HC Deb 06 July 1999 vol 334 cc821-33 3.32 pm
The Secretary of State for Health (Mr. Frank Dobson)

The new White Paper which I am presenting to the House today is called "Saving Lives: Our Healthier Nation", and that is exactly what it is about. It spells out how we want to save lives by stopping people becoming ill in the first place.

We aim to save 300,000 lives by 2010 by reducing the death rate from cancer in people under 75 by at least one fifth; by reducing the death rate from coronary heart disease and stroke in people under 75 by at least two fifths; by reducing the death rate from accidents by one fifth; and by reducing the death rate from suicide by one fifth. Those are ambitious targets, which should mean that we become a healthier nation. They are bigger reductions than we suggested in the Green Paper—and unlike the Green Paper, those tough targets now apply not only to people under 65, but to people under 75.

Those targets are backed by action. On cancer, it is action against smoking, action to improve diet, action to improve screening uptake and quality, action to modernise cancer scanners and equipment, and action to improve treatment. On heart disease and strokes, again there will be action on smoking and diet and also action on blood pressure and exercise, action to cut heart attacks and action to improve rehabilitation.

However, that is only part of the story. We are not only setting tougher targets than the previous Government: we are explicitly aiming to do something quite different. Poor people are ill more often and die sooner, so we are going to tackle the inequalities in health, which grew under the previous Government.

Our policies are designed to improve most of all the health of the least healthy. The national health service has a big part to play, but our strategy requires a three-way partnership between the whole Government, local communities, families and individuals. None can succeed without the others. We reject the idea that individuals are powerless victims of their fate, but we also reject the Tory idea that individuals are entirely to blame for their own poor health.

We need to use all the means at our disposal to make it possible for everyone to lead a healthier life. Unemployment, low wages, poor housing, crime and disorder, lack of education, and environmental pollution all make people ill. The Government are taking action to tackle them. The windfall levy, opposed by both the Tories and the Liberal Democrats, provides jobs and training for young people; and 400,000 more people are now in work than when we were elected. Low pay is a health hazard, so we shall improve the health of more than 2 million people and their families through our introduction of a national minimum wage. This autumn, those families and many others will be further helped by the working families tax credit. Many thousands more will benefit from having a decent home to live in as a result of our increased investment in new and better homes for people who are badly housed at present. Improved educational standards are providing economic opportunity and pathways out of social exclusion.

The Government will play their part, but so too must communities. In some areas, whole neighbourhoods are unhealthy because of poverty, pollution, crime and disorder. We must target effort on those neighbourhoods. The most deprived areas are being helped by the extra effort and extra funding that flows from regeneration schemes, from health and education action zones, from lottery funds going into healthy living centres, from the replacement of substandard general practitioner premises, from the sure start programme for children, from the healthy schools project, and from our £96 million public health development fund.

We want to work with community organisations, local councils and health bodies to ensure that those programmes are delivered on the ground. Every health authority will have to draw up and implement a health improvement programme that identifies and meets the particular health and health care needs of its area. That is because priorities differ in different parts of the country, with different individuals and groups having different problems—for example, respiratory disease in areas of heavy industry, or formerly of heavy industry, or the higher incidence of heart disease or cancer among certain ethnic groups. Local councils, businesses and voluntary organisations will all be involved in developing and implementing those plans.

Fluoridation illustrates the new approach. The White Paper makes it clear that we will conduct an independent expert review of the safety and benefits of fluoridation. If that shows that fluoridation is beneficial, local authorities will be given new powers to require water companies to fluoridate where there is local support for doing so.

We also propose to strengthen the public health professions and to develop extended roles for health visitors, community and school nurses, and midwives. The new primary care groups will enable GPs and practice nurses to draw upon their unique relationship with patients to help to promote better health. Many of the groups are already doing that.

We want action by Government and action by communities, but that cannot be the end of the story. Individuals and families must play their part—for example, on smoking, which is the biggest single cause of avoidable death and of inequalities in health in this country. We have a twin-track strategy to stop the tobacco companies recruiting new smokers and to help existing smokers to give up the habit. Unlike the Tories, we accept the overwhelming evidence that tobacco advertising helps to get children addicted, so the Government intend to play their part by banning advertising from December. However, we also accept that individuals need help to give up smoking, which is why we are making free nicotine replacement therapy available to poor smokers who want to give up.

