share was of any particular use. The letter written two years ago by Sir Peter Walters to Sir Peter Middleton giving the assurances demonstrated precisely what use it was. That would have been no good on paper if the assurances had not been met, and in practice they have been. The letter referred to the period "up to 1990". That is the period we have had to consider and monitor carefully. I can assure the hon. Gentleman that we have done so.
As for the future, BP will be able to operate in the North sea in the same way as any other international oil company and, if I may say so, it should be able to do so.

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It is because of the freedom of movement that so many major international oil companies, including BP in a big way, are pouring literally tens of millions of pounds into further exploration on the United Kingdom continental shelf and particularly the North sea. The interest I have found in the 12th and frontier rounds is of a high order and I suggest that that is because of the free market we operate. Those companies could just as easily put their money into Indonesia or offshore Brazil or Australia. They choose to come here because, subject to the licence and a tough safety regime, they are allowed to be free agents. We should welcome that.
Sir Hector Monro: Does my right hon. Friend agree that this is exceptionally good news for Scotland for investment, expansion and the long-term future of the oil industry? Does he agree that the Scottish Office and my hon. Friend the Minister responsible for industry have played a part in achieving it? Can my right hon. Friend give a breakdown of jobs in the future? How many does he anticipate being in the headquarters in Glasgow and how many does he anticipate in the north-east, particularly around Aberdeen?
Mr. Morrison: I can certainly confirm that the discussions that my hon. Friend the Minister of State, Scottish Office and I have with my right hon. and learned Friend the Secretary of State for Scotland and my right hon. Friend the Secretary of State for Energy about the North sea are perhaps not on a daily basis, but they are on a weekly basis. We could not work more closely together. I agree with my hon. Friend that the news for Scotland, as well as for the United Kingdom as a whole, is unadulteratedly good in terms of what is happening in the oil and gas sector and the knock-on effects that brings with it in terms of the supply company, the fabrication yards and so on.
I have with me the most up-to-date figures I have for the number of jobs in Glasgow and in Aberdeen, and I hope that it will be helpful to my hon. Friend. There will be 3,500 in Aberdeen, 1,155 in Glasgow and 880 in places such as Sullom Voe and elsewhere. In total that is 5,545. That is direct BP employment. There will be related jobs because of BP orders being given to the yards and so on.
Dr. Norman A. Godman: I came in quite by chance just as the Minister was getting to his feet. It is a disgrace that this statement has been made this morning. It is far from the action of a decent and honourable Government to do such a thing, given that so many of my colleagues are in their constituencies in Scotland.
The offshore oil and gas industries have not made Scotland a land of milk and honey in terms of employment. My constituency has had a long and often not very happy relationship with Britoil. It will surely agree with the comment made by the hon. Member for Orkney and Shetland (Mr. Wallace) that job losses were suffered by constituents of mine who worked for Britoil. For many people in and around Glasgow who work for Britoil—the Britoil-BP company is chaired by a Greenockian, Sir Robin Duthie—the golden share was seen as a sort of insurance policy. It was seen as a guarantee that their interests would be cared for.
With regard to jobs, has BP given an assurance that orders for offshore structures will be placed with Scottish companies? There is still under-capacity in the offshore
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yards in Scotland, particularly at Scott Lithgow. The Minister has not played the game with people in Scotland today.
Mr. Morrison: I am sorry that the hon. Gentleman feels that it was a mistake to make a statement. In previous announcements about golden shares, there have been statements and written answers. I offered the Opposition a statement if that was what they preferred, because I realised that there was considerable interest. That is why I have come to the House to answer any questions that hon. Members may wish to put.
The hon. Gentleman said that the employees of Britoil in Glasgow lay much store with the special share. That is true. They thought it important at the time of the takeover that the assurance should be sought and given and should be adhered to. That is precisely what was happened. The hon. Gentleman will be aware that, a week or so ago, BP announced that it was to form a Scottish advisory board under the chairmanship of the chairman of the BP group, with Sir Robin Duthie as the deputy chairman. I believe that I am right in saying—I will be corrected if I am wrong—that that advisory board has been welcomed. It was welcomed in an editorial in The Scotsman.
With regard to the terms of reference of the advisory board, the chairman of BP said:
"I believe it is important that decisions relating to our Scottish activities should get the benefit of sound advice from a Scottish perspective. The Advisory Board will achieve this and also help BP to meet its wider obligations to the Scottish community."
That is a strong and firm commitment to Scotland by the chairman of BP.
The hon. Gentleman will be aware that the level of United Kingdom content of services, including fabrication, for the North sea is just over 80 per cent. By any stretch of the imagination that is a lion's share, and we have achieved it because we happen to be more competitive, more professional and better than our international competitors. I would not expect any company operating in the North sea to give a categorical undertaking that it will always buy British. If I did expect that, I would frighten those companies away and they would not spend the hundreds of millions of pounds that they do spend on exploration and appraisal, and the 12th and frontier rounds would not be a great success.
Several Hon. Members rose—
Mr. Speaker: Order. I ask hon. Members to bear it in mind that this is a private Members' day. I will endeavour to call those hon. Members who are rising, but we should get back to private Member's motion in 10 minutes. I ask hon. Members to be brief.
Mr. Peter Rost: Would my right hon. Friend confirm that the Select Committee on Energy very carefully considered BP's takeover of Britoil? The Select Committee took all the evidence, saw all the documents and concluded that the accusations that BP had not met its original agreements and commitments were totally unsubstantiated and quite contrary to the misleading statements made by the Opposition Front Bench Spokesman, the hon. Member for Holborn and St. Pancras (Mr. Dobson). As I am the only member of the Select Committee present in the Chamber today who worked on that report, I hope that my right hon. Friend

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the Minister will persuade the hon. Member for Holborn and St. Pancras to withdraw his quite misleading comments.
Mr. Morrison: I am most grateful to my hon. Friend. He will recall that I was a witness before the Committee. When the Committee had considered carefully what BP had to say and considered how the Department was monitoring the assurances, it reached the same conclusions as those drawn by my hon. Friend the Member for Erewash (Mr. Rost). I am afraid that I cannot make the hon. Member for Holborn and St. Pancras (Mr. Dobson), who speaks for the Opposition, withdraw his remarks. I am not responsible for him, no matter how wrong he may have got it in this case.
Mr. Alan Williams: Does not the Minister realise that the Government will be seen as cowardly and shifty for making this statement without warning on the last Friday before three months of parliamentary recess? Is not the impact of the Minister's comments today the fact that, having sold off an important national asset, he has now given away the last protection of the national interest? Will he spell out what the taxpayer will get in exchange for this surrender? Will he also give us a clue about the future? After the next reshuffle or election, which ex-Minister can we expect to see joining the board?
Mr. Morrison: I do not think that coming to the House and making a statement is either cowardly or covering up. I have allowed myself to be cross-questioned by Opposition Members. I cannot look into the crystal ball and say what benefits might accrue in future in terms of BP and its contribution to the economy. However, BP is wholly committeed to its investments in the United Kingdom, and the United Kingdom Treasury benefits substantially from the company's success and the profits.
Mr. Peter Viggers: Does my right hon. Friend agree that the golden share mechanism is a blunt instrument which has no part to play in the longer term structure of a company? Is it not surprising that Opposition Members have made no reference to the Opposition's oil policy? Does my right hon. Friend recall the busted flush or five-legged camel known as the British National Oil Corporation? Does he agree that, since 1979, the Government have freed the oil industry? My right hon. Friend's announcement today will continue to free the oil industry, and that is a great benefit to workers and taxpayers.
Mr. Morrison: I certainly agree with my hon. Friend that in this case the special share had run to the end of its useful life. I have seen what one Opposition Front Bench spokesman has had to say about the Opposition's policy on oil and gas, and I quite understand why the Opposition now want to cover it up as fast as they can.
Mr. Skinner: Now that the golden share has been removed and any participation by the state has been lifted, will the Minister guarantee that no ex-Tory Minister, Cabinet or otherwise, will get a job on the board? Will he also give a categorical assurance as an ex-vice chairman of the Tory party that the Tory party will never collect funds from BP or any of its subsidiaries? Will he give us that guarantee?
Mr. Morrison: My answers to the hon. Gentleman are no and no. Of all people, the hon. Gentleman likes freedom and it would be wholly wrong for me—
Mr. Skinner: Are you going to moonlight?
Mr. Morrison: He likes freedom and it would be wholly wrong of me to restrict anybody from being asked or joining any particular board.
Mr. Spearing: Can the Minister give any reason why his statement could not have been made on Monday or any other day next week? Does he agree that, while statements and other actions in the House may be important, actions that go against general understandings are not acceptable unless there is very good reason for them? Is it not clear that, if the Government cannot properly give a square deal to the nation of Scotland, which is part of our United Kingdom and Union of nations, we cannot expect the Government to properly defend the interests of England, Scotland, Wales and Ulster in any wider union of nations that may be proposed?
Mr. Morrison: On the second part of the hon. Gentleman's question, outside of London and my constituency, I visit Scotland more than any other part of the country, and rightly so.
Mr. Dobson: You own part of it.
Mr. Morrison: No, my eldest brother does.
The contribution which the oil and gas sector makes to the Scottish economy is significant and we want that regime to continue in the way that I have outlined.
With regard to the first part of the hon. Gentleman's question, it is not for me to meddle in matters of business management. Suffice it to say that I gather that there are a number of statements pending for next week and I thought that it was best, as I have said, to come to the House as soon as the decision had been made to be cross-questioned by whomsoever wished to put questions to me. I informed the Opposition last night.
Mr. Edward Leigh: Would not most independent analysts conclude that, with the sophistication of the international oil exploration markets, blocking mechanisms like the one we are discussing today have outlived their usefulness?
Is it not also rather depressing that some hon. Members according to the exchanges in the Chamber today do not seem to have learnt the lessons of the past 10 years? Large companies like the one that we are discussing really must be allowed to run their own affairs. Despite all the glitz and glitter of Labour party documents claiming that Labour has understood that, the Opposition clearly have not. They want to go back in history, interfere and return to the bad old days. My right hon. Friend's announcement today is very timely.
Mr. Morrison: My hon. Friend is 100 per cent. right. However much the Opposition protest, they would not for a second stop interfering in the activities of many oil companies operating off the Scottish coast. That would lead to much less investment in exploration and appraisal and that would lead to fewer jobs.
Mr. Peter L. Pike: Does not the Minister accept that any sensible Government would have retained the golden share to maintain an influence on this country's energy policy and on investment in jobs in Scotland? Has

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the right hon. Gentleman not put party dogma first and sold those down the river today? Has he not sent out a clear signal to the other industries with a golden share that that share means nothing at all because the Government believe in market forces and not in the prosperity of the country as a whole?
Mr. Morrison: There is nothing dogmatic about doing what one said one would do. We said that, once the assurances had been met, we would release the golden share—the special share and that is precisely what we are doing today.
Mr. Anthony Beaumont-Dark: Does my right hon. Friend accept that, apart from spurious anger, some of the other comments expressed today have been unfair to the biggest and most profitable British company, which is one of the top four companies in the world? The taxation income brought in by British Petroleum and the thousands of millions of pounds that it has invested in North sea oil brings us huge tax revenues, huge sums of which go to support the Scottish economy. Have we now reached the stage where Scotland does not look upon itself as part of the United Kingdom, but wants to operate only in this little narrow vessel, which is what makes Scotland so unappetising to many industrialists?
Mr. Morrison: I agree with my hon. Friend. The frightening thing is that the international oil companies will read what has been said this morning and will therefore see what the Labour party would do in the unlikely event of it coming to power in, say, the year 2020. A significant number of hon. Members still want to intervene in the North sea in a major way, and that is what will drive away lots of investment and cut the labour force substantially.
Mr. Allen: There is not a great deal of family silver left to sell, but with the Government's economic problems, it is pretty clear that they will sell off every thing they can. I ask the Minister to talk to his colleagues, and I ask him and them to give the House an assurance that the golden shares and other Government shareholdings in British Telecom, British Aerospace, British Steel Enterprise Ltd., the water companies, Jaguar, Sealink, Cable and Wireless and other companies will be retained. Many of us feel that this announcement is a prelude to the grand closing down sale of the Thatcher Government.
Mr. Morrison: The hon. Gentleman would not expect me to give such an assurance because, as he appreciates, all the golden shares to which he has referred are matters for my right hon. Friends the various Secretaries of State concerned. That is how the matter lies. In future each will be looked at over a period on its merits.
Mr. Dobson: As the hon. Member for Erewash (Mr. Rost) has cast some doubt on the accuracy of what I said about the report of the Select Committee on Energy, will the Minister confirm that, as recently as 13 December last year, the Select Committee on Energy stated of the employment assurance:
"we are not ourselves convinced that BP's recent policy is fully in accord with the spirit of that assurance".
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It also stated:
"The Special Share in Britoil should remain in existence for the time being."
In what the Committee then described as its "main conclusions"—those are the Committee's words, not mine—it stated:
"It is debatable whether the proposed asset sale to Oryx can properly be considered to be 'in the ordinary course of trading'. Further substantial asset sales would not be consistent with the assurances."
Will the Minister confirm that, by removing the golden share he can no longer prevent further substantial asset sales and, indeed, that that is a likely consequence?
Finally, will the Minister clarify what he said and confirm that the decision taken on the golden share by the Secretaries of State for Energy and for Scotland, which may cost the Treasury as much as £100 million in lost revenue, was taken without any consideration being given to that loss of revenue?
Mr. Morrison: On asset sales, I am sure that the hon. Gentleman knows that, when there is a change of ownership, there is a process within the Department by which the Department looks at it carefully and either approves or does not approve it. In that respect, the Department will keep some control, as it would be for any asset sale in the North sea—and rightly so, because the licences were given to a particular group, which gave certain undertakings in its application for the licence.
It would be wholly inappropriate for me to delve into the matter of—
Mr. Dobson: Why?
Mr. Morrison: Because I am concerned about whether Sir Peter Walters's assurances were or were not met. That is what the special share was about and that is what I have adhered to, taking into account the Select Committee's thorough consideration of the matter. I have concluded, with my right hon. Friend's, that all the conditions have been met and that is why the special share will be redeemed.
Mr. Speaker: We now return to the—
Mr. Wallace: On a point of order, Mr. Speaker.
Mr. Speaker: The hon. Gentleman's colleague, the hon. and learned Member for Montgomery (Mr. Carlile) is on his feet—
Mr. Wallace: I shall be very brief, Mr. Speaker. You will have noted that the Minister said that he had informed the official Opposition last night that this statement would be made. While my hon. Friends and I do not expect to be consulted about whether a statement is to be made, do you agree that it would have been a courtesy to tell other Opposition parties about the statement, especially since my party and hon. Members from the Scottish National party represent constituencies that have a significant interest in the oil industry.
Mr. Speaker: That will have been noted by those on the Front Bench. We now return to the debate on the importance of the promotion of good health. Mr. Alex Carlile.

