Public Health (Hansard, 5 February 1998)

§ The Secretary of State for Health (Mr. Frank Dobson)
With permission, Madam Speaker, I should like to make a statement about public health.
On 9 December last year, I announced to the House the publication of our White Paper, "The new NHS", which set out our proposals to modernise the health service, so that in years to come people will be able to depend on it to look after them when they fall ill. Today, I announce the publication of our proposals to do more to stop people falling ill in the first place. The proposals are set out in the Green Paper, "Our Healthier Nation".
Health in our country has generally improved over the years, but far too many people still fall ill more often and die sooner than they should. That is bad, not only for the individuals concerned and for their families, but for the country as a whole, with 187 million working days lost to the economy through ill health every year.
There are huge inequalities in our society, and the worst are in health. Poor people are ill more often and die sooner. That is the greatest inequality of all: the inequality between the living and the dead.
Successive surveys have shown that over the past 20 years the gap between rich and poor has been growing. As a result, as recent official figures show, the health gap between rich and poor has also been growing. In the early 1970s, there was scarcely any difference in the percentage of deaths from heart disease between men in social class I and men in social class V. Today, men in social class V are three times more likely to die from heart disease.
Far from addressing those growing problems, the previous Government pretended that they did not exist. They even banned Department of Health officials from using the very words, "inequalities in health". Things have changed: we recognise inequalities in health, and we have changed the policies.
The previous Government concentrated their attention exclusively on trying to get people to change their personal life styles, which sometimes needs to be done, but they ignored the factors that made people ill but were beyond the control of individuals. The Labour Government are different: we recognise that poverty, poor housing, low wages, unemployment, air pollution, crime and disorder can all make people ill in both body and mind.
The Green Paper sets out how we intend to tackle the root causes of bad health; how we intend to concentrate on the major killers: heart disease, stroke, cancer and accidents; and how we shall take major initiatives to promote healthy schools, workplaces and neighbourhoods. We shall also give equal priority to mental health, which has been ignored for far too long.
The drive to promote better health is not a matter for the Department of Health or the national health service alone: it requires concerted action by the Government as a whole, in partnership with local organisations. That is happening already.
Far too many people have been made ill by what they eat. Food poisoning incidents have trebled in the past decade. We have already spelt out our detailed proposals for a Food Standards Agency. That will improve people's health.
1226 Having nowhere decent to live is bad for health. We are already tackling the problem of homelessness and bad housing, and have already released the first £900 million of the takings from the sale of council houses for investment in new and better housing. That will improve the health of the worst-housed families.
Low wages leave people without the money to buy decent food or warm clothes, or to keep their homes warm in winter. That is bad for their health and for the health of their children. Therefore, the health of the worst-off families will improve when we introduce the national minimum wage. Being out of work makes people ill. It increases the incidence of cancer, accidents and suicide. That is why our new deal to get people back to work, using the £3.5 billion raised from the windfall tax, will improve the health of the people who get the jobs that are created.
The huge increase in crime and disorder has damaged people's health, and not merely those who are actually assaulted. Living in fear makes people depressed, and depression leaves people ill in mind and body. Our crackdown on crime and disorder will help them feel more secure and so feel better.
Air pollution makes people ill. It can make asthma worse—2 million people in England now suffer from asthma badly enough to need regular medical attention. Our transport policies to reduce traffic congestion and promote public transport will reduce pollution. That will improve people's health.
Therefore, right across Government we are already taking action. The changes that we intend to make to the national health service will make a big contribution. Health authorities will be required to produce and then implement health improvement programmes. Those programmes will include the local contributions to be made to the national targets, but—and just as important—they will also set local targets for improving the health of particular local groups. Those will reflect local circumstances and so will vary from to place to place. The top priority in Camden Town, Wigan, Gloucester or Loughborough may well differ from the top priority in Surrey. That will encourage people in every locality, by showing that what they are doing makes a noticeable and worthwhile difference to them, their families, their friends and neighbours. The cumulative effect of all that local effort will be to raise national standards.
This Green Paper sets out our proposals for concerted action by Government as a whole, in partnership with local organisations, to improve people's living conditions and therefore their health. It also recognises that there are limits to what the Government can do, so it spells out what the individual can do, providing the Government do their bit. It is what we call a "contract for health", working together to make it easier to be healthier.
The Green Paper explicitly recognises that, by its nature, life is risky. It is the job of Government to identify risks to health and assess them and, where appropriate, to take action themselves either to reduce the risks or to ensure that people who might be affected are aware of them and know what the odds are.
The Green Paper puts forward suggested specific targets for tackling some of the major killer diseases together with proposals for local action, but it is a Green Paper. This Government do not believe that we have a monopoly of concern, knowledge or wisdom. Therefore, 1227 we are inviting everyone who is interested to let us have their comments on what we are proposing and to put forward proposals of their own. We can achieve a healthier nation only through a partnership with the people and with the professionals. That partnership starts now, before the policy is finally decided. We can succeed in getting a healthier nation only if everyone is pulling in the same direction. That means that we have to give everyone a say in deciding the direction in which we should go. That is what we are doing with this Green Paper today.

