Health Action Zones

HC Deb 31 March 1998 vol 309 cc1033-48

30 pm

The Secretary of State for Health (Mr. Frank Dobson)

Two weeks ago, I came to the House to announce that the extra £500 million earmarked for the national health service in the Chancellor's Budget would be devoted to reducing hospital in-patient waiting lists. That was part of our modernisation programme for the health service, which was set out in our recent White Paper "The New NHS". That programme will be necessary if patients and taxpayers are to get the full benefit of the extra resources we are providing, and if the million dedicated staff are to be able to use their talents to the full.

Our Green Paper on public health spelled out the action that the new Government intend to take to prevent people from falling ill in the first place, and to narrow the health gap between rich and poor./lb/> Today I come to the House to announce the 11 areas in England that will become health action zones, where special arrangements will be made to benefit local people by both modernising the local health services and taking concerted action to tackle the root causes of ill health.

Health action zones will involve local partnerships between the health service, local councils and voluntary groups and local businesses. Their job will be to make measurable improvements in the health of local people and in the quality of treatment and care. They will break down existing barriers that are holding back local partnerships, which everybody recognises are crucial to tackling intractable health problems in many of the worst-off parts of the country.

Applications to become a health action zone were received from 41 health authorities covering widely differing areas: inner cities, coalfield communities, struggling rural areas and places where wealth and poverty live cheek by jowl. I shall now announce the 11 areas chosen for the first wave.

The South Yorkshire coalfield communities of Barnsley, Doncaster and Rotherham with a population of 770,000, want in particular to tackle the problem of young people growing up in communities ravaged by pit closures and the chronic ill health of many older people. Bradford, with a population of 470,000, has already shown a willingness to work in partnership to tackle deep-seated causes of ill health.

The east end of London, covering the boroughs of Hackney, Newham and Tower Hamlets, with a population of 580,000, has the greatest concentration of poverty and poor health in the whole country. Lambeth, Southwark and Lewisham, with a population of 730,000, rank second only to the east end on the scale of need, and have the highest rate of under-age pregnancies in the country. Luton has a population of 180,000, and the unitary council and the health service have shown a remarkable commitment to working together.

Manchester, Salford and Trafford, with a population of 880,000, have shown an exemplary willingness to abandon old rivalries and instead to get together to promote the health and well-being of local people. North Cumbria, with a population of 320,000, is a predominantly rural area with acute deprivation on the coast of west Cumbria, whose needs were ignored by the previous Government.

Northumberland, with a population of 310,000, is another predominantly rural area. It also contains pockets of severe deprivation, where both the health of the local people and the environment are scarred by the legacy of industrial decline. Plymouth, with a population of 260,000, contains some of the most deprived neighbourhoods in Britain, and has often been ignored in the past because of its location in the west country.

Sandwell, with a population of 300,000, has an excellent record of collaborative regeneration, but faces major public health challenges. Tyne and Wear, with a population of 1,100,000, contains many seriously deprived areas, and the health service and local councils are committed to a common strategy to improve the health of the whole conurbation.

The areas chosen cover a total population of almost 6 million, and include many of the most deprived parts of the country. Every health service region is represented. The health action zones cover a wide range of circumstances, as the people living in them face a wide variety of problems. The hospitals, clinics and GP premises in the zones range from the very best to the very worst. All the zones need special help; all have demonstrated a willingness and capacity to change and modernize—to help themselves. The zones will make real changes in people's experience of health services, and will begin to make real progress in tackling inequalities.

Let me give just one example of the conditions that should receive special attention in a health action zone: diabetes. Diabetes is the principal cause of blindness, and a major cause of coronary heart disease and amputations. Many of those drastic consequences of diabetes could be avoided by early diagnosis, advice, help and treatment. In health action zones, bureaucratic obstacles to early and continuing top-quality attention and treatment for diabetes will be removed, so that primary, community and social services join hospital specialists to provide a continuous range of services. That is just one example of the changes that health action zones can bring about.

People will begin to experience real differences in health action zones. Let me give an example of local priorities from each of the zones that have been chosen. I mentioned diabetes. In Bradford, a new community-based diabetes service is being set up—a partnership between the health authority, general practice and community and acute trusts to deliver integrated preventive, specialist and primary care to a very needy population. That is an instance of the different parts of the NHS working together, rather than in competition.

In the South Yorkshire coalfield communities, a heart health programme will be implemented, and rehabilitation services will be redeveloped to better support the casualties of the coal and steel industries. In the east end of London—in recognition of the fact that everyone is healthier if they have a job—the health action zone will target improving job opportunities for disadvantaged young people, particularly those from ethnic minorities. It will work in partnership with the local authorities, new deal agencies, local employers—including health trusts—and voluntary groups.

