Public Health

HC Deb 24 January 2001 vol 361 cc987-1032

Mr. Deputy Speaker (Mr. Michael Lord)

Mr. Speaker has selected the amendment in the name of the Prime Minister.

7.28 pm

Dr. Liam Fox (Woodspring)

I beg to move, That this House notes with concern the failures of Her Majesty's Government's public health policy, particularly relating to immunisation and communicable diseases; and calls on the Government to consider urgent measures to reduce the risks to public safety and to take urgent action to allay public concerns. When we debate health in the House, we often debate the structure and financing of the national health service, rather than considering health policy in detail. Health policy is an issue that we should discuss more. In this necessarily short debate, I intend to concentrate on areas of public health policy about which there is public anxiety, or in which I believe there to be a lack of information or a need for correction in the Government's position.

Those who take an interest in these issues expect public health policy to have more all-party support than most others. Indeed, I hope that this will be a matter on which the public can take reassurance from the agreement on both sides of the House when we come to decisions on the basis of the proper scientific evidence before us. That is why we have tabled a relatively modest motion on the failures, rather than the failure, of the Government's policy on public health.

In that spirit, I shall begin by speaking on immunisation. We need to congratulate the Government and the Department of Health on the success of the influenza vaccination campaign, and on the campaign relating to meningitis C, both of which we supported. Indeed, it shows exactly what can be done when the Department, through its advertising agencies, makes great play of such policy. We look forward to the development of a pneumococcus vaccine, for example, which offers great potential for advertising campaigns.

There has been great focus in recent days on MMR. As the House will know, MMR is the vaccine given to protect children against measles, mumps and rubella. There has also been much media coverage in recent weeks of possible links between the MMR vaccination and the incidence of both autism and Crohn's disease. We believe that MMR is still the best and the safest way to protect children from those diseases and that there is no evidence published that proves a link between MMR and those diseases. None the less, the vaccination uptake rate has declined.

The World Health Organisation recommends 95 per cent. as the figure needed to ensure herd immunity—in other words, that is the point at which the immunisation of others protects the rest. Immunisation reached 92.5 per cent. in 1995, but has fallen to 88.3 per cent. More important, the children who did not receive the vaccine when the health scare came to light are now reaching school age, and school is an environment in which the transmission of measles is much more common.

It is worth pointing out to those who fear MMR that 1 million children die from measles worldwide each year. In developing countries with poor vaccination programmes and poor nutrition rates, measles is an even more severe disease. It is rare in the United Kingdom but, even here, complications are common when children catch it. Those complications include a severe cough and breathing difficulties, pneumonia and eye infections. Most are caused by secondary bacterial infections, but there is a one in 1,000 chance of measles leading to encephalitis from which three in 10 will die.

It is important that those who make a choice about immunisation understand the relative risks that they may encounter. Those who do not die from encephalitis can suffer severe disabilities, including brain damage. Ireland is having similar immunisation problems. In 1999, there were more than 1,500 cases of measles and hundreds of young children had to be hospitalised, some suffering from dangerous inflammation of the brain. Two died, and many were left with long-lasting disabilities.

Another risk is that rubella and mumps will return. One mumps sufferer in 25 will suffer a degree of hearing loss. Before MMR was introduced, mumps was the most important cause of viral meningitis in children. We forget such statistics at our peril. Equally, before 1988 there were more than 40 cases of congenital rubella syndrome every year, which is not an insignificant number.

We need to immunise at a level sufficient to prevent any possible epidemic. We are below the level required, and recent events in Ireland and the Netherlands show the tragic consequences of failure to immunise. I believe that the scientific evidence clearly shows that MMR is safe and we are not convinced that there is any link between autism and MMR. However, many members of the public and some in the medical and nursing professions believe otherwise. That failure of confidence in the programme is resulting in a considerable public health risk.

I wrote to the Secretary of State on 1 December 1999 and, for the sake of giving information to the House, it is worth referring to that letter and his reply. I said: During our time in our relative positions, we will no doubt have a large number of issues where we will profoundly disagree. Well, that was right. I added: I hope, however, that in other areas, notably public health policy, we will be able to work together for the common good. One of these areas must be childhood immunisation and I know that you share my concerns about the low levels of MMR immunisation and the consequent risk of a measles epidemic. There has been a great deal of scientifically dubious information put into the public domain creating scare stories recently. The only possible outcome of this is a greater risk to all children of a measles outbreak which, as you know, can cause severe damage even in healthy populations like those in the UK. On behalf of the Opposition, I can assure you that we would be only too happy to undertake any joint initiative which shows that politicians can put party political differences behind them when important principles of public health are at stake. I hope you will accept this offer in the spirit in which it is offered. The Secretary of State thanked me and said that he would get in touch with the Minister for Public Health to decide how we could take forward an all-party initiative on improving uptake. I am sorry that it has taken longer than I would have liked for the Government to suggest the programme to educate the public about MMR, which I welcomed this week.

Mr. Stephen Hesford (Wirral, West)

Will the hon. Gentleman deal with this point? He may know that I am secretary of the all-party group on primary care and public health. We organised a meeting in June on that very topic.

He was invited, as was my hon. Friend the Minister for Public Health, who attended. We had a good meeting to take evidence, but I am afraid that the hon. Gentleman did not attend. Given his remarks about a bilateral approach to the issue, where was he that evening?

Dr. Fox

Considering the spirit and the tone of my remarks, the hon. Gentleman does himself and the House no service by making such a puerile point. The position of the Opposition was and is clear.

The Secretary of State will be aware that many people will be listening to the debate, hoping for reassurance. What would the Government's position be should MMR rates continue to fall? I do not ask him for a figure at which he might decide to alter policy because that would only encourage those who are sceptical not to opt for immunisation. However, I put it to him that if trends continue to fall, he may face the extraordinarily unpalatable decision of accepting single-dose vaccines as preferable to no vaccine at all.

I understand that that would not be an easy choice in terms of public health because the Secretary of State would not want to send out a wrong signal that might encourage people to believe that MMR is not safe. Nor do I believe that it would be responsible to leave people no option should parents decide that they were not satisfied about the safety of MMR, perhaps because of stories that they have read in the newspapers. In a spirit of co-operation, will he seriously consider how the Government would respond in such a situation? On tuberculosis, the problem is twofold. The school immunisation programme has been suspended in many parts of the country. At the same time, the number of TB cases is rising appreciably. The BCG vaccination was introduced in the United Kingdom in 1953, but the number of vaccinations fell from 476,000 in 1998–99 to only 196,000 in 1999–2000 due to the shortage of the vaccine, which we all understand.

The Government's most recent position was set out in a written answer on 8 January: Routine immunisation of all school children at age 10–14 was suspended in September 1999 due to severe manufacturing problems encountered by the sole United Kingdom licensed source, Celltech Medeva. The Department is doing all it can to secure a robust supply of UK licensed and batch released BCG vaccine, and will announce as soon as possible when the routine schools programme can resume. All those who missed their BCG vaccination due to the suspension of the programme will be recalled as part of a catch up programme.—[Official Report, 9 January 2001; Vol. 360, c. 539W.] I ask the Secretary of State to give us an idea of when the programme may resume because we are all receiving letters from concerned parents, especially those in areas where the health authority policy has for some time been not to immunise and the rate of TB infection has risen.

Tuberculosis has increasingly been associated with areas of urban decay. In 1998, the national survey of TB found that 56 per cent. of cases were in people born abroad, many in Africa. According to the Public Health Laboratory Service, there were 6,143 notified cases in 1999, 40 per cent. of which were in London. That has a massive implication for how the public health service is organised in the capital.

One major problem is lack of staff. Only 14 per cent. of the 43 health districts with the highest TB rates meet the minimum staffing standards. In Newham, for example, there are only two nurses to deal with 240 cases. The British Thoracic Society recommends one nurse per 40 cases. There are also problems with maintaining screening of asylum seekers—only 80 per cent, of asylum seekers at Heathrow are screened, for example. I should like to know what discussions the Secretary of State has had and what measures might be taken to increase that figure, especially for those coming from high-risk areas.

The number of cases of multi-drug resistant TB is increasing: there were 50 in the UK last year. A patient with multi-drug resistant TB costs the NHS an average of more than £60,000. That TB is usually caused by unmonitored patients failing to take the drug treatment correctly and developing resistance to effective anti-TB drugs. The Public Health Laboratory Service has reported a cluster of drug-resistant TB in north London. Twenty-six cases have been resistant to Isoniazid—25 in north London and one in south London. Again, that is an issue of concern. The House would welcome any comments that the Secretary of State can make in his reply on the implications for the organisation of health care services in London.

The next issue that I want to touch on briefly is CJD. There are two separate issues in this regard: the first is haemophiliacs, and the second is the measures that the Government introduced over Christmas and new year. Among haemophiliacs—I am sure that all hon. Members will have received correspondence on this—there is a feeling that there is unfairness in the United Kingdom. Patients with haemophilia in Scotland and Wales can obtain genetically pure recombinant factor 8, which poses no risk to the recipient. However, haemophiliacs in England still receive blood-derived products, which necessarily entail a higher risk. Haemophilia groups have made major representations, and I should like to ask the Secretary of State what measures the Department intends to take in future to minimise the risks for haemophiliacs.

Haemophiliacs have already had to endure a far higher risk of most diseases than any of us will ever have to endure. Having run the gauntlet of hepatitis and HIV, it is intolerable that they should have to go through further risk to save what is not a large amount of money for the NHS. At the very least, patients in England should be brought into line with those in Scotland and Wales on what is available from a publicly funded service.

Will the Government provide further information about the decision on tonsillectomies and single-use instruments that they announced over the Christmas recess? Last November, John Collinge of the Imperial College school of medicine claimed that half the surgical instruments used for tonsil operations could be contaminated by variant CJD. The Department issued guidelines and announced at Christmas that tonsillectomies would be performed using single-use instruments at the end of this year.

Concern has arisen because prisons, which are believed to cause variant CJD, are far more resistant to cleaning and heat sterilisation than normal bacteria and viruses. The tonsils are believed to be infected with variant CJD before obvious symptoms of the disease appear. It would therefore be possible for a surgeon to carry out a tonsillectomy on an apparently healthy person, contaminate his instruments and pass the infection on to someone else.

The infectious protein has also been found in the spleen, thymus, brain and lymph nodes. From the current debate on MMR, we are all aware that, if the public believe that information is not being made fully available, they are far less likely to listen to any messages coming from the Department. The Secretary of State may not be able to tell us this evening, but perhaps he can publish information and advice he has received about the relative risk of the operations that I have mentioned and the capacity of different tissues to harbour the protein that causes CJD. The more open we are about this debate and the more information that the public can have at the earliest possible date, the more likely we are to persuade them of the safety of this health policy.

Mr. Phil Hope (Corby)

The hon. Gentleman talked about providing public information and people knowing the issues surrounding all those communicable diseases. In my constituency, we have established the sure start programme, in which parents of very young children get advice and support and go somewhere where they can talk about the issues among themselves and to health professionals. Would the Opposition, if they were ever to come to power, keep or abolish the £500 million spend on the sure start programme, which is doing so much good in my constituency?