That is a recognition of the fact that up to now most health promotion strategies have actually widened the health gap, because the better-off have taken more notice than the worst-off. We need to develop strategies that have the most impact on the least healthy. That is one reason why the White Paper announces our decision to replace the Health Education Authority with a new hard-hitting Health Development Agency, with a much bigger role in working out and delivering the approaches that will work best.

Individuals and families can help one another. That is why we are launching a health skills programme that will give young people first-aid skills and health information; that is why we are launching our expert patients programme to help people with chronic diseases such as asthma and diabetes better to manage their conditions. That will be good for the NHS and good for patients, as fewer complications mean better health and less demand on GPs and hospitals, with resources used to tackle the highest priorities.

The White Paper sets out long-term plans for improving the health of the nation and reducing inequalities in health. They really are long-term plans: their full benefits will show up only in a decade or more. That is the time scale involved, but it is no reason for delay. It is all the more reason for getting on with it: 300,000 lives saved, 300,000 reasons for action.

Fifty-one years ago this week, the national health service, which Nye Bevan founded, came into operation. We all benefit from the far-sightedness of that Labour Government, whose action cut inequalities in access to health care. By itself, that action could not reduce inequalities in health, but common justice requires that we do so.

Conservative Members who represent areas where people are comfortably off and pretty healthy should recognise that ours is a simple but difficult aim. We want to help to make sure that the standard of health of the people they represent in Surrey or Sutton Coldfield is shared by the people we represent in Barnsley or Bethnal Green. That is what we mean when we say that we want to end the divisions that mar our society and instead create a genuine one nation. I believe that that is what all decent people want, wherever they live and whatever their own state of health. That is why I commend the White Paper to the House.

Hon. Members

Hear, hear.

Dr. Liam Fox (Woodspring)

Usually, farewell performances get a better cheer than that. The Opposition would welcome any genuine measures to improve the health of the people of the United Kingdom, but we deserved better than the right hon. Gentleman's remarks.

There are some aspects of the White Paper that we welcome. Since the publication of the Green Paper, the Secretary of State has changed the targets, but I am sorry that he has not widened them. For example, the expert patients programme he outlined for asthma and diabetes is welcome, but it is not a substitute for targets, which we wanted. Of course we need to send positive health messages to the population—lose weight, eat sensibly, exercise more and, as it says in "Ten Tips For Better Health": Manage stress by … talking things through … Practise safer sex and follow the Highway Code. Those are important messages for the public, but the White Paper is heavy on gimmicks and short on substance.

Let me give one example. The section on defibrillators says: members of the public can use them as soon as it is clear that they are needed in, for example, supermarkets, railway stations and airports. How are members of the public to know when a defibrillator is needed? How will they be trained? What will any indemnity consist of—will the Government provide blanket indemnity? If the Government are truly concerned, it would be better to spend the money on improving ambulance response times.

If, as the Secretary of State said, cancer scanners are to be modernised, are more staff to be recruited to operate them and interpret the results? There is currently a shortage of both radiographers and radiologists. At a time when fully trained obstetricians and gynaecologists are being laid off, how does that give comfort to women suffering from cervical or uterine cancer? The reality does not match the rhetoric. If exercise is to be encouraged, why has sport been removed from the national curriculum for primary schools? Does the right hon. Gentleman genuinely believe that suicide rates are the best way to measure the prevalence of mental illness, and on what basis has he arrived at that judgment?

If the White Paper is big on rhetoric, it is short on facing up to the big issues. The new approach was well illustrated by the Secretary of State's remarks about fluoridation: if it is shown that fluoridation is beneficial and there is local support for it, local authorities will be given powers in that respect—but only after there has been an independent expert review. Information on fluoridation is pouring out of the Department of Health, but the Government refuse to make a decision because somebody, somewhere, might not like it. That is a cowardly and pathetic approach to public health.

Rather offensively, the Secretary of State suggested that the Conservatives had said that individuals were responsible for their own ill-health. No Conservative Member has ever suggested such a thing. However, the Government cannot solve all the nation's health problems; the right hon. Gentleman was correct to say that there must be a partnership. He said that there must be a three-way partnership between the whole of Government, local communities, families and individuals—four parties, not three. There was no mention of the medical profession, which seemed to be noticeably lacking from what he had to say—perhaps because he has alienated almost all its members in recent times.