In Lambeth, Southwark and Lewisham, the zone will develop an integrated approach to improving child health and supporting families, including programmes to improve parenting skills and reduce under-age pregnancies, and home start schemes to support families with vulnerable children. In Luton, the health needs of Asian women will be particularly addressed. There will be a focus on increasing the uptake of cervical screening, the development of a community-based coloscopy service with a female consultant, and a partnership between the NHS and the Asian community to address child development problems.

Manchester, Salford and Trafford will take an integrated approach to mental health, with programmes to provide employment and training opportunities for people with serious mental problems, and accompanying programmes to improve mental health services. North Cumbria will go ahead with an anti-poverty strategy and will work with local transport services to improve access to health services in rural areas.

Northumberland will develop a network of healthy living centres, ranging in scope from one based on a large community hospital and health facility, to making use of new technology—virtual centres for the most isolated rural areas. Plymouth will develop new approaches to improving dental health, particularly in children. In Sandwell, the health action zone will build on valuable work that has been carried out in your constituency, Madam Speaker, action on community health in Tipton and the Neptune health park, and will be used to develop community-focused health services throughout the zone.

In Tyne and Wear, there will be a new partnership approach to improving the health of elderly people, with a new system for assessing high risk, improved access to public transport, improved special housing, and a programme to improve home insulation and reduce hypothermia.

Now that the health action zones have been chosen, they must get on with the job, and much remains to be done. With the help of the NHS executive, each of the chosen areas will have to prepare detailed plans to implement what they have proposed. We shall be monitoring closely to check that their actions are having a real impact on health. They must ensure that they work in consultation with front-line staff, patients, carers and users.

I expect health action zones to develop ways of involving patients and the public in making decisions about local priorities. Each will be expected to produce by October a practical programme for measurable change.

Some £5.3 million will be made available in the coming year to promote joint working in each locality. A further £30 million will be made available in the following year to finance direct improvements in local health and health care. Further additional resources will also be available from the new opportunities fund to provide healthy living centres. We shall also look to give priority to the zones in terms of further development funds and initiatives, including giving them greater freedom and flexibility to improve health and social services for their people.

To improve local health, the health action zones will promote local partnerships to tackle pollution, homelessness, unemployment and poverty. To improve local health services, they will develop primary and community services, improve premises, promote the use of telemedicine, modernise hospital services and develop a health service that is moulded to the needs of local people.

To carry out both those tasks, the health action zones will have to tackle all the bureaucratic impediments that presently stand in the way. When they do that, it will save money and time, and that will let doctors, nurses and other staff get on with their real job of looking after patients instead of having to tend to the needs of the bureaucratic machine that we have inherited. That is a long-term challenge, and that is why this is a long-term commitment. It is seven years for each zone.

I realise that there will be great disappointment in the areas that have not been chosen, but this is just the first wave. A further group of 10 or a dozen areas will become health action zones next year. Once again, they will be chosen on the basis of need, and of being able to demonstrate a willingness and capacity to put together an effective local partnership.

I urge everybody concerned to continue to develop local partnerships. We know from the number of applications that that is what people throughout the country want to do, and that is further proof that what we are doing goes with the grain. I remind everyone that partnership can be put into practice without having to wait for health action zone status. Early partnerships will bring practical benefits for the health of local people, as well as improving the chances of success in the next round of applications.

The cornerstone of our public health strategy is our commitment to driving up the standards of health among the poorest at a faster rate than for the general population. We also want to modernise the NHS to meet the needs of patients and carers, and to give the dedicated staff of the health service the resources and opportunities to bring about the improvements in quality of treatment and care that they are striving to achieve.

This is a massive double challenge. No Government have previously dared to set themselves such a challenge. It means partnership in action, not partnership on paper. To meet the challenge will require targeted effort and targeted resources. Health action zones will deliver both.

Mr. Patrick Nicholls (Teignbridge)

First, may I apologise for the fact that my hon. Friend the Member for Stratford-on-Avon (Mr. Maples) is not making this response, and for the fact that I will have to go before the exchanges are over, for the reason that I have already given in correspondence to you, Madam Speaker, and to the Secretary of State?

The theme running through the White Paper is clearly that, if one can improve co-ordination between the various services, that must help inequalities in health. I say at the outset that that is a perfectly laudable aspiration, and I commend the Secretary of State for it. I am pleased also that the health action zones that have already been announced include rural areas. I cannot think for one moment why I ever doubted that they would, but I commend him for it.