Dr. Fox

I am not aware of the details of the programme in the hon. Gentleman's constituency, but similar programmes work very well in other constituencies. Where publicly funded information programmes—established by that mechanism or other mechanisms which I should be happy to examine—ensure that the public feel confident about the information that they receive, that should be encouraged. This is a simple message about trying to reassure the public.

That is one of the biggest problems that we have as politicians. In the light of CJD and the fact that the public are necessarily sceptical about the evidence that scientists give them, Members of Parliament need to reassure them by every possible mechanism if they are to have confidence in public health policy and be part of the numbers required to make that policy work.

We also need to look at the resources provided for sterilisation units in our hospitals. We have heard recent examples of hospitals cancelling routine surgery because of a lack of confidence in their sterilisation equipment. Those things need to be considered as part of a wider policy review.

Finally, will the Secretary of State tell the House more about the details of the Government's sexual health strategy, which we have been promused for some time? However, according to the Public Health Laboratory Service, there has recently been a rapid increase in acute sexually transmitted disease infections. Since 1995, cases of chlamydia, for example, have risen by 76 per cent.; gonorrhoea by 55 per cent.; syphilis by 54 per cent.; and genital warts by 20 per cent. There have also been outbreaks of infectious syphilis in the homosexual community in Brighton and Manchester. Those trends are extremely worrying.

Will the Secretary of State deal with those issues in his reply? Will he tell us about the Government's intended approach to MMR and what policies on prevention and treatment they will introduce to deal with the increasing number of TB cases? Will the Government ensure that recombinant factor 8 will be made available to all haemophiliacs in England? Will the Secretary of State publish all the evidence on the relative risks of the transmissibility of CJD, and put that into the public domain? Will he also publish details of the Government's sexual health strategy, along with details about funding implications and targets?

We often have extremely partisan debates in the House and it is relatively unusual for us to have potentially consensual ones. However, public health is of concern to us all.

Mr. Christopher Leslie (Shipley)

rose—

Dr. Fox

I am not giving way.

I hope that the areas that I have outlined to the Secretary of State will make it clear that, potentially, there are areas of wide agreement between us. Failures in public health policy, particularly in relation to communicable diseases, are not acceptable. Those diseases put everyone at unnecessary risk. We can stop that, and we know how; it is simply a matter of having the will to do so. The Government will have our support if they put those measures in place. The Secretary of State now has a chance to ask for that support.

7.48 pm

The Secretary of State for Health (Mr. Alan Milburn)

I beg to move, To leave out from "House" to the end of the Question, and to add instead thereof: condemns the widening health inequalities between 1979 and 1997 and the failure of Conservative governments to acknowledge health inequality or address the growing health gap between rich and poor; and supports initiatives to improve public health and tackle health inequalities, including new vaccination programmes for influenza and Meningitis C, the allocation of an extra £450 million to improve cancer and coronary heart disease services in England, the extension of the breast screening programme to women aged between 65 and 70, the strategy to reduce teenage pregnancies, the largest-ever investment in smoking cessation services and the proposed ban on tobacco advertising and sponsorship. It is a top priority for the Government to improve the health of the nation, as the hon. Member for Woodspring (Dr. Fox) rightly said. Our country's vaccination programme is the first line of defence against serious disease and illness. As the hon. Gentleman rightly said, there is much of which we should be proud. We are the first country in the world—indeed, the NHS is the first health care system in the world—to have introduced the new meningitis C vaccine. The vaccine programme is the biggest that the country has seen since the polio vaccine was introduced four decades years ago. My right hon. Friend the Member for Holborn and St. Pancras (Mr. Dobson) was responsible for making that brave and right decision, which has saved lives. Already, about 500 cases have been prevented and we estimate that 50 deaths have been avoided. That will improve even further now that the programme is completed.

The hon. Member for Woodspring alluded also to the flu vaccine programme. As he knows, flu vaccine has been made available for the very first time to people 65 and over. In the three months to January 2001—thanks to the hard work of family doctors, practice nurses, health authorities and others—65 per cent. of the eligible population of over-65s have been immunised. When we set ourselves a target of 60 per cent. immunisation, some people said that it could not be done. It has been done. Indeed, the target has been exceeded. That is extremely welcome news.

Dr. Evan Harris (Oxford, West and Abingdon)

I support the Government's programme to deal with meningitis. However, does the Secretary of State realise that, because of the smaller number of meningitis C cases, there is a slight danger that the public will become complacent about the other strains of meningitis? The number of cases of other strains of meningitis has increased. The danger of headlines proclaiming "Meningitis solved", rather than "The meningitis C situation is improved" is that fewer people will be able to recognise the symptoms. There is still a long way to go on those other strains.

Mr. Milburn

The hon. Gentleman is quite right, and he speaks with some knowledge on these issues. As he is probably aware from the chief medical officer's press release early in the new year, that is precisely what Professor Donaldson was warning us against. We have made real progress on meningitis C, but a vaccine is not yet available for the other strains. The hon. Gentleman is absolutely right that we have to make more progress on those strains; of course we do.

The example of meningitis C demonstrates the importance of technology. The case is often made against the national health service that it lags behind other health services which have a better proven record in dealing with some health issues. Sadly, even in this country, people very often assume that the NHS is not up to scratch. However, meningitis C is a case in which the national health service has shown that it is leading the world, and that is capable of leading the world providing that we have the courage and the conviction to do the right thing, which is to put in the investment.

It is sometimes risky to be at the leading edge. My right hon. Friend the Member for Holborn and St. Pancras took that risk, and it was the right risk to take. The consequence is that lives have been saved.

The hon. Member for Woodspring also raised the issue of MMR vaccination. It is a very serious issue, and I should like to deal with it in some detail. I should start by saying that many parents understandably feel confused, and sometimes fearful, about the MMR vaccine. I fully understand those concerns, to which all hon. Members should listen extremely carefully.

For us as parents, there are always real dilemmas when it comes to protecting our children. All of us want to do what is right by our children. As parents that is our responsibility. We want to obtain the best advice and the best information so that we can make the best decisions for our children. There is also no doubt that reassurances from politicians—and, in the past, from scientists and others, most notably in relation to the BSE scandal—have made people more sceptical about the advice and information that they receive whether from government or from other quarters. That is just a fact of life, and we all have to deal with it as responsibly as possible. That goes for hon. Members and certainly for the media who report on events in this place.

The Government also have a responsibility to do what is right. We have to make decisions and policy according to the best evidence available—as the hon. Member for Woodspring was calling for us to do as recently as Monday, in our debate on the Tobacco Advertising and Promotion Bill.

If I may, I should like to read to the House the following statement: MMR is a very effective vaccine with an excellent safety record. It is recommended by the World Health Organisation and used in over 30 countries around the world. We believe that the support for the MMR vaccine among health professionals remains exceptionally high—despite recent claims to the contrary. All of the major health organisations in the UK support the MMR programme. Prior to the introduction of MMR there were thousands of cases of measles, mumps and rubella—and dozens of children died. This need not happen again. MMR is scientifically proven to be the safest and most effective way to protect children from disease. The new report by Dr. Wakefield does not present any evidence to change this view. There is a real concern about his advice that the vaccines should be given separately, since children would be left unnecessarily unprotected from these potentially serious diseases. We strongly recommend that children are protected with MMR and not left at risk. The vast majority of parents do get their children vaccinated but some parents remain concerned. We want to listen to these concerns and to work with parents and health professionals to provide reassurance and the best possible advice. That is not my reassurance. It is not ministerial advice to parents. It is not a statement by one politician or party or by a group of politicians or parties. It is the joint statement recommencing the use of MMR signed at the chief medical officer's national summit, on Monday. It was issued jointly by the Royal College of General Practitioners, the British Medical Association, the Royal College of Nursing, the Faculty of Public Health Medicine, the United Kingdom Public Health Association, the Royal College of Midwives, the Community Practitioners and Health Visitors Association, Unison, Sense, the Royal Pharmaceutical Society, the Public Health Laboratory Service and the Medicines Control Agency.

Those are not the only organisations sharing that view. Just today, the World Health Organisation issued a statement that said: WHO strongly endorses the use of MMR vaccine on the grounds of its convincing record of safety and efficacy. The combination vaccine is recommended rather than monovalent presentation when available and the disease burden justifies its use. There has been no new scientific evidence that would suggest impaired safety of MMR. On the contrary, all results from vaccine trials published reaffirm the high safety and efficacy of MMR vaccine. The hon. Member for Woodspring asked for the facts. Those are the facts of the situation.

Miss Julie Kirkbride (Bromsgrove)

The right hon. Gentleman has to understand that he can quote as many organisations as he likes, but some parents will still strongly believe that they should not give their child the MMR vaccine. For those parents, the Government have closed the door on the option of single vaccines. If we want to increase immunisation rates, surely it would be sensible to allow those who wish to have single vaccines to have them.

Mr. Milburn

I shall address the issue of parental choice in a moment or two if the hon. Lady—who I know has concerns of her own—will bear with me.

The hon. Member for Woodspring asked about coverage. As he knows, the coverage situation is not static at all. Rates of MMR vaccination started to fall in 1996, I think, and certainly they have fallen since. As he knows, coverage at age five is 93 per cent, but coverage at age 2 is 88 per cent. We know that those rates are not high enough and that action must be taken to increase them, to avoid precisely the type of measles outbreak that occurred very recently in Ireland, most notably in Dublin.

There is barely a country in the world that prescribes single vaccines. Japan is the only country that I know of that prescribes them. As the hon. Gentleman is well aware, between 1992 and 1997, Japan had, I think, 79 deaths from measles. In that period the United Kingdom had no deaths from measles. That is a salutary lesson for us all on the issue.

Miss Kirkbride

Will the right hon. Gentleman give way?

Mr. Milburn

I am coming to the hon. Lady's point, if she will be patient just one moment longer.

The hon. Member for Woodspring asked what the Government have been doing in the past year or so, since he wrote to me on the matter and I replied to him commending his approach. In the past year, we have placed advertisements on television. Posters and leaflets on MMR have been sent to every GP practice. Additionally, parents have received direct mailshots on the MMR vaccination. As he knows, there will also be a major public information campaign to inform parents of the facts about MMR so that they can make the best choices for their children. That campaign is supported by all the organisations that I mentioned earlier.

The policy that some people advocate—to put the health of children at risk by use of single vaccines—is fundamentally not about choice, but about chance. Parents always have the choice about whether to have their children vaccinated. However, I should make it clear that where licensed single jabs exist, or where unlicensed single jabs are legally provided, we have not prevented their use. What the Government cannot do, however, is to endorse a choice that the experts clearly believe will put children's health and children's lives at greater risk. It would be irresponsible of us to promote an alternative on the NHS that leaves children's lives to chance.

I am grateful to the hon. Member for Woodspring for the tone of his remarks this evening, which stands in some contrast to much of what he was saying only last week. I believe fundamentally that the position that his party has adopted has not allayed concerns but has, frankly, risked adding to them. If he wants to avoid damaging the case for MMR, I suggest that he gives unfettered support for the vaccine, without qualification.

This is a point not only for the hon. Gentleman but for some sections of the media to bear in mind. This is not a bandwagon for anyone in politics or outside to leap on. It is a serious public health issue that demands responsibility, not irresponsibility, on the part of every politician who is committed to improving the health of our children.