§ Mr. John Maples (Stratford-on-Avon)
On Tuesday, I complained that the contents of the Secretary of State's statement had been comprehensively leaked to the press. The same has happened again today. On Tuesday, the right hon. Gentleman said that it was not only not his fault, but that he was very angry about it. I can now tell him where to look. He should ask the Minister for Public Health exactly what she was doing yesterday afternoon. I happened to be with someone then, who said, "Excuse me, John, but I have to go and make a telephone call. I've been asked to telephone the Minister of State, so that she can brief me on the Green Paper."
Therefore, Madam Speaker, we now know how those discourtesies arise, and it is time that that practice stopped and that the House was accorded the decency of being told first what the Government plan to do.
On Tuesday, the Secretary of State announced his decision on Bart's and got a nice headline. Yesterday, I visited all four hospitals in the Royal London group, including Bart's, and I could not find a nurse, manager or consultant who thought that he had made the right decision?

§ Mr. David Hinchliffe (Wakefield)
This is about public health.

§ Mr. Maples
I was discussing public health with them. The trust thinks that the decision will cost it £20 million a year extra. That is the price that the people of east London will have to pay every year for one day's headlines for the Secretary of State.
On today's announcement, we entirely share the Government's objectives. Health policy must seek to improve health, not just treat ill health. In fact, much ill health has nothing to do with health services; it has more to with life style, environment and the genes that we inherit. The Government are building on previous policies. [HON. MEMBERS: "What about public health?"] I am coming to that. May I make my statement in my own time? The Government are building on previous policy: "The Health of the Nation" White Paper, published in 1992 and the excellent work of Sir Donald Acheson and his team. The aim of that policy was to improve people's health, and there has been substantial progress. The death rate from coronary heart disease fell by 20 per cent. for the under-65s; from strokes by 14 per cent; and from breast cancer for women over 60 by 10 per cent. We moved considerably closer to 18 of the 21 targets. The World Health Organisation commended the Government's strategy as a model for others to follow. 1228 I hope that the new Government, with the measures outlined in the Green Paper, will be able to build on those successes.
I am pleased that the Government plan to continue with four of our priority areas: heart disease and stroke, cancer, accidents and mental health. Those are important causes of premature ill health and death. I am surprised that AIDS has been excluded just as we appear to be having some success with the public education programme and new drug treatments that seem to be able to arrest the disease. Above all, I am disappointed that the Government have dropped so many targets. They have set themselves only four, but we also need to target the underlying causes of many diseases. "The Health of the Nation" targeted smoking, blood pressure and diet. Without such targets, there is nothing to aim at. We must have some measurable objectives. How otherwise will we or the Government know whether the policy has been a success? I hope that during the debate on the proposals, targets will be reinserted. Without them, it will be difficult to make a serious assessment of progress.
When we launched "The Health of the Nation", the then shadow Secretary of State derided the targets as too easy. The right hon. Gentleman has set himself four, not 21, and all are easier than those in "The Health of the Nation". Will he say by what measures he wishes the policy to be judged? If not, it will seem that the Government want to avoid responsibility for failure in advance.
The Secretary of State made much of the evidence of the link between poverty and ill health, but I do not believe that the relationship is as simple as he makes out. If the Government think that all inequalities are caused by poverty, they will not only fail to correct them, but fail at huge cost. Where there is a link, I believe that it is through unemployment and depressing housing conditions. The previous Government tackled both. [Laughter.] I wondered how long it would take for the barracking to start. I cannot even say what happened in the past 18 years without attempts to shout me down. Unemployment has fallen dramatically over the past five years and there was a huge programme for improving council housing estates, especially the worst ones. I hope that the Government will continue both trends. There is definitely some direct connection: if people live in damp housing—

§ Mr. Hilton Dawson (Lancaster and Wyre)
rose—

§ Mr. Maples
This is a statement; there can be no interventions.