However, whether or not the Secretary of State will succeed in his aspirations will depend not so much on the rhetoric of today's statement as on his response to some of the detailed questions that I imagine he is going to be asked. He has said that there will be 11 health action zones now and some 10 to 12 more next year. How far does he see the process of health action zones going? Ultimately, how many zones will be in place throughout the country?

Is there not the difficulty that, if the ultimate aim is that there should be a health action zone everywhere, the Secretary of State will be faced with a conflict of priorities in trying to work out which area is going to have more priority than another? In short, I ask him effectively to draw the dividing lines between what will count for inequality and what will not, because he knows as well as I do that, throughout the country, it would be possible to make a case even for areas of apparent affluence where there are inequalities that need to be addressed.

On finance, the Secretary of State said that £5.3 million would be made available in the coming year. He went on to say that £30 million extra will be made available in the following year. Is that new money or old? If it is new money, he is going to have to tell us why he thinks that those funds should be applied in this way and not in other, proven ways within the national health service to improve matters. If he is talking about new money, he is going to have to satisfy the House, and ultimately the public at large, that those relatively substantial sums should not be applied directly into reducing waiting lists.

Alternatively—it is not entirely obvious from what the Secretary of State has said—is it in fact old money? Is the money already there in the system? Some people will say that, if it is simply old money, this is very much a question of the emperor having no clothes. We hear enough strictures from the right hon. Gentleman, usually blamed on us, but that cannot last for ever—[HON. MEMBERS: "Oh no?"] They know how to take the bait. Wait and see what the response will be in the 13th month.

We hear enough strictures from the Secretary of State about why more resources are not available, so, if this is old money, where is the money being taken from? What areas will be rifled to produce that money? What areas will find that they have fewer resources to make up for the extra resources that are being applied in this way?

The Secretary of State talked eloquently about bureaucracy. I should like to know what increases in bureaucracy he is expecting. What new structures—not in theory, but in practice—is he expecting? Are we going to have a co-ordinator general? Are we going to have a team of outreach workers who will help to monitor the performance of the co-ordinator general?

In short, the Secretary of State seems to be doing two contradictory things, although doubtless with the best intentions. He talked about tackling all the bureaucratic impediments that presently stand in the way. Elsewhere, he talked movingly of the needs of the bureaucratic machine". Judging from his statements today, it is a recipe not so much for cutting bureaucracy as for increasing it.

Both today and since 1 May, the right hon. Gentleman has made great play of the fact that the way in which to deliver extra resources to the health service was to cut bureaucracy. How does it come about that one cuts bureaucracy and tackles the bureaucratic machine, while creating a new bureaucracy to do so?

The Secretary of State believes—it runs clearly throughout the statement as it did through the press release that announced the initiative some months ago—that health action zones will be able to address those inequalities in health that matter so much to him and to hon. Members on both sides of the House. However, his statement does not make it clear how he will measure the success of that policy. Indeed, it could not make that clear because, in his Green Paper, the right hon. Gentleman has reduced from 27 to four the criteria by which one judges whether the health of the nation has been improved.

I could offer my thoughts on that, but, knowing the cynicism that sometimes permeates the Labour Benches, I can tell the right hon. Gentleman that he does not have to take my word for the fact that the reduction of those targets will make it impossible for him to know whether his health action zones are successful. He has only to consider the remarks of Karen Caines of the Institute of Health Service Management. When talking about the effect that reducing the targets would have on inequalities in health care, she said: on this most crucial issue of health and equality they"— the Government— have bottled out. Without measurable targets, even over a long-term scale, there will be less pressure for change and less scope to hold them to account. I cannot say whether that lady is a right-wing nutter, but I have never yet heard that term applied to a leader writer in The Guardian. Considering whether health action zones and the like would succeed, that leader writer said: The Government is wrong to shrink the number of targets from 27 to four … Most serious of all is the absence of targets for reducing health inequalities. Anti-poverty campaigners must insist on their inclusion. There must be a specific commitment to close the gap. That is what The Guardian thought about the Secretary of State's approach to these matters, and the right hon. Gentleman needs to address that.

The Secretary of State has to say what he regards as the criteria of success. Aspirations do not cure anything. The right hon. Gentleman is engaged on a noble crusade to improve the health of those who are most disadvantaged in our country, but he has not yet told the House—it does not appear in the statement—what criteria he will use to decide whether that has been achieved.