Perhaps the worst part of the statement came at the end, with the Secretary of State's class warfare rhetoric. As a result of Conservative economic policies and his party's very large majority, many of his Back Benchers represent the constituencies that he says are very affluent and therefore need less money. His ugly soundbites will offend many inside and outside both the House and the medical profession, as well as the natural decency of many people who care about those less fortunate than themselves. Is he saying that there is massive inequality in the allocation of money in the health service on a geographical basis? Will there be a transfer of resources from the Prime Minister's beloved middle England, or is the rhetoric merely aimed at those voting for a London mayor?

Despite laudable aims, better health can be achieved only with a health care system that is working well. Faced with a system in which morale is at an all-time low, junior doctors are being betrayed, complaints against the NHS are up and patients are waiting to go on waiting lists, we have heard nothing but complacency. Health is getting worse under Labour. Although the Secretary of State is excelling at soundbites and photo opportunities, he has failed in his primary duty to put patients before his party politics.

Mr. Dobson

The hon. Gentleman speaks a little quicker than his predecessor, but he does not talk much more sense. The first target of his mockery was the Government's chief medical officer. I would rather stick by that distinguished doctor more than the one who has just been speaking.

In talking about people dying, the hon. Gentleman apparently upbraided me for choosing the measure of suicides. As a doctor, he ought to know that, if suicides are successful, they involve people dying. If we can reduce the number of suicides, we will reduce the number of deaths. That seems to be a reasonable proposition.

The hon. Gentleman complained that we are not getting on with fluoridation. My understanding is that the data at present available in the Department of Health are rather out of date. We want an up-to-date assessment. I have never for one minute made any secret of my view that fluoridation works and should be introduced, but in fairness to those who have what they see as legitimate doubts, it is only right and proper that we have an independent review in which people may put their point of view and we may come to sensible conclusions.

On the rest of it, it was very interesting that the hon. Gentleman never seemed to recognise that ill health is caused by unemployment, poverty, low pay, crime and disorder—that soared under the Conservative party—or poor housing. We are addressing all those matters. We are improving the NHS so that it can make a bigger and better contribution. The point that I was trying to make was that all the Government and all the country must be involved.

If the hon. Gentleman thinks that it is class war for me to suggest that I would like the people whom I represent to be as healthy as those in the constituencies of my Tory predecessors, he believes in a strange version of class war. Most decent people in his constituency, or in the Surrey constituency of one of my predecessors, would probably agree that it is a good idea for us all to be as healthy as one another, and to achieve that by raising, not lowering, standards.

Mr. David Hinchliffe (Wakefield)

I warmly welcome my right hon. Friend's statement. Does he agree that for the previous Administration, public health was politically inconvenient—for the reasons that he has set out—and that as a consequence they sidelined, for example, the crucial Black report, on which we should have acted in the early 1980s and which would have delivered so much in public health to the generations who are being born today? Did they not also sideline the public health function?

I want to pick up one point on which my right hon. Friend knows I feel strongly. One thing lacking from what he said today is the restoration of the public health function to the political mainstream in local government, where it used to be, alongside housing, social services, education and environmental health. Will he consider that point, which is crucial to achieving the objectives that he has rightly set out today?

Mr. Dobson

I agree with my hon. Friend's point about the previous Government refusing to address health inequalities. Not only that—they banned the use of those words in the Department of Health, so that officials were forced to refer to variations in health because the Conservatives practised inequality but were not willing to preach it.

We appointed Sir Donald Acheson, who had been one of the previous Government's chief medical officers, to produce a report. His excellent report on various sources of inequality in health put forward many sensible propositions on how we should go about reducing those inequalities, and I am glad to say that we are getting on with that.

As my hon. Friend knows, I sympathise with his view about the disappearance of the post of medical officer of health from local government—but when we consulted, in opposition, on whether that post should be restored, local government had little enthusiasm for the idea. That is one of the reasons why we placed in the Health Act 1999 a duty on health authorities to draw up a health improvement programme to identify the health care needs of their areas. That must be done through co-operation and consultation with local government and voluntary organisations. I hope that the report and that approach will eventually have the status that the chief medical officer's report had in times gone by.