§ Madam Speaker
Order. We are not in a debate. The hon. Member for Stratford-on-Avon (Mr. Maples) is responding to a statement by the Secretary of State.

§ Mr. Maples
Unemployment has fallen dramatically and many estates have been improved. I hope that that trend will continue. There is obviously some direct connection. If people live in bad, damp housing and get chest infections, there is clearly a connection. However, I believe that far more ill health is caused by smoking, the overuse of alcohol, bad diet and lack of exercise. We already know about all those things.
It may be—and it probably is—extremely difficult to get people to improve their life style if they are depressed by unemployment and awful housing, but in many cases 1229 people can and must take more responsibility for their own health. The Government must not give people an alibi for their bad habits by allowing them to blame circumstances for everything. Nor must we overlook the enormous importance of our genetic inheritance. We must recognise that although some people are ill because they are poor, I suspect that there are many others who are poor because they are ill. Reducing unemployment and improving bad housing conditions will help, but getting people to improve their own life style is the key. There cannot be anyone in the country over the age of 10 who is ignorant of the danger of smoking, yet hundreds of thousands of people still do it.
I wish the Government well with their objectives. I hope that they will give greater recognition to individual responsibility. I also hope that they will set more measurable targets by which we and the nation can judge success or failure in tackling the causes of ill health, not just its incidence.

§ Madam Speaker
The hon. Gentleman's contribution contained very few questions for response by the Secretary of State, so, before I call them, I caution hon. Members that they must ask questions—this is not a debate. They must ask direct, brisk questions of the Secretary of State.

§ Mr. Dobson
The Secretary of State challenged me about leaks—

§ Mr. Maples
The shadow Secretary of State.

§ Mr. Dobson
Yes. I shall be able to go back to the office and tell people what to do, but the hon. Gentleman will not be able to do so.
The hon. Gentleman challenged me about leaks of my statement. All I can say is that if there were any leaks, they were from our election manifesto. As for Green Papers, in the past they were often not accorded a statement in the House, but we made sure that there was one today.
As for the apparent unpopularity of my decision on Bart's, I can say only that I must have seen a mirage yesterday when, in a rather strange reversal of the usual arrangements, I received in my office a large bouquet of carnations from the people on the cardiac ward at Bart's, who thanked me for that decision.
As for the questions that the hon. Gentleman actually asked, I emphasise that it is a Green Paper, and we are consulting on it. Provided that the points raised by Conservative Members are couched in reasonable terms, we may even listen to some of them, although I admit that that is not particularly likely.
We do not think that it is a good idea to proceed with as many as the 27 targets that the previous Government set—for instance, their effort to reduce teenage pregnancies. To set such a target in areas where the level of teenage pregnancies is well below the target does not gain very much.
We want to set four major targets. Every health authority will be obliged to contribute to those major targets under their health improvement programmes. They will set themselves particular targets to meet their particular problems. Those targets will be vetted by the national health service, and progress towards achieving 1230 them will also be vetted. We believe that that effort, which is specifically designed to try and deal with the circumstances that arise in particular places, is better than a lot of generalised targets.
We also believe that we must target the fundamental causes of ill health. I make no apology for talking about that in my statement. I do not seek to excuse people for not trying to look after themselves properly, but many people in our country today suffer because they live in lousy housing and have no job, or, if they have a job, they receive low pay for it. They also have to cope with massive air pollution and crime and disorder on the streets or in the park where their child would like to play. The problems that hit the worst-off are like the sorrows referred to in "Hamlet", because they come not single spies, But in battalions". We will roll back those battalions.