Good Health
Question again proposed.
11.45 am
Mr. Alex Carlile: I am grateful for the opportunity to resume the sentence that I was in the middle of when we reached the statement.
I had been just about to commend the hon. Member for Ealing, Acton (Sir G. Young) for his well publicised energy on a bicycle. He has done much for the image of those hon. Members who strive to draw attention to the need for public health awareness. However, I fear that, like many cyclists, the hon. Gentleman finds riding a bicycle in central London a risky business not only because of traffic problems, but because of the incredible pollution that hits every cyclist as he tries to cycle along the roads of London.
Nevertheless, cycling is undoubtedly a healthy activity and everthing possible should be done to enable cyclists to use the streets of London in a far more congenial way than is available at present.
One thing about cycling concerns me on safety grounds. I am referring to the prevalent use of Walkmen by cyclists. I do not know whether the hon. Member for Acton listens to a Walkman as he cycles —
Sir George Young indicated dissent.
Mr. Carlile: I am glad to see the hon. Gentleman shaking his head about that. It seems dangerous for cyclists to ride in the rush hour listening to loud music. which obscures the sound of the approaching traffic. Even as a car driver, I find it useful to hear the sound of the traffic around me, and I am sure that cyclists should find it even more useful.
This Friday morning, right hon. and hon. Members who are smokers are conspicuous by their absence—with one or two exceptions. I wonder whether they find that a four-day week is about as much as they can manage, whereas those of us who do not smoke can also leap to our feet in the House on a Friday morning.
We face an incredible number of hazards to our health, which are increasing daily. We have heard quite a lot this morning about tobacco advertising and about the sponsorship of sport by tobacco companies. It is extraordinary that a cigarette company should sponsor a grand prix for racing cars, for example, because if one were to light up a cigarette in the pits, I suspect that one might run the risk of causing a major disaster.
Equally, it seems extraordinary that the most energetic form of county cricket—not the form that I prefer, which is the slower five-day variety—is sponsored by a tobacco company. I doubt whether some of our more athletic young cricketers who score the largest amount of runs on a Sunday would find it easy to achieve their greatest successes if they were heavy smokers.
The increasing use of tobacco by young people, especially by those under 18, is a particular hazard to their health.
We have all heard the evidence about the number of young people in that age group who become alcoholics before they reach the age of 18. That is a shocking fact.
In my years as a criminal lawyer, I have noticed all too often how crime is committed by young people who have drunk to excess. It is committed not by people who are blind drunk—they are usually incapable of committing crime—but by people who have simply had rather more
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than they can safely manage which makes them, to use the psychiatrists' word, disinhibited, to the extent of committing crime. Such people tend to ask their lawyers to tell the judge that they were drunk, as if that was a mitigating factor.
Young people ought to understand that crime is just as serious if it is committed when they are disinhibited by drink as at any other time. The Government—indeed, all political parties and all groups with an input in education and which have contact with young people—should stress that alcohol leads to crime. There is a direct relationship between alcohol and crime. I am not talking about shop windows being broken. I am talking about the commission of offences such as rape and robbery as a result of young people becoming disinhibited by taking drink.
We continue to face increasing hazards to our health in the workplace as a result of industrial practices. The Health and Safety Executive, under its excellent chief inspector of factories Mr. Linehan, has done a great deal to improve the position. However, the funding of the Health and Safety Executive still leaves a good deal to be desired. I should like the executive to send factory inspectors out on a much more frequent random basis, particularly to smaller factories and workplaces. It is often in smaller workplaces that the worse practices are followed—for example with machine tools—which lead to many wholly unnecessary accidents.
I represent an agricultural constituency. Indeed, I believe that it is the most agricultural constituency. There are far too many agricultural accidents. A better funded agricultural safety inspectorate could do much to obviate that.
A more general issue affecting public health is town and country planning policies. They way in which they are operated causes a great deal of anxiety. Although there is a tendency to allow areas which were not traditional industrial centres to be developed—I commend the success of the Development Board for Rural Wales in my constituency and neighbouring areas on that score—town and country planning policies continue to concentrate jobs in conurbations. That compels huge numbers of people to travel to work on congested routes, which often leads to accidents, stress and consequent disruption of family life.
Those of us who sometimes drive alone in the rush hour from our London homes to this palace—I admit with some shame that I am one—are all too accustomed to the flash of anger which the rush hour can cause as one sits in one's car surrounded by other people who travel to work alone in their cars in this great city of London. I should like far more energy to be spent on finding imaginative ways of improving our public transport system. The state of London Regional Transport is very bad, as those of us who use it frequently can testify. The buses are unpredictable and infrequent—
Ms. Harriet Harman: And filthy.
Mr. Carlile: —and filthy.
The underground is unpredictable, sometimes infrequent, and filthy. Indeed, recent weeks have seen the virtual closure for several days of the District line, a line used not only by many Members of parliament, but, more importantly, by vast numbers of members of the public who try to lead reasonably well-organised lives in London. The consequence of that closure is that they all get into

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their cars and sit in queues in the rush hour suffering stress and anger with all the consequences to the health that that causes.
The hon. Member for Preston (Mrs. Wise) mentioned homelessness and the consequences for people's health. When I first came to the House in 1983, there was no homelessness in my constituency to speak of. There may have been a small handful of people who were homeless, but if people in need came to me and asked me to help them to obtain a house of flat, the Montgomeryshire district council or the Development Board for Rural Wales could generally help within a reasonably short period. That is no longer so.
Newtown is the largest town in my constituency, with about 11,000 inhabitants. There are at least 50 young people living rough there, many of whom have good, regular jobs in factories and service industries in Newtown. There is a waiting list for homes of between 400 and 500. That is only part of the constituency. It is a reasonably affluent rural area. It has low wages but low unemployment, so it is reasonably affluent, taken overall. We have a waiting list for rented accommodation of about 1,000 people: those are the ones we know about.
I have one of the smallest electorates in the House, although I have one of the largest constituencies geographically. If we have long waiting lists in Mongomeryshire, what on earth is it like in other places with much denser populations? From what I have read, it seems that, particularly in London, the problem of homelessness is desperate.
We know what homelessness does to young people, because we can see it for ourselves. There is a risk that young people who are homeless will be driven on to the streets, into crime, into drink and, in some cases, into prostitution. Of course, it does not happen to all of them;. but the real risk does not seem consistent with the housing policy of a Government seeking to promote public health seriously. If young people are to be healthy, it is vital that they are given a reasonable prospect of having a home.
I am also worried about the privatised water industry. Again I can relate the matter to my constituency. The privatised water companies have inherited a large and elderly sewerage burden. In Montgomeryshire, in the town of Welshpool there is an historic problem of poor drains and decrepit sewers. A further problem which affects areas such as mine must be tackled. A statutory responsibility has rightly been placed on the district council to ensure the cleanliness of private water supplies. I am willing to lay a substantial bet that most of the private water supplies in Montgomeryshire are a good deal more healthy than the public water supply yet it is right that we should be sure. I make no complaint about the public water supply as such, but there are some excellent private water sources.
In my constituency, over 4,500 dwellings have a private water supply. That is an extraordinarily high proportion when one considers that the area has a population of not much more than 50,000. To fulfil its statutory responsibilities, the district council will have to foot an enormous bill, running into hundreds of thousands of pounds. It cannot meet that bill. It simply cannot pay for its responsibilities unless the Government are prepared to devote substantial extra resources to it. I have written to the Secretary of State for Wales and he has set up a consultation exercise to deal with the matter. We await the result with keen anticipation.
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I hope that the Minister and her colleagues in the Department of Health will pass on to the Secretary of State for Wales the view that it is extremely important that resources should be made available to enable a district council, such as Montgomeryshire, to test private water supplies, without detriment to the other services which it provides. In other words, extra money should be supplied for that purpose.
I join in the congratulations to the hon. Member for Chislehurst (Mr. Sims) on choosing this important subject for debate today. He and I have the privilege of serving together as appointed lay members of the General Medical Council. Although our appointment is fairly recent, I know that he, like me, already takes it seriously and regards it as extremely interesting and important. We have the opportunity to learn a good deal about the way in which modern general practice operates. Certainly, I did not know much about it before. Some of it has been a source of pleasant surprise, but some of it has caused me a good deal of alarm.
The health of the nation is not assisted by the prevalence of a substantial number of single-handed general practitioners, particularly in our cities. I do not want to run down every single-handed GP because undoubtedly, some are among the best. Generally speaking, a practitioner who is working on his own is forced to use contractual on-call services for night visits and days off, with all their unpredictability. Generally, they are unsatisfactory. He is not providing the same level of service to the community as a practitioner who operates in a group practice, which has duty doctors on call, most of the time at least, servicing the patients of the practice.
Mr. James Arbuthnot: As always, I agree with a great deal of what the hon. and learned Gentleman says. In my constituency, there is an abnormally high level of single-handed practitioners. One result is that constituents who are unhappy with the idea of going to a locum doctor if their GP is on holiday, spend far too much time going to the casualty departments of local hospitals. That is putting a huge strain on local hospitals. My constituents then complain that the waiting lists in casualty departments are too long. It is hardly surprising if the health service is misused in that way. That flows, at least partly, from the prevalence of single practitioners.
Mr. Carlile: I agree entirely with the hon. Gentleman. It is not merely casualty departments that are affected. Recently, the professional conduct committee of the GMC heard a case—in which, I hasten to add, the doctor was found not guilty—of serious professional misconduct. A family was anxious about the mother—the wife of the complainant. The patient, having had an unsatisfactory response from an on-call service, twice called out an ambulance. The family was uncertain whether to ask the ambulance to take her to hospital or to wait for a GP to turn up. The end result was detrimental to the patient's health.
There are two important aspects to this GP problem. First, it is a matter of sheer management common sense in relation to the organisation of a medical practice to have group practices. I speak with some indirect experience, because my late father was a GP. When I was a child he worked single-handed, and as I grew up he went into what is now a well-developed and successful group practice in

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the north-west of England. My friends in that practice undoubtedly offer a far better-organised service than was offered in the early 1950s. It is much better for the patients and more efficient for the doctors in management terms if they are working in a group.
The second aspect can be highlighted by an analogy with the Bar. The Bar is a collegiate profession, as are most modern solicitors' offices. Practitioners work together in groups and exchange ideas. We are sometimes accused at the Bar—my wife always accuses us of this—of being a gossipy profession; in a sense, that is true, but it is only a symptom of the fact that, when problems fall on to our desks, we share discussion of them.
It is certainly of great benefit to the client that we can bounce large numbers of ideas and problems off our colleagues. Senior colleagues have experience, and junior ones are full of ideas. Medical practice, particularly general practice, would benefit greatly from an increase in size of group practices, so that collegiate aspect of the learned profession of medicine could be more effective.
The personal relationship between the individual patient and the individual doctor has diminished, because it is often difficult to see the doctor on whose list one is registered. That does not matter greatly, unless a patient is seriously or chronically ill, in which case most practices ensure that one doctor sees the patient regularly. Much can be gained from allowing that one-to-one relationship to slip a little and replacing it with medical efficiency and patients' confidence that the doctors will know about the problems which they are asked to treat. That is important for all of us.
Over the years, we have seen a considerable shift of emphasis within dentistry. At one time one thought of the dentist as the person who pulled teeth; now he is the person who saves teeth. Dentistry has made enormous strides, from treatment to prevention. In the years to come, the same can be done with general medicine. The right place to invest money for the future, while maintaining a good treatment service, is in the prevention of illness. I urge the Government to invest ever greater sums in that direction.
12.7 pm
Mr. Toby Jessel: The whole House has heard the hon. and learned Member for Montgomery (Mr. Carlile) with great interest. I warmly agree with his support for the concept of larger, joint general practices. They will come about increasingly and will assist in preventive medicine. I was interested in his reference to dentistry. Although he did not tell the House whether he was in favour of the fluoridation of water, I noticed that earlier in his speech he mentioned water, which is important in preventive medicine.
I warmly congratulate my hon. Friend the Member for Chislehurst (Mr. Sims) on his motion on preventive medicine. The House and the country are in his debt. The central part of his motion is that this House
"recommends the adoption of healthier lifestyles to help protect against major disabling and premature death causing conditions such as heart disease, stroke and cancer".
Our prime object must be to delay or defer death for as long as possible. In the Gilbert and sullivan opera "The Yeoman of the Guard" the character Fairfax, who was under sentence of death, began his famous song:
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"Is life a boon?
If so, it must befall
That Death whene'er he call,
Must call too soon."
Fairfax, a young man when he sang that, was awaiting execution. One often hears the young say, "I do not want to live over 80". They may feel differently on reaching 79. [Interruption.] I hope that the hon. Member for Peckham (Ms. Harman) will chat to her hon. Friend the Member for Glasgow, Pollok (Mr. Dunnachie) a little more quietly because I am finding it distracting.
Enormous improvements in medicine have occurred this century, and particularly in the last 10 years. The Library informed me this morning that the average expectation of life for a child born in 1986—the last year for which accurate figures are available—was 721 years for a boy and 77.8 years for a girl. Apparently girls and women have an expectation of life five and three quarter years more than boys and men.
That differential has greatly increased in recent generations. For example, a boy born in 1932 had an expectation of life of 58.7 years, and a girl, 62.9 years. That gave an average difference of four years, where as today it is five and three quarter years. It is not clear why that should be the case, but it is clear that the expectation of life has improved substantially for both sexes.
There has been a remarkable improvement in the infant mortality rate in the last decade—and the Minister may have up-to-date figures. The trend given in the Library figures shows that in 1981, the infant mortality rate was 11.2 per thousand and in 1989, projected, it was 8.4 per thousand. It is remarkable that the infant mortality rate should have dropped by about a quarter in the eight years 1981 to 1989.
There have been other significant improvements in mortality rates. I note in the analysis of causes of death given in the official year book for Britain that, for example, in respect of bronchial disease, the number of deaths from pneumonia dropped from 54,000 in 1981 to 26,000 in 1988, a fall of more than half in the number of deaths from pneumonia in seven years. The number of deaths from bronchitis and emphysema dropped from 17,000 in 1981 to 9,000 in 1988, a drop of nearly a half. It seems highly likely that preventive health measures had much to do with that improvement.
My hon. Friend the Member for Ealing Acton, (Sir G. Young) who I am pleased to see has returned to his place, referred in his interesting speech to the wearing of seat belts. In 1981, the year when seat belt wearing in the front two seats of cars became compulsory, the number of deaths from road accidents was about 5,500. By 1988, that number had dropped to 4,500. I have no doubt that in the significant drop of 20 per cent. in the number of deaths from road accidents during those years the introduction of seat belts played a part.
One could go on giving examples of improvements, but there remain two great killers, cancer and heart disease. The number of deaths from heart disease amounts to nearly half of all deaths. In 1988, it was 268,000 out of 568,000. The number of deaths from cancer of all sorts totalled about 144,000, or about a third of all deaths.
We must all die at some time and from some cause, but undoubtedly those two areas of illness provide great scope for preventive medicine. That is why my hon. Friend the Member for Chislehurst is right to refer in his motion to heart disease and cancer. He is also right to advocate

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"the widespread dissemination of advice and information"
in the context of the national health service.
In welcoming the increasing emphasis on preventive medicine I commend the excellent work of the Maddison clinic at Teddington in my constituency. It was founded by the late Dr. Maddison to enable elderly people to have regular health checks and be given information about, among other things, what to eat to protect their health. It is a highly popular institution which is widely patronised.
There are occasional rumours about the clinic closing. Such rumours were circulating seven years ago. We conducted a great campaign, and it was saved. There have been rumours in the past few months to the effect that it might close, but I am glad to say that the general manager of the Richmond, Twickenham and Roehampton district health authority has confirmed to me that the clinic will remain open.
I hope that the Minister will note what I have said about the valuable work done by that clinic and what the district health authority has said about it not closing. I emphasise that because some local general practitioners have shown a noticeable lack of enthusiasm for the clinic; they prefer patients to receive all the health checks from the GPs and not from the clinic. I repeat that the clinic is extremely valuable, and I hope and believe that it will long remain to serve this and future generations of elderly people resident in my constituency.
The concept of preventive medicine contains a large proportion of what can be done to reduce the incidence of premature death. I would not object to an element of compulsion, as occurred with seat belts, or as would be the case with water fluoridation. We need more discipline in preventive medicine, as well as compulsion, and we need more incentives. We should pay doctors more to achieve a high target of immunisation of babies against diphtheria and smallpox. That is part of the purpose of recent legislation, which we were right to pass, because it should be compulsory for babies to be immunised in that way. Parents who are so ignorant as to seek to prevent immunisation should be overridden by the law, as in the case of seat belts.
Mrs. Wise: Is the hon. Gentleman aware that vaccination against smallpox no longer takes place?
Mr. Jessel: Well then it ought to take place, and so should the immunisation against diphtheria because one never knows when such things will break out again. There should also be other vaccinations.
I can tell the hon. Member for Preston (Mrs. Wise) of the greatest episode of compulsory immunisation in recent times when I was on a delegation in 1971, 10 million refugees went from Bangladesh to India because they were being ill treated by the Pakistan army, based in West Pakistan. A massive number of refugees had to live in the most appalling conditions, in the ditches and fields in the open, when they went into India. The Indian Government wanted to feed those 10 million people, look after them and protect their health until they were able to get back into their own territory of East Bengal.
But there was a terrible threat of a cholera epidemic. The Indian Government insisted that every one of those refugees was injected against cholera and produce a certificate of inoculation before being entitled to receive a food ration card. That must sound tough, but it was toughness based on the motive of compassion. It forced everyone to have an inoculation against cholera before
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they could get food. That was done and in that way, the number of deaths from cholera was kept down to 3,000 out of 10 million refugees. Without that policy, probably hundreds of thousands of people would have died of cholera. That is what I mean by compulsion in preventive medicine. The Indian Government were right, and that episode made a great impression upon me. Ever since, I have believed that there is little place for freedom in preventive medicine, and there should be more compulsion, discipline and inoculations where necessary.
Mr. Arbuthnot: I am listening to my hon. Friend with increasing nervousness. About two centuries ago, if my hon. Friend's philosophy were followed, it would have been compulsory to have cupping and blood-letting of everyone as a matter of course. Medical science moves on, and from time to time things that are thought to be good are later thought to be bad. If such progress can be achieved through encouragement and incentive, that is all to the good, but doing it through compulsion makes me wary.
Mr. Jessel: I am sure that if my hon. Friend had been a Member of the House in the late 1970s and early 1980s, he would have voted against the compulsory wearing of seat belts. We had passionate debates on that subject when people who thought like my hon. Friend thought that it would be a monstrous interference with individual liberty for people to be compelled to wear seat belts and people should make their own decision about it. The other argument prevailed, and we are saving 600 or 700 lives a year, preventing 10,000 serious injuries a year and saving the National Health Service £8 million or £9 million a year from treating people who would have been severely injured on the roads and might, in some cases, have been human cabbages and taken up beds in national health service wards, which are now available, instead, to other people who need the treatment.
I am, at heart, as much of a libertarian as my hon. Friend, except in health matters. That may sound inconsistent, but my hon. Friend should remember the wise words of Emerson:
"A foolish consistency is the hob-goblin of little minds,"
and …
"Speak what you think to-day in words as hard as cannon balls, and to-morrow speak what to-morrow thinks in hard words again, though it contradict everything you said to-day."
It is a most barren and foolish form of politics for people constantly to try to look for remarks, quotations or attitudes that are in conflict with what someone has said or thought in a different context or at a different time. We have to say what we believe is right at any particular time. It seems monstrous that young babies should not be protected against the risk of diphtheria because they happen to have a misguided mother. It is better to make a few mistakes than to make a lot.
I remind the House that a few years ago we were constantly being told that there were 2,000 deaths a year from cervical cancer in women and being asked why the Government and the House of Commons were not doing more about it. People said that something must be done about it. We have done something about it in the recent legislation. We have introduced targets for general practitioners to ensure that a certain percentage of women have checks, cervical smears and screening against cervical cancer. Now, those same people who were saying that we