We are dealing today with part of the same process that has permeated Government health policy since they took office, which is that they have not produced a radical agenda for improving the health of the nation. They have produced a blizzard of acronyms and snappy-sounding titles. Today we have heard about health action zones. We can add that to the Soviet-sounding NICE and Chimp, which can also be added to local community groups and primary care groups, as well as to the healthy living centres referred to so movingly today by the Secretary of State.

Will the right hon. Gentleman tell us something more about that, or will he rely instead on the quotation from the Minister for Public Health, his hon. Friend the Member for Dulwich and West Norwood (Ms Jowell)? In a memorable but infelicitous way, she talked about healthy living centres and said that they will be "Lycra-free zones". She said that they will be "exercise on prescription". I must ask the right hon. Gentleman how behaviour such as that, together with such nanny statism at its absolute worse, can take forward this agenda.

The statement is laudable enough in its aspirations, but it is woefully short on detail and on the criteria that must be used to see whether it is ultimately a success. Today, the Secretary of State must begin to address those questions. He must show that he is capable of transforming an ill-thought-out and ill-judged press release issued months ago into a coherent intellectual statement about how the health of the nation can be improved. So far, the Secretary of State's record in office has shown that he is completely incapable of doing so. Perhaps today, for once, he will prove that we are wrong.

Mr. Dobson

Criticism from Karen Caines—she and her husband were the principal architects of the lunatic system for organising the national health service that we inherited from the Tories—is music to my ears. Although it may sound strange coming from a Labour Cabinet member, the same applies to The Guardian leading articles.

I would take up too much time if I attempted to reply to all the points—some of which were conflicting—made by the hon. Member for Teignbridge (Mr. Nicholls). I welcome his welcome for our emphasis on co-ordination, which has certainly been lacking in the past. He accused us of making proposals for improving the health of the worst-off parts of the United Kingdom, and of abandoning proven ways of dealing with health inequalities. However, there are no proven ways of dealing with health inequalities in the UK. If there were, the Tories must have ignored them, because health inequalities grew—the health of poorer people fell even further behind the health of wealthy people—while the previous Government were in office.

We are determined to tackle the ill health that results from poverty where poverty occurs. That objective has very little to do with national targets, but everything to do with local targets. People are suffering from pneumoconiosis in Barnsley, Doncaster and Rotherham; people are not suffering from pneumoconiosis in east Surrey. Setting a national target for dealing with such conditions would therefore be a spurious approach. We are saying that, in those areas, effort will be targeted and bureaucracy broken down, as local people wish.

If the hon. Member for Teignbridge—who made a gallant effort to substitute for, and did much better than, the hon. Member for Stratford-on-Avon (Mr. Maples)—thinks that our proposals are not popular, he will have to explain why 41 health authorities applied for health action zone status. Sadly, 30 of them will be disappointed.

Mr. Jim Cousins (Newcastle upon Tyne, Central)

I congratulate my right hon. Friend—as only one hairy man can do to another—[Laughter.]

Mr. Peter Snape (West Bromwich, East)

Better move off that one, Jim.

Mr. Cousins

Yes; move off it, but hang on to it.

I congratulate my right hon. Friend on his statement, which will be greatly and warmly welcomed in Tyne and Wear, the largest of the health action zones. He will know that action will come not a moment too soon in Tyne and Wear, where—against the trend of the past 150 years—death rates are rising among younger men, who should be in the prime of their lives as earners, fathers and sportsmen, and among older women, who should be looking forward to many more happy and active years. I ask my right hon. Friend to consider that very difficult situation and accept that it requires urgent action—to ensure that the promises of partnership stated in the document submitted by Tyne and Wear are truly met; that specialists are winkled out of civic centres and hospitals and put to work with at-risk groups in communities; and that, together, we consider people's total well-being, mental and physical, in ensuring that the objectives are delivered.

Mr. Dobson

I thank my hon. Friend—like myself, a fully paid-up member of the hirsute tendency—for his welcome. I acknowledge the parlous state of health among many of the worst-off people in Tyne and Wear—which is why Tyne and Wear has been chosen as a health action zone. The fact—which, until recently, was denied by Conservative Members—is that unemployment is one of the principal causes of ill health. In younger people, unemployment leads to suicide and accidents; despair and hopelessness; and drug use, which itself leads to illness and early death. If a middle-aged man loses his job, his chance of dying in the next five years is doubled.

We therefore cannot tackle health problems by using health measures alone. We have to create jobs, build houses and get wages up. We have to tackle poverty, and pollution.

As for getting the specialists and consultants out doing the work, my experience of health service consultants, limited as it is, is that most want nothing more than an untrammelled opportunity to improve the health of people who are poorly. That is why they went into the profession. Many have been inhibited by bureaucracy and a lack of resources, which is why we are trying to tackle both.