§ Mr. Hinchliffe
Bearing in mind the fact that the public health policy of the previous Conservative Government appeared to consist almost entirely of insulting remarks by Mrs. Edwina Currie about northern males, may I welcome the significant change in approach announced by the Secretary of State today? In accordance with your direction, Madam Speaker, I should like to ask him two brief questions.
First, in view of the success of local authority public health departments—until their abolition by the Conservatives in 1974—in impacting on significant local health problems, what consideration have the Government given to restoring a public health function within local authorities?
Secondly, will my right hon. Friend give me an assurance that the Government recognise that the fundamental improvements in public health that he outlined today depend on a fundamental redistribution of wealth in the direction of poorer communities?

§ Mr. Dobson
My hon. Friend raises two significant points. Local authorities will have a massive involvement in any programme to improve the health of the people, because health authorities will have to draw up health improvement programmes in collaboration with other parts of the health service, local authorities, voluntary bodies, and anybody else who is involved in a particular locality. All who are signed up to the programme will have to contribute to its development. It is our intention, subject to the outcome of the consultation document to be produced shortly, to place on local authorities a basic duty to promote the economic, social and environmental well-being of their area, as we said we would before the election.
On my hon. Friend's point about targeting resources predominantly on the areas that are most deprived, the Government are already doing that. In the new deal for jobs, the areas where jobs are needed most are almost certainly those where people will benefit from the introduction of a national minimum wage; they are the areas that frequently suffer most from air pollution, and the areas where people are ill most often and die sooner.

§ Dr. Peter Brand (Isle of Wight)
We welcome the fact that the Government, unlike the previous Government, recognise the important link between poverty and ill 1231 health. Will the Secretary of State and the Chancellor ensure that some of the nation's wealth is redistributed to improve the nation's health?
I hope that local targets will not be an excuse for complacency or defeatism. It is no more acceptable to have an unwanted teenage pregnancy on the Isle of Wight than it is in the centre of London, and if one is suffering from asthma, it is as bad on the Isle of Wight as anywhere in the country.
I welcome the four specific targets, but will the Government commit resources to achieve them? On heart disease and strokes, the biggest step that the Government can take is to ensure that GPs' prescribing budgets are adequate for them to prescribe lipid-lowering agents. With the cost-limited drugs budget that was recently introduced, that might be extremely difficult.
On accidents in the home, will the Government take steps to set up a screening programme for osteoporosis, and encourage its treatment, so that we can avoid some of the hip fractures, of which there are 70,000 each year and which affect women, predominantly?
Will the Government look at the effectiveness of the Health and Safety Executive in investigating accidents in the workplace?
Will local government be funded to make cycling on our public highways safer for children?
On cancer services, will there be the resources fully to introduce the Calman/Hine proposals? Will the Government extend—[Interruption.] They are all very brief questions.

§ Madam Speaker
Order. I shall instruct the Secretary of State to answer only the first two questions if this goes on. We shall be here for the entire afternoon if the Secretary of State is required to answer all those questions. The hon. Gentleman has seen the interest that there is in the statement. There can be only one or two questions asked on the statement.

§ Dr. Brand
May I finish on mental health?

§ Madam Speaker
Yes.

§ Dr. Brand
Will the Government ensure that social services are sufficiently resourced so that they have adequate day centres, which are staffed by adequately trained people?

§ Mr. Dobson
I shall try to answer quickly. The basic object of concentrating on poverty-stricken areas in an effort to reduce ill health is already covered by the priorities of the Government's spending. The new deal for jobs, which is geographically targeted on those areas, the release of funds for building new houses, and the other things that we have done, such as reducing VAT on fuel, will certainly benefit people in those areas. As we promised at the general election, huge sums are already going into the areas that most need them. There is no question of local targets being sloppy and slack. The whole object is to ensure that each locality with its particular problems sets and meets tough targets—tougher than national targets—because, in the most deprived 1232 areas, unless we make a lot more progress than the national average, we shall never reduce inequalities between different areas.
Osteoporosis is one of the major causes of accidents and injuries to old people. As part of our drive on accidents, we shall seek to prevent osteoporosis. I am perfectly prepared to consider setting up general screening for osteoporosis, but I cannot just accept it standing at the Dispatch Box. The same goes for many of the other points that the hon. Gentleman made. I emphasise that we have issued a Green Paper, and if hon. Members on either side of the House want to make sensible suggestions and proposals for improvements, we are very happy to listen.