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must do something about it are beefing and complaining, whining and whingeing—the usual lobby—saying that it is an interference with their professional liberty. We should disregard that sort of lobby and get on with what we believe to be right. It is wrong to pay too much attention to people who complain in that way. In public life, sometimes we must lead public opinion and not just follow it. It is right to do so in this matter.
My hon. Friend the Member for Chislehurst, who introduced the debate, was one of the supporters of compulsory seat belts, as was my hon. Friend the Member for Acton. If I may say so, I was also active in that. That was the right philosophy and I regard the prevention of accidents as part of preventive medicine.
Much of the speech of my hon. Friend the Member for Chislehurst was devoted to smoking. He is famous for the lead that he has given in that subject. He should have more backing from the House as a whole and from within my party. In an intervention in his speech, I mentioned that it is more difficult to book a non-smoking seat in a crowded aircraft than a smoking seat. I suggested that he should invite the Minister of State for Health to make representations to Ministers with responsibility for transport that there should be international co-operation among Transport Ministers from different countries to remind airlines that they should keep ahead of the public demand for that instead of lagging behind it, and ensure that there are more non-smoking seats available to meet that public demand in view of the decreasing proportion of people who habitually smoke when travelling.
There should be higher taxation on cigarettes. The tax on cigarettes should go up in every Budget systematically and regularly so that over a period of five or 10 years cigarettes become at least relatively twice as expensive as they are. Whenever they have gone up a little, due to tax changes introduced by successive Chancellors of the Exchequer, there have been complaints from tobacconists in my constituency, but never by more than three or four of them. People quickly settle down to a 5p or 10p increase in the price of cigarettes. The Government then have the extra revenue to spend on the health service or whatever they and the House believe to be right. I should like the tax to be increased progressively, year by year, until cigarettes become much more expensive. I agree with my hon. Friend the Member for Chislehurst that cigarettes should not be included in the cost of living index.
I am greatly concerned about the number of children who smoke, and particularly about girls at school, who seem to smoke more than the boys. I do not know why that is and I would be grateful if anyone could throw any light on it, but it is a worrying trend. I am glad to have heard from my hon. Friend the Member for Acton that the Home Office intends to tighten up its regime for the prosecution of shopkeepers who sell cigarettes to minors.
Cancer remains a major cause of death, and within the total figures there has been no significant reduction in the number of deaths from lung cancer. There were 35,000 in 1988, compared with 34,000 in 1981. That remains a great cause for concern because it is preventable to a large extent.
I turn now to heart disease. We are all told these days that we must cut down the proportion of cholesterol in our diets. My hon. Friend's motion refers to
"the widespread dissemination of advice and information."
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But in some respects there is not yet enough information about diet. I could not help noticing when there was anxiety about beef three months ago and about eggs 18 months ago—[Interruption.] I must ask my hon. Friend the Member for Billericay (Mrs. Gorman) to whisper a little more quietly as I find her distracting, too—
Mr. Irvine Patnick: That is a sexist attack.
Mr. Jessel: It is not. I am always interested to hear what my hon. Friend has to say—
Madam Deputy Speaker (Miss Betty Boothroyd): But the hon. Gentleman would prefer to hear it when the hon. Lady takes the Floor and makes her own speech.
Mr. Jessel: Absolutely, Madam Deputy Speaker, and I am grateful for your assistance.
I could not help noticing when we heard so much about eggs in the winter 18 months ago or about beef in the spring of this year that hardly anyone mentioned that eggs and beef contain a high proportion of cholesterol, which enters into people's diets.
Fish are another area of diet. We are all told to eat more fish, but there is little reference to shellfish. It is far from clear whether a healthy diet includes shellfish in the same way as it includes flat fish, white fish or oily fish. At least one eminent heart specialist, who is a fellow of the Royal College of Physicians, has written that shellfish are just as healthy as white fish and that there is no reason why we should not all eat a large amount of them. But that is not reflected in the information put out by the societies that advise on diet, so there is a conflict of information.
We should remember that if we are told to reduce our intake of milk, cream, butter, cheese, eggs and meat, there is not much left that does not contain those foods. We cannot live all the time on kippers, cabbage and aspirins. If people could include a substantial proportion of shellfish in their diets that would add to the variety of what they can feel free to eat.
There are two main classes of shellfish: crustaceans and molluscs. Crustaceans are crabs, lobsters, shrimps, prawns and crayfish. Molluscs include winkles, whelks—which are described as sea snails on menus in France—clams, mussels, cockles and oysters. It is sometimes suggested that shellfish, whether crustaceans or molluscs, are luxuries, but I see the hon. Member for Peckham in her place, and I hope that she will not mind my mentioning that in 1964 I was the Conservative candidate for Peckham; indeed, I had been the prospective candidate there since 1960, which may well be before she was born. When I was there I had a drink in every pub in Peckham. They then numbered 117, and at least 20 of them had shellfish stalls outside. Peckham is not one of the richest areas in the country, as I am sure the hon. Lady would not deny. The consumption and enjoyment of shellfish was widespread throughout the whole of society in Peckham.
Of course there can be tremendous changes in relative food prices. We all know that salmon has come down in price. I was told by the main fishmonger in Twickenham, Mr. Ray Sandys, that the price of salmon last week was lower than the price of cod. That is absolutely astonishing: no one 10 years ago would have believed it possible. We all know that chicken is now much cheaper than beef, and 50 years ago it was the other way around. The same applies to certain shellfish.

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When Lewis Carroll wrote "The Walrus and the Carpenter" in the 1880s, the oysters which feature prominately in that poem were a dish regularly and frequently eaten by working men in London. It would not have been surprising in those days for carpenters to eat oysters; these days, oysters are more likely to be consumed by yuppies. I believe that the wheel will turn full circle because, owing to improved fish-farming methods in Brittany and all along the west coast of France—methods which I hope will be extended to include places like Whitstable and Colchester in this country—the price of oysters has gone down. One can now buy 12 big ones at a fishmonger in Brittany for 20 francs, which is £2. I believe that it will not be long before some enterprising business man finds a way of importing oysters into Britain far more cheaply, so that their dissemination can be much more widely enjoyed among the population as a whole. In the context of preventive medicine, it is all the more important that we should know whether oysters are good for health and ought to be enjoyed as much as possible.
Next, I turn to eels. When we are told by health experts that we all have to eat more oily fish, they invariably mention herrings and kippers, but they make little mention of eels. Jellied eels are a traditional British dish, and they can be bought outside pubs in Peckham and outside a few pubs in Twickenham, which I have the honour to represent.
We should be told whether the consumption of eels ought to be encouraged to promote health, as well as that of kippers and herrings. They are high in calories—that is known—but they are a delicacy that is enjoyed less and less often than used to be the case, because so many people have a snobbish attitude towards eels. They think jellied eels in particular a proletarian dish, although smoked eels are considered more smart or eels in a green sauce, as one would eat them in Belgium or Holland. I want my hon. Friend the Minister for Health to obtain departmental advice, and to let me know in writing whether eels are as healthy as herrings and kippers. I shall make the result of this inquiry known in my constituency.
I now turn to lobsters. I spoke of food farming in relation to oysters which could make them much cheaper here. Recently I was on a visit to Canada, where I was representing the Council of Europe at a conference in Ottawa on global warming and the ozone layer. I flew back via Toronto. There is in the heart of Toronto a restaurant where one can eat as much lobster as one likes for 24 Canadian dollars, which is about £13. It is analogous to the carvery that one might come upon in a British restaurant, where people can eat as much pork or beef as they want for a certain sum.
I went into this place, and I must confess to the House that I ate seven lobsters for 24 Canadian dollars. I had never had more than half a lobster in my life before, so it was a tremendous treat to eat seven lobsters. They told me in that restaurant that the record was 35 lobsters. I did not aspire to emulate that; I might have expired if I had.
I have never felt better than I felt on that occasion. Lobsters have become much cheaper in Canada because there is farming of lobster taking place, either in Hudson bay or Newfoundland—I do not know where exactly. If it takes place there, presumably it can take place around the coast of Scotland and I think that lobster will become much cheaper here in future years. We should be told whether lobsters are a healthy diet so that in future we know, because if we are not told, we shall not know.
Mr. Arbuthnot: My hon. Friend has several times mentioned fish farming, but I wonder whether this is the best route to healthy eating. Some of the fish farming in Scotland produces, for example, salmon that are fatty because they do not have the proper lifestyle of wild salmon. They do not taste nearly as good, and presumably they are not nearly as healthy for us as wild salmon. I should have thought that the same would apply to lobsters. While I am sure that one and even two lobsters would be a healthy part of one's diet, 35 are probably not.
Mr. Jessel: I did not eat 35, I ate seven. I am grateful to my hon. Friend for his intervention because he raises an important point to do with whether farmed salmon are a healthy part of a diet in terms of preventive medicine. As I said earlier, the country has been advised by the Department of Health and oily and fatty fish are good for health, and it mentioned herrings and kippers. I asked my hon. Friend the Minister for advice about eels, but now my hon. Friend the Member for Wanstead and Woodford (Mr. Arbuthnot) asks about fatty salmon. He believes that salmon that are farmed are more fatty than salmon caught in the wild on the River Tay. In view of the fact that price of salmon fell last week below the price of cod, the public should be told whether salmon, albeit slightly fatty salmon, is as healthy as other types of salmon or other fatty fish such as herrings, kippers or, dare I say it, eel.
I think that I have said enough about fish and I now turn to the important subject of back pain. The national headquarters of the Back Pain Association is at Teddington, in my constituency, where it was founded by Mr. Stanley Grundy CBE, who happens to be the patron of my constituency Conservative association. He is an industrialist, and he is extremely fit. The Back Pain Association has been running for about 15 years. This is a subject in which my hon. Friend the Member for Bournemouth, East (Mr. Atkinson) takes a great interest, because he has the Anglo-European College of Chiropractic in his constituency.
I believe that much more can be done to relieve the country of the scourge of back pain, by preventive health measures. People do not usually do anything about back pain until they are hurt and afflicted by it. If only people learnt to bend in the right way when picking up heavy articles, and were trained at an earlier age in physical recreation and physical training classes at school, the incidence of back pain would be greatly reduced. Much can be done to prevent it.
For example, far too many nurses—I mention them in particular because this has to do with the national health service—suffer from back pain because, when they are lifting patients, they do not follow the instructions that they have been given on how to stand or bend their knees when lifting patients or turning stroke patients in bed. Back pain is not a glamour cause in the health service or in the charitable sector, but it afflicts a great many people, and I should like the Government to devote more of their time and resources, and more of their share of the preventive medicine budget, to the prevention of back pain.
Earlier I mentioned fluoride. I used to represent the Greater London council on the Metropolitan water board—when it was the forerunner for Thames Water. I took an interest in the fluoridation of water. I ask my hon. Friend the Minister to report to the House, either now or at some convenient time, what progress is being made. The great

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law suit in Strathclyde three or four years ago—a case to end all cases, which lasted for many months and took massive medical evidence—clearly established that fluoridation is not only safe but is the most effective measure that can be taken to protect children's teeth. Unfortunately, we are making rather slow progress. I hope that the whole process will be bucked up and that my hon. Friend will give us some information about it. I did not give her notice that I intended to raise the matter, so I should be content to accept a letter from her if it is not convenient for her to reply now.
Mr. Ian Taylor: I am grateful to my hon. Friend and neighbour. Is he aware that the chairman of the anti-fluoridation campaign lives in my constituency? I listened with interest to what my hon. Friend said and I wonder whether he would like to receive correspondence from my constituent, rather than my constituent writing to me.
Mr. Jessel: No, I would not. I have had correspondence from the person in question for some 20 years.
Mr. Sims: Have not we all?
Mr. Jessel: Indeed we have. I admire the gentleman's tenacity, but he never seems to learn anything. He just churns out the same old stuff, and I see no point in reading it again. I do not want to hear from him. Indeed, I once had to threaten to sue him. I hope that the process of fluoridation will now proceed more rapidly.
I was pleased to hear the hon. and learned Member for Montgomery refer to water, because water is the basic foundation of health. A year ago, when water was still nationalised, some horrible green midges appeared in the pools of water waiting to go into the water supply at the waterworks at Hampton. Since water was privatised, those green weevils have not reappeared. That is an argument in favour of the privatisation of water.
I have one complaint about the water administration, and it is that the water pumping station—
Mr. Alex Carlile: Does the hon. Gentleman believe that there is a cause and effect relationship between the privatisation of water and the disappearance of those monsters? If so, can he explain why quantities of green algae have now appeared in water sources in Wales?
Mr. Jessel: The green things that appeared in my constituency were not algae; they were midge larvae. They wriggled, they were shown on television and they alarmed a great many people, even though they were perfectly harmless. I do not know whether the algae are harmless, but I am sure that they do not wriggle. They are therefore less likely to bring about fear, anxiety and despondency, and so are a less worrying matter.
I want the waterworks in my constituency to stop sounding a hooter at 9 am. It is a Victorian relic summoning people to work and it annoys those of my constituents who are still asleep—and there are a few. I hope that the chairman of Thames Water will stop the hooter noise forthwith, after which I shall cease complaining about it.
12.49 pm
Ms. Harriet Harman: It is a challenge to follow the hon. Member for Twickenham (Mr. Jessel), who has much in common with the green things that he found in his water supply: he too is perfectly harmless but frightens many people.
I am grateful to the hon. Member for Chislehurst (Mr. Sims) for taking the opportunity provided by his success in the ballot to debate such an important topic, and for drafting a motion with which I and many other right hon. and hon. Members agree. His speech was wide ranging and struck the balance interestingly between private and Government responsibility.
Every individual has a responsibility to take care of themselves, and it is the responsibility of every parent to care for the health of their children. The Government also bear a major responsibility in caring for the nation's health—to promote good health and to prevent ill health—but they are failing to meet it. There has been progress in cutting deaths from preventable disease, but it has been too slow. Heart and liver disease and lung cancer are still major killers, but many deaths from them could be prevented.
We know much more now about the causes of disease and of accidents, and about their prevention. We know of the link between alcohol and liver disease, smoking and lung cancer, poverty and ill health. That knowledge places a moral obligation on the Government, which they should discharge by setting targets for preventive medicine and formulating strategies that will meet them. They should also monitor progress. That will not happen by itself, so the Government must take the lead.
Of course there must be a partnership between individuals, local authorities, health authorities, industry, and the Government, but they must take the lead. The reason they are failing to do so is that all their health initiative and enterprise is bogged down and tied up with their efforts to press ahead with national health service reforms that the public do not want. If one goes to any district health authority or family practitioner committee, one finds it discussing not public health strategy but how it can manage to make ends meet and to implement the Government's ludicrous reforms.
A further obstacle to the Government being the real champion of preventive medicine and good health promotion is their hostility to planning and regulation, which, as other hon. Members have remarked, are a vital element in maintaining public health. Nor are the Government prepared to invest the resources necessary to improve it.
I shall mention some of the aspects involved, though I am afraid that I shall not range as widely as the hon. Member for Twickenham. I hope to shed more light on family planning than he was able to do, but I cannot compete with the hon. Gentleman when it comes to the price of lobsters in Toronto.
Lung cancer, which is caused by smoking, is a major killer. We know that smoking is also a major cause of disability and premature death. Recently, I visited a hospital in my constituency whose patients included those who had just undergone amputations as a result of circulation problems caused by smoking. I went from ward to ward seeing babies born prematurely because their mothers smoked, and adults struggling to breathe as they