The same is true for some of the other issues that the hon. Gentleman raised. He raised serious issues concerning TB, sexual health and CJD. On TB, yes, it is true that cases have been rising. They have been rising since the early 1990s. They are rising throughout the world. He asked what we have done in response. The Government have responded with a firm programme of action, including more surveillance, better screening, and now the development of more rapid diagnostic and drug susceptibility tests.

The hon. Gentleman asked about the availability of the BCG vaccine, which is indeed a serious issue. He knows that we hit production problems with the one company producing the vaccine. Sadly, that was outside our control. He might not know that we have now been able to resume vaccinating schoolchildren in London, which is the area of highest risk. We are pursuing the matter actively. There are, sadly, not many manufacturers of the vaccine around, but we are doing all we can, and I hope that we will be able to make progress before too long.

Dr. Fox

When?

Mr. Milburn

I cannot say as yet, because we are still pursuing the matter. If I could give the hon. Gentleman an answer, I would.

The hon. Gentleman asked about sexually transmitted infections. They have been increasing since 1995. For 16 to 19-year-olds, there was a 53 per cent. increase in cases of gonorrhoea and a 45 per cent. increase in cases of chlamydia between 1995 and 1997. That is why we are now piloting chlamydia screening for the first time, with a view to rolling it out across the country as a whole. That is also is why we have introduced a policy to offer all pregnant women an HIV test, to reduce maternal transmission. The early results are very encouraging, and I hope that we will be able to build on them. Those are the reasons why the Government's health promotion campaigns are so important.

The hon. Gentleman asked about the publication of our sexual health strategy. I very much hope that we will be able to publish it within the next couple of months. What we cannot have, in the House or elsewhere, is a situation whereby people rail against high levels of unwanted pregnancy and then oppose making contraception more accessible. To do so begins to fall off the Richter scale of cant and hypocrisy.

The hon. Gentleman also asked about recombinant factor 8. My ministerial colleague, Lord Hunt, is considering precisely the issues that he raised, and had a meeting with the Haemophilia Society today to discuss that, among other matters.

The hon. Gentleman asked about the publication of relative risk in relation to transmission of vCJD, particularly in surgery. The Minister of State, my hon. Friend the Member for Southampton, Itchen (Mr. Denham), has already given a commitment that we will seek to get that information into the public domain, and that is the right thing to do. Relative risk is always a difficult issue, but it must be right to make the public aware. We must get away from a situation whereby politicians pronounce things 100 per cent. safe. We have to talk the language of safest, and assess what the risk is. [Interruption.] The hon. Member for Mid-Dorset and North Poole (Mr. Fraser) is laughing—

Mr. Christopher Fraser (Mid-Dorset and North Poole)

Not at what the right hon. Gentleman was saying.

Mr. Milburn

If it was a private joke between the hon. Gentleman and the hon. Member for New Forest, East (Dr. Lewis), perhaps they will share it with me.

Dr. Julian Lewis (New Forest, East)

I am delighted to share the joke. When the Secretary of State said that nothing was 100 per cent. safe, I observed to my hon. Friend that that included the job of the Secretary of State for Northern Ireland.

Mr. Milburn

That was an extremely amusing joke. [HON. MEMBERS: "You asked for it."] I suppose I did—and I got it, as did the whole House.

Fiona Mactaggart (Slough)

Does my right hon. Friend share my frustration at the fact that, 45 minutes into this debate, we have not even discussed the greatest threats to public health: coronary heart disease and cancer? Does he share my anger that, when the Conservatives were in power, death rates from those diseases among poorer people went up, so that someone in Slough is twice as likely to die from coronary heart disease as someone in the rest of the county, which is much more prosperous?

Mr. Milburn

My hon. Friend makes a cogent and important point.

I think that I have answered the questions that the hon. Member for Woodspring asked.

Dr. Fox

There was one little point that the Secretary of State missed out. I am sure that the medical profession, as well as parents, would be interested in the possible availability, perhaps as soon as the end of this year, of pneumococcal vaccine. What are the Government's plans for rolling out that vaccine, given the success in controlling meningitis C?

Mr. Milburn

My hon. Friend the Minister for Public Health advises me that our position on new vaccines is that we will roll them out as quickly as we can, but we need first to check their effectiveness to ensure that the programmes that we institute have the impact that we want.

Improving public health is about getting the vaccination programmes right and ensuring that immunisation programmes are relevant. It is also about assuring the public that those programmes produce the right result. We all have a part to play in that. There is, however, a wider issue. As my hon. Friend the Member for Slough (Fiona Mactaggart) rightly said, improving public health is also about tackling our country's biggest killers: cancer and coronary heart disease. It is about improving the health services that prevent illness as well as those that treat it. Fundamentally, it is about addressing the single most significant underlying cause of ill health and health inequality: the poverty that afflicts and divides our nation.

On cancer and heart disease, after decades of, frankly, shameful neglect, services are finally getting the investment that they need. This year, these life-saving services will get more investment than ever before: an extra £450 million. There will be more money for new drugs, for new equipment, for more staff and for more operations. There will be new national standards for heart disease and cancer care. Over the next few years, patients will see in the NHS the fastest improving cancer services anywhere in Europe.

The hon. Member for Woodspring asked about preventive services. For the very youngest to the very oldest, such services are being expanded. They are receiving new investment. For the first time, newborn children are receiving hearing tests. Primary school children are being given free fruit as part of the biggest programme to support child nutrition since Mrs. Thatcher scrapped free school milk in the 1980s. Women aged over 65 will, for the first time, be screened for breast cancer. New screening programmes are planned for colorectal cancer and, when the technology is developed to make it effective, for prostate cancer too. Already in this country we now have the most comprehensive smoking cessation services anywhere in the world, available to the seven in 10 smokers who say that they want to give up smoking.

Miss Kirkbride

Tobacco consumption is going up.

Mr. Milburn

The hon. Member for Bromsgrove (Miss Kirkbride) says, from a sedentary position, that tobacco consumption rates are rising. I am afraid that that is the factual inaccuracy peddled by the hon. Member for Woodspring in our debate on Monday. Although consumption rates were certainly rising for smokers overall right up to the point when the previous Government left office, the latest figures suggest that tobacco consumption is now falling. I believe that the measures that we have taken and that we plan to take—most notably the banning of tobacco advertising—will help protect the people who are most vulnerable to the dangers of smoking in the future. Those are young people, children and teenagers.

Underpinning all of our efforts to improve public health is the Government's commitment to address the causes of poverty that condemn so many to poorer health and shorter lives. This debate is about the public health agenda. The greatest public health challenges facing our country will never be addressed unless we deal with their fundamental causes—poverty of income and aspiration, lack of educational attainment and employment, and discrimination and social exclusion.

When we came to office, one child in five lived in a household where no one worked. Three million working-age people were out of work and had been dependent on benefits for two years or more. Four million children were living in poverty in 1995—three times the number 20 years before.

The health gap had widened too. In the late 1970s, death rates were over 53 per cent. higher among men in social classes 4 and 5 than among men in social classes 1 and 2. By the late 1980s, the health inequality gap had widened to 68 per cent. [Interruption.] The hon. Member for Bromsgrove thinks that that is something to smirk about—

Mr. Deputy Speaker (Sir Alan Haselhurst)

Order. We cannot have a running conversation from a sedentary position.

Mr. Milburn

We all know the Conservative position on issues of poverty and inequality. The hon. Member for Woodspring summed it up when he said: Poverty, poverty, poverty—la, la, la … it is just boring for Conservative Members.—[Official Report, 22 October 1992; Vol. 212, c. 636.] Poverty might be boring for the hon. Gentleman and other Conservative Members, but it is a sad fact of life for very many of our constituents. It has direct health implications. We shall not make the progress towards securing the healthier nation that we want until we secure a fairer society. That is what the Government are committed to—opportunity for all, and improving health for all. We are making new investment in health services, in prevention as well as treatment, and new vaccination and screening programmes. All of that is coupled to the Government's national crusade to end child poverty in a generation.

That is the path to better public health, and we are making progress along it.

8.13 pm

Mr. Nick Harvey (North Devon)

I welcome this opportunity to debate important issues of public health. Taken together, they constitute an agenda that should be the starting point for health debates in the House more often than is generally the case.

Although public health in Britain has improved over a long period of time, there is still a great deal to be worried about. Britain has the highest number of underweight babies in Europe. According to Government figures, there are 1 million children living below the poverty line who do not qualify for free school meals. Fuel poverty is still a problem too. According to latest figures from the National Energy Association, 8 million households cannot pay for the warmth that they need. Finally, the UK has the highest teenage pregnancy and birth rates in western Europe.

I welcome the NHS plan's attempt to address public health, and particularly the fact that there is to be more screening, although I believe that that needs to go even further and that more resources should be made available for capital expenditure in new technology. I also welcome the work of primary care groups and primary care trusts in identifying and registering those who are at greatest risk of ill health, and also the setting of national health inequalities targets.

It bears repeating that the state of public health depends on much more than just the state of the national health service. Much public policy in other Departments has a significant impact on public health outcomes. Equally, however, Britain's record on public health cannot be divorced from the state of the national health service. Many of our health problems stem from under-investment over a long period of time.

Many avoidable health problems have been exacerbated by a lack of nurses, and the lack of a co-ordinated public health programme that could have prevented many of the problems that the NHS has struggled to deal with. It is worth remembering that the number of nurses recruited fell from 37,000 in 1983 to 6,000 in 1995.

Other factors over the period also give cause for concern. In 1979, there were free sight tests, but people now pay £17 or £18 for the tests. Dental charges have risen 400 per cent. since 1979. Both those changes present significant barriers to health for those most in need of it—the poor. However, the charges make little significant contribution to the Exchequer.

As I say, many other factors beyond the immediate issues of the health service make an impact on public health. For example, the doubling in the crime rate, the disastrous public transport privatisations and deregulations, and the refusal—until this week—to implement a tobacco advertising ban were all significant public health failures of the past 20 years. It is only by addressing such background issues that we will bring about a significant improvement in levels and standards of public health.

I noted earlier that Britain has the highest rate of underweight babies in Europe, at 7 per cent. Lord Patel, a gynaecologist, says that he has clearly demonstrated a strong link between low birth rate and the low socio-economic group of the mother. Low birth weight has also been linked to adult diseases such as hypertension, heart disease and diabetes.

The Government should commission research into what constitutes a healthy income. Historically, rates have been based on political expediency, rather than on scientific principle.

Another concern has to do with school nurses, and the availability and quality of school health education programmes. We need at least another 500 school nurses, as teachers cannot be expected to provide health care as well as education. Dedicated expertise is required to meet the needs of the school-age population. In addition to the other postcode lotteries, we have a postcode lottery of health education. There must be a radical shake-up of the system, with better partnerships between the NHS, social services and local education authorities to ensure total availability to schools and their pupils of nurses and health visitors.

Liberal Democrats want there to be a statutory right for every child to have access to an independent health professional. We also want every school to have a named health professional provided through the local primary care group or primary care trust. In due course, we should like to see the creation of a national service framework on school health, with benchmarks and targets for improvement.