Mr. Simon Hughes (Southwark, North and Bermondsey)

My colleagues and I warmly welcome the Secretary of State's statement. We congratulate him on following up the Green Paper of a few days ago, which was a statement of principle, with a statement which delivers some resources, targeted specifically to many of the worst-off areas. That is right even though, by the Secretary of State's admission, the first step is fairly modest.

I have three simple questions. First, given that 41 areas applied and only 11 were chosen, on what criteria was the choice made? Secondly, although the Secretary of State is of course right to say that each area has a different priority, does he agree that the ideal outcome of the scheme should be that, as far as health action zones go, everyone should have one?

Finally, given that it was implied in the statement, if not explicitly expressed, that the Berlin wall between health, social and other services needs to be broken down, has the right hon. Gentleman yet arrived at the view shared by my colleagues and me that the sooner we join health and social services commissioning, the better?

Mr. Dobson

I thank the hon. Gentleman for that welcome, which I suppose was to be expected as his constituency is in one of the chosen zones. I have to say that the zones were chosen on the basis of my estimation of the need in particular areas and on my estimation, with the advice of my ministerial colleagues and some officials, of the ability and capacity of the relevant people in a particular area to deliver what they said they could deliver. I am not pretending that it was a wholly objective activity. Unlike the previous Government, I will not shelter behind officials. In the end, the decisions were taken by me, and I take responsibility for them.

These are new ideas that we are putting into practice. We want to learn as we go along. It is what works that counts, and it may be that many of the ideas developed in health action zones are eventually incorporated into health improvement programmes, which every health authority will be expected to deliver.

Yes, we are dedicated to bringing down the Berlin wall between the national health service and social services. The people working in both services did a brilliant job last winter in working together and making use of the extra £300 million that we found, but no, we do not think that the services should be managed by one and the same organisation.

Mr. Kevin Barron (Rother Valley)

I welcome my right hon. Friend's statement. The need in the South Yorkshire coalfield is apparent to most people who have seen the devastation that has taken place over the past 15 years. The health action zone is most welcome, and we will be endeavouring to ensure that it works out for the people of South Yorkshire. Does my right hon. Friend agree that it will build on the partnerships that are already working in some parts of all three boroughs? I am thinking of the health and benefits bus which has been operating in Rotherham for many years and which has won national awards.

What discussions is my right hon. Friend having with other Government Departments about the action that they can take to assist in health action zones?

Mr. Dobson

I thank my hon. Friend for his welcome. The places chosen are ones where the relevant people were already demonstrating the capacity to work together on behalf of local people. We need to build on those partnerships and strengthen them, and I hope that we will be able to do that.

Of course, other Government Departments are also targeting their efforts. Many of the areas on which the Department for Education and Employment and the Department of the Environment, Transport and the Regions, for example, are targeting their efforts are the very places that have been chosen for health action zones or are broadly similar. That is because the need in those areas spreads across health, education, employment, housing and the environment. My right hon. Friend the Deputy Prime Minister will, in the fulness of time, be announcing the measures that we will be taking better to co-ordinate the various initiatives.

Mr. Graham Brady (Altrincham and Sale, West)

I welcome steps to improve health in Manchester and Salford, provided that they are not to the detriment of people in Trafford. Can the Secretary of State guarantee that the health action zone will not be used as a vehicle to transfer funding from Trafford to Salford or Manchester, and will he further guarantee that there will be no reduction in beds at Trafford general hospital or Altrincham general hospital?

Mr. Dobson

Both Trafford council and those responsible for the provision of health services in Trafford were enthusiastic members of the group that put together the bid for health action zone status for Manchester, Salford and Trafford. It is a great step forward for that part of Greater Manchester that they are working together, instead of the fractious, damaging and wasteful relationships that prevailed in the past.

As the elected representatives and those working for the health service in Trafford are enthusiastic supporters of the proposition, I assume that it will not involve the transfers that the hon. Gentleman fears. We have to make sure that the various services provided in those two cities and a borough help one another and work together in partnership. Perhaps Manchester can provide some services that are not available in Trafford or Salford, or vice versa.

Mr. Dale Campbell-Savours (Workington)

On behalf of my constituents and the people of north Cumbria, may I welcome my right hon. Friend's decision? I see it as a victory for all those who, ever since the Black report in the early 1980s, have argued right through that the only way to solve problems of deprivation in health care is to have an anti-poverty strategy directed towards those objectives. My right hon. Friend is the first Secretary of State for Health to deliver on precisely that agenda.