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tried to talk to me about smoking. The toll that that habit takes on public health is intolerable. The facts and figures, as the hon. Member for Chislehurst said, are appalling.
We did not always appreciate how dangerous smoking can be, but we do now. I remember an advertisement from the 1950s which was shown recently on television. It was a public information advertisement to encourage people to go to see their general practitioner. A woman was invited into the GP's surgery but one could hardly see the GP for the cloud of smoke from the fag he was puffing on. He invited her to sit down and, in order to show how to take it easy in a GP's surgery, and how a GP can set patients at their ease, he offered her a fag, she lit up and the cloud of smoke deepened.
One of the people I met in hospital who had had an amputation said that he was given cigarettes as part of his rations in the armed services. He said that he had not chosen to be a smoker but had become addicted to smoking at a time when information about the link between smoking and ill health was not known.
Now that we have information about the effects of smoking and ill health, we must have clear and unambiguous policies to cut down smoking and prevent ill health. The facts are appalling. In its strategy document for 1990–95 entitled "Strategic Plan", the Health Education Authority says:
"Cigarette smoking is the greatest cause of preventable death and disability in this country. It is estimated that some 110,000 deaths each year in the United Kingdom are attributable to tobacco products. This is the equivalent of one million years of life lost annually."
It is the equivalent of 300 people dying every day from smoking. Smoking causes 90 per cent. of deaths from lung cancer, 90 per cent. of deaths from chronic bronchitis and emphysema and 20 to 25 per cent. of deaths from heart disease.
Smoking rates are still much too high. A total of 32 per cent. of the British adult population are regular cigarette smokers. Worryingly, at the age of 15, 22 per cent. of girls—more than one in five—and 17 per cent. of boys are regular cigarette smokers. We have to act decisively on this issue.
We have to have a target. That target should be to reduce by the end of the century the number of adult smokers from 32 per cent. to 20 per cent. We should aim to cut to 5 per cent. or less the number of children under 16 who smoke. That would be a realistic target. I too support the Parents Against Tobacco initiative which is looking at new ways to deter children from smoking.
We need to have regular increases in the price of tobacco. We should have an advertising levy on tobacco promotion which could be used for health education. Really, we should abolish advertising for tobacco and tobacco products. We know that smoking kills. Why do we still allow advertisements for a product that causes major ill health and death? We should have a total ban on advertising and sponsorship. It is horrifying to see in toy shops toy cars with the name of cigarette companies all over them and during motor racing on television the cars whizz past with highly visible adverts. Cigarette sponsorship runs throughout sport.
Mr. Arbuthnot: Will the hon. Lady say the same about alcohol advertising? Is she saying that a Labour Government would ban advertising of both products?
Ms. Harman: I shall come to alcohol advertising shortly. If the hon. Gentleman reads "Looking to the Future", our policy document, which was quoted by my hon. Friend the Member for Preston (Mrs. Wise), he will see that we are committed to a total ban on advertising and sponsorship. We must be clear about that.
The ceiling for permitted tar yields must be reduced and there should be no Government subsidies, through any Department, for the production, import or manufacture of tobacco products. That will be hard, because the tobacco industry, including the manufacture, importing, sale and supply of tobacco products, accounts for many jobs in this country. However, the Department of Health should not have to pick up the pieces of illness caused by smoking while the Department of Trade and Industry is subsidising the tobacco industry in this country.
Mr. Jeremy Corbyn: Does my hon. Friend agree that one of the most distressing problems at the moment concerns the export of high-tar tobacco products to poorer countries and the promotion by British companies of tobacco in Third world countries? Does she agree that those companies should be rapidly encouraged to adopt product diversification instead of promoting the sale of those dangerous tobacco products to poorer people in poorer countries?
Ms. Harman: I agree with my hon. Friend. The Government should have an honest and coherent approach to smoking across all Departments. Smoking cannot be dangerous in this country but safe in the third world. Different Departments should not be pulling in different directions.
There should be more resources for health education targeted at smokers and to prevent people from taking up smoking. We need more training in the risks of smoking for health professionals, and smokers who are trying to give up should be supported and receive counselling.
We also need legislation to control all public and workplace smoking, because that smoking involves a twofold problem. First, non-smokers are smoking passively and that is a problem for everyone, but particularly for people with respiratory diseases and for children. Secondly, workplace and public smoking seems to create the idea that smoking in public is somehow acceptable and that we can expect to see people on buses, in restaurants or at work smoking.
Smoking should not be allowed in day rooms in hospitals. It is an amazing irony that a mother who has given birth prematurely to a low birth weight baby with a health risk as a result of smoking can go and have a fag in the day room. We must have a public health strategy in which the Government take a lead in their role as an employer and provider of facilities and services. Cigarettes should not be sold on health service premises. Selling them there is a contradiction in terms.
The hon. Member for Ealing, Acton (Sir G. Young) made an interesting point about the sale of cigarettes bearing the House of Commons insignia. I would be interested to hear what the Minister for Health thinks about that.
The Minister for Health (Mrs. Virginia Bottomley)indicated dissent.
Ms. Harman: The Minister is shaking her head. It seems that she is going to try to avoid that point. However, I hope that she will consider the matter.
There must be a named individual in each health and local authority to co-ordinate action. Smoking control plans should be part of every local and health authority's strategy.
There has been a great advance in child immunisation, as several hon. Members have said. However, there should be more stringent checks to discover whether children have had the correct immunisations. Those checks should be made when children enter school, because if children have missed out on immunisation before then, they can be caught and their parents can be encouraged to have their children immunised.
The Government must back that kind of service with resources. The Government took up on the excellent MMR vaccination campaign. Obviously, we should aim to stamp out rubella; it can have a terrible effect on a child if its mother had rubella when she was pregnant. That illness is entirely preventable. However, it is ironic that, when the advertising campaign for MMR was at its height, district health authorities were rationing the vaccine because they could not afford it. Parents were told to bring their children back on a different day because there was not enough vaccine available. They were told that, although their children were eligible for vaccination, they were not in the main target group and therefore they should bring their childern back on another occasion. We should take every oportunity to ensure that children have received their immunisations and vaccinations.
More and more stress is being placed on health visitors yet their posts are being frozen as a result of cuts and difficulties with health budgets. Health visitors play a vital role in promoting public health and in encouraging women to have cervical smears and to take their children for vaccinations. They must be an important part of any health promotion strategy. Their posts should not be frozen because health authorities are having financial difficulties.
I should like the Minister to respond to my next point, about vaccine-damaged children and their eligibility for compensation. As I understand it, a child is eligible for compensation only if he or she has suffered 80 per cent. disability. As the compensation scheme does not cost very much in any case—because vaccine damage is rare—it seems unfair that children who have been vaccine-damaged should not be eligible for campensation unless they cross the threshold of 80 per cent. disability.
We know that health inequalities relating to income are as deep as ever. The map of the variations in health and disease patterns shows that the picture remains largely unchanged since the Black report. Our health strategy and our targets for health promotion should focus not only on certain diseases, such as those caused by smoking or alcohol, but on the ill health that exists in different regions and individual cities. We need to set targets for cities and to encourage healthy city projects such as those in Liverpool and Sandwell, and the one that I have visited in Oxford. We need public health profiles so that the agencies concerned and the local community can join in setting and achieving targets to improve the health of their region or city.
Many hon. Members have referred to food safety. Our discussion has ranged across salmonella, botulism, listeria and the problems of a contaminated drinking water
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supply. Our knowledge of food safety and of the link between poorly stored food and ill health is growing as food science is becoming more developed and microbiology is telling us more.
The Government should not lag behind. They should see the research as an opportunity. They should not bring in controls reluctantly, only when everybody is screaming and shouting; they should look closely at what science can now tell us about food and ill health, which it could not previously, and be poised to cut the incidence of ill health caused by food.
The Government should not be dragged kicking and screaming to introduce new regulations. As my hon. Friend the Member for Preston has said, we need a sufficient number of environmental health officers to enforce the regulations, because regulations by themselves have only a limited value if there are insufficient environmental health officers to police them. No local authority has sufficient environmental health officers to ensure that the current law is being complied with, let alone to make the improvements in the regulations that we are seeking.
While I am dealing with food and nutrition, I must emphasise that the low level of breast feeding in this country is a scandal. All the evidence shows that the best food for a child when it is born is its mother's breast milk. However, the companies that produce artificial milk are still giving out free samples of their products in hospital maternity wards. Although that is against the regulations, it is still happening because the milk manufacturers have been clever and have recognised that maternity wards no longer give out packs to new mothers.
In the past, a new mother could take a nappy, some baby lotion or vaseline and some talcum powder from the hospital supplies. The national health service used to provide such things, when it was not so strapped for cash. That is one of the cuts that has taken place. Therefore, milk suppliers provide what are called "bounty boxes" for expectant mothers. In the bounty box there is stacks of commecial advertising material for artificial milk.
Despite the increase in the number of babies being born, the number of maternity beds has been cut. That has led to mothers being discharged sooner after they have their babies. The amount of time that women spend in hospital after having a baby is rapidly decreasing. One of the casualties of that is that women return home with a new baby without having established breast feeding with the support of the midwives in the hospital. The community support of the midwives is the hospital. The community midwife service is too stretched to enable mothers who have nothing wrong with them to establish breast feeding.
Mr. Arbuthnot: Will the hon. Lady give way?
Ms. Harman: We have an expert on breast feeding; I shall give way.
Mr. Arbuthnot: As the hon. Lady will understand, I am not an experienced breast feeder. Would she cope with the problem by banning the advertising of babies' milk?
Ms. Harman: A Department of Health regulation states that hospitals should not advertise babies' milk. I simply argue that that regulation should be enforced. I am sorry if I did not make myself clear. The Minister will confirm that it is already Government policy that milk should not

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be advertised in hospitals but that the regulation is not enforced. The milk companies encourage hospitals to break the regulation by offering free samples which hospitals stretched for cash take up.
Mrs. Wise: I agree entirely with my hon. Friend's point. Does she agree that the community midwife service needs to be strengthened and that it would be a good thing if new mothers were again given a home help so that they could rest more and give more attention to the baby? That would help in the establishment of breast feeding.
Ms. Harman: I absolutely agree with my hon. Friend. The home help service was introduced to assist mothers with new babies, but it is now almost entirely devoted to the elderly and people with disabilities.
I wish to touch briefly on maternity services. We must increase pre-conceptual care and promote understanding of the issues behind it, but we must also increase the number of women who come forward for ante-natal assistance and screening.
There is still an appallingly high toll from industrial illness and accidents at work. Many of those accidents simply should not happen. There is an unacceptable level of accidents among employees of cowboy builders. My hon. Friend the Member for Preston mentioned repetitive strain injury. Ill-health and disease is caused in the chemical and nuclear industries. Farmworkers are affected by chemicals and machinery used in agriculture.
We need a combination of openness, so that people know and assess the hazards in their workplace, and good inspection by the Government which is properly resourced, so that employers know that, if they breach regulations, there is a substantial chance that they will be discovered and fined. We need unionisation so that management can negotiate with strong unions acting in the interests of their members to ensure their safety.
I wish to touch briefly on ill health caused by poverty. A severe winter always brings an epidemic of hypothermia, which is preventable. The Scandinavian countries, which have far harsher climates, do not experience the increase in deaths by hypothermia that we have in Britain. If people had a decent income, if there were good incentives for insulation and if the cost of fuel was lower, we would not have that unacceptable Dickensian epidemic of death by hypothermia that arises every time that there is a cold winter.
We have too many accidents in the home. We need to have better regulations to ensure that unsafe toys and electrical goods do not reach the market. My hon. Friend the Member for Preston mentioned the safety of people in bed-and-breakfast accommodation. In her previous incarnation as a social worker, she will have visited families in bed-and-breakfast accommodation. Such accommodation lacks cooking facilities. The electric kettle is inevitably without a table because there is no space between the beds, and its wire snakes across the floor. That is of particular danger to children. Several families share the same toilet and inadequate washing facilities. They are prone to infectious diseases, such as gastroenteritis. It is a contradiction in terms to claim an interest in public health promotion when so many families live in these squalid, unhealthy hostels for the homeless.
As I came here today, I went down Haygate street in SE17 and saw a touching shrine of a little dog made up of flowers. Obviously, a child has been killed there recently.
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Recently I went to Doncaster royal infirmary and chatted to two children who had been hit by a car. We have an unacceptably high level of road accidents. It is ridiculous that, when one argues on behalf of one's constituents for a school crossing, better enforcement of the speed limit or more school crossing attendants, one is told, "Yes, we recognise the need, but you will have to wait because spending restrictions mean that you are 50th in the queue."
We need improvements in public transport and deterrents to private cars—for example, road humps and parking restrictions. Hon. Members have talked about cycling, and it is welcome to see more people wearing cycling helmets. Sometimes cyclists wear elaborate masks because of the appalling pollution in central London and our other cities.
In any accident and emergency department there are people who have injured themselves by falling down when they were drunk. There are people, certainly in my constituency, with punch or stab wounds from being hit by someone who is drunk. As the hon. and learned Member for Montgomery (Mr. Carlile) said, in court people give as a defence, "I hit him because I was drunk." In every hospital there are people suffering from liver and other diseases caused by drink.
A cut in the volume of alcohol consumed, particularly high consumption, must be a target in improving the nation's health. Alcohol consumption should be cut by 20 per cent. by the year 2000. In particular, we must halt the increasing alcohol consumption by women, reduce consumption among high risk occupational groups and reduce the proportion of the population drinking more than the recommended number of units. The Government have a responsibility in that. Advertising plays an important part. We should have mandatory, clear labelling of alcohol content and the recommended limit on consumption on all containers. There is more information now that even small levels of alcohol can damage health.
Family planning clinics are an important health promotion and preventive medicine resource. The Government are wrong to allow hard-pressed, cash-starved, district health authorities throughout the country to cut those clinics because they are desperate to reach he end of the financial year without going over budget.
Research recently undertaken in Warwickshire showed that 45 per cent. of those presenting themselves for abortions had not used any form of contraception. In the light of that appalling figure, a strategy has been developed in that area with the aim of reducing the number of abortions by a third by the end of the century.
Family planning clinics and sex education are important in the prevention of unwanted pregnancies and it is wrong to reduce such services in the face of a possible epidemic of a sexually transmitted disease. Family planning clinics are a good base from which to conduct health and sex education and to provide people with information about sexually transmitted diseases such as AIDS.
There are about 180,000 abortions in Britain every year. If nearly half of those involve people who have not used contraception, it is clear that a major objective of the Government should be to reduce the number of people not using contraception.
Giving evidence to the Select Committee, the Secretary of State made an astonishing remark. He seemed to think that family planning had no relationship to contraception