§ Audrey Wise (Preston)
I, too, add my congratulations to my right hon. Friend on the welcome recognition of the link between poverty, bad housing and ill health. Will he make quite sure that the needs of children are fully addressed? Poverty has a great impact on children, and there are worrying trends in the field of child mental health. Obviously, when we are considering children's health, we are considering future public health. Will my right hon. Friend keep those facts in the forefront of his mind?

§ Mr. Dobson
I thank my hon. Friend for her kind words, which are also addressed to the Minister for Public Health, my good and hon. Friend the Member for Dulwich and West Norwood (Ms Jowell), who has made a major contribution towards the production of this Green Paper.
I share the concern of my hon. Friend the Member for Preston (Audrey Wise) about the impact on children because some children's afflictions are getting worse, not just among the worst-off. Child mental health is declining and we need to do something about it. As my hon. Friend points out, if we can influence children from the start, we shall stand a chance of having a generation that grows up taking health much more seriously. That is why we shall have a healthy schools initiative. We are reintroducing nutritional standards for school meals, which is a step forward. It is worth remembering that in 1906 a Labour Member of Parliament said that a hungry child cannot learn. That is just as true today as ever it was, which is why schools must now introduce breakfast clubs, so that children get a decent meal and can learn.

§ Mr. Andrew Rowe (Faversham and Mid-Kent)
The Secretary of State will be pleased to note that we all share his vision of a teetotal, non-smoking nation, cycling from new homes in the green belt to new jobs provided through the new deal. Does the Green Paper go into detail about how such people can be persuaded not to spend their increasing wealth on more alcohol and tobacco, and on trading in their bicycles for the kind of car that creates the very pollution to which he objects?

§ Mr. Dobson
Although I do not drink very much, I am relieved to say that the medical advisers at the Department of Health constantly advise me that a glass of this, that and the other in moderation probably does people good. I would not want to suggest for a minute that the Government endorse the idea of a teetotal world. What we want is a tobacco-free world as soon as possible, 1233 and the drive must be to stop tobacco companies recruiting children. Few adults take up smoking, and we must make that drive to stop children smoking.

§ Mr. Patrick Nicholls (Teignbridge)
What about formula one?

§ Mr. Dobson
The hon. Gentleman refers to formula one. Let me remind him that, as a result of the negotiations carried out by the Minister for Public Health, a Europewide directive will soon come into operation to ban advertising and reduce sponsorship all over Europe. The directive could have been introduced years ago if it had not been blocked by the stupid, backward-looking Tory Government.

§ Dr. Lewis Moonie (Kirkcaldy)
For me, as one of the few possessors of an original copy of the Black report, today has been a long time coming. Does my right hon. Friend accept that it is for local communities to decide on their health priorities in the light of the health experience of their population, and for the Government to set the general scene? With that in mind, will he consider reinstituting the office of medical officer of health?

§ Mr. Dobson
I thank my hon. Friend for his remarks, which draw on his professional experience. I can go one better than him, because I possess two copies of the Black report. Between us, we have 3 per cent. of all the copies that were printed: the previous Government wanted to keep it quiet. I agree that it is right for the Government to set the general scene, and for local people and professionals to decide local priorities to address the particular problems of each locality.
I have some sympathy with my hon. Friend's point of view on the post of medical officer of health. It is no good me denying that, because I am on record as saying so before the general election. I was disappointed that no one took up the idea of a medical officer of health when the Labour party consulted on the future role of local government. What we must and shall do through the health improvement programme is to raise the status of the promotion of public health in each locality. We shall give real status to the people involved, because it was ripped away when a long-dead Tory Government got rid of the medical officers of health.

§ Mr. John Wilkinson (Ruislip-Northwood)
There is a much higher percentage of smokers in social class V than in social class I. They are proportionately much more susceptible to the three main killer diseases that the right hon. Gentleman cited: heart disease, stroke and cancer. How are the Government actively promoting his vision of a tobacco-free world to help those people? Is it by providing British taxpayers' money for European Union subsidies to tobacco-growing countries?