Mr. Dobson

I thank my hon. and good Friend for his kind words. I did not really need to read the Black report to understand what it was about, and the terrible wrong and injustice represented by the differing life chances between children born in Kentish Town or Cleator Moor compared with those living in Surrey or the most prosperous parts of Hampshire.

I wish people in those prosperous areas well, but I want children in every part of the country to have the same chance of a decent life expectation, a job, a healthy life, a successful marriage producing healthy children and breaking out of the terrible cycle of deprivation that has dragged down the lives of millions of people whom Labour Members have tried to represent. In my limited and humble way, so long as I stand at this Dispatch Box, I will remain committed to that, and my colleagues are behind me.

Mr. Peter Atkinson (Hexham)

I welcome today's announcement, particularly that a large, sparsely populated rural area has been included in the Northumberland health action zone. It provides an opportunity to congratulate the staff of the Northumberland health authority, who have produced an imaginative scheme using new technology to help those who live many miles away from local hospitals. The Secretary of State could do one further thing for my constituents in Hexham: he could give the go-ahead for a new district general hospital, which was promised by the previous Government but delayed by the present one.

Mr. Dobson

I am grateful to the hon. Gentleman for paying tribute to the Northumberland health authority and others associated with the bid, and their intention to demonstrate that new technology does not represent a threat, but, properly deployed, can result in massive improvements in health care, particularly for those in isolated rural communities. In respect of the new hospital at Hexham, I do not make promises at the Dispatch Box that I cannot guarantee to deliver. I hope that I will not be accused of breaking a promise that was made not by me, but by the hon. Member's hon. Friends.

Mr. Snape

Will my right hon. Friend accept my thanks and congratulations on behalf of my constituents in the borough of Sandwell for his welcome announcement? Widespread concern has been expressed locally about the future of the health service in the borough, particularly the accident and emergency services in West Bromwich and surrounding areas. His announcement will go a long way to allaying those concerns.

Will my right hon. Friend join me in congratulating the officers and members of the local health authority and health trust on the way in which they put together their successful bid? Will he also accept the congratulations of my hon. Friend the Member for Warley (Mr. Spellar) and the right hon. Member for West Bromwich, West (Miss Boothroyd), whose duties prevent them from expressing their thanks publicly?

Mr. Dobson

I could do nothing else, for fear of my life. I join my hon. Friend in congratulating those who put together Sandwell's fine application. It reflected the needs of the area and showed the effort and commitment of the local authority, the health authority and the trust. It is a great credit to them all.

Mr. Nicholas Winterton (Macclesfield)

The Secretary of State has made an exciting statement, but I am sure that he agrees that the proof of the pudding will be in the eating. I hope that all the areas that have been granted health action zone status take up the opportunity.

Does the right hon. Gentleman accept that even prosperous areas with low levels of unemployment, such as Macclesfield, have small pockets of extreme poverty and deprivation? He may be interested that the village of Poynton in the north of my constituency used to boast a number of coal mines, including the Nelson pit and the Anson pit. Particularly in the town of Macclesfield, there are some small pockets of extreme deprivation. Will there be an opportunity in future tranches for an area such as south Cheshire to gain health action zone status?

Mr. Dobson

I thank the hon. and generous Gentleman for his welcome for our proposals. He rightly says that the proof of the pudding is in the eating. I shall not claim credit until the proposals have worked. There are small pockets of deprivation in every part of the country. Their problems cannot be addressed fully by health action zone status. We are trying to ensure that the primary care system makes a positive contribution to the lives of people on small, rundown estates. Even in relatively prosperous villages, there are often people who are badly housed, badly paid, badly off and not very well.

Ms Rosie Winterton (Doncaster, Central)

May I add my congratulations to my right hon. Friend on designating the South Yorkshire coalfields as a health action zone? Will he join me in paying tribute to the hard work of the local authorities and the health authorities in forming the new partnership, which will tackle not only the effects of industrial diseases, but the worrying issue of the number of under-age pregnancies? The area has one of the highest levels of under-age pregnancy in the country.

Mr. Dobson

The performance of officials and the elected and appointed members of health authorities and trusts in Barnsley, Doncaster and Rotherham was exemplary in putting together their successful bid. God knows, few parts of the country have been as ill served in the past two decades by central Government as the South Yorkshire coalfields. We owe it to people there to provide services in an attempt to make up for all the awful things that have happened over the past few years, and to bring back the prosperity that they used to enjoy. We should aim to go beyond that, and raise standards of living and health higher than they were even when the pits were working.