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and that contraception had no relationship to unwanted pregnancies. He seemed to think that, in any event, none of that had anything to do with him.
It is difficult to have a sensible strategy to promote good health and prevent ill health when financial spending restraints are placed on the national health service in such a way that the service cannot improve in the way it should. People who are diagnosed as needing heart surgery must wait for that surgery and they become more ill all the time they are waiting. People requiring hip replacements are having to wait, and they suffer immobility and further disability while waiting for their operations.
The same is true of cuts in provisions for the menopause clinic in my constituency at King's College hospital. Menopause, pre-menstrual tension and post-natal depression services all have the aim of preventing situations from deteriorating. It is a false economy to cut their financing. A doctor recently told me, "Unless we can help women suffering the effects of the menopause, many of them will end up as in-patients across the road at the Maudsley." I am sure that the hon. Member for Billericay (Mrs. Gorman) will have more to say about that.
My hon. Friend the Member for Preston was right to talk about the importance of our commitment to abolish the charges for eye tests and teeth checks. Such checks are major preventive measures against glaucoma, diabetes, brain tumours and many other ailments. The hon. Member for Twickenham seems to appreciate that, if the price of a packet of fags goes up, fewer people will smoke. Yet he seems to think that, if a charge is slapped on eye tests and teeth checks, people will continue to go to the optician and the dentist. That does not make sense.
Does the Minister share my concern about the mushrooming of bogus advertisements for slimming aids, which clearly are not aids for slimming? Numerous magazine and newspaper advertisements urge people to spend their money on such projects, which would either not have any effect or, if they did, would harm people.
Likewise there are a growing number of advertisements for cosmetic surgery. We are constantly told, "Get your nose done," "Get your breasts fixed," "Have a slice taken off your thighs," and "Have a face lift." We do not want to go down the path that they have trodden in the United States, where one sees increasing numbers of elderly women with faces like a baby's skin, stretched thin. The Government should take a view on such matters. It is obscene.
The path that people are encouraged to take—cosmetic surgery for no good reason so that doctors in private clinics can make a fat profit—is wrong. I do not say that there is not a place for cosmetic surgery under the NHS. There are important uses for such surgery, but at present it is turning into a racket, and I promised to say that one need not have a face lift to look young. Look at the hon. Member for Billericay.
I should like the Minister to comment on the adverts about hair loss. There are increasing numbers of adverts encouraging people to spend money on hair transplants that will no doubt mutilate their scalps without making them look as though they have thick hair. Other adverts encourage people to spend money on potions that will allegedly thicken the hair shaft. There are also bogus adverts inviting people to spend money to deal with
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memory loss. There are many quasi-medical claims in those adverts. If they are to have a serious and scientific approach to educating people about health and what effects their bodies, the Government should take a stance on such adverts and do something about them because they are becoming a scandal and a rip-off.
The Government must also ensure that there are adequate resources for research. We are able to have a cancer screening service because the research has been done, so that we know how to detect the early signs of cancer and prevent it. We have made major breakthroughs in a number of cancers such as Huntington's disease and childhood leukaemia, but we still need more research to prevent ill health caused by cancer. We need an integrated, comprehensive, well-resourced health service, with local government working in partnership with health authorities, partnerships between unions and management, the Government acting to prevent environmental pollution, and above all, a determination to end the poverty that is the cause of so much ill health.
1.26 pm
The Minister for Health (Mrs. Virginia Bottomley): I shall not follow the hon. Member for Peckham (Ms. Harman) by ranting about the shortcomings of the private sector and what basically sounded like the need for a national plan. I thought that even her party had abandoned the idea of such a salvation from the difficulties that we faced some years ago. I strongly support the sentiments expressed by many hon. Members who paid a most warm and fulsome tribute to my hon. Friend the Member for Chislehurst (Mr. Sims) for his motion and the manner in which he delivered it. I echo the words of my hon. Friend the Member for Ealing, Acton (Sir G. Young), who paid a tribute to my hon. Friend the Member for Chislehurst for his non-sermonising Jimmy Young style. That was an excellent description of the way in which my hon. Friend the Member for Chislehurst presented the motion and drew together its main strands.
I shall seek to describe the steps that the Government are taking and the reforms that are already under way in the health service, which for the first time will, we hope, achieve a health service rather than a disease service. It is a recognition of the emphasis that we put on health promotion that a major, central section of the leaflet that we distributed to every household in the country relates to health promotion matters such as looking after the heart and the importance of healthy eating. I must tell my hon. Friend the Member for Twickenham (Mr. Jessel) that I fear that it does not cover lobsters, shellfish or eels, but it covers smoking, alcohol and other matters of great concern. It explains in a clear and direct manner how the new reforms will lead to enhanced and better care for our people.
It is well known that health promotion has had a long history. The bible describes dietary laws to prevent disease and contains detailed passages on the control of leprosy. In the middle ages, communities took steps to avoid the plague. Quarantine later helped to control the spread of diseases such as cholera. Modern health promotion stems from the major sanitary revolution of the previous century. I suspect that plumbers, rather than pharmacists or physicians, had the largest part to play in the improvement of health standards of our and other nations.

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Sound engineering, the separation of sewage and clean water revolutionised health care and reduced mortality from water-borne diseases such as typhoid and cholera.
The hon. Member for Preston (Mrs. Wise) referred to housing. The revolutionary concept of having a sink inside the house led to a marked decline in food-borne killing diseases such as infantile diarrhoea. The gradual reduction in overcrowding reduced the airborne infections such as streptococcal disease, rheumatic fever and tuberculosis.
The second era, of medical intervention, dramatically increased people's opportunities of surgical and medical treatment. I refer to the remarkable development of antibiotics and then to the era of vaccination and immunisation, of which more in a moment. The result has been that polio, diphtheria and many of the killer diseases of childhood of the past are scarcely seen in our country any more.
The new challenge is to combat the diseases in which personal responsibility and individual action can play a major part. Heart diseases, strokes and cancers, the great modern killing diseases, are the areas on which so much of our debate today has centred. We know only too well that the key risk factors in strokes overlap with those for coronary heart disease—high blood pressure and cigarette smoking; we know less of the causes of cancer, but cigarette smoking is certainly the cause of 30 per cent. of all cancers in this country. My hon. Friend the Member for Acton spoke about the influence of smoking on other chest diseases, too.
My hon. Friend the Member for Chislehurst and others mentioned how the developments in the health service are for the first time placing responsibility on district health authorities for analysing and assessing the health needs of their populations. The Acheson report on public health made a major contribution to the way in which we analyse and study public health, as has the appointment of a director of public health in each district health authority with a crucial part to play in carrying forward the district health board's responsibilities to provide for health needs and to draw up contracts. Let no one underestimate the significance of the new and enhanced nature of the role of the district health authority or of the prominence that will inevitably be given to public health matters and the prevention of disease by analysing the needs of the local community and purchasing services to meet those needs.
My hon. Friend the Member for Chislehurst also mentioned the changed nature of the general practitioner's contract. There, too, there has been a marked shift towards recognising the importance of health promotion. I pay tribute to the Royal College of General Practitioners which, in its policy statement in response to our Green Paper "An Agenda for Discussion", said that many of the problems brought by patients to doctors are best understood by the doctors who know the patients as people, who understand their fears and feelings and who know the problems in their daily lives.
More and more the principle of healthy living and much of the management of chronic disease depends on people making changes in the way that they eat, drink and smoke. Personal preventive medicine is now a major feature of the modern health service, and it is logical for people to be offered preventive services in the same place and by the same team as offers them treatment services. Fusing prevention and treatment into comprehensive clinical care is an exciting development in modern practice.
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As the House will know, we decided to make health promotion an explicit part of the GPs' new contract. I was interested in the remarks by the hon. and learned Member for Montgomery (Mr. Carlile); his role on the General Medical Council, like that of my hon. Friend the Member for Chislehurst, is an important new development. The hon. and learned Gentleman spoke about the collegiate ethos of the Bar and about how that could apply in general practice, thereby registering a point that was also picked up by my hon. Friend the Member for Wanstead and Woodford (Mr. Arbuthnot). So often those who cannot gain access to single-handed practitioners might make excessive use of a casualty department.
Our reforms in the recent National Health Service and Community Care Act mean that doctors who choose to become fund holders can invest in their own practices. They can develop services, provide anti-smoking clinics and diet-exercise clinics, and they can make sure that health promotion becomes the key to their work. There will be extra help for the over-75s, who will be offered an assessment of their medical needs. There will be a requirement regularly to assess both current and new patients on doctors' lists.
We are already seeing in practice the effects of that important new work. The general practitioner service—the family practitioner service—is the gatekeeper to the national health service: it is where most people go first when they are worried about their health. It is essential that the key messages from the debate should be echoed by the general practitioners, and by the new groups of practice staff who have been able to join general practice thanks to the investment that the Government have made.
Throughout the health service all members of staff—doctors, for instance, and the health visitors to whom the hon. Member for Preston paid especial tribute—have a role to play. We have seen a dramatic increase in the number of health education officers, from about 200 in the mid 1970s to nearly 700 now. Their job is to ensure co-operation, and to ensure that the messages that are spread from the centre—from the Health Education Authority and others—are properly disseminated.
I should like to refer particularly to the appointment of Professor Michael Peckham as the new director of research and development for the national health service. I think that he will be able to inform and enlighten the service from the top to ensure that the latest research is properly evaluated, and that we draw on those lessons in carrying out our health promotion campaigns.
The major arm of Government, in health promotion and disease prevention, is the Health Education Authority. Since it was established as a special health authority, it has had a substantial increase in funding, and its work in carrying out health promotion is a force for good. Its recent strategic plan for the first half of this decade identifies seven key programmes as priorities for the next five years: HIV and AIDS prevention, and sexual health; "Look After Your Heart"; cancer education; smoking education; alcohol education; nutrition education; and family and child health. All those issues have been raised by hon. Members in the debate.
The plan identified key settings in which the programmes should operate—primary health care, schools and colleges and youth settings. I think that all of us would agree about the importance of education at school in encouraging health promotion. Health Education is a cross-curricular theme in schools. The chief medical officer

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has recently had discussions with the chairman of the National curriculum Council to discuss how that can be carried out further. If people can understand the importance of healthy living, of exercise and of avoiding smoking at an early age, it sets a good pattern for life.
The strategic plan for the Health Education Authority also identified the special needs of women and members of the ethnic minorities. We want good health to be available to all groups in our community. The other day I went with my hon. Friend the Member for Croydon, North-West (Mr. Malins)—my Parliamentary Private Secretary—to his constituency to meet a group from the Commission for Racial Equality, where we discussed what more could be done to ensure that the ethnic minorities were informed about, and had access to, high-quality health care and services.
Addressing the health needs of elderly people is of major importance, and Age Concern has carried out a considerable amount of work in that area. The Health Education Authority and my Department have been developing—in consultation with health professionals—the concept of a personal health record, which would be provided for GPs to issue to their patients. It is intended to organise a major consultation exercise to examine how those proposals can be implemented.
The idea of a personal health record is a powerful statement in itself. We have just taken through Parliament legislation concerned with access to medical records. It demonstrates a change in culture and attitudes that there is now an expectation that individuals should have their own personal health record. In the past, many felt that they were being denied access to vital information about their own health. That is a message about individual involvement and responsibility.
Many hon. Members spoke about coronary heart disease, prevention of which has to be a high priority for us all. In April 1987, the Department and the Health Education Authority launched a joint "Look After Your Heart" campaign, in response to concern about the high level of coronary heart disease. We know of the success of health education campaigns in other countries with initially far higher rates of death and disability from the disease. The original aim was to increase knowledge of the risk factors for coronary heart disease. In its first three years, the campaign enjoyed considerable success. Although there are other notable campaigns against coronary heart disease, we believe that ours is the first national campaign of its kind in the world. All Health Authorities have been involved in it. "Look After Your Heart" has sponsored more than 270 projects at a cost of over £500,000.
The involvement of the campaign with industry has been a great success. The hon. Member for Preston said that industry believes that it owns its employees body and soul. If that means that employers are increasingly aware of the contribution that they can make by promoting good health and passing on health education messages, that is a welcome development.
I know that this is an interest of my hon. Friend the Member for Bournemouth, East (Mr. Atkinson) and there is no doubt that, in the "Look After Your Heart" campaign, an excellent example has been set. Some 300 major organisations, with around 3 million employees, are
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actively involved in the campaign, both in the public and private sectors, including large organisations such as ICI and smaller organisations, the TUC and most Government Departments.
The "Heartbeat Award Scheme", which is run in conjunction with local environmental health officers, encourages not only good standards of hygiene but health menus and no-smoking areas in all eating places from canteens to restaurants. Although it was launched nationally only two months ago, already 40 per cent. of local authorities are taking part. Many of the remarks by hon. Members today lead me to think that they will welcome that development and that they understand how vital it is that people should take steps to promote healthier eating and to discourage smoking.
I have had any number of invitations to take up the issue of smoking on aeroplanes with Ministers in the Department of Transport. It would be less than generous of me to fail to do so after the strength of the remarks made on that subject.
The "Look After Your Heart" campaign has also been working with the food industry and last year developed a "Less Fat Fortnight". This year, it will be mounting a month-long promotion called, "Food For the Heart". These are all ways in which a campaign that is determined to meet with success can draw together people from the public and private sectors and from Government Departments. It is vital that they work successfully together. The campaigners have worked continuously with the National Forum for Coronary Heart Disease Prevention and the coronary Prevention Group to inform and enlighten their work further.
In that context, I am pleased to announce that we are able to give further section 64 resources this year to the Chest, Heart and Stroke Association, which we shall be funding to the tune of £35,000 this year and £36,000 in each of the following years for the important work that it does in promoting nurse facilitators associated with doctors' practices, particularly in the north of England, to make sure that the lessons on heart disease are fully incorporated and understood.
My hon. Friend the Member for Chislehurst mentioned the recent report of the standing medical advisory committee on whether opportunistic cholesterol testing can make a cost-effective contribution to combating heart disease. Copies of the report are available in the Library and a consultation period is under way. I hope that my hon. Friend and others will contribute to those consultations.
Another subject that has been the source of a great deal of comment today is smoking. The effects of smoking are devastating, as my hon. Friend the Member for Chislehurst made clear. Each year, it kills more than 100,000 people and costs the NHS around £500 million. What it costs in forgone earnings, and in personal misery and bereavement can scarcely be accounted for in terms of money. The habit accounts for millions of days of absence from work. It is a staggering toll in both human misery and cost.
There can be little doubt that if cigarettes were introduced today, their production and sale would probably be banned, but the habit has a 400-year history of acceptance and approval and it is too firmly established for a ban to be imposed now. However, when new tobacco products are introduced in the United Kingdom, we can

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consider a ban. Indeed, at the end of last year we responded to the evidence that oral snuff products were linked with mouth cancer by banning their sale.
We can and do use the law to protect children. Tribute has been paid to the "Parents Against Tobacco" campaign and discussions are taking place on how further we can strengthen the law to ensure that young children do not gain access to cigarettes and tobacco products. It is not only a question of the law; it is a question of public perception and social accountability. The more that can be done to make the sale of tobacco products to children unacceptable and offensive, the better. That is certainly an area in which the good will of the campaign is important.
Smoking harms not only the smoker. As hon. Members said, there is a growing rejection of the effects of passive smoking. There is an increasing demand for smoke-free areas, both in public places and in the workplace. We welcome that change in public attitudes. I shall take up the suggestion of my hon. Friend the Member for Acton and ask the Health Education Authority to accept his invitation to draw up guidance on passive smoking for general distribution.
Another important plank in the Government's response to the grave health risk posed by tobacco has been to strengthen and refine the system of voluntary agreement with the industry. As hon. Members will know, recent developments in the European Community mean that there must be changes, and we are still considering the implications of some of the latest directives. We are all committed to ensuring that smoking is reduced, that there are proper controls over advertising, and that needless deaths are avoided at all costs.
Nutrition has also been a subject for debate today, and it has been a long-standing debate over recent months and years. I cannot furnish my hon. Friend the Member for Twickenham with detailed replies on all the various products that he identified, such as eels, oysters, herring, kippers, salmon and so on. However, I can give him some good news. Next week the Department of Health, the Ministry of Agriculture, Fisheries and Food and the Health Education Authority will jointly issue joint guidelines for a healthy diet. They are intended to be exactly what hon. Members wish—a clear statement of guidance about healthy eating and the importance of nutrition, to try to develop a sense of coherence and understanding in an area that is easily moved to emotion rather than common sense. "An apple a day keeps the doctor away" is an old maxim. The importance of diet for health cannot be understated.
I want to speak briefly about the importance of alcohol. I agree with the hon. and learned Member for Montgomery, who spoke about the effects of alcohol not only in terms of disease and illness, but in terms of crime, and especially domestic violence. I am closely associated with a Minister who is committed to the eradication of drinking and driving. He has been most successful in making people think through the dangers of drinking and driving. We could spread the message more widely.
My right hon. and learned Friend the Lord President currently chairs the ministerial group on alcohol misuse. In launching "National Drinkwise Day" this year, he said most aptly that alcohol can either be a good friend or a bad enemy. We all know of the many circumstances in which alcohol makes a very bad enemy.
My right hon. and learned Friend co-ordinates that group, which draws together Ministers from different
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Departments to ensure that policies are developed and initiatives planned in a co-ordinated way. A report describing the progress that has been made in combating alcohol misuse will be published early next year. When sensible drinking rules are breached, that poses a serious threat.
In our proposals announced this week for phasing in the implementation of community care, a commitment was made to introduce a specific grant for the treatment of those with drug and alcohol misuse problems, which demonstrates the seriousness with which we view alcoholism. Alcohol Concern provides an important service in that regard. The Government are funding it to the tune of £500,000 this year, but by 1992–93 that figure will rise to £2.5 million.
Little mention has been made of the dangers of drug misuse, but we are committed to ensuring not only that supplies from abroad are reduced but that enforcement is effective, that there are strong deterrents, and that improved rehabilitation treatment is available. Above all, we want education and prevention to be spread as widely as possible.
My hon. Friend the Member for Twickenham, the hon. Members for Preston and for Peckham, and others, mentioned child health. We have seen a dramatic reduction in infant mortality, from 12.8 per 1,000 live births in 1979, to 8.4 in 1989. Perinatal mortality fell from 14.7 per 1,000 births in 1979 to 8.3 in 1989. The figures are now at an all-time low, and that achievement is a source of considerable pride. However, none of us is satisfied that we have gone as far as we can. We must encourage every group and community throughout the country to take every possible step to ensure that children benefit from all the advantages of modern health care.
Immunisation rates have also dramatically improved, from 85 per cent. to 89 per cent. between 1985 and 1990, provisionally, in respect of tetanus, diphtheria and polio. Immunisation against measles improved from 68 per cent. to 88 per cent. in just five years, and against whooping cough from 65 per cent. to 82 per cent. That is a remarkable and impressive achievement.
Our efforts will not stop there. Recently, we published a handbook, "Immunisation Against Infectious Disease", which has been sent to all doctors and health visitors. It reminds them of the continuing importance of the immunisation campaign. In September, we shall launch with the Health Education Authority a further publicity campaign, "Immunisation, the safest way to protect your child", which will carry forward that work. We have learnt the lessons of the past as to how easy it is to allow a campaign to become forgotten. The momentum must be kept up, and there is no better way of doing that than the commitment in the general practitioner contract to provide an incentive for GPs who go out of their way to ensure that the children on their lists are properly immunised. Again, we are seeing important and impressive results already, which will lead to further improvements in child health.
I take issue with the hon. Member for Peckham's remarks concerning maternity services, which have continued to show a considerable improvement. This week, I was pleased to speak at the annual conference of the Royal College of Midwives, when I emphasised that our maternity services provision is based, as it has been for the past 10 years, on the reports of the Maternity Services Advisory Committee, and that we recognise the