§ Mr. Dobson
I personally believe that European subsidies for tobacco growing are ludicrous, but that is the ludicrous situation we inherited from the previous Government. We want to persuade people to stop smoking, and we shall produce a White Paper setting out our intentions. We propose not only to ban advertising, but to use other methods to reduce the number of children who take up smoking. I am not making excuses for anyone, but for single parents living on a rundown estate 1234 with three or four kids, very little money, not much grub and a world of worry when they wake up every morning, a cigarette every now and again may be their only relaxation, and I find it hard to condemn them.

§ Mr. Kevin Barron (Rother Valley)
I welcome the Green Paper and the consequential consultation. Does my right hon. Friend agree that, by tackling inequalities in many aspects of our lives, the Government will improve the health of the nation? There are no lessons to be learnt from the Opposition. For 18 years they governed this country and created many of the inequalities that cause people to suffer ill health.

§ Mr. Dobson
I entirely agree. Let me remind the House of a plain statistical fact. In the 1970s, the incidence of death from heart disease was the same across all social classes—for men, that is. Now men in social class V are three times as likely to die from heart disease.

§ Mr. Peter Bottomley (Worthing, West)
Is not that because the lives of some have not changed? Is not that the lesson that we learn both from Keith Joseph's studies following his "Cycle of Deprivation" speech and from the Black report—of which there are two copies in our household? [Interruption.] I am not saying that we have done better than the Secretary of State; I am saying that we have the same number of copies as he has.
Is it not true that the only significant aspect that the right hon. Gentleman omitted from his introduction to the Green Paper is sexual health? Is it not also true that people in this country are more likely to contribute to the statistics for conceptions and terminations than they are to take up smoking? The figure for the former is 6,000 a week, while the figure for the latter is 5,000 a week.
The Secretary of State spoke of using reasonable terms. Should he not try to unite the House rather than artificially divide it?
Does the right hon. Gentleman not accept that members of all parties come to the House with the aim of reducing avoidable disadvantage, distress and handicap, and acknowledge that by working together we can learn from each other? To argue that we have started from scratch with this Green Paper is to deny that he has read the last one.

§ Mr. Dobson
We appear to have tracked down five of the 100 copies of the Black report. I do not know whether anyone else has a copy.
The fact that I did not mention sexual health—AIDS and HIV, for instance—in my introduction does not mean that it is not mentioned in the Green Paper. There is an awful lot in the Green Paper, and a good deal of work has been done.
I must be fair to the hon. Gentleman. When he was a Transport Minister, he did a substantial amount to reduce the number of accidents and deaths from accidents, and he deserves credit for that. As I said at the beginning, we are willing to listen to points that people make, and it is true that the previous Government made some efforts to promote health; but they were unwilling to recognise one factor. I believe that it was the other half of the Bottomley duo who ruled out the use by officials of the words 1235 "inequalities in health", because she did not like to hear them. If people will not listen to the words, it is very unlikely that they will address the problem.

§ Mr. Eddie O'Hara (Knowsley, South)
Does my right hon. Friend agree that public health is a matter of concern not only for every locality, but for every Department of State? Will he assure us that his Minister for Public Health will be responsible for the co-ordinating and shaping of public health policies across all Departments?

§ Mr. Dobson
We promised at the election that we would appoint the first-ever Minister for Public Health. My hon. Friend the Member for Dulwich and West Norwood has that task. We are co-ordinating efforts right across the Government, and my right hon. Friend the President of the Council chairs the Cabinet Committee with that responsibility.

§ Mr. David Tredinnick (Bosworth)
The right hon. Gentleman will be aware that demand for complementary and alternative medicine is at record levels. Has he any plans for greater use of the 750,000 complementary and alternative practitioners in the national health service? Does he accept that, as most complementary and alternative medicine is currently available only in private practice, poorer people are being discriminated against?
The right hon. Gentleman mentioned heart disease and asthma. Is he aware that very effective homoeopathic and herbal medicines are available to treat those conditions?

§ Mr. Dobson
I certainly recognise that complementary and alternative medicines work for some people in some circumstances. We are looking at the report produced by the Prince of Wales's group on what should be done to promote them, while protecting people from charlatans. After all, one of the reasons for the regulation of the medical profession was the fact that there used to be charlatans in it. If we are to allow people to practise, we need some rules and regulations, and those are being extended. I hope that they will provide the protection that people need, while also giving them the opportunity to use treatments that work on them. That is the test in the end: if something makes people feel better, it obviously works.