Mr. Simon Hughes (Southwark, North and Bermondsey)

We very much welcome the White Paper as far as it goes, but why is it much more timid than it was originally billed to be? Are the Government yet committed to putting more resources from our national wealth into national health? Are they committed to putting more resources into public health, or will those resources come from the money allocated to the NHS? What indication is there that there will be, for example, a great programme to make sure that people do not live in badly insulated, damp flats and that local government has the money to deal with that?

Why were there 21 targets under the previous Government, but only four targets now? Why is there no target to reduce smoking? Why is there no target to reduce traffic? Above all, why is there no target to reduce health inequality, which is meant to be at the centre of the whole policy?

Will all Government policies be audited? If so, will we be given a guarantee that there will not, for example, be policies to take away benefits from single mothers, to reduce help to asylum seekers or to prevent pensions from increasing in line with national wealth, none of which can be great for health equalisation?

Did I understand the Secretary of State to say that the Health Education Authority—the one body that might be able to stand up and speak independently about what the Government are or are not doing—is to go? We want a body that can tell the Government when they are not meeting their targets and hold the Government to account. If the Government are tough on themselves, they might deliver; but if they are weak on themselves, they will let the rest of us down.

Mr. Dobson

It sticks in the gullet to listen to a Liberal Democrat say that the Government are not putting money into measures that combat ill-health, when his party voted against imposing the windfall levy on the fat-cat utilities. That money has been invested in providing jobs and training for young people—and as the hon. Gentleman should know, the only group whose mortality and morbidity figures were increasing was young, unemployed men. We are reducing those figures, and we are doing so with money that the hon. Gentleman did not want to collect, so he cannot complain about the way in which we are spending it.

We are putting £96 million into the public health development fund.

Mr. Hughes

Is it new money?

Mr. Dobson

It is new money. It is money that was not previously intended for that purpose, so it must be new. We are putting £5 billion into building new houses and improving old houses. Much of that money is intended to make sure that houses are well insulated, and it will concentrated on families who are poor and old people who are poor. That is more money that we are spending.

Mr. Hughes

Is it new money?

Mr. Dobson

The hon. Gentleman talks about new money as though there were something different about it. It is money. It gets houses built and improved; it gets jobs for young people; and it gets all sorts of other improvements.

When talking about health, we must remember that the Tories wanted to spend only £500 million a year extra. We want to reduce inequalities, but it is sensible to measure them in particular localities. It is necessary to be a statistical freak to obtain any significant run of figures about reducing health inequalities in less than about a decade.

The hon. Gentleman should know, having burbled on about pensions, that they have increased faster than wage inflation.

Mr. Kevin Barron (Rother Valley)

My right hon. Friend's statement will be welcomed by right hon. and hon. Members and by many of those who have worked in the medical profession for many years. Does he agree that the rant about the national health service from the Opposition Front Bench shows little understanding of public health? If economic and social environments lead to ill-health in certain regions and if getting rid of it is a war, it is a war that should have been fought many years ago.

Mr. Dobson

When it comes to fighting a war against poverty or one against ill health among the poor, the Tory party would only qualify for white feathers.

Mr. Stephen Dorrell (Charnwood)

Is it not extraordinary that the Health Secretary can come to the House to make a statement about his future policy towards public health and spare virtually not a word for the future of the medical profession? Rather than inventing entirely spurious party political differences between the Labour party and the Tory party, should he not have devoted himself more seriously to his statutory responsibilities for the national health service on the day after Dr. Bogle accused the Government of achieving total alienation from the medical profession? Does the right hon. Gentleman remember the speeches that he used to make in opposition about how morale in the health service had reached an all-time low? That is what he and his hon. Friends used to say. Has he not used his two years in the Department of Health to prove himself wrong?

Mr. Dobson


Mr. Dennis Skinner (Bolsover)

Is my right hon. Friend aware that we have just about got rid of the two years of Tory spending plans, albeit that he secured a little extra money for health? We are now moving into an era where my right hon. Friend will be able to spend £21 billion over the next three years, which is about 10 times as much as the Liberals wanted and more than twice what the Tories wanted. Does he accept my opinion that he must ensure that not a penny of that money is wasted? Come the general election, when some people will be prattling on about the euro and all that crap, we should be talking about saving people's lives.