According to the Government's own figures, there are 1 million children living below the poverty line who do not qualify for free school meals. That is a cause for alarm, and it must constitute a priority for action. We support the Government's free fruit scheme for four to six-year-olds, but we hope that there will be scope to expand it to include older children. Malnutrition is a significant factor in health inequalities. Good eating habits and health education, supported at school, are vital.

Health inequalities must surely be one of the greatest concerns to all those with a sincere interest in public health. In the United Kingdom, people are twice as likely to die early in the poorest areas as in the richest, according to the UK Public Health Association.

Dentistry charges also promote inequalities. Access to NHS dentists is declining in many areas, as dentists drop out and move to private provision only. We believe that there is a need to do everything possible to bring more dentists back for at least part of their time into the NHS, to protect the poorest from ill health.

We also think that more help is needed in particular areas on the issue of water fluoridation, particularly in the light of York university's findings on its benefits. Areas with fluoridated water, either natural or added by the water companies, show as little as half as much tooth decay as areas without.

Dr. Fox

Would the hon. Gentleman go all the way with that view? Is it his party's policy to recommend fluoridation throughout the United Kingdom?

Mr. Harvey

We think that fluoridation should be available and that it should be a matter for local decision. There are great natural differences in the water in different parts of the country. That provides a logic for there being local decisions. Local authorities should have a greater responsibility for public health and should be the bodies to take responsibility for it, if need be by taking account, through a referendum or by other means, of the wishes of the local population. We certainly believe that fluoridation should be available as an option in all areas throughout the country.

It is also very important for eye check-up charges to be abolished. There is no greater impediment to making any improvement in public health than charging people for basic, routine tests which should be provided free as a matter of course.

I mentioned that fuel poverty is still a real problem. According to the latest figures, 8 million households cannot afford to pay for the warmth that they need. One in five lone parents reports damp affecting his or her children's health, and 22 per cent. of lone parents have no central heating. These are important factors determining health outcomes.

In 1998 there were far more extra deaths due to temperature drops in Britain than in the rest of Europe. In the UK, there was a 31 per cent. increase in deaths in the winter compared with the rest of the year, whereas the figure was only 14 per cent. in Sweden, 10 per cent. in Norway and 12 per cent. in Germany, according to House of Commons Library figures. Those are serious factors that have a real impact on health outcomes. Ending fuel poverty would mean fewer visits to GPs, fewer hospital admissions and fewer prescriptions.

The UK has the highest teenage pregnancy and birth rates in western Europe, with birth rates twice those in Germany, three times those in France and six times those in the Netherlands. The Government aim to halve those rates by 2010. That could be viewed as unambitious, but without proper co-ordination, and particularly the involvement of authorities on the ground at community level, I think that they will struggle even to meet those targets.

Evidence shows that some groups of young women are more likely than others to become pregnant: women from large families, those in lower socio-economic groups, those in families headed by lone parents and those with low levels of academic achievement. Resources, therefore, obviously need to be targeted and channelled effectively.

Some areas have rates of teenage pregnancies five times higher than those in other, more affluent areas. There is specifically a comparison between the Southwark area and the Chilterns. These figures are sometimes compiled by local authority ward, and there was a point in the mid-1990s when a local authority ward in my constituency—this may strike people as improbable and cause raised eyebrows—had the highest teenage pregnancy rates in the country; higher than any inner-city area, for example. So the matter is not as simple as identifying certain big cities that need to have all the money ploughed into them, while other areas—typically rural areas or southern areas—may be assumed not to need it. That is a long way from the truth. The facts are rather more complex. We must look at the wider causes, and all the agencies dealing with these age groups will need to be involved.

The burden of sex education should not always fall on teachers, some of whom will not be best qualified to give advice on these subjects. The Secretary of State mentioned that he hoped very much to bring out his sexual health strategy within the next couple of months. I welcome that, although it must be said that it seems to have had an extraordinarily long gestation period. I hope very much that when it comes it will tackle the issues involved head on. [HON. MEMBERS: "It may be an elephant."] The gestation period might imply that, but I hope that it will be rather more nimble and fleet of foot and will not kowtow to those in certain elements of the tabloid media who seem able to whip themselves up into a state of frenzy about the very things that are most needed to tackle some of these complex issues. Those countries that take a more progressive approach to these matters seem to have the best outcomes. I hope very much, therefore, that the target audience will not be the editorial writers on some of the newspapers to which I have referred.

Dr. Harris

Is it not surprising that the Conservative party is whipping against moves toward greater access to emergency contraception, given the evidence from other countries where children, young people and teenagers are not having any less sex than they are, I think prematurely, in this country? That evidence shows that better access to such contraception decreases the amount of teenage pregnancy, teenage abortion—which I know particularly worries the hon. Member for Woodspring (Dr. Fox), as it worries all of us—and teenage births.

Mr. Harvey

My hon. Friend makes a series of very good points. My advice to him is never to be surprised by anything that the Conservative Whips do.

According to the Public Health Laboratory Service, there was a record number of new HIV diagnoses in heterosexual females in 1999. That is cause for serious alarm. The hon. Member for Woodspring (Dr. Fox) made some pertinent points about the increasing incidence of sexually transmitted diseases over the past five years. Perhaps it is in no small all part due to the fact that, after the worries about AIDS which broke out in the 1980s and carried through into the early 1990s, there has probably been far less observance of safe sexual practices in recent years than there was before that. I think that that is in no small part due to the general perception in society and perhaps in the media that, because the AIDS epidemic has not reached the sort of numbers that were originally predicted, the whole problem has somehow or other been beaten. It certainly has not. If the growing incidence of these very serious conditions is an indication that people have become more relaxed about them, they are wrong to do so, and this lack of caution has potentially dangerous consequences. It must be a matter of concern to all of us that there are an estimated 30,000 HIV infections in the UK, with a third of them undiagnosed.

The tobacco advertising ban, which started its way through the House on Monday, and some of the commitments the Government have made in their NHS plan, are welcome signs that the Government are taking the public health agenda seriously, We gladly support them. But there is still a long way to go to put right some of the UK's real problems. That is why we should like to see a Minister of public health not in the Department of Health, but in the Cabinet Office, bringing together relevant policies across all Government Departments. Putting the important questions of public health at the very heart of Government is the surest way to making the further improvements that all of us in the House, of whatever colour, want to see.

8.30 pm

Mr. Stephen Hesford (Wirral, West)

I shall be shorter than I might have been, in the light of the way in which the Opposition have staged their debate. As the hon. Member for Woodspring (Dr. Fox) leaves the Chamber, I should like to draw attention to the motion. I am puzzled; it is worded in a weasel way. What is the purpose behind it? One might have expected a full-frontal attack on the use of MMR vaccines. The hon. Member for Woodspring did not do that, for which I am sure the House is grateful. I will say more about that in a moment.

Is it simply coincidence that we are having this debate when there is what I call the "Daily Mail tendency" debate in the press on MMR? Conservative Members do not have the courage of their convictions to join in that debate. They want to sail close to the debate for the sake of cheap publicity, but they will not come out with it.

Mr. Philip Hammond (Runnymede and Weybridge)

Does the hon. Gentleman not accept that part of the duty of the Opposition is to articulate in this place—the proper forum for debate—in a measured way issues that are of grave concern and are receiving a substantial airing in the media?

Mr. Hesford

The hon. Gentleman is clearly upset at what I say. I do not retract anything of it. Perhaps he could deal with my point about coincidence. Why are we having this debate now? I see that the hon. Gentleman is not about to rise.

Mr. Hammond

I am happy to rise, and the hon. Gentleman will hear more when I wind up. The debate is being held now because matters of great public concern are being aired in the media, and there may be misinformation about them. We believe that when issues of great public concern are being debated, it is right and proper that they should be aired in this place, in a measured way, and the Government should be given a proper opportunity to respond.

Mr. Hesford

So would it be wrong for us to have in mind a slight bandwagon tendency?

Mr. Peter Luff (Mid-Worcestershire)

Is the hon. Gentleman seriously suggesting that the House should ignore matters that are of concern to the public and deal with issues that are not of concern to them?

Mr. Hesford

I have to say—[Interruption.] Conservative Members do not want to hear the answer; they want to speak among themselves. [Interruption.] What Conservative Members wish to debate is a matter for them. I am simply seeking to understand why they want to debate this now.

I should like to touch on what I learned from the meeting that the all-party group on primary care and public health held on the important issue of MMR. As I said in my earlier intervention, an all-party approach was taken. My hon. Friend the Minister for Public Health came; we had an excellent debate, and heard from several eminent sources. The hon. Member for Woodspring asked for a cross-party approach on the issue, yet he failed to attend that meeting; he failed to adopt that approach. As a result of that meeting, there were several important press items affirming public confidence in the MMR vaccine.

Three issues arise from this question. The first is the safety of the immunisation programme. I know that there are concerns about that on the Opposition Benches. There are also the consequences of non-immunisation if people do not take part in the programme. The two cannot be dismissed—they have to run side by side. There is also the question of press treatment. I am afraid that in this country, certainly at the moment, the press are letting themselves down as the fourth estate in dealing with these issues. That makes the job of my hon. Friend the Minister that much more difficult in getting across a proposition that the scientific community agrees on. That is a barrier to proper debate and to putting across the information to my constituents and others.

At the meeting of the all-party group in July, we heard from Dr. Liz Miller, a very senior person at the Public Health Laboratory Service. She dealt with what I will call the rogue report—the report by Dr. Andrew Wakefield and his team, based at the Royal Free hospital. Rather curiously, one of the 37 studies, including that of the Committee on Safety of Medicines, was also based at the Royal Free and found that the adverse reports and the allegations were founded on data that were either not robust or had been disproved. Does the hon. Member for Runnymede and Weybridge (Mr. Hammond) accept that the Wakefield report is nonsense, and that there is nothing in it?

Dr. Miller went on to discuss—[Interruption.] I see that the hon. Member for Mid-Dorset and North Poole (Mr. Fraser) thinks that the entire debate is a joke.

Mr. Deputy Speaker

Order. I think that I might best advise the hon. Gentleman to move on with his speech and to turn as deaf an ear to sedentary interventions as I am occasionally indulgent enough to do.

Mr. Hesford

Your indulgence is well known, Mr. Deputy Speaker, and appreciated from time to time. Perhaps the hon. Gentleman will react in the same way.

Dr. Miller went on to discuss a paper in The Lancet in 1999 which reviewed the idea of the link between the MMR vaccine and autism. The main findings of the paper were as follows: there was no clustering of onsets shortly after the MMR vaccine, no difference in age at diagnosis between cases and the rest of the population, and no difference in MMR vaccine take-up between cases and the rest of the population. The paper also found that a rise in diagnosed autism cases pre-dated the use of the MMR vaccination, and that the rise continued while the vaccination uptake was constant—or, as we have heard, falling.

The Wakefield report was designed around invalid evidence. Dr. Miller stressed that the Wakefield report was entirely fallacious. Curiously, she concluded that a paper by Chadwick, et al, published in an august journal in 1998, decided that there was no link between MMR and alleged side effects. One of the authors was the same Dr. Wakefield.