§ Mr. Dale Campbell-Savours (Workington)
Does not the delivery of targets greatly depend on the quality of local authority services and advice? What does the Green Paper propose in order to make social services and other advisory departments work closely with NHS departments? That conflict is at the heart of problems in many parts of our health service.

§ Mr. Dobson
My hon. Friend makes a valid point. Since we came to power, I have been concerned about the Berlin wall between the NHS and social services. Some of the proposals in the White Paper that was published in December are intended to address that problem, as are some of the suggestions in today's Green Paper. We shall also produce a White Paper on social services. We must reach the stage where people who need treatment and attention will simply be dealt with. They will go to officialdom, and officialdom will treat them. It should not 1236 be up to them to sort out whether to go to a community trust, a mental health trust, an acute trust, a social services department or a voluntary body. They should be able to go where they know that the best that is available will be given to them straight away when they need it. That is the object of all our changes.

§ Mr. Philip Hammond (Runnymede and Weybridge)
I am pleased to see the inclusion of targets in the Green Paper, which speaks of setting tough new targets in the context of various causes of death. None of those targets is new: they are all included in the White Paper entitled "The Health of the Nation", and none of them is tough, because every Green Paper target is lower than the corresponding one in the White Paper. Why has the Secretary of State reduced those causes-of-death targets?

§ Mr. Dobson
I have not.

§ Helen Jackson (Sheffield, Hillsborough)
I wholeheartedly welcome the Green Paper. My right hon. Friend spoke about local circumstances. When such circumstances include specific problems affecting public health, such as water supply and lead piping, will the Secretary of State expect all agencies, public and private, to co-operate with health authorities to remedy them?

§ Mr. Dobson
I shall. That is covered in the Green Paper, as is the need to make sure that adequate water supplies are available to everyone at prices that they can afford. That applies especially to large families or to families in which someone is incontinent and they need a great deal of water for laundry.

§ Mr. Tony Baldry (Banbury)
Does the Secretary of State appreciate that his statement will sound a bit hollow to councils, for example, in Oxfordshire where, as a consequence of this year's local government settlement, millions are being cut from the social services budget? Does a penny of new departmental public spending go with the Green Paper?

§ Mr. Dobson
I do not know how any member of the Tory party can complain about the allocation of funds to social services, because we are allocating to them this year for next year more money than the Tories intended, even if the witless Liberal Democrats did not notice it when they issued their press releases yesterday. We are allocating £1.5 billion more to the national health service. I should like to see more than that and I hope that more will go into the NHS eventually. We look forward to that, but I will accept no criticism from that lot opposite.

§ Dr. Howard Stoate (Dartford)
As a proper doctor, I welcome my right hon. Friend's statement. Does he agree that the role of a caring and compassionate Government should be to narrow the health gap between rich and poor? How will the Green Paper set about doing that?

§ Mr. Dobson
Over a lengthy period, I think that there will be a gradual improvement in the health of all social classes. Our object is so to target the additional resources and address the problems that batten down on the health of the worst-off that their progress will be faster than that of the well-off and reasonably healthy. That is the thrust 1237 of what we are trying to do, and I hope that we shall command support throughout the country. Our White Paper on the organisation of the health service has proved extremely popular with the professionals who will have to implement it, and I hope that today's proposals will be too because, as with the White Paper, this Green Paper is based on much talking by us, but even more listening.

§ Mr. Andrew Lansley (South Cambridgeshire)
I represent the healthiest constituency in Britain, but it is by no means necessarily the richest, so perhaps the Secretary of State will accept that there is no straight-line relationship between those two facts. Will he have the good grace to acknowledge the gains that were made in public health after "The Health of the Nation" White Paper? Will he explain how those gains can be built on by dropping some targets, diluting others and shuffling responsibility for public health away from his Department and on to every other Government Department? Furthermore, will he explain how a healthy schools initiative will be furthered in my constituency by the Department appearing to consent to the abandonment of the school nursing service?