Mr. Dobson

I say to my good and hon. Friend that I hope that by the time of the next general election there will be some signs of improvement in people's health. However, we can only measure those signs locally, not nationally.

Mrs. Virginia Bottomley (South-West Surrey)

The right hon. Gentleman will know that I applaud the strategy, unpopular as it often is, and difficult as it is to win battles with colleagues in delivering it. However, I ask him to look again at some of his comments. Why did his party vote against the new GP contract? It provided bonus pay for GPs in deprived areas; it paid them for the first time to screen new patients; and it gave them additional resources for hitting targets on immunisation and cancer screening. There are few practical steps that could do more to raise standards in poor areas.

Secondly, I applaud the reappearance of mental health as a target, but regret that a more sophisticated target has not been found than suicide figures. Will the right hon. Gentleman examine the effect of NHS Direct, which is starving of resources Samaritans and Saneline, which offer a practical service for people with mental health problems?

Finally, is it the right hon. Gentleman's policy to make the sick healthy by making the healthy sick? Mr. Roger Humphreys was admitted to the Royal Surrey hospital at 2.30 on Sunday. He was not found a bed on the ward until Monday night. He is 90, and he happens to live in a healthy area. People in that area feel that the Government's policy is to starve them of resources.

Mr. Dobson

We are not starving any area of resources.

Mr. Nicholas Soames (Mid-Sussex)

Yes, you are.

Mr. Dobson

The craw can wait. Every part of the country is getting more money in real terms this year than last year, and that is an increase by anyone's standards.

I congratulate the right hon. Member for South-West Surrey (Mrs. Bottomley) on some of the things that she did when she was Secretary of State, but not all that many. We are devoting more resources to mental health now than have ever been devoted in the past, and we are paying great attention to that aspect. It is fairly significant that of the Nye Bevan awards that were awarded yesterday, three were for mental health projects. The overall winner—the Nye of Nyes—was also for a mental health project, because we believe that in the past mental health has not had the attention that it deserves.

It is rather foolish of the right hon. Lady to start attacking NHS Direct, which is a good service. It has worked well. When I announced its extension, it was welcomed from the Tory Front Bench, which is a fairly novel experience for me, at least. NHS Direct provides a first-class service and offers help to people with physical and mental health problems. It is not draining resources from anyone. It is providing a 24-hour nurse-led service in 40 per cent. of the country now; it will cover 60 per cent. of the country by December; and it will probably cover the whole country by this time next year. When an independent survey of satisfaction was carried out, 97 per cent. of the people contacted were satisfied.

Mr. John Gunnell (Morley and Rothwell)

How will my right hon. Friend judge public opinion on fluoridation in a particular area? My family, who were brought up in New York, still benefit from the fluoridated water that they used there. I hope that we will introduce fluoridation and give the right instructions.

Mr. Dobson

Our proposal, subject to the outcome of the independent review, is that the law should be changed so that local councils conduct the process of consultation, because they have a democratic legitimacy that the local health service does not have in that respect. We would then have to sort out the form that the consultation would take in order to meet the requirements, whatever they were. Once that consultation had been carried out, and if there was a local majority, the water company serving that area would be obliged to fluoridate.

Dr. Peter Brand (Isle of Wight)

I very much welcome the consultation on social inequality in the report, but I am extremely worried about the loss of the national targets. They seem to have been shoved off into some never-never land of local targets. When the Green Paper was issued, the Minister gave an undertaking that he would place the local targets, in amalgamated form, in the Library, so that we could see whether they were being met through local endeavours.

Primary care groups have been working to health improvement programmes—and no doubt setting targets—for the past two months, yet we have not seen any Government figures to indicate what targets are being set, let alone what they are trying to achieve. When will we have a statement on these matters?

Mr. Dobson

The hon. Gentleman speaks as though the "The Health of the Nation" project succeeded, but it did not. It failed. It did not make the progress that it should have done. It is our view, and that of a substantial number of people who could be described as practitioners of public health—although I accept that it is not a universal view—that it is better to have a series of local targets and to monitor progress. The health improvement programmes will include targets, they will be monitored by the NHS regions, and therefore they will be monitored nationally—

Dr. Brand

Will the targets be published?