Among the other contributors to the all-party meeting was Dr. Tony Jewel, a director of public health and a member of the UK Public Health Association. He made several telling points. If the public are to be re-engaged in accepting public vaccination programmes, the concept of no-fault compensation in vaccine damage cases should be sympathetically considered. Those involved in immunisation could have that at the back of their minds, if it were felt relevant to them as parents.

Dr. Jewel stressed also that the public must be reassured, with complete transparency in the communication of reports dealing with MMR research and use. I remind my hon. Friend the Minister of her comment on that occasion that the Government need to take vaccination safety seriously and must demonstrate that there is no cover-up in the dissemination of safety studies.

Another participant in that all-party meeting mentioned a worrying subset of the consequences of non-immunisation. I do not know how widespread this is, but Dr. Ruth Gallatley, Bradford's district immunisation co-ordinator, pointed out that some of the people withdrawing from immunisation programmes are ABC1s—members of the upper and middle classes.

Miss Kirkbride

Shameful.

Mr. Hesford

That was not a class-based point but, like one of Pavlov's dogs, the hon. Lady immediately shouts out. Dr. Gallatley was making the point of what she described as herd immunity—secured by a massive uptake in the immunisation programme; we have heard that MMR uptake used to be as high at 92.5 per cent. The figure is now below 90 per cent. Within herd immunity, certain people can hide behind sensible immunisation by a sufficient number of others, so that they can make so-called life style choices. That is worrying, because those are just the people—opinion formers—who should be sensible enough to stick with the programme and ensure that as many families as possible adhere to it.

I am not sure of the point of the motion or why we are debating it at this time. I am absolutely sure that, through my right hon. and hon. Friends, the Government are on top of the public health agenda. Far from being concerned about the Government failures that the motion suggests, the opposite is true. I commend my hon. Friend's work and look forward to working with her and others in future on this particular programme.

8.43 pm

Miss Julie Kirkbride (Bromsgrove)

I am grateful for catching your eye, Mr. Deputy Speaker, because I want to base my remarks on my views about the MMR vaccine. To that extent, I commend my hon. Friends on the Front Bench for bringing forward a motion that allows me to talk about my concerns relating to MMR and the public health debate on that issue.

Before I begin, I am a tempted to respond to the remarks by the Secretary of State, who made a typically gung-ho speech of the kind that he often gives to the House but which always contains some inaccuracies. The right hon. Gentleman is right to say that all parties would like a reduction in the number of people who live in poverty and its elimination, which is a desirable outcome in terms of public health. However, the Government must accept that the gap between the rich and the poor is widening under Labour, just as it widened under the Conservative Government—for which they castigated us. I am not sure whether they are as successful in their aims as the rhetoric from the Treasury Bench would have us believe.

The Secretary of State pointed out that, back in the 1950s and 1960s, there were extremely poor outcomes for people in the lower social classes—much worse than today. One of the reasons for that is that many hundreds of thousands of people worked down the mines and that killed them; yet during the period of the changeover from coal to gas, it was the Labour party that was most vociferous in saying that the change should not take place. However, the change clearly had public health outcomes—sadly, because of the reasons that I outlined.

My concerns this evening are about the MMR vaccine. As you probably know, Mr. Deputy Speaker, I am promoting a private Member's Bill that I hope will receive its Second Reading on 9 February. It is about MMR—especially my desire that the Government should offer choice to parents so that their children can receive separate measles, mumps and rubella vaccinations. It is right and proper for the Government to offer choice; the Government were wrong to close the door on that choice when they came to office by failing to continue to licence the single vaccinations, which had been available, for those parents who—no matter what—will, for perfectly legitimate reasons, want a single vaccination programme. Parents should be allowed that choice.

The Government are reaping the consequences of their decision. One of the main reasons for the fall in the number of people being given the MMR vaccination and thus the reduction in inoculation throughout the general population is the fact that they are given only the MMR vaccination or nothing—they no longer have the option of a separate vaccination programme. That is a great mistake and one for which the Government will rue the day unless they decide—sooner rather than later—to accede to the demand for parental choice.

Dr. Harris

I am listening carefully to the hon. Lady's thoughtful remarks. If she saw evidence that the introduction by the NHS of more choice in that matter might lead to more deaths from measles or to more cases of mumps and congenital rubella disease, would she continue to say that the provision by the NHS of the choice of what appears to be a less effective treatment was a price worth paying?

Miss Kirkbride

I respect the hon. Gentleman in many ways—certainly as he is a medical professional—but I do not accept that there would be a price worth paying in the way that he puts it, nor do I accept that it is likely that he could show me evidence that would prove his point.

I think that the evidence that we have heard so far in the MMR debate is flawed—a belief shared by many parents and which causes them to fear the MMR vaccination. The hon. Member for Wirral, West (Mr. Hesford) asks why we are hodling the debate. It is obvious to most hon. Members—even to the hon. Gentleman's colleagues on the Government Back Benches—that we are holding the debate because immunisation rates are falling to the point where we are in serious danger of an epidemic of measles. That could have extremely serious consequences.

The way to boost immunisation rates so that children escape the possibility of catching measles is to offer parents the choice of separate vaccinations if they want them. That would lead to an increase in the number of immunisations. The MMR vaccination should also be available for those parents who are happy with it.

The issue is fundamentally one of parental choice. It is about the nanny state saying, "You will have this vaccination or you will have nothing at all". Parents are not prepared to be bullied or patronised in that way. They must be given choice. They take difficult decisions on behalf of their children and do so with the best interests of their children at heart. It is not good enough for Ministers to say that they do not like that and that they have their own reasons for thinking that such choice is unacceptable or that it may lead to dangers. I do not accept their premise that it is more dangerous to offer single vaccinations. On the balance of probability, the greatest danger at present is that children are not being vaccinated at all. To boost rates by giving some vaccinations, because parents can choose the single vaccine programme, clearly has major public health benefits.

I should like to put on record—the Minister would upbraid me if I did not do so—the fact that I am a big supporter of the public inoculation programme; it has been hugely successful and has transformed childhood mortality during the past 50 years—and increasingly so, as medical science has progressed. However, we should not blindly accept that every inoculation programme is fine and must not be questioned I. The volume of circumstantial evidence—I fully accept that it is circumstantial, but it is worrying nevertheless—that exists about MMR is a cause for concern. That is one reason why I am pressing ahead with my Bill.

I understand why the Government have pursued a public information programme, costing £3 million, but they would have been better off putting that money into proper research that would truly allay parents' fears about the MMR vaccine. They should not assume that if they keep telling parents, they will eventually be believed. I am afraid that the public do not respect politicians—or, indeed, medics—to the extent that they are prepared to accept on trust a view expressed by either of those professions.

The Secretary of State mentioned the BSE saga. I am afraid that we have to bear that in mind because when the BSE difficulties first arose, politicians and the chief medical officer said that there was no cause for concern and no reason to believe that BSE causes CJD. The truth is that we still do not know whether BSE causes CJD; we cannot prove it. We can say the same about the link between BSE and CJD as about the possible link between MMR and autism. There is no proof that they are linked, but some people believe that they are. Many people believe that BSE and CJD are linked, but some people believe that there is a link with MMR that causes autism in some rare cases.

Since I decided to proceed with the private Member's Bill, I have received a huge postbag from anguished parents who are very upset that they do not have a choice. Parents, health workers and teachers have told me the story of their children. They have said that the personality of their children changed following the MMR inoculation. I do not know whether those changes are linked to the MMR vaccination, but I am happy to accept that the visible symptoms of autism occur at roughly the same time as the MMR vaccination. The problem is that a growing body of parents are concerned because they believe that there is a link.

Research has been undertaken by maverick, but nevertheless respectable, professionals into the possible link between the MMR and autism, so we should ask questions. It is wrong that the Department of Health does not take the issue more seriously if it wants to strengthen public confidence in the MMR vaccination.

Dr. Harris

The hon. Member for Woodspring (Dr. Fox) clearly supported single vaccines on a pragmatic basis, which we can discuss, but he explicitly rejected the possibility of a link between MMR and autism on the evidence that he had seen. Is the hon. Lady saying that part of the motivation for her promoting single vaccines is that she fears that there may be a link and that she is not satisfied with the evidence that there is no link between MMR and autism or Crohn's disease?

Miss Kirkbride

I am not satisfied that there is no link. I believe that there are reasons to be concerned. I do not say that there is a link, but I cannot say in all honesty that there is not.

I am fortunate to have recently had a child of my own. I have to judge my reaction to public policy on the basis of the choices that I would make for my family. If I were to take my young son to have an MMR vaccination—fortunately, I do not have to do so for another year—I would do so with fear in my heart because of the queries that have been raised in my mind about the vaccine's safety, about which I should like further reassurance.

Although there is no proof to support the concern of parents, there is a logic to it. They believe that if three live vaccines are given to children who, at the age of just over one, have a very immature immune system—certainly in this world where cotton wool and disinfectant are everywhere—there is a risk that the triple attack on the immune system may cause proteins to leak out of the intestine and cause brain damage. Some experts believe that children are being damaged in that way and think that it is a different form of autism.

Hon. Members who disagree with those parents have to explain why autism is so much on the increase in this country. Perhaps it is being diagnosed more often, but it is still a subject on which all hon. Members must get many letters every week from parents of autistic children about them being statemented. Sadly, it is a common condition among the children of people who write to us, and we need an explanation.

The evidence that the Department of Health has produced to reassure parents like me has done it no favours. The recent Finnish study of 1.8 million children has been used to prove that there is no problem, but the difficulty is that it did not find a single case of autism in all those children. That is statistically inconceivable, given the rise in the number of autistic cases. Not having found a case of autism worries me more than if it had told me that it had found a certain number of cases, because those would have been a statistical probability and have nothing to do with the MMR vaccination.

The study asked GPs to report their findings on the children after four to six weeks, but that was not long enough for the symptoms of autism to become apparent. The study was self-selecting and did not address the problem of autism. In addition, since the MMR vaccine was introduced in Finland, there has been a fourfold increase in cases of autism. The Department should give a more detailed response to those serious issues. The figures and information that it has provided so far have not been good enough.

The Secretary of State referred to Japan, on which he would not take my intervention, and the terrible case of 79 children who died from measles. The Department of Health has decided that that provides proof that single vaccines do not work. It has used the case to tell Conservative Members—and me in particular—that we are wicked because we advocate single vaccines and therefore a death sentence for our children. That is not true. Those children died because they were not vaccinated at all, which is rapidly becoming the case in this country. The huge crisis of public confidence in the MMR vaccine in Japan in the 1990s was caused—for want of a better description—by a rogue vaccine that would not have been licensed here either. It was rightly withdrawn, presumably on the advice of a body with equivalent responsibilities to the World Health Organisation.

As a result, the Japanese public lost confidence in vaccinations against childhood diseases and their children were not given them. Some of those children sadly died of measles. However, they did not die because they received single vaccinations but because they received no vaccinations. It is wrong for the Department to say that we cannot choose to have single vaccines because of what happened in Japan. The false and partial information that it provides makes people who strongly believe in choice, as I do, unhappy about the truthfulness of the Department in giving parents the full picture of the public health implications of the vaccine. That is why we should offer parents choice.

Clinics that administer single inoculations tend to leave a six-week gap between them. I accept that children are vulnerable to the diseases in that period, but that is nothing compared with the period of vulnerability if a child has no inoculations.