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importance of the continuity of the midwife's role and of a coherent and integrated service. Those are precisely the policies that we shall be pursuing. The process of contracting is being examined carefully in two areas—Maidstone and Lewisham. I have invited the Royal College of Midwives to discuss the effects on maternity services, to ensure that all the aspects about which it may have concerns are properly addressed.
To pay tribute to the midwives, only this week they launched a new video on "Rights and choice in maternity care" particularly intended to ensure that those from ethnic minorities receive the services and are aware of the importance of protecting their child as they approach childbirth and in the months afterwards. It was funded by the Department and is an excellent and professional video. It will be a force for good.
The hon. Member for Peckham mentioned breast feeding. We recognise the importance of breast feeding and have been involved in a joint initiative funding three voluntary groups. We are determined that the messages should be carried forward because, as the hon. Lady said, there is no doubt that breast feeding in the early stages can make an important impact on health, apart from the relationship that develops between the mother and child.
I should not be doing justice to the great programme of work that the Government have been undertaking if I did not refer to the important breast and cervical cancer screening programme. We are the first country in the Community to introduce a nationwide breast and cervical cancer screening programme based on inviting women by computerised call and recall. We have been setting the pace in terms of preventive health care for women.
There is no doubt that on the basis of the Forrest report on breast cancer screening and the inter-collegiate report on cervical cancer screening, early detection and intervention can mean that many lives will be saved. It is vital that throughout the country women should accept the invitation for a test and ensure that the family practitioner committee is aware of any change of address. They should ensure that in following up their invitation they encourage others to do the same. It is a waste of resources to have failed appointments but, my goodness, it may be a waste of years of a woman's life if she fails to take up the appointment. We know, sadly, that the vast majority of those who have died from cervical cancer have never been screened or have not been screened in the recent past. It is possible to save lives and to promote health.
Concern has been expressed by some about the availability of results. There has been a substantial increase in those going for cytology testing but I can assure the House that about 80 per cent. of results come through within the four weeks in which health authorities are asked to provide them. We are looking carefully at local authorities where there may be difficulties or delays.
This is an important programme, which is a force for good for women. It is backed up by the GP contract, where the incentive is such that we are going out of our way to encourage GPs to ensure that the women on their lists have taken advantage of screening. We have also asked the national co-ordinating network for the cervical screening programme to ensure that the lessons that are learnt in terms of the fast implementation of the programme are properly disseminated throughout the country.
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Women are a particularly important group, not only in terms of the health issues that affect them, but in terms of their role so often as the communicators about the health service within their families. They are often the gatekeeper to the health service for their family. They are often responsible for their family's food habits and many of their social habits and the way in which they conduct their lives. It is right to make a special effort to inform and work with women's organisations to ensure that those messages are spread.
I regularly have meetings with a series of women's organisations to ensure that all those lessons are properly understood and that they take steps to inform their members. I have meetings with the National Council of Women for Great Britain, the British Federation of University Women, the Townswomen's Guilds, Women's Gas Federation, the Fawcett Society, the Business and Professional Women's Federation, the National Federation of Women's Institutes and the National Association of Women's Clubs. Not only are women so often the gatekeepers to the health service, setting the tone for their families, but the majority of health service workers are women, so they play a particularly important part.
I must briefly refer to a subject that has been strangely absent from our debate. More resources are spent on AIDS by the Health Education Authority than on anything else. It would be unacceptable for any Government to fail to recognise the great importance of that major modern threat to public health. For a disease for which there is no known cure, prevention and education—the theme of the motion before us—must be fundamental.
We are committed to a programme of prevention, to monitoring, surveillance and research and also to treatment, care and support. Dramatically and significantly, those in the groups most affected by AIDS seem to have been able to change their behaviour as a result of health education messages. It is easy for us to agree what the messages should be, but it is much harder to turn those messages into action in terms of diet, sexual behaviour, smoking or drug addiction.
We have launched a further publicity campaign about AIDS and HIV. It is important that we have introduced an anonymous screening programme and before long it will be possible to debate the subject on the basis of facts rather than fiction. Sometimes the debate on AIDS seems to suffer from too much heat and too little light. However, we continue to give AIDS a very high priority, working closely with the Health Education Authority.
I have not been able to respond to all the points that have been raised. If hon. Members feel that I have not covered their points, perhaps I can write to them. My hon. Friend the Member for Chislehurst asked about the progress that we are making on the European region of the World Health Organisation's "health for all by the year 2000 targets". We have been making good progress in several areas, particularly on cardiovascular disease and infant mortality. We are doing as well as any on accidents. The next formal response is due in 1993. However, those matters are carefully monitored by the Department's central health monitoring unit. I shall ensure that we look carefully to see whether there are any other ways in which the information can be provided before the next formal reporting date.

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This has been an important debate, with many thoughful and considered contributions. I hope that I have left the House in no doubt that the Government take enormously seriously the challenge that confronts us. We believe that our proposals for reform in the national health service will ensure that health promotion and disease prevention are given the proper consideration that they deserve and that we will indeed well and truly have established a national health service.
2.3 pm
Mr. Simon Coombs: Since this debate started about four and a half hours ago, more than 100 of our fellow citizens have died of coronary heart disease. To put it another way, every day in this country a number equivalent to a Boeing 747 jumbo jet full of passengers die from that crippling disease.
I congratulate my hon. Friend the Member for Chislehurst (Mr. Sims) on moving his motion and I thank him for the opportunity to debate this subject. This debate has ranged widely over the whole question of health promotion and illness prevention. I shall concentrate on one aspect—coronary heart disease. It is particularly appropriate to discuss this issue now, just after the third anniversay of the establishment of the Health Education Authority, the "Look after your heart" campaign, the publication of its five-year plan, "Beating heart disease in the 1990s" and the recent publication of the report on cholesterol testing by the Standing Medical Advisory Committee, which has been mentioned by several hon. Members.
Much has been said in the debate and both inside and outside the House on many occasions about the incidence of coronary heart disease, what causes it and where it is likely to he found in the United Kingdom. The four countries of the United Kingdom have an appalling record with this disease. Of the top six countries in terms of the incidence of coronary heart disease, four are Northern Ireland, Scotland, England and Wales. The other two are Finland and Czechoslovakia. Naturally, I welcome the progress that has been made in the past three years, but we started late on the journey and we have a lot of catching up to do.
I should like to give the House one or two pieces of information about the incidence of coronary heart disease in this country. In Scotland, for example, the Scottish Medical Journal says that people in social classes 3, 4 and 5—especially men—are "closely associated" with a high mortality rate. Male unemployment is also strongly associated with coronary heart disease death rates. A Whitehall study of civil servants showed that men in the lowest grades, including messengers, had three times the coronary heart disease mortality rate of men in the highest grades, the administrators. The Health Education Authority has said that a man's unemployment is a strong predictor of his subsequent risk of getting coronary heart disease and that unemployment is more significant than any other risk factor. Coronary heart disease is more prevalent among manual rather than professional social groups. A man in social class 5 has nearly three times the chances of dying prematurely from coronary heart disease than a man in social class 1.
However, it is only fair to say that coronary heart disease death rates are falling fast in the younger age groups. Since 1972 death rates from coronary heart disease
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in England and Wales in the 35 to 74 age group have fallen by 18 per cent. for men and 11 per cent. for women. That seems good, until one compares it with the decreases in other countries such as the United States and Australia, where the decreases are three or four times greater than those which I have just quoted. In the past 15 years, reductions in coronary heart disease mortality rates for women aged 35 to 44 have been nearly seven times greater than for women aged 55 to 64, and two and a half times greater than the rate for men. It is undoubtedly true that mortality rates are falling faster in the younger age groups than in the ones that I have quoted.
Much has been said inside and outside the House about the location of high rates of mortality from coronary heart disease and about the north versus the south. According to the figures, Scotland and Northern Ireland have high incidences, with the north-east, the north-west, Merseyside, Yorkshire, the Trent area and the west midlands all having high figures; but so—it must be said—have the east end of London, Plymouth and Cornwall. We should not talk about a north-south divide in coronary heart disease, nor should we say that simply because someone happens to be of a certain age and class, he is certain to contract the illness.
However, what has to be said—I echo the comments at the beginning of the debate by my hon. Friend the Member for Chislehurst—is that it is up to the individual to decide whether to have a healthy life style. There is no reason why people on a low income, for example, should not eat wisely. The food that is harmful to diet is often more expensive than that which is good for the diet, but it is rejected.
I support my hon. Friend the Minister in saying that in 1990 we are more likely to perish of a self-inflicted disease than from a contagious disease. That is a complete reversal of the situation 100 years ago. In 1890 we were likely to die of cholera, typhoid or another of the water or air-borne diseases. That it is not so today is a triumph for technology, engineering and, as my hon. Friend the Minister said, plumbers. Today our lives are literally in our own hands, not in those of others or of the environment.
It has already been said that we spend a relatively small amount of public resources on prevention of coronary heart disease. We spend about £10 million a year in England and Wales. Let us set that against the cost of treating coronary heart disease, which is £500 million a year. Another even more alarming statistic is that 40.5 million working days are lost in Britain as a result of the disease. That represents 11.6 per cent. of all the days of sickness. That lost production costs £1.8 billion a year. Yet we spend only £10 million encouraging people to avoid the habits which lead to coronary heart disease.
The Public Accounts Committee in its report last year, just 13 months ago, said:
"We are concerned at the stark contrast between the levels of expenditure on the prevention and treatment of coronary heart disease. We conclude that our examination illustrates our predecessors' concerns about the Department's failure to evaluate the full potential for spending on prevention to save on treatment costs."
I ask my hon. Friend the Minister, what more we can do to counter that charge? I listened with interest to what she said, of course, and I recognise that more is being done, but we are not yet doing enough to counter coronary heart disease.
There are two main causes of the disease—diet and smoking. There is a third cause—alcohol—but in view of

1347
the time I shall restrict myself to a few remarks on the first two. The major factor in diet is an excess of fat in the diet of ordinary British men and women, particularly of saturated fats. We were told six years ago by the Committee on Medical Aspects of Food that such consumption should not exceed 35 per cent. of total energy intake. But the figure remains above 40 per cent., despite all the best efforts of experts and politicians to advise people to reduce their intake of saturated fat.
There has been a slight improvement from saturated to unsaturated fat, but the total amount of fat in the diet is still far too high. It is true that people consume less butter, milk and red meat and have changed to semi-skimmed and skimmed milk. But when I hear people say, "Oh well, we cannot afford to eat the things that the experts tell us to eat", I look at the price of 250 grammes of butter. It is two and a half times the equivalent cost of 250 grammes of margarine. So it can be done.
Smoking accounts for approximately 20 per cent. of deaths from coronary heart disease in Britain. Those who have hypertension, are overweight or have high blood cholesterol are more likely to contract the disease than others. The risk is two and a half or three times greater for smokers than for non-smokers. In men under 45, 80 per cent. of heart attacks are due to smoking cigarettes.
It is even more appalling that schoolchildren aged between 11 and 15 are taking up smoking. In that age group 7 per cent. of boys and 9 per cent. of girls smoke regularly. There is tremendous public support for reducing the level of smoking. A recent survey showed that 82 per cent. of the population supported banning smoking completely in restaurants; 72 per cent. supported a ban in banks and post offices; and 70 per cent. supported a ban at work. Even 42 per cent. of the population said that they would support a complete ban on smoking in pubs. That is a substantial and remarkable figure. Seventy-four per cent. of hon. Members support bans on smoking on public transport, 63 per cent. support bans on smoking in school buildings and 60 per cent. support bans on smoking in shops. The will is there. We must translate it into action.
In 1987 "Look After Your Heart" produced a guide to healthy eating. It recommended the need to cut down on fat, sugar and salt and to eat more fibre-rich foods and plenty of fresh fruit and vegetables, to go easy on alcohol—a weak way of putting it—and to get plenty of variety in food. As my hon. Friend the Minister has already spoken, perhaps later she will let me know how many copies of the guide were produced and what happened to them. What monitoring was done to see whether they went to the people who needed to read them? Although a large proportion of people think about what they eat and try to eat healthily, a substantial proportion of them ignore advice and dismiss any suggestion as ludicrous. They are the ones who are at risk from this killing disease. Clearly, we must do far more to get the message across to those who, until now have been deaf to it or have refused to listen.
Unless we tell people the contents of food, it is unlikely that they can make the right choice of what they should eat. The Standing Medical Advisory Committee estimates that if every adult adopted its dietary recommendations, those needing clinical supervision due to elevated blood pressure would decrease by two thirds. Information on
1348
blood pressure and diet would influence public attitudes and behaviour, thereby influencing good manufacturers' approach to labelling.
Professor John Goodwin, the chairman of the National Forum for Coronary Heart Disease Prevention, recently said:
"To help achieve a healthy diet, we need compulsory food labelling so that people can put into practice the advice given in the healthy eating leaflets."
How much longer will we talk about food labelling? Surely the time has come for action. We are in the middle of yet another consultation period, this time involving all the European Community countries. We should be taking a lead in those talks. For the benefit of producers, manufacturers and, most important, consumers, we need to bring the talking to an end as quickly as possible and make it abundantly clear to the population exactly what they are eating so that those who wish to make the right decisions can make them in the full-knowledge of what they are buying.
This month the SMAC published its report on blood cholesterol levels. It states:
"An elevated level of blood cholesterol is one of the chief factors which lead to an increased risk of coronary heart disease…Some programmes of opportunistic blood cholesterol testing and treatment have the potential to make a cost-effective contribution to CHD prevention, whilst others are likely to perform less well."
We have some decisions to make following the consultation and I hope that we make the right ones. The committee suggests that doctors give priority to high-risk categories, such as those with high blood pressure, smokers, diabetics, people with a family history of CHD or hyperlipidaemia, and those who already have CHD, and in particular that high priority should be given to people with more than one of those symptoms. The committee states:
"If blood cholesterol testing and treatment programmes are to remain cost-effective the proportion of prescribed drugs must be kept to a minimum by careful dietary counselling."
I say amen to that. Let us not get into the position where GPs, faced with a patient who has a high level of blood cholesterol, simply prescribe pills to help get rid of it. This is crucial. We must not turn another group of people into pill pushers. The answer lies in the life style and the diet of the people, not in having people think, "I can eat, drink and smoke what I like because a magic pill will put it all right." Unless we get that right, the NHS will have another problem with its drugs bill.
To give an example of what it could cost, if the figures for people with high levels of cholesterol in their bloodstreams in this country are anything like the figures in the United States—the evidence suggests that, in all probability, the figures here are much higher than those in America—we could be talking about well over £1 billion a year for the drugs needed to bring blood cholesterol down to safe and acceptable levels. I cannot believe that such expenditure is the answer to the problem that undoubtedly lies ahead.
The opportunity to do the testing of cholesterol levels on GPs' patients must be grasped. We must ensure that GPs have the training to be able to cope with those who come to them presenting high levels of blood cholesterol so that they can give the right advice about the diet and life style necessary to bring down cholesterol levels.
There is no doubt that physical activity and exercise can help to reduce obesity, blood cholesteral and blood pressure. Again, men and women in professional groups are more likely to go in for physical activity in their leisure