Mr. Dobson

Yes, the targets will certainly be published. Everything is published. The health improvement programmes themselves are published and the progress reports will have to be published. That brings pressure to bear on those on whom it should be brought to bear—the local people who are supposed to be doing the job.

Ms Diane Abbott (Hackney, North and Stoke Newington)

My right hon. Friend said earlier that mental health is a much-neglected area of public health. Does he agree that the mental health of black and ethnic minority people is an even more neglected area, even though a disproportionate number of black people are diagnosed as schizophrenic or are in the mental health system?

For three years, successive Health Ministers have told me that the Department is collecting figures nationally. For three years, successive Health Ministers have told me that they still do not have figures that they can make publicly available. Will my right hon. Friend take steps to ensure that his Department does what it says it has been doing for the past three years—collect figures on the number of black and ethnic minority people in the mental health system so that strategies can be developed to give the whole community the service it deserves?

Mr. Dobson

As my hon. Friend knows, I am determined to make sure that every individual and group in the country receives the proper, targeted attention they deserve, but, as she knows, one of the problems is that there are disputes about whether some black people are being diagnosed in what might be described as a racist way as suffering from mental illness, or a particular form of it, when that is not the case. We are wrestling to get statistics on which we can genuinely rely, rather than publishing statistics that we believe to be unsatisfactory and possibly misleading.

Mr. Peter Brooke (Cities of London and Westminster)

Where does the thinking behind the White Paper take the Department's contribution to the debate within the Government on the future of housing benefit?

Mr. Dobson

We are involved in all debates and all discussions within Government on housing policy generally, which is the responsibility of my right hon. Friend the Deputy Prime Minister. They include all aspects of housing policy, including benefits. We are involved, and we have to try to make sure that people have homes that are safe, secure and healthy at rents that they can afford.

Mr. James Wray (Glasgow, Baillieston)

Does my right hon. Friend believe that including fluoridation in the White Paper will set alarm bells ringing all over the United Kingdom? Is he aware of the moral, medical and legal aspects of fluoridation? Does he know that fluoridation breaches the Medicines Act 1968, the Water Act 1945 and the Food and Drugs (Scotland) Act 1956? No one in the medical or dental professions decided that fluoridation was good for people's health; that decision was made by a researcher appointed by an aluminium smelting company, who decided that, because dumping its waste was costly and because that waste was attracted to teeth and bones, water should be fluoridated. That is why people get skeletal fluorosis, dental fluorosis and chronic fluorine poisoning.

For the past 20 years, the medical and dental professions have been divided equally on fluoridation of public water supplies. I hope that, following the independent review and in order to stop one holy war in which I shall certainly play a great part, we do not fluoridate water and do not breach the civil liberties of individual citizens of the United Kingdom.

Mr. Dobson

It is certainly the case that there are divisions within the medical and other related professions over the merits or otherwise of fluoridation, but it would probably be an exaggeration to say that they are evenly divided. In so far as I have looked at the most modern evidence—one of the problems is that quite a lot of the evidence is not modern—I am reasonably convinced that the benefits exceed any risks. We should consider the health of children of poor families in Birmingham and in big cities where there is not fluoridation. There is a danger that some people may be putting their principles above a great deal of pain and unpleasantness for a large number of children.

Mr. David Curry (Skipton and Ripon)

Where will the dividing line be between the Health Development Agency and the Food Standards Agency in matters of nutrition? What are the implications of the statement for the Government's review of local authority standard spending assessments?

Mr. Dobson

We have made it clear that the Food Standards Agency will have some responsibility for nutrition. That is also being made clear by my colleagues on the Committee considering the Bill. The primary responsibility for nutrition will remain with the Department of Health, where it properly lies, as part of our overall programme to improve public health. We did not think that it was right to separate nutrition, as some people have suggested. Quite a few people thought that the Food Standards Agency should take on a substantial part of the Department of Health's role and virtually the whole function of the Ministry of Agriculture, Fisheries and Food, and that that role should be recreated at arm's length. We did not think that that was a sensible approach.