Again, I upbraid the Department of Health. A back door was open to single vaccinations for those people who felt strongly about the issue. A clinic in Edinburgh and a clinic in south London, called Direct Health 2000, probably met with the Department's disapproval because they have the temerity to be private, but if the Department really believes that it is better for children to have the MMR vaccination, there is no reason why people should not use their own money to have the inoculations done singly at their own expense. However, both clinics have been told that they can proceed with a single vaccination programme only for named children who have already received a vaccination.

It is wrong and stupid of the Department of Health to proceed on that basis. The clinics offered an option for the parents who felt strongly, but the option has been removed and the clinics have been given a stern reprimand about continuing to offer the choice. That has left an awful lot of parents disappointed that their one option of choice has been removed. The Department is foolish to be so bull-headed on the issue that it is not big enough to leave a bock door open for those parents who feel strongly.

I should also upbraid the hon. Member for Wirral, West. He seemed to suggest that the answer to increasing immunisation rates is to offer no-fault compensation for children who develop autism. That would make everyone have the vaccination. No parent will say, "That's all very well. I do not mind if my child develops autism, because I'll be compensated.' That is not how parents think about their children. While they have a fear that has not been allayed by proper research, no-fault compensation will not be the answer.

I suspect that I know why the Department does not want to reintroduce single vaccinations. Litigation is proceeding about the potential link with autism and compensation might have to be made available to those who have already been affected. Its lawyers are probably telling it not to give ground while the litigation is proceeding.

I also upbraid the hon. Member for Wirral, West for his old Labour stance that, because ABC1s do not want the vaccination, there is no cause to worry. They form a big part of the population and they are entitled to their opinion even if he does not think that he represents them. That is another reason why the alternatives should not be rejected out of hand.

The Secretary of State gave the impression that a speech like mine would create unnecessary fears and that it would be irresponsible to ask for single vaccines to be available to the general population. I reject that argument. It is irresponsible of the Department to continue, in its bull-headed fashion, to refuse to allow choice for parents. We do not live in the nanny state any more, however much Ministers would like to rewrite history. Parents are no longer prepared to accept on trust the advice of Ministers and some doctors. In a poll last week, health professionals also voiced their private concerns about MMR.

The public are not prepared to respond with complete trust; they will respond by making their own informed decisions. If we want our children to be protected and want to preclude the possibility of a measles outbreak in the United Kingdom, in which some children might die, we have to offer parents choice. I hope that this debate and perhaps my Bill—if it gets an airing on 9 February—will do something to persuade Ministers that they are being deliberately obdurate and that the time has now come for a change in Government policy.

9.4 pm

Judy Mallaber (Amber Valley)

I decided to seek to speak in the debate when I realised that it was likely to focus on immunisation and vaccination, because I was so concerned that the current debate on MMR vaccination could affect public confidence in our immunisation and vaccination programmes generally. Given the fairly measured speeches by Opposition Members, I am surprised that the motion does not reflect that, but implies that there is a general problem with the Government's public health policy on immunisation and communicable diseases. In terms of reducing confidence in the MMR vaccination it would have been helpful if the motion had not referred to the vaccination programme in general. That concerns me.

I was also surprised by the comments made by the hon. Member for Woodspring (Dr. Fox) about CJD and the public believing that full information had not been made available. One of the first people to visit a surgery I held just after being elected to Parliament was a woman on her way to visit her son who was dying in a local hospital of CJD. She would not believe now that full information was made available during the years covered by the Phillips inquiry. I hope that the House will soon have a debate on the Phillips report, because it is important that the full facts emerge and that the culture of secrecy that prevailed is wiped away.

The reason that I am so concerned that people should not have a problem with vaccination generally and that I am surprised at the terms of the Opposition's motion is rooted in one of the worst things that has happened to me since becoming a Member of Parliament. In summer 1999, while on holiday in Devon, I received a pager message from a member of staff in my constituency office mentioning the name of a small boy who had just died. The reason that message was so upsetting was not just that it told of the death of one particular boy, but that it confirmed that a village in my constituency had suffered a wholly inexplicable series of outbreaks of meningitis.

Several deaths and other cases of the disease occurred in three separate outbreaks despite every measure being taken that would normally be taken to deal with an epidemic. No one in the world could explain the outbreaks. I spent much of that summer on the phone with my right hon. Friend the Member for Holborn and St. Pancras (Mr. Dobson) who was in Yorkshire, and other senior Government advisers who were on holiday in other places, trying to persuade them to grant the request made by my local health authority to get the vaccine that was just being trialled and had not yet been licensed into that village, because there was no other way in which to solve the problem.

I was deeply grateful when that action was taken, and extremely relieved to hear of the latest results, which show what an amazing success that vaccination programme has been in tackling meningitis C. Far from talking about the failures of Government public health policy coupled with reference to immunisation programmes, we should recognise that the meningitis C programme and the flu programme have been among our major successes. We should applaud that, not suggest that all of the programmes are in danger. I am concerned about any lack of confidence in one programme spilling over into others.

Mr. Philip Hammond (Runnymede and Weybridge)

Will the hon. Lady acknowledge that, when opening the debate, my hon. Friend the Member for Woodspring (Dr. Fox) specifically said that the motion was worded as it was so that he could make it clear that he was not suggesting that the Government public health policy was failing as a whole, but that there were certain failures that needed to be addressed?

Judy Mallaber

I said that it was the fairly measured comments made by Opposition Members that caused my surprise that the motion did not explicitly recognise that attitude. Someone outside reading the motion would not have taken that point. I explicitly acknowledged that Opposition Members' speeches had been fairly measured.

It is important that we applaud the successes of the programme. Before coming into the Chamber, I spoke to the southern Derbyshire consultant in communicable diseases. He told me of his fear that, once a specific illness had almost been eradicated, the public would not be so keen to get their vaccinations, leading to a danger that deaths would occur, whereupon the public would flood back, banging on the door, desperate to be part of the immunisation programme. My area and others have witnessed remarkable successes in terms of the incidence of and the number of deaths resulting from meningitis. As other speakers have said, we cannot be complacent. Even with the meningitis C programme, a number of people have still not been vaccinated. In the past year, cases of meningitis C in my area have arisen only among groups that have not yet reached the vaccination stage. There are still some who have not been treated under the programme.

The trauma, despair and terror of a village and an area that is imbued by such a disease are horrendous; there is hysteria, upset and anxiety. As was pointed out, we still need to find a vaccination for meningitis B. Parents and families must be on their guard, and it is important for that message to keep going out.

I thank my hon. Friend the Minister for Public Health for the quick response that she gave when I informed her of local fears that the Public Health Laboratory Service would charge for the polymerase chain reaction—or PCR—test, which has been important in identifying what is going on in relation to meningitis. The test has been one of our major successes in public health policy.

My neighbouring Member of Parliament, my hon. Friend the Member for Erewash (Liz Blackman), was influential in setting the terms of the debate about the flu vaccine. She initiated a debate on the matter last year in the House and was one of those who argued for lowering the age at which free inoculations can be given. The response given to the vaccination programmes by health authorities and all those involved has been remarkable.

I want briefly to mention broader public health issues. In my area and elsewhere, a number of imaginative initiatives are ensuring substantial success on the broader public health agenda, in direct contradiction to the terms of the motion. That success has occurred not only because we are putting massive extra resources into the health service—it is hard to see how the Opposition can square their incredible policies of tax cuts and maintaining spending—but because of the new structures and the way in which they are working.

I should like to give a couple of examples. The House recently discussed smoking cessation. My area now has smoking advisers, who are available in general practitioners' surgeries. Doctors can pass patients on to such advisers, who will provide assistance and talk to them about what giving up smoking will mean. If people decide to go ahead with the programme, the advisers can give them free nicotine patches. The chief executive of my primary care group said that her mother had been smoking 60 cigarettes a day for the past 40 years. As she pointed out, if she can give up because of the counselling programmes, anybody can.

We have also managed to reduce waiting times for GPs by introducing another initiative under which counsellors work in their surgeries. When people go to a doctor with mental health problems, whether they have been caused by bereavement or specific problems in their lives, they can be referred immediately to counselling services within the surgery. Such provision is now available throughout Amber Valley. It is reducing waiting times and dealing with the difficulties that arise when GPs do not have time to get to the bottom of what is happening to the patients who present themselves in their surgeries.

There are a number of other imaginative new initiatives, such as the use of physio-triage within GPs' surgeries. The range of initiatives that have been introduced are making a genuine and important impact on public health. That is down to the new structures that are in place, which are enabling us to spread best practice and to make resources available in GPs' surgeries while also linking them into services in local community hospitals and acute hospitals.

My Conservative opponent in the forthcoming election has just been reported in the local paper as saying that she will conduct a survey of all the local health service failures and that she will pass on the results to the hon. Member for Woodspring. I hope that she will leaflet Ripley market, as I have done recently. I was astounded to meet two people in one hour who had just left Glenfield hospital. They were extremely bright after triple heart bypass operations.

When I mentioned the incident to the chief executive of my primary care group, she assured me that it had not been deliberate and that she had not planted the people there simply because she knew that I was leafleting. The group had decided to set up a major programme to deal with triple heart bypasses. I do not know whether it has a conveyor belt programme, but we are starting to make an impact. We need new structures as well as resources.

We have had major successes in public health. They have helped people who suffered unbelievable trauma in my constituency. I am grateful for the support and help of Ministers in dealing with some of those difficulties.

9.15 pm

Mr. Peter Luff (Mid-Worcestershire)

I point out to the hon. Member for Amber Valley (Judy Mallaber), who spoke in generally measured tones, that I could reveal a different story about coronary care in Worcestershire and the west midlands. However, that is not the subject of the debate.

The debate is important and has been measured. I welcome that. It was intended to be about issues of real anxiety to people outside the House. Those issues deserve to be addressed seriously. I was genuinely puzzled by the comments of the hon. Member for Wirral, West (Mr. Hesford), who questioned the point of the debate. He spent much of the early part of his speech doing that rhetorically. He should realise that this place exists to address the concerns of people outside it and that it is not irresponsible but responsible to deal with them. Were the hon. Gentleman in his place, I would ask him what was the point of Parliament if not to tackle such anxieties.

I was encouraged by the opening remarks of the hon. Member for Amber Valley. She began to draw us towards the two important issues that underlie the debate. How does society and Parliament debate risk? How do we deal with anxiety about risk? Those questions are relevant not only to health but to many aspects of public policy. For example, they apply to transport policy. Despite the tragic incidents on the railways, it remains safer to travel by train than by car. The shift from trains to cars increases the risk to which people are exposed. However, people feel that they are in control of a car and not of a train. They are making a mistake because they are at the mercy of other drivers, but they believe that they are safer.

On MMR, people want to take control and make decisions about vaccinations for their children. If a child contracts a disease, the parents will not blame themselves. However, if they believe—rightly or wrongly—that their action in getting the child immunised has led to autism or some other condition, they will blame themselves. That is a crucial difference.

There has been a series of health scares in our nation. They have often been unfounded, but they have led to declining respect for professionals and politicians who advise on health. We should be genuinely worried about that. I therefore emphasise to the hon. Member for Wirral, West, who is now in his place, that it is important to conduct a measured debate on the subject.