1349
time than are men and women in unskilled manual groups. So the people who are eating the wrong foods are likely to be doing nothing about it in terms of taking exercise.
In socio-economic groups A and B, 15 per cent. said in a recent survey that they had taken no exercise the previous week, compared with 35 per cent. in group E, who similarly said that they had taken no exercise. Nearly twice as many people in socio-economic groups A and B went running or jogging than those in C2, D and E groups.
Younger people said that they exercised to feel fitter. Older people said that they exercised for health reasons. In either case, it was predominately the people who were already eating more sensibly who were taking more exercise, rather than those who were taking risks with their diets or life styles.
We must also consider the younger section of the population, those at school eating school meals. The national forum for CHD prevention has demanded national nutritional standards, and I support its call. School meals account for a third of children's energy intake, and 45 per cent. of that comes from fat, well above the levels recommended by the experts to whom we turn for advice.
Two years ago the Government introduced the FEAST—fun eating at school today—campaign, which was designed to promote healthy eating and attract as many pupils as possible to eat healthy, nutritious school meals.
The problem with a debate such as this—we are grateful to my hon. Friend the Member for Chislehurst for initiating it—is that it is answered by a Health Minister, and we are grateful for her presence. But we see no sign of Ministers from the Ministry of Agriculture, Fisheries and Food or from the Department of Education and Science, both of which have a key role in the promotion of healthy living. I hope that that message will be passed to those Departments, although I welcome on the Front Bench my right hon. Friend the Minister of State, Home Department; the Home Office is always anxious to see that we are looked after in every possible way.
The Minister of State, Home Office (Mr. John Patten): I am obliged to my hon. Friend.
Mr. Coombs: It is essential to check what youngsters at school are eating and to make sure that they do not eat the wrong foods, and I hope that the message that was given to me last year by the former Under-Secretary of State, my hon. Friend the Member for Coventry, South-West (Mr. Butcher)—that the Government were anxious to see local authorities taking up the chance to participate in the FEAST campaign—means that that campaign continues and has the Government's support.
With regard to home economics and health education, it is crucial that the new national curriculum should take into account the need to teach children how to look after themselves when they grow older and have responsibility for themselves and their children. Having looked at the national curriculum guidelines, I am not entirely satisfied that the emphasis is sufficiently clearly placed on the need for healthy eating and cooking with unsaturated fats. I urge my hon. Friend the Minister to pass on the message to the Department of Education and Science about the need for action on that.
I congratulate the Government on what they have achieved so far. I hope that nothing that I have said in the past 20 minutes or so gives the impression that I do not
1350
welcome the progress that has been made. I believe, in concert with large numbers of people outside the House, that we still have a great deal to do to beat coronary heart disease. Other countries have tackled the problem and produced major reductions in the number of people suffering from CHD.
Last year, the Public Accounts Committee said:
"We are also concerned at the varying levels of local commitment to the heart disease prevention programme in England, and by the slowness of the Department of Health in obtaining essential monetary information from health authorities."
We must continue to monitor the work of local health authorities in this matter because some of them are doing a great deal more than others. I pay tribute to my health authority in Swindon, which is well advanced. Not all the others have managed to achieve the same amount of progress in the past three years.
Mrs. Teresa Gorman: Will my hon. Friend give way?
Mr. Coombs: I shall stop in a moment, if my hon. Friend will allow me.
I welcome the large number of projects related to looking after the heart that are being undertaken, particularly the Allied Dunbar national fitness survey. That company, which is located in my constituency, has taken an important lead.
In relation to food and its impact on health, I hope that the Houston initiative on the common agricultural policy of the European Community will be given every encouragement to succeed—principally and ideally through the end of the CAP. It is ludicrous that we are spending 800 million ecu on community support for the tobacco industry in Europe, when tobacco is a killer drug.
The CAP does not mention food or consumers, only farmers. We must remember that there are more consumers in every constituency in Europe than there are farmers. They are the people who will count in the future. We need to promote greater consumer confidence in food safety. I welcome the National Farmers Union suggestion of an independent food assessment and monitoring body; it deserves careful consideration. I urge my hon. Friend the Minister to be unremitting in her efforts to secure more money from Treasury Ministers to enable the prevention of coronary heart disease to continue in the future, with an ever greater determination to beat that dreadful disease.
2.28 pm
Mr. Sims: With the leave of the House, Mr. Deputy Speaker, I shall speak again.
I thank all those who have spoken in the debate It has been time well spent. I appreciated the kind comments about my initiative in tabling the motion. I am sorry that our proceedings were interrupted by a statement over which we had no control, which has precluded two or three of my hon. Friends who were anxious to contribute to the debate from doing so. That is unfortunate, but that is how things happen in Parliament, and we have to take the rough with the smooth.
I hesitate to refer specifically to any of the speeches because all of them either picked up points that I had touched on or elaborated on others which simply due to lack of time, I had been unable to mention. I hope that the debate has brought home to hon. Members and the country the importance of preventive medicine and what

1351
we can do to promote our good health. I particularly appreciated the comprehensive reply by my hon. Friend the Minister, who covered a great deal of ground in a relatively short time. It will be interesting to hear whether she has more to tell us about the extraordinarily fishy speech of my hon. Friend the Member for Twickenham (Mr. Jessel).
I am grateful to all hon. Members who have supported me in the debate and I hope that the message that I was endeavouring to put across—that individuals have responsibility for their own health, and that the Government have a responsibility to take measures to promote good health and disseminate information—has got through to the House and to the country. I am grateful for the opportunity to have had this debate.
It being half-past Two o'clock, the debate stood adjourned.

Orders of the Day
  Private Members' Bills

    CONSUMER GUARANTEES BILL
    Order read for consideration of Lords amendments.
    Hon. Members: Object.
    Consideration of Lords amendments deferred till Friday 19 October.

    ROAD TRAFFIC (TEMPORARY RESTRICTIONS) BILL
    Order read for further consideration of Lords amendments [6 July].
    Hon. Members: Object.
    Mr. Deputy Speaker (Sir Paul Dean): Second Reading what day? No day named.

    SEXUAL OFFENCES BILL
    Order read for resuming adjourned debate on Third Reading [6 July].
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    Mr. Deputy Speaker: Second Reading what day? No day named.
    Mr. Simon Hughes: On a point of order, Mr. Deputy Speaker. Because the same issue will arise several times, can you tell us which dates if any are available, given that there appears to be some confusion about which days can be named?
    Mr. Deputy Speaker: I am glad that the hon. Gentleman asked that, because it might help our proceedings. The answer is that there is no further time available in this Session for private Members' Bills.

    PROTECTION OF BADGER SETTS BILL
    Order read for consideration (as amended in the Standing Committee).
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    Consideration deferred till Friday 19 October.
    Mr. Tony Banks: On a point of order, Mr. Deputy Speaker. It appears that everyone is now saying that no one objected—
    Mr. Deputy Speaker: Order. There was an objection.
    Mr. Ken Livingstone: On a point of order, Mr. Deputy Speaker. I think I saw—

    RADIOACTIVE MATERIAL (ROAD TRANSPORT) BILL
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    PENSIONERS' TELEVISION LICENCES BILL
    Order for Second Reading read.
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    Second Reading deferred till Friday 19 October.

    BAN OF IMPORTS (CHILD LABOUR) BILL
    Order for Second Reading read.
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    Second Reading deferred till Friday 19 October.

    FORMER CABINET MINISTERS (INTERESTS) BILL
    Order for Second Reading read.
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    Second Reading deferred till Friday 19 October.

    TRADE UNION ACT 1984 (AMENDMENT) (No. 2) BILL
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    Hon. Members: Object.
    Second Reading deferred till Friday 19 October.

    SAFETY IN CHILDREN'S PLAYGROUNDS BILL
    Order for Second Reading read.
    Mr. Deputy Speaker: Not moved.

    COMMUNITY CHARGE (LANDLORD AND TENANT) BILL
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    COMPUTERS (COMPENSATION FOR DAMAGE) BILL
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    Hon. Members: Object.
    Second Reading deferred till Friday 19 October.

    REFORM OF THE HOUSE OF LORDS BILL
    Order for Second Reading read.—[Queen's consent, on behalf of the Crown, signified.]
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    HUMAN RIGHTS BILL
    Order for Second Reading read.
    Mr. Deputy Speaker: Not moved.

    MISUSE OF DRUGS BILL
    Order for Second Reading read.
    Hon. Members: Object.
    Second Reading deferred till Friday 19 October.

    WRITTEN CONSTITUTION BILL
    Order for Second Reading read.—[Queen's consent, on behalf of the Crown, signified.]
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    FUEL AND ENERGY PROVISION BILL
    Order for Second Reading read.
    Mr. Deputy Speaker: Not moved.

    POLL TAX (ABOLITION) BILL
    Order for Second Reading read.
    Mr. Deputy Speaker: Not moved.

    LOCAL AUTHORITY PLAYING FIELDS BILL
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    Mr. Deputy Speaker: Not moved.

    CONTROL OF TOXIC WASTE RESIDUES BILL
    Order for Second Reading read.
    Hon. Members: Object.
    Second Reading deferred till Friday 19 October.

    DRUG TESTING (SCHOOLS) BILL
    Order for Second Reading read.
    Hon. Members: Object.
    Second Reading deferred till Friday 19 October.

    EUROPEAN PARLIAMENT ELECTORAL REFORM BILL [LORDS]
    Order for Second Reading read.
    Mr. Deputy Speaker: Not moved.

    FORMER MINISTERS (INTERESTS) BILL
    Order for Second Reading read.
    Hon. Members: Object.
    Second Reading deferred till Friday 19 October.

    DEVELOPMENT CONTROL (PROTECTION OF GREENFIELD SITES) BILL
    Order for Second Reading read.
    Hon. Members: Object.
    Second Reading deferred till Friday 19 October.

    BEACHES AND COASTLINE (REGULATION) BILL
    Order for Second Reading read.
    Hon. Members: Object.
    Second Reading deferred till Friday 19 October.

    SAFEGUARDS FOR RESIDENTS IN REGISTERED HOMES BILL
    Order for Second Reading read.
    Hon. Members: Object.
    Second Reading deferred till Friday 19 October.

    ADOPTION (AMENDMENT) BILL
    Order for Second Reading read.
    Mr. Deputy Speaker: Not moved.

    DOGS BILL
    Order for Second Reading read.
    Mr. Deputy Speaker: Not moved.

    PRIVATE SECURITY (REGISTRATION) BILL
    Order for Second Reading read.
    Mr. Deputy Speaker: Not moved.

    MOTOR TRADE (CONSUMER PROTECTION) BILL [LORDS]
    Order for Second Reading read.
    Mr. Deputy Speaker: Not moved.

    TRADE UNION ACT 1984 (AMENDMENT) BILL [LORDS]
    Order for Second Reading read.
    Hon. Members: Object.
    Second Reading deferred till Friday 19 October.

    MORTGAGE ASSISTANCE BILL
    Order for Second reading read.
    Hon. Members: Object.
    Second Reading deferred till Friday 19 October.

    CONTROL OF DETERGENT POLLUTION BILL
    Order for Second Reading read.
    Mr. Simon Hughes: Ever hopeful—now, Sir.
    Hon. Members: Object.
    Mr. Deputy Speaker: Second Reading what day?
    Mr. Hughes: 13 October, Sir.
    Mr. Deputy Speaker: That is a non-sitting day. We had better make it 19 October.
    Mr. Hughes: 15 October, Sir. That is our first day back.
    Second Reading deferred till Monday 15 October.

    POLL TAX (RESTORATION OF INDIVIDUAL PRIVACY) BILL
    Order for Second Reading read.
    Hon. Members: Object.
    Second Reading deferred till Friday 19 October.

    RAPE IN MARRIAGE (OFFENCE) BILL
    Order for Second Reading read.
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    Second Reading deferred till Friday 19 October.

    HARE COURSING (ABOLITION) BILL
    Order for Second Reading read.
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    Second Reading deferred till Friday 19 October.

    GAMING MACHINES (PROHIBITION OF USE BY PERSONS UNDER EIGHTEEN) BILL
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    Hon. Members: Object.
    Second Reading deferred till Friday 19 October.

    DECLARATION OF WAR AND COMMITMENT OF TROOPS ABROAD (CONSTITUTIONAL ARRANGEMENTS) BILL
    Order for Second Reading read.
    Mr. Jeremy Corbyn: On behalf of the hon. Member concerned and all peace-loving peoples, I beg to move that the Bill be now read a Second time.
    Hon. Members: Object.
    Mr. Speaker: Second Reading what day?
    Mr. Corbyn: In deference to the warmongers, 19 October.
    Second Reading deferred till Friday 19 October.

    PRESCRIBED DRUGS (COMPENSATION) BILL
    Order for Second Reading read.
    Mr. Deputy Speaker: Not moved.

    ABOLITION OF FOX-HUNTING BILL
    Order for Second Reading read.
    Hon. Members: Object.
    Second Reading deferred till Friday 19 October.
    Mr. Tony Banks: On a point of order, Mr. Deputy Speaker. I am in no way challenging what you have said, but Opposition Members heard not a word when the title of the Protection of Badger Setts Bill was read out. In view of the earlier experiences of some hon. Members. I understand why others do not wish to be associated with objections to that Bill. Nevertheless, will the hon. Member who objected—if indeed it was an hon. Member—identify himself or herself? Will he or she at least have the courage to admit it, so that we can all see who it was?
    Mr. Deputy Speaker: As the hon. Gentleman and the House know very well, we have been round this course many times before. The procedure is well established: one objection stops a Bill proceeding any further, and—whether it happens at 2.30 pm on a Friday, at 2.30 pm on a main sitting day or at 10 pm—no hon. Member need identify himself in such circumstances.
    Let me also remind the House that an objection does not necessarily mean that the hon. Member concerned objects to the Bill; he may simply be objecting to the Bill going through a stage without any discussion or debate.
    Mr. Banks: Further to that point of order, Mr. Deputy Speaker. I fully understand that, but there is some confusion on these occasions. People are objecting to Bills, of trying to move Second Reading motions for Bills that have already been passed. There is a general climate of confusion.
    All the hon. Members who were in the Chamber at the beginning of the process through which we have just gone are still present; none has admitted to objecting to the Protection of Badger Setts Bill. It could well be, Sir, that you heard something that was not actually said. No one is admitting to having objected.
    Mr. Deputy Speaker: Order. We cannot pursue the matter any further. As I say, this is a well-trodden path.
    Mr. Nicholas Bennett: Further to that point of order, Mr. Deputy Speaker. I am somewat surprised at the Opposition's concern. Opposition Members objected to three Bills that have received general consent in the House—the Road Traffic (Temporary Restrictions) Bill, whose Second Reading I moved, the Sexual Offences Bill and the Radioactive Materials (Road Transport) Bill. The Road Traffic (Temporary Provisions) Bill was objected to by the hon. Member for Clwyd, South-West (Mr. Jones) if a fit of pique because his Bill was objected to before.
    Several hon. Members rose—
    Mr. Deputy Speaker: Order. I have let hon. Members on both sides of the House get the matter off their chests and we must now move on.

Bangladeshi Communities
Motion made, and Question proposed, That this House do now adjourn.—[Mr. Wood.]
Mr. Simon Hughes: I am grateful—
Mr. Ken Livingstone: On a point of order, Mr. Deputy Speaker.
Mr. Deputy Speaker: Order. The hon. Gentleman is now cutting into the time for the Adjournment debate. I am sure that he does not want to do that.
Mr. Hughes: Thank you, Mr. Deputy Speaker. I hope that we can be encouraged by the prospect that we might get further with this subject than we did with the ones set down for consideration earlier.
I am pleased to have secured at last an opportunity to debate the needs of the Bangladeshi community in Britain. I say that because, like other hon. Members, I have got this opportunity by lottery and one can apply often without success.
Mr. Jeremy Hanley: Could not the hon. Gentleman have persuaded his party to take one of the Supply Days that it is allocated to debate this matter?
Mr. Hughes: That is true. Had we more than about two days a year, we might have been able to find some time, but we have little time. My party has discussed the possibility of debating the matter, but the Government and the Labour party have far more opportunities than we do and have never used them to debate this subject.
Specifically, we could have debated this subject at any time since December 1986. I say that conscious that much of the work done by Committees does not get debated in the Chamber. But the Home Affairs Select Committee reported nearly four years ago on Bangladeshis in Britain. It investigated the Bangladeshi community, reported and made a series of recommendations because it believed, and this belief was confirmed by its report, that the Bangladeshi community is "considerably the most disadvantaged" of Britain's minority ethnic communities.
For example, the Committee found that Bangladeshis live in some of the worst accommodation of any community, and that 78 per cent. of 15-year-old Bengali speakers are not fluent in English. The Committee called that an "educational and social disaster". It also found that many Bangladeshis are unskilled and that the percentage of unskilled workers among Bangladeshis is much higher than in any other group and that many Bangladeshi women have a high incidence of depressive illnesses. It concluded that it is even unclear how many Bangladeshis live here.
Those concerns have led me to introduce this debate, so that we can consider the range of social provisions that we afford—or, sadly, too often do not afford—to people who come from Bangladesh to make their home here with us. They come from a country that is one of the most disadvantaged in the world in its own right, because of its geography and because it lacks natural resources.
The Government responded to the Select Committee report in July 1987. There was then a follow-up check by the Home Affairs Select Committee. I now challenge the Government on what has been done about the recommendations of the Select Committee.