Mr. Gerry Sutcliffe (Bradford, South)

I, too, welcome my right hon. Friend's statement and thank him on behalf of the people of Bradford for his kind words about Bradford's successful bid. Will not two key elements make health action zones successful: true partnership between local players and ownership in developing health platforms? I am sure that this will be superb news for all our districts.

Mr. Dobson

My hon. Friend missed out one person; in bringing people together to work positively for the health of the people of Bradford, nobody has played a bigger role than my hon. Friend himself. I congratulate him on that. It just shows what we can achieve when everybody is committed to working together to look after the interests of their town, village or great city, rather than working against one another, when things fall apart.

Mr. Nick Gibb (Bognor Regis and Littlehampton)

How will setting up 11 health action zones help people in West Sussex health authority, which is facing a very serious financial crisis that is threatening both community hospitals in my constituency? Twelve beds are to be closed at Littlehampton hospital tomorrow and 12 beds in the accident and emergency unit are under threat at Bognor Regis War Memorial hospital. How will the Secretary of State's announcement help to save those beds?

Mr. Dobson

It will not; there is no point in pretending that it will. The area is not a health action zone, so the measures will not help. I hope that the additional funding that we have provided for the health service—the £1.2 billion announced in the Budget, the £300 million found for the winter and the extra £500 million to deal with waiting lists for the coming year—will make some contribution. I do not know offhand the details of the finances of West Sussex health authority, but I could probably wager a tenner that it inherited some deficits from the previous Government.

Ms Margaret Moran (Luton, South)

Does my right hon. Friend accept my warmest congratulations on his great wisdom in selecting Luton as one of the health action zones? Is he aware that one of the key issues that the health action zone will need to tackle is the tragedy of high child mortality, which in Luton is 14 per cent. higher than the national average? Does he recognise that that is but one example of health inequality, which deepened in Luton over the past 18 years and should be to the eternal shame of Conservative Members?

Mr. Dobson

I thank my hon. Friend for her kind words. I have been accused two weeks running of being wise, which may be dangerous: I may be praised in a leading article in The Guardian if I am not careful. Child mortality is probably the worst manifestation of inequality in health. It is a disgrace to those of us who have been fortunate enough to experience the pleasure and thrill of a healthy child coming into this world and growing up that society denies such opportunity to so many.

Mr. Andrew Lansley (South Cambridgeshire)

Representing the healthiest constituency in England, I would be churlish to complain about initiatives intended to reduce health inequality. None the less, the Secretary of State should recognise that he talks of £5.3 million for a population of nearly 6 million, which is less than £1 per head, yet authorities often spend about £1,000 per head on health. Does he agree that every health authority should pursue initiatives such as those he is describing? Increasingly, health authorities should not have to jump through bureaucratic hoops to satisfy the Secretary of State. They should be given adequate funding and local freedom and responsibility to undertake initiatives that they judge are in their best interests, rather than undertaking simply what the Secretary of State judges ought to be in their interest.

Mr. Dobson

I certainly accept the hon. Gentleman's sensible point that the object must be to get every health authority to pursue such policies, targeted on improving health and taking down bureaucratic barriers that are preventing across-the-board efforts to improve health. That is our intention.

When we change the laws, as we will in the next Session, we shall place a duty on every health authority to draw up a health improvement programme for their area, in consultation with local people, reflecting local priorities. That is why we are not laying down national targets, as the previous Government did; we are allowing authorities to follow the four major targets that we have laid down and to identify how they will contribute towards them. They could also identify the particular problems that beset the people of their areas and come up with proposals for dealing with them.

At least on this occasion, we are broadly in agreement. I do not pretend that the £5.3 million that will be available to the health action zones in the forthcoming year will make a major contribution to health improvements this year; it is intended to facilitate some of the changes. However, £30 million extra will be available to health action zones in the following year and, because the Government will give them high priority for health spending, they will receive all sorts of other additional funds to help them deal with the problems facing their people, and to enable the dedicated staff in those parts of the country to do the job that they want to do.

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

I welcome my right hon. Friend's statement, but may I also refer him to my Adjournment debate on health inequalities in north Staffordshire? If he could offer the people of north Staffordshire some hope in connection with the consideration of subsequent health action zones, we would feel that we stood to benefit from his statement today, as we are so acutely aware of the huge health inequalities in our area. We are already working in partnership, and we would really appreciate an opportunity to discuss with my right hon. Friend how we could ensure that a subsequent bid would be successful.