We should also be frank about our lack of knowledge of diseases. I am inclined to believe that we have the necessary knowledge to reassure people about MMR. However, I am glad that my children are old enough for me not to worry about making the decision. We do not have such knowledge about other matters.

When I was Chairman of the Select Committee on Agriculture, we spent a long time considering the link between tuberculosis in badgers and in cattle. We have no idea what the link is. The science is unclear and almost non-existent. We may believe that we know through anecdotal evidence, but we do not. That is often the problem in public health matters. Bovine tuberculosis is not irrelevant to the debate because there is increasing evidence of farming families contracting the bovine form of the disease. That seems to be related to their exposure to cattle, and is a matter of considerable anxiety.

We must grapple with the reality that we do not know how to manage risk and that sometimes we cannot reassure people because we do not have absolute knowledge.

MMR has been the focus of the debate, and I, too, will focus on it. The World Health. Organisation recommends an immunisation rate of 95 per cent. to avoid the spread of a new epidemic in the population. Our immunisation rate for the three diseases controlled by MMR is only 88 per cent., and in some parts of the country the rate is only 75 per cent. We are therefore at genuine risk of epidemics of the three diseases involved.

I hope that the Minister and the Secretary of State will ask themselves again where the real balance of risk lies. I know that this is a difficult and controversial area, but I have to say that Governments are no longer respected by people out there: they are no longer trusted to give secure and safe advice on public health policy.

The Secretary of State said clearly at the Dispatch Box that MMR was the best way of dealing with the problem, but even if the Government are entirely right I do not think that he will reassure people. Many will still be worried and will opt for no vaccination at all. That could have serious consequences, as we seem to see already from the current statistics. I do not say this in a partisan way, but the Minister cannot duck it: immunisation rates have declined over the past few years, having reached about 92 per cent. in 1996–97.

I hope that the Secretary of State and his ministerial colleagues will realise that in public health policy it is sometimes necessary to choose the least worse option. I recommend a twin-track approach. There should be reassurance—I welcome the reassurance that the Government are trying to give about MMR—but parents who are not reassured should be offered the alternative of treatment on a single-vaccine basis. I realise that that would involve problems in doctors surgeries and a greatly increased work load. It is not an easy solution, and it is not without its costing problems. It should, however, result in an increase in overall immunisation rates.

Some children will be exposed to measles, mumps and rubella for longer than is necessary, which is bad: I do not rejoice in it at all. It is possible, however, that we shall manage to raise the overall immunisation rate to the critical 95 per cent. level.

This has been a good-natured debate, which has approached the issues seriously. However, I ask the Government to consider whether what the official Opposition are saying, in a non-partisan fashion, may represent the best way of avoiding the spread of dreadful diseases whose effect is often underplayed now that we have lost our experience of them.

9.22 pm

Mr. John Heppell (Nottingham, East)

I hope that my tones are not quite so measured—I cannot say that I am prepared to sit here and take lessons from the Tory party about any health issues.

Like my hon. Friend the Member for Wirral, West (Mr. Hesford), I asked myself why the motion had been tabled. My first thought was that there is a bandwagon, and that Tories cannot not resist jumping on to every bandwagon that comes along.

My impression was strengthened by the comments of the hon. Member for Woodspring (Dr. Fox). If this is not a bandwagon, it is certainly sensational. Somehow, he developed a selective memory. He told us about his letter. I was quite amused by it—it she wed the Opposition spokesman supporting the Government and deploring the scaremongering about MMR. Then, he was unequivocally happy to back the Government in their fight against that scaremongering. However, the hon. Gentleman suddenly forgot about that and, a year later, qualified what he had said. If that is not jumping on a bandwagon, I do not know what is. [Interruption.] If I am wrong, the hon. Member for Runnymede and Weybridge (Mr. Hammond) will be able to tell us that the Conservatives are backing the Government's campaign to ensure that as many children as possible are given the MMR vaccine. The Secretary of State made it clear that not doing so would put children's lives at risk, and that it would be irresponsible to act otherwise.

I then asked myself why people should concentrate on MMR. Part of the reason is sensationalism. I noted headlines about not just MMR but CJD, sexually transmitted diseases, asylum seekers—anything that feeds prejudice. I am not prepared to enter into a mealy-mouthed debate; I will say my piece, and not mince words. It is bizarre to have the Tories lecturing us about anything. They have all developed a selective memory; they seem to have forgotten those 18 years.

There are lots of problems and challenges in the health service and lots of things that we have to put right. Cancer kills 127,000 people a year in this country. That is a matter of public health that has not been mentioned in the debate. Heart disease and strokes kill 214,000 people a year; accidents kill 10,000 people a year; and 4,500 people die by committing suicide each year. All those are public health matters that have not been mentioned. One of the reasons for the Conservatives concentrating on a very narrow subject is that they do not want to debate the big picture because it paints them in a bad light.

Mr. Hammond

I am sorry to disappoint the hon. Gentleman, but the reason for focusing on a narrow area is that there is a large degree of consensus on these matters. When my hon. Friend the Member for Woodspring (Mr. Fox) opened the debate, he made it clear that he wanted to focus on the issues on which there is a large degree of consensus across the House.

Mr. Heppell

It is only fair that the electorate should know what we agree on. If, at the end of the debate, Conservative Members want to tell the House that they agree with the Government on this issue, fine. However, it is also worth while pointing out the matters on which they do not agree with us. Okay, there are problems, and they need to be tackled. The Conservatives have conveniently forgotten that they did not tackle those problems for 18 years, and that they also created others. The reason why the Conservatives will never have the same commitment to the national health service and to public health as the Government is simple: we support the national health service in practice, but we also support it in principle. The Tories do not. That is a fact.

I was born in 1948—the same year that the national health service was created. We have something else in common: we are both products of the Labour party. The Labour party created the NHS against Tory opposition. The Tories did not oppose only the detail, the mechanics, the structure and the cost of the national health service; they opposed it in principle. They were ideologically opposed to the national health service, and if we scratch a Tory nowadays we find that they still are. That is why they starved the NHS of the resources needed for it to thrive and grow during those 18 years.

The average real-terms growth in the NHS during the Tories 18 years was 3 per cent. We have now doubled that and are putting in 6 per cent. That is 6 per cent. not just for one year, but for three years. By 2004, the national health service will have received three such increases, which is an unprecedented investment by the Government.

Hon. Members do not have to take my word for that. You may have thought, Mr. Deputy Speaker, that I was reading a newspaper earlier; in fact, I was looking at a document published by my local health authority. It is worth referring to it to illustrate the difference between the Conservatives and the Labour Government, in terms of the resources that have been put into the national health service. Under the headline "Making a difference this winter", it describes the extra money that has been put in to get the service through the winter crisis. It states: Making a difference—the NHS … is changing for the better. It is right. The NHS is changing for the better.

The document goes on to describe the new ear, nose and throat centre at Queen's medical centre, and the £6.2 million state-of-the-art accident and emergency department being built there. No wonder Prince Charles always goes to Queen's medical centre when he falls off his horse.

The document goes on to describe gearing up for the winter, social care, the boost in critical care funding, NHS Direct and the extra money put in for the flu vaccine. I could go on and on. There are other things that the document does not mention—for example, the new scanner at Queen's medical centre or the new treatment for cancer at City hospital. All those improvements have happened in the short time that we have had a Labour Government. The people of this country were deprived of such improvements under the previous Government.

The debate was deliberately narrowed for two reasons: to grab headlines and to ensure that the broader picture was not discussed. The Tories have a record on public health that none of them can be proud of. Our record is not perfect, but we have made a start and we are going to get there. We are going to turn the NHS into not just what it was before the 18 years of Tory rule, but what it was when it was founded—the envy of the world.

9.30 pm

Mr. Philip Hammond (Runnymede and Weybridge)

I wrote a note to myself saying that the tone of this brief debate was by and large measured and constructive, but that was before the hon. Member for Nottingham, East (Mr. Heppell) made his contribution.

My hon. Friend the Member for Woodspring (Dr. Fox) set the tone at the outset, and that tone was reciprocated—initially, at least—by the Secretary of State, who gave a measured response. Rather later in his speech, he moved off the subject that my hon. Friend had addressed and read out a section from his draft election manifesto. We have lots of opportunities to discuss issues on which there is scope for confrontation across the House, but tonight's debate represented an attempt to hold a constructive exchange on issues on which there is a good deal of consensus.

The hon. Members for Wirral, West (Mr. Hesford) and for Nottingham, East asked why we chose to hold the debate. I make no apology for reiterating that one of the Opposition's jobs is to raise issues that cause public concern or consternation so that they can be debated and responded to in the House. Governments of any colour may not always like that because it implies a measure of accountability, but it is no use Labour Members dismissing as scaremongering any Opposition attempt to use the proper forum to debate issues that are clearly of great public concern and are receiving an airing in the media, perhaps accompanied by misinformation. This is the proper place to hold a measured debate, to raise the issues and to allow the Government to respond to them.

I say to those hon. Members who raised such points that today's debate has no single immediate cause. We are responding to a growing sense of unease in the country that infectious diseases, which we thought had been consigned to history, are once again posing a threat and that the response to the threat, and the public's perception of it, is inadequate. The price that we pay for maintaining the upper hand in the battle against infectious and contagious diseases is eternal vigilance. We question not the Government's commitment to maintaining that fight, but their tactics for delivery and whether they have perhaps allowed themselves to be distracted from that most fundamental of Government health responsibilities.

There is a serious debate to be had on a serious subject, and it is not all gloom. My hon. Friend the Member for Woodspring acknowledged the apparent success of the meningitis C vaccination campaign—I am happy to do so as well—which appears to have nipped in the bud an extremely disturbing growth in reported cases. We are also happy to acknowledge that, after a rocky start, the flu vaccination campaign this winter has been a positive triumph of the will and effort of people working in the national health service over formidable logistical obstacles. That programme was largely delivered as a result of their commitment and hard work.

Those are the successes and, as my hon. Friend the Member for Woodspring said, they show that, where the commitment and the political will are present and when the Government work with the mood of public opinion, great things can be achieved. However, tempting as it is to dwell on the successes, our duty of vigilance requires us also to focus on some less successful aspects of public health policy and to articulate to the Government the frustrations and concerns that people up and down the country clearly feel. Nowhere is that public frustration and concern clearer than over the triple-dose MMR vaccine, which, inevitably, has been the centrepiece of the debate.

Mr. Hesford

In my speech, I asked for confirmation of whether Opposition Members reject the Wakefield report.

Mr. Hammond

I shall specifically come to the hon. Gentleman's question in a moment.

The problem, simply stated, is that concerns raised about the safety of the triple-dose vaccine have led immunisation rates to fall to a level that puts the population at risk of epidemics. My hon. Friend the Member for Woodspring clearly asserted that the weight of scientific evidence supports the combination vaccine. I am pleased to state that again.