Mr. David Lock (Wyre Forest)

I welcome the White Paper. When is the review likely to be published? I invite my right hon. Friend to take this opportunity to congratulate the water companies—through Water UK—on their responsible attitude towards the discretion that was given to them under the Water (Fluoridation) Act 1985. It proved to be hopeless in practice. The water companies, the British Medical Association and the British Dental Association did not want that provision, and the Government have said that they will remove it.

Mr. Dobson

We intend to publish a report next April. I hope that it will be then, but these matters tend to drag on, as my hon. Friend knows. The water industry wants the law to be clarified. As for most organisations, a little clarity is a great help.

Mr. John Bercow (Buckingham)

Given the importance of exercise to the health of the nation, what discussions prior to the publication of the White Paper did the Secretary of State have with the Department for Culture, Media and Sport, with specific regard to the reduction in the time that is devoted in primary schools to physical education in general, and to the abolition of the compulsory requirement for team games to be played competitively after the age of 14? Furthermore, if the right hon. Gentleman believes in leading by example to show the importance of exercise and fitness—he appears to be shaking his head at that suggestion—will he take up my challenge to take me on at a game of better than five sets in lawn tennis on the assumption that I shall readily give him a 30:love start in every game?

Mr. Dobson

Apparently, the hon. Gentleman is so talented that, but for the fact that he was unable to find the time, he would have won the Wimbledon championship. One advantage of my girth is that no one ever accuses me of being part of the nanny state.

The Department for Culture, Media and Sport was involved in our discussions. In fact, when the hon. Gentleman complains that sport has been eliminated from schools, he is criticising the Government who eliminated it.

Mr. John Austin (Erith and Thamesmead)

Like my hon. Friend the Member for Wakefield (Mr. Hinchliffe), I remember the days of the old medical officer of health. I welcome the statement, which has elevated public health on the political agenda, and begins to transform a national illness service into a national health service. I congratulate my right hon. Friend and the Minister for Public Health on the attention they have paid to the problems of osteoporotic fractures and the possibility of prevention. I welcome the national guidelines.

In his statement, my right hon. Friend emphasised the importance of local decision making. What attempts will be made to ensure that those important national guidelines, which will reduce the cost to the Exchequer and to the health service, as well as the cost in human suffering, are implemented locally? On his commitment to action and his reference to smoking, given that most Departments, local authorities and private employers have policies on smoking in the workplace, when will the House be dragged not into the second half of the 20th century, but into the new millennium?

Mr. Dobson

The House of Commons Commission and the House itself are responsible for what happens here, so I am cleared of all responsibility. Like everyone else, I just have my one vote.

As I said earlier, I have some sympathy with the view that it was a sad change when the role of the medical officer of health disappeared from local government, and the task was taken on by people in the third and fourth tiers of a health authority as a part-time job, when they could get around to it. By changing the law in the Health Act 1999, we have made the production and implementation of a health improvement programme part of the core of the national health service. I hope that that will elevate the function in a way in which it has not been elevated for a long time.

I pay tribute to the National Osteoporosis Society for the developments to which my hon. Friend referred.

Sir Sydney Chapman (Chipping Barnet)

Is the right hon. Gentleman aware that his statement was a classic of its genre? A similar statement led a former Leader of the Opposition to observe that parts of it were true and parts of it were trite, but that, unfortunately, what was true was trite and what was not trite was not true.

Let us take an example: the question of fluoridation of our public water supplies. All the research has been done, and all the evidence has been amassed. What is needed is a decision whether to insist that our public water supplies are fluoridated, or that they are not—or to leave it to someone else to make a decision. No further research is needed.

Mr. Dobson

I have considered the matter carefully, as has my right hon. Friend the Minister for Public Health. We are both in favour of fluoridation, but we recognise that a substantial amount of the research that has been done, and is in the literature, is now pretty old. We would like a review to consider the up-to-date position.

We live in a democracy. A substantial number of people do not share my views on putting fluoride in water, so I think that I—and all the rest of us—have an obligation at least to deal with any legitimate concerns expressed by those people. If we are left with plain prejudice against fluoridation, we can assess that at the end of the process; but I feel that we owe it to everyone to try to get a group with sufficient authority, status and independence to carry all sensible people with them.

Several hon. Members


Madam Speaker

Order. We must move on.