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For me, and I am sure that I speak for other hon. Members, the Bangladeshi community is a welcome addition to the complexity of our society. The figures are unclear, but there are over 100,000, and perhaps approaching 150,000, of them. They are to be found mainly in a few cities and towns and there are more in Tower Hamlets than anywhere else. I therefore particularly welcome to our debate the right hon. Member for Bethnal Green and Stepney (Mr. Shore), who is a former Secretary of State for the Environment and has shown a career-long concern in this community for which we are grateful.
Other large towns and cities have large numbers of Bangladeshis, too—Birmingham, Luton, Oldham, Bradford and, in London, Camden and my borough of Southwark. I know from my dealings with those in my community and elsewhere that they are a committed, industrious and persuasive people in terms of what they want to contribute. I had that confirmed by the privilege that I had last year of visiting Bangladesh for the first time. I was lucky to go with three of my Liberal Democrat colleagues from Southwark—Councillor Anna McGettigan, Martin Downs and Paul Hobbs. We went for almost a fortnight and had a fascinating and informative time. I had always taken the view that I could not properly represent Bangladeshi and Bengali-speaking people without visiting the country from where they came, and I am very glad to have done that.
Unfortunately, there is little time available, so I shall highlight the matters of greatest concern. I begin with housing. The Select Committee rightly drew attention to housing issues which are still the most immediate concern. The dual problem is overcrowding, coupled in many instances with the fact that the housing stock is poor. Homelessness has affected Bangladeshis more than any other ethnic group in the community. The report says that 67 per cent. of Bangladeshi households contains five or more members, compared with the national average of 10 per cent. There is no doubt that there is a tradition of difficulty in obtaining equal treatment. The Commission for Racial Equality and many local authorities have accepted that there is often an inherent disadvantage in the meeting of Bangladeshi housing needs because of the nature of the stock and because of the way the people are dealt with as a result of the lack of linguistic ability to put the case as well as others might. I shall single out one action that we must take to meet those needs. We must ensure that the test of the amount of housing that we provide is that which meets the needs of the people, not just the demands of the market economy. Above all, in the allocations of housing funds or approvals from the Department of the Environment budget, whether directly to and through local authorities or via the Housing Corporation, we must specifically provide more housing for larger families. Without that, Bangladeshi families will often remain grossly overcrowded or he unable to stay together. This week the Prime Minister made a key speech on the family. It is no good talking about rights of maintenance and divorce if social policy does not allow the families who wish to stay together to do so.
Education lies at the heart of many of the needs and problems currently affecting the Bangladeshi community—not just the young, but the middle-aged and older
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generations. As I said, the report shows that five years ago, 78 per cent. of 15-year-olds were not fluent in English. Another report, published by the Inner London education authority in its last days, showed the poor educational performance of Bangladeshi youngsters compared with those from other ethnic minorities. For example, Indian families, who have often come from East Africa, attain much better results. The problem has been exacerbated because the areas in which there are many Bangladeshi youngsters at school have been among those with the greatest teacher shortage.
There are certain actions that we could take to help. There should be more mother tongue teaching for the very young. All the evidence is that cognitive functions are improved if that is provided at an early age. Last year, I argued in Committee that rather than having only European languages as first choice foreign languages in the national curriculum, non-European languages should also be available as first choice languages. We need more English as a second language teaching provision for all ages. In particular, we must ensure that we meet the educational needs of the older communities, especially those who otherwise would be handicapped or housebound because of their lack of skill in English.
Of course, all this is directly related to employment problems. About 62 to 65 per cent. of the Bangladeshi community who wish to work are unskilled, compared with 16 per cent. of the white community. That leads to disadvantage. We know that of all the ethnic groups, the Bangladeshis earn least. That is partly because of language and discrimination problems, because they do not have sufficient knowledge of the way the system works. It is all cumulative. We could alleviate the housing problems fairly quickly, but educational disadvantage causes a much longer-term problem. I want the Minister and other Departments to address several linked issues. Most people wanting to set up a small business in Tower Hamlets or Southwark, for example, must compete against a big developer and will be confronted by high land costs. Unless we as a society intervene to help, that will be impossible to overcome. Accommodation must be made available as well as skills provision.
Social services departments have a supportive role to play. Soon, there will be many elderly Bangladeshis to care for. We have an elderly population as a whole, and we are adapting our social provision accordingly, to allow them to participate in society. As an example, I can say that it took years to arrange in Southwark the handover of land for a community centre where, for example, women past working age can meet others who share their interests and aspirations. Only this week, I attended the opening of a Turkish centre in my borough which clearly offers a great advantage to that section of the community. We must do the same for Bangladeshis.
A sense of alienation and isolation gives rise to illness, particularly depressive conditions. We must ensure that people do not feel alienated from the health service and that they can find at the hospital or doctor's surgery someone to whom they can talk. This year, the London hospital introduced a language line so that members of the ethnic communities can communicate in their first language. That sort of practical help counteracts the feeling that barriers are being erected.
A high proportion of the Bangladeshi community are women. Women have enough problems in society anyway, but those from the ethnic minorities have particular

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difficulties. That is even more true of women from the black or Asian communities. They often carry the burden of an overcrowded home, a lack of suitable skills to allow them to join the work force, and language difficulties. Earlier this week, I mentioned to the Minister that I am encouraged to believe that the lessons learnt from our Overseas Development Administration in Bangladesh are being considered for translation into the development of policy in Britain. However, I should like to know what are the initiatives regarding women proposed by the committee that the Minister chairs, and what are the plans for increasing the opportunities available to women from Bangladeshi communities.
Bangladeshi young people represent our future as much as do white young people. They have an enormous contribution to make to the arts, sport, the academic world, and practical employment, yet often we write them off. That is not done intentionally but because there is insufficient provision to ensure that they succeed. Certain features of Government policy are intended to help. For example, there is a provision known to those in the trade as section 11 grants, made specifically to deal with the needs of the ethnic minority communities. However, I was disappointed to learn from a parliamentary answer that this year section 11 grants look likely to be reduced, for the first time, from £115 million to £110 million.
Mr. Hanley: That provision is not cash limited.
Mr. Hughes: Perhaps not, but it is not enough to say that such a reduction is justifiable, even if there are many other demands. I am not asking for something that is incapable of being answered, or suggesting that money is not being made available in other forms, but the Government's key mechanism for helping such people must not be cut.
Britain is coming to terms with the Bangladeshi community, as it has with others in the past. I recognise that some action has been taken. For example, the Home Office has entered into a commitment to reduce the height and chest measurement requirements for recruits entering the police and there are many agencies now serving that community. But I do not see sufficient changes to ensure no discrimination against Bangladeshis who are already in this country, let alone those who have still to arrive here.
I could have dealt with immigration or the problems of racial harassment and racial attacks because they are also important. However, I have concentrated on the general point so that Parliament has a springboard from which to jump to pressurise those in power to take more steps more quickly and to ensure that we do not ignore a community which, because of its economic and social status, currently depends more on others for help. I hope that after today's debate there will be increased awareness of our obligation to ensure that all these people, as part of our community, have the opportunities that we would wish for ourselves.
2.55 pm
Mr. Peter Shore: I congratulate the hon. Member for Southwark and Bermondsey (Mr. Hughes) on his successful initiative in bringing the important subject of the Bangladeshi community in the United Kingdom to the Floor of the House. I have the honour to represent the constituency of
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Bethnal Green and Stepney, which contains a substantial number of Bengali settlers. I am as conscious as anyone of the great problems that they face.
However, I do not think that the story is one of unrelieved gloom. When one looks at the enormous number of people who come from the entirely different environment of Sylhet in Bangladesh to live in the east end of London, the enormous adjustments that both they and the settled host community have made in accommodating each other reflect creditably upon all concerned. It is admirable to see people of Bengali origin occupy some of the seats on the local council as properly elected members. We all wish to see greater integration of the community in the future.
I want to deal with three important points. First, as the hon. Member for Southwark and Bermondsey said, racial harassment is a major problem. There are more racial incidents and more violence due to racial causes in the borough of Tower Hamlets than anywhere else in England with the possible exception of Newham. That requires an energetic police presence as well as a continued stream of advice, warning and encouragement from everyone in public life so that there is a proper appreciation of the difficulties of both communities and so that the racial tension underlying attacks can be reduced.
ducation is the second great problem. I have been to see the Minister and raised on the Floor of the House at least three times in the past 12 months the appalling problem of the 300 to 400 children of school age who are not receiving any education, let alone making up for the special difficulties and problems that a recent immigrant community is bound to face in the education system and with the English language. That problem must be dealt with. I urge the Minister to agree to the proposition that a timetable should be laid down for when we can expect every child in the Bangladeshi community and in Tower Hamlets to have the same right to education provision that is guaranteed to all our citizens.
Thirdly, our housing problem is appalling. It is difficult to describe and I shall not even attempt to do so. It is Dickensian. It is overcrowded and there are many homeless people, particularly Bangladeshi families. The housing stock in Tower Hamlets is in a pretty bad state of repair. The Select Committee report, which underlies much of what we have said in the debate, said about the effect of housing on race relations:
"It is hard to imagine anything more damaging to racial harmony in Tower Hamlets than competition between different communities for increasingly scarce housing. It is not adequate for the Government to deplore racial hatred but to accept no responsibility in respect of situations which forment it. For these reasons, we recommend that Tower Hamlets' HIP allocation be significantly increased, to at least the extend needed to prevent further deterioration in housing conditions in the borough."
I regret that that recommendation has been ignored. The housing investment programme for Tower Hamlets in the past two years is just under 34 per cent. of what it was 10 years ago. That is a problem that Ministers can address urgently and I hope very much that the Minister will urge it on his colleagues.
2.59 pm
The Minister of State, Home Office (Mr. John Patten): It is always a pleasure to follow the right hon. Member for Bethnal Green and Stepney (Mr. Shore), who has an unparalleled reputation for personal integrity both inside

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and outside the House and I know that he looks after the interests of his Bangladeshi constituents as carefully as he can and never plays politics with the race issue. In that regard, I listened with care to the moderate and moderately phrased way in which the hon. Member for Southwark and Bermondsey (Mr. Hughes) spoke to the House. I found his tone characteristic of the way in which he normally speaks, but surprising when compared to a press release that he issued on Monday, in which he gave an entirely different account and flavour of what he would say this afternoon.
The press notice issued by the hon. Member for Southwark and Bermondsey was more political and, alarmingly, was inaccurate and might cause some distress to the Chair. I shall place a copy of the document in the Library so that hon. Members may read it. The press release states that the hon. Member for Southwark and Bermondsey
"is to force a Commons debate on 'The needs of the Bangladeshi communities in Britain.??
I had always thought that Adjournment debates are raised somewhat differently and are not forced upon the Chair. I have heard about muscular Christianity, but muscular liberalism is a contradiction in terms. The idea that the Liberal party could force anything on anyone, inside or outside the House, is ludicrous. I hope that the hon. Gentleman will take the earliest opportunity to write to Mr. Speaker and apologise for his doubtless inadvertent mistake in suggesting to the outside world that he had somehow heroically forced this debate.
I have also indulged in a little textual criticism of the hon. Gentleman's press notice, which was brought to my notice by my hon. Friend the Member for Richmond and Barnes (Mr. Hanley) who I am happy to see is in the Chamber now. He has given distinguished service to the Select Committee on Home Affairs and has travelled to Bangladesh on an important fact-finding mission. I believe that he was surprised at the tone of the speech made by the hon. Member for Southwark and Bermondsey and his references to the Home Affairs Select Committee report and the Government's attitude to it. My feeling of unease was reinforced when I opened my mail and discovered a letter from the Chairman of the Home Affairs Select Committee, my hon. Friend the Member for Westminster, North (Sir J. Wheeler), who cannot be present today.
My hon. Friend the Member for Westminster, North is a most distinguished Chairman of a distinguished Committee and he has given me his authority to quote his letter. I shall place a copy of my hon. Friend's letter in the Library. In his letter, my hon. Friend refers to the press notice and then states:
"I am afraid this"—
and "this" refers to the press notice—
"does not reflect the truth and the most generous interpretation I can place upon these remarks is that Mr. Hughes is not familiar with the work done."
My hon. Friend draws my attention in his letter to various reports from the Home Affairs Select Committee and states:
"In each of these reports, my Committee dealt in detail with the needs of the Bangladeshi community, and following the publication of these reports, the Home Office replied setting out in detail what was being done and the achievements made. In particular, I would draw attention to"—
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and he then refers to several responses from the Home Office and continues:
"as well as statements made by ACPO and the Metropolitan Police Commissioner.
I am concerned that the interests of race relations may be harmed by selected statements which do not represent the truth concerning these issues."
It is important that the House and in particular the Bangladeshi community is made aware as widely as possible of the views of the Chairman of the Home Affairs Select Committee.
I want now to consider the welfare of the Bangladeshi community, which I have got to know quite well over the past three years particularly, interestingly enough, in Tower Hamlets—the constituency of the right hon. Member for Bethnal Green and Stepney. He knows that I have made a number of visits there recently.
Any member of the Bangladeshi community would resent the implication that Bangladeshis are making no contribution to British life. I was delighted to hear the right hon. Gentleman refer to the considerable contribution that that community is making to British life and to local government, and to the fact that Bangladeshis do not simply present a problem that needs to be solved. When taking about delicate issues, it is important that we balance the problems—and the right hon. Gentleman certainly pointed out some problems—against the successes and contributions of the Bangladeshi community. I pay due tribute to their successes.
The Government accept that, despite its capacity for self-help, to which I have just referred, and some individual successes, the Bangladeshi community is among the more disadvantaged of the ethnic minority communities in this country. I, personally accept that also. The Bangladeshi community suffers especially in those areas where the Bangladeshi population is relatively small, sometimes located next to members of other Asian groups. We must all make a substantial effort to recognise that the needs of Bangladeshis in this country may be different from the needs of other Asian groups. They must be differentiated.
In defence of the problems that the Bangladeshi people face, they would be the first to recognise that they are among the newest arrivals to this country. Young groups of Bangladeshi men and women—and especially young women—who have arrived here as recently as 18 months ago, have been to see me at the Home Office to talk about the problems that they face. They recognise that it will take some time for them to establish themselves in the mainstream of British life. Family reunions mean that there has been a fairly regular flow of people needing time to adjust to this country, its culture and language.
If one looks to the success of slightly older-established Asian minority communities to see how they have managed to enter the mainstream of British life, that makes me full of hope for the future of the Bangladeshi communities, notwithstanding the problems of Tower Hamlets, and Southwark and Bermondsey. Their achievements have been widespread—in the professions and in business. I wish that the Hon. Member for Southwark and Bermondsey had mentioned the contribution made by the Bangladeshi community.
Mr. Hanley: Will my right hon. Friend also confirm that as a result of the report of the Select Committee on Home Affairs, the Metropolitan police are considering

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relaxing the height restrictions for entry to the police, so that the Bangali community can play a full part of the policing of London?
Mr. Patten: Yes, the Metropolitan police and police forces in other parts of the country wish to have as many recruits as possible from the Bangladeshi communities, as soon as possible. I am a great believer in community policing and in communities policing themselves, although not totally. Obviously, having more people from the Bangladeshi communities in our police forces can only help.
I want to see the Bangladeshi communities being able similarly to contribute to many other parts of British life. We hear quite a bit about Islam these days, and the Islamic values of many Bangladeshis, such as the commitment to family life and the belief in hard work and enterprise, correspond closely to some core elements of British society. I am sure that hon. Members of all parties would agree with that.
I refer now to some points in detail. I was asked why the findings of the Select Committee on Home Affairs have not been debated on the Floor of the House. We sit long and hard—longer than any other legislature anywhere else in the world, as you, Mr. Deputy Speaker, will doubtless reflect from time to time late at night. It would be impracticable for the Government automatically to initiate debates on every Select Committee report that is produced. However, the Government published a comprehensive reply to the report in July 1987, and an update was published in 1988. Copies have been placed in the Library.
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I was also asked about how many fellow Bangladeshi-British citizens we have. The current estimate, which is based on the 1986–88 surveys, is of a Bangladeshi population of about 108,000. For those who are statistically minded, that is about 0.2 per cent. of the total population of the United Kingdom. The 1991 census will solve the problem because it will contain a question that asks people to classify themselves, if they so wish, as Bangladeshis.
Housing is another important issue. I certainly do not think that all Bangaldeshis live in the worst housing in the country, but I acknowledge the considerable problems in inner London boroughs where the Asian community has chosen to live and where there are large concentrations of Bangladeshi families. The Department of the Environment, and my right hon. Friend—and namesake—the Secretary of State for the Environment, looks to the housing authorities to identify housing measures that will help Bangladeshis and other ethnic minorities and asks them to include provision to address such problems in their bids to the Department.
I fear that time is probably about to run out, Mr. Deputy Speaker, so I seek the permission of the House to write to the hon. Member for Southwark and Bermondsey and so deal with all the points that I have been unable to cover in the debate.
Question put and agreed to.
Adjourned accordingly at nine minutes past Three o'clock.