Mr. Dobson

I understand the disappointment that will be felt in north Staffordshire—especially by my hon. Friend, who has put enormous effort into trying to get everybody there working together to improve health in the area, and into trying to persuade me to give north Staffordshire health action zone status. It is no criticism of my hon. Friend that I could not afford to give that status.

The problem is that I could choose only 10 or 11 areas, and in terms of a combination of need with a demonstrated capacity to start addressing the problem, north Staffordshire was not in the first 11. However, it was not far down the list, and I repeat what I said in my statement—that the more the people in each locality can work together, the more they will bring immediate benefits for the health of the local population. They will also be able to produce a more convincing case for health action zone status by demonstrating that they are already doing what we want them to do.

Mr. Owen Paterson (North Shropshire)

The aims are laudable, but we have heard little detail about how health action zones will work. Will the Minister please explain?

Mr. Dobson

I am sorry if my halting explanation in the statement seems to have passed the hon. Gentleman by. The idea is that in the health action zones all the organisations concerned—the health authorities, the trust or trusts, local authorities, voluntary organisations, community organisations, businesses and the various professions—should get together and start working together to draw up plans for targeted improvements in health and sensible changes in the way in which things are done—

Mr. Ian Bruce (South Dorset)

They could have an aerobics class together.

Mr. Dobson

I do not know whether it would be anything to do with an aerobics class in South Dorset, but it would have needed only 77 people in the constituency—an aerobics class, perhaps—to vote the other way at the election for the hon. Gentleman to have been replaced by a Labour Member. Until now, we have managed to have a perfectly sensible discussion with people making sensible points. Such empty-headed comments as the hon. Gentleman' s do no good, but they do show why, in as Tory an area as South Dorset, we got within 77 votes of winning the seat.

Mr. Lawrence Cunliffe (Leigh)

May I convey my congratulations to my right hon. Friend, even though the Wigan, Leigh and Bolton health authority has not been included? There is some disappointment about that, but we have put down a marker for mark II of the grants. Wigan is a classic example of an area of mining obsolescence, and the same is true of textiles in the Bolton area. We have the worst dental health records in Wigan—it is top of the pops in that respect—and the incidence of pneumoconiosis, emphysema, bronchitis and silicosis in our textile towns is very high. In setting any future criteria for health action zones, will my right hon. Friend ensure that favourable consideration is given to that part of the world?

Mr. Dobson

My hon. Friend has long been a powerful advocate of the interests of the people of Wigan and Bolton, and he continues today. I promise to look carefully at next year's applications, but I emphasise that anything he can do to get people to work together now will immediately benefit people, and will further the area's chances of being chosen next time.

Mr. Ronnie Campbell (Blyth Valley)

I congratulate my right hon. Friend and his team on a very, very good statement. I look forward to improved health for the men and women who worked in shipbuilding, the mines and the steelworks in the north-east—particularly in my constituency of Blyth Valley—because the legacy of poor health is starting to show through on the older people who worked in those industries. I hope that the proposals will help young people also—particularly in terms of the drugs scene, which is very big in the area and has been a bit of a mess for a long time. The proposals must be a giant step for the Labour Government.

Mr. Dobson

I thank my hon. Friend for his kind words. It is a sobering thought that the heavy industries in his part of the world have closed down, but have not been replaced to anything like the extent necessary to provide employment and reasonable prospects, particularly for a lot of young men in the area. At the same time, the suppliers of drugs have moved in to fill the vacuum. The efforts being made by my right hon. Friend the President of the Council and the Government's drugs co-ordinator will help, and should be part of the consideration for future health action zones.

Mr. Stephen Hesford (Wirral, West)

I congratulate my right hon. Friend and his team on what is essentially a public health approach to the matter. Does he accept that more than 1 million people on Merseyside will be disappointed that the area has not received health action zone status? My health authority, Wirral health authority, was one of the main players in the bid. Does he accept that progress was made across Merseyside to put the bid together?

I welcome the fact that my right hon. Friend courageously told the House that he took a personal approach in difficult circumstances in choosing the health action zones, as there were going to be only 10 or 11, and he will perhaps confirm that the Merseyside bid was very close. Can he assist areas such as Merseyside, which were disappointed on this occasion, by giving considered directions as to where they fell short?

Mr. Dobson

I can confirm that it is our intention—some of this may have been done already—that officials in my Department will be advising all the applicants on the strengths and weaknesses of their applications. I hope that that will lead to improvements. I tried my best not necessarily to make my judgment on the presentation of the individual application but on the substance behind it. We all know in various spheres that sometimes a flash application is not likely to be followed by flash performance.

Several hon. Members

rose—

Madam Speaker

Order. We must move on.