§ Mr. Dobson
I believe that the hon. Gentleman was working in the Cabinet Office before he was elevated to the House of Commons. I say again that the spending totals that may have caused his local health authority not to be able to afford the school nursing service were set when he was advising the previous Government; I do not know whether he gave bad advice and they took it, or good advice and they ignored it.
There has been no dilution of targets, although they have been changed. The point that I try to make at all times is that there are some national targets, but we intend that there should be local targets that reflect local needs. Those targets are going to be tough and the people responsible will have to meet them.

§ Ms Margaret Moran (Luton, South)
Is my right hon. Friend aware that, in my constituency of Luton, South, the incidence of tuberculosis is twice the national average and is clearly linked, despite the comments of Conservative Members, to unemployment, bad housing and poverty? Will he join me in commending one of our local preventive health projects, called "Our House", which works primarily with women and children from the Kashmiri and Bangladeshi communities? Will he seek to extend that type of project, so that we can begin to tackle the appalling health inequalities that are the legacy of 18 years of Tory government?

§ Mr. Dobson
The scheme to which my hon. Friend refers is precisely the sort of local initiative that we wish to encourage.

§ Dr. Evan Harris (Oxford, West and Abingdon)
Sex was an area that the previous Government were not good at in terms of delivering good public health and meeting their targets on things such as sexually transmitted disease, teenage conceptions, and HIV infections—particularly in specific groups such as young gay men—which continue to occur. Will he give an assurance that—by working with other Departments, if necessary—the HIV strategy to follow will be adequately financed, that sex education can be brought into the national 1238 curriculum so that it can be delivered effectively, and that the stain on our law that is section 28 of the Local Government Act 1988, which prevents good sex education in schools and elsewhere, will finally be abolished?

§ Mr. Dobson
I was rather taken aback by the hon. Gentleman's opening remarks in relation to the previous Government; I personally try to avoid any moralising about anyone. It is certainly true that we need to ensure that further efforts are made to reduce and to stop the further spread of HIV and AIDS. It is also important that we find the resources to give treatment, which appears to be working in either restraining or, apparently in some cases, almost setting back the disease altogether. It is expensive, but it is worth while, which is why we have made additional funds available for the forthcoming year and why I personally ensured that those funds were still targeted at hospitals and areas that provide the bulk of the service, which have developed the necessary expertise and to which some people wish to go for reasons for anonymity, rather than going to their local hospital. However, we must counter any feeling which may develop that, because it may be possible to treat the disease, we need not care any more about whether we catch it.

§ Ms Tess Kingham (Gloucester)
How do the Government intend to address the wide regional variations in the level of infant deaths, which are clearly unacceptable?

§ Mr. Dobson
As I explained, the object is to have four national targets and to require each health authority, in collaboration with the rest of the health service, local authorities and other people, to say what is needed to deal with a particular problem, and then to get on with addressing it. The whole object is to achieve real, targeted, effective effort in each locality, addressing the problems of that locality. Having 27 targets did not really do the trick, although I do not deny that some progress was made and they helped in certain spheres. However, we do not think that they did the trick of encouraging the effort to be made where it was needed.

§ Mr. Neil Gerrard (Walthamstow)
My right hon. Friend will realise from some of the comments that have been made this afternoon and from some of the speculative media coverage of the Green Paper, that the identification of four main targets is being misinterpreted by some people as suggesting that other issues, particularly sexual health and HIV, have dropped off the agenda. Will he consider what he can do during the next few months to ensure that people, particularly those who do not read the Green Paper itself, realise that that is not the case and that they are still regarded as important? Will he ensure that, particularly for a condition such as HIV, which tends to be concentrated in a small number of health authorities, the health authorities that do not have many cases are not absolved from responsibility for doing some preventive work and setting their targets, even though they may be different from targets in high-prevalence areas?

§ Mr. Dobson
I commend my hon. Friend on his work as the chair of the all-party group on HIV and AIDS. 1239 There is no question of our downgrading the effort; we want to upgrade the effort. As one of my local hospitals, the Middlesex, is one of the world's leading hospitals in the treatment of HIV and AIDS, I have a close interest in what goes on there and I do not want to see anything that it is doing held up or reduced. However, as my hon. Friend says, we must ensure that every health authority and trust makes a proper contribution to the fight against the spread of those diseases and, where possible, to treating them.

Several hon. Members
rose—

§ Madam Speaker
Thank you. We shall now move on to the business statement.