We may know best, but the challenge is to convince people in the real world. Since the first publication in 1998 of the Wakefield findings, the Government's policy has not wavered for a moment, and has denied any link between the MMR vaccine and autism. To support that, they have cited the large body of scientific evidence that points in favour of their position. I went to a briefing meeting in the Department of Health two and a half years ago—when the Minister for Employment, Welfare to Work and Equal Opportunities was Minister for Public Health—which was attended by concerned Members from both sides of the House. When the question of the single-dose vaccine was raised, the Minister and the chief medical officer, who were both present, firmly rejected the idea and made it clear that parents should not be offered an alternative for fear of weakening the arguments in favour of the combination vaccine.

I am sure that that was the right position for a Minister to take then. It may still be the right position for Ministers to take now. However, in his remarks, the Secretary of State was ruling out for all time the possibility of needing to reconsider the matter if vaccination rates do not recover. When the Minister for Public Health winds up the debate, will she reassure the House that the Government will promote safety and arguments in favour of the combination vaccination, but that they will continue to take a pragmatic approach if vaccination rates do not recover?

Mr. Milburn

I am grateful to the hon. Gentleman for giving way on this issue. Would he just remind the House of precisely what happened on a previous occasion when, as he says, decision makers wavered in relation to a suspected problem with a vaccine—in this case, the whooping cough vaccine in the 1970s? If he does not remember, I can tell him that one publication cited a link between the vaccine for whooping cough and brain damage, which was subsequently proven to be wrong. In the meantime, whooping cough vaccine was not distributed in the way that it had been and the country had a whooping cough epidemic, which included many deaths. Would the hon. Gentleman remind the House of that and learn the lessons?

Mr. Hammond

I am grateful to the right hon. Gentleman. My hon. Friend the Member for Woodspring has already made it clear-I hope that I am making it clear again—that we will support the Government in seeking to convince public opinion of the efficacy and safety of the combination vaccine. However, when the Minister winds up our debate, will she confirm that the Government's commitment to the combination vaccine is pragmatic, based on the fact that they believe that the population protection that is needed against measles, mumps and rubella will best be achieved by promoting the combination vaccine? There should not be a dogmatic commitment, based on an obscure idea that one solution alone must be promoted. I urge the Minister to reassure us that the Government will take a pragmatic approach to our debate this evening.

Fiona Mactaggart

What would the hon. Gentleman say to a constituent who came to my advice surgery last Friday and said that she was worried about the triple vaccine? She said that the single vaccine must be fine because a doctor from the Opposition said so. Why, she wanted to know, could she not get it on the NHS? That is what my constituent believes Perhaps the hon. Gentleman can say something to her, which I will show her in Hansard and which, perhaps, will reassure her.

Mr. Hammond

What I would say to the hon. Lady and to her constituent is what I have already said: the overwhelming weight of scientific evidence supports the Government's case, which we are happy to support. However, in his opening remarks, the Secretary of State himself acknowledged that public confidence in the weight of scientific argument and the way in which politicians present that argument is at an all-time low. There are all sorts of reasons for that. However, we live in the real world and have to deal with the situation that exists. The Government know that. Their challenge—we support them in meeting it—is to deal with real public perceptions, not with the perceptions that we would like them to have.

Dr. Harris

Will the hon. Gentleman give way?

Mr. Hammond

No; I shall not give way again. I should like the Minister to have plenty of time to reply to the debate.

I should like to ask the Minister a question. I have a letter from the Minister for Employment, Welfare to Work and Equal Opportunities, who wrote to me on the subject in September 1998, when she was Minister of State at the Department of Health. She said: The UK Health Departments have been working on producing publicity material for parents and their medical advisers … The aim is to provide a factual briefing on the issues to enable parents to make an informed choice about the MMR vaccine in consultation with their health professional. The Government seem to acknowledge that parents have to make an informed choice, and they are about to embark on a major advertising campaign to provide information to parents so that, as the Secretary of State said earlier, they can make an informed choice. However, what informed choice does the Minister want parents to make? Surely she does not want to open the door to parents choosing the option not to vaccinate their children. Will she confirm that it would be a disaster if parents were to receive the message that the choice that the Government are seeking to empower them to make could ever be not to vaccinate their children?

Dr. Harris

Will the hon. Gentleman give way?

Mr. Hammond

I shall not give way; I have only a moment left.

Today's debate has inevitably focused on the MMR issue, as it is very much in the public mind. However, my hon. Friend the Member for Woodspring also drew the House's attention to the TB situation and the explosion of TB cases. It is no longer just a third-world problem but a problem that affects us here. London has the highest incidence of TB of any city in Europe. The Secretary of State sought in his speech to address some of those issues.

I hope that the Minister will be able to tell us just what the Government are doing to ensure that we never again become vulnerable to a single-source supplier of vaccine, which for technical or other reasons can of course fail.

Will the Minister also tell the House what the Department is doing to assess the port of entry screening programme which is a vital part of the battle to combat TB in the United Kingdom?

I want to ensure that the Minster has plenty of time to respond to the comments made today by hon. Members on both sides of the House. We have raised the issue of failures in public health policy, particularly in relation to immunisation and communicable diseases, because that issue greatly concerns the public and all hon. Members. It is necessary that Ministers have an opportunity to address such issues in this place, which is the proper forum to consider them.

It is impossible to switch on a television without becoming aware of the extent and depth of public concern and confusion about some health issues, especially MMR. I repeat that hon. Members on both sides of the House agree that the overwhelming weight of evidence supports the contention that MMR is a safe and efficacious response. However, concern will turn to anger if the public do not perceive that the Government are sensitive to their concern and are dealing with it. It is the job of the Opposition to hold the Government to account for their performance in that most fundamental role of the modern state.

Since Edwin Chadwick and the great Public Health Acts of the 1840s and 1850s—long before the welfare state or the concept of a health service that is universal and free at the point of use—it has been established that a core, central role of Government is to secure the public health by preventing the spread of communicable disease.

As technology and sanitation have developed, we have come to take for granted the gradual elimination of disease after disease that was once a killer but has become little more than a historical curiosity—so much so, that we may sometimes forget the Government's vital public health role. It may be the unglamorous end of the Health Department's work, but it is vital that Governments are not distracted from that vital work by higher-profile health policy matters.

Nothing is as fundamental to the health and welfare of the British people as a sound public health policy, effectively implemented, to ensure the continued protection of the population from the killer diseases that we have, mercifully, all but forgotten, and from the newer scourges that threaten.

Tonight's debate is a gentle wake-up call, a reminder that Government must focus on this most fundamental role of the state, and a reassurance to them that, if they go about that business with a sound policy, pragmatically implemented and sensitive to public opinion, we will support them in it.

9.46 pm

The Minister for Public Health (Yvette Cooper)

I am grateful for the opportunity to reply to this debate on an extremely serious subject—ultimately, lives are at stake. The tone of the debate has been largely measured, but I am not so convinced that the content has been as responsible as the tone would suggest.

The hon. Member for Woodspring (Dr. Fox) asked several questions about communicable diseases, many of which were fully answered earlier by my right hon. Friend the Secretary of State. The hon. Member for North Devon (Mr. Harvey) welcomed many of the public health measures in the NHS plan. I welcome his comments, although he rightly pointed out how far we still have to go. The hon. Member for Bromsgrove (Miss Kirkbride) voiced her concerns about MMR, while my hon. Friend the Member for Wirral, West (Mr. Hesford) set out strong evidence offered by scientific bodies in support of the vaccine.

My hon. Friend the Member for Amber Valley (Judy Mallaber) talked poignantly about the impact of meningitis C vaccine in her constituency. The hon. Member for Mid-Worcestershire (Mr. Luff) returned to MMR and referred to the problems of risk and the precautionary principle. My hon. Friend the Member for Nottingham, East (Mr. Heppell) argued clearly that the big problems come from poverty, ill health and the big killers: cancer and heart disease.

The hon. Member for Runnymede and Weybridge (Mr. Hammond) referred to TB, to the BCG vaccination and to the risks posed by monopoly suppliers. We are certainly concerned about that, although there is not always an easy way of getting round the problem.

My hon. Friend the Member for Amber Valley described the meningitis C campaign. It is a wonderful story for public health and an immense tribute to the NHS that the programme was implemented so quickly. Early results show that it prevented 500 cases of and 50 deaths from meningitis C in the past year. That is 50 tots and teenagers who are still arguing with their parents and taking their lives for granted because of the vaccine.

MMR has been debated in great detail. Many parents of young children will feel confused and worried following the reports that they have read in the newspapers these past few weeks. Any parent of young children will know quite how much we worry about whether we are doing the best by our sons and daughters. That is why the debate about MMR is so deadly serious. We need to take parents' concerns on MMR seriously. We must take seriously every question raised about any drug or vaccine.

That is exactly why we have referred every single claim or allegation about the safety of the vaccine to committees of experts on both vaccination and the safety of medicines for them to examine in great detail. That is why we referred all the latest Dr. Wakefield allegations to them and why we will investigate any new allegation that is made.

We have gone to great lengths to publish every detail of the advice and to make it as widely available as possible, and sought the views of all the independent health professional bodies with an interest in the area. They have all told us very clearly that MMR remains the safest way of protecting children against deadly diseases. They have found no evidence of any link with autism, even though they have studied all the research—from Finland, Sweden, the north Thames region and Dr. Wakefield. They found that children would be at risk of infection for longer with the single vaccines and that, ultimately, their lives would be at stake.

Those experts have no interest in denying the risk or in putting children's health at risk. They spend their lives trying to improve children's health. We have asked them many times to advise us on this subject, and their advice every time has been the same. We need to take that advice very seriously. Their recommendation on the question of single jabs is clear. They say that to introduce a programme of single jabs on the NHS would be less safe than MMR, and would put children's lives at risk.

My right hon. Friend the Secretary of State referred to the case of whooping cough vaccine in the 1970s. The then Government introduced to the NHS a less safe alternative in response to scares about the pertussis component of the DTP vaccine, even though those scares proved unfounded. When the alternative was offered on the NHS—and effectively endorsed by it—everyone opted for it. They felt that, because the NHS was endorsing the alternative, it therefore must be the safest option for their children. The result was that there were 200,000 cases of whooping cough, and 100 deaths.

Exact comparison can never be made between decisions taken on previous occasions with regard to different vaccines. Every case is different and must be considered on its merits, taking into consideration the evidence from the experts. However, we have an obligation to listen to the advice that we are given as well as to the anxieties expressed by parents.

If we ignored that expert advice and, on the basis of no evidence, endorsed on the NHS an alternative that the medical experts say would risk children's lives, we would be betraying parents and children. As a parent, I would feel betrayed by the NHS and by the health professionals that let such a thing happen.

Miss Kirkbride

I respect what the Minister has said and accept her point about the NHS, although I should prefer her to change the way in which she approaches the problem. However, why do not the Government allow the private clinics that offer the separate vaccines to proceed? Why have the Government clamped down on those clinics' ability to make the licensed vaccines available?

Yvette Cooper

There is no clampdown. Under the Medicines Acts, the Medicines Control Agency has an obligation to ensure that unlicensed products are supplied according to very strict rules, because there is a serious concern to prevent unlicensed products that may be unsafe from being improperly supplied. The single vaccines available for use in the UK are unlicensed. They have not been through the MCA's safety checks.

I welcome the more measured tone displayed today by the hon. Members for Woodspring and for Runnymede and Weybridge (Mr. Hammond), but the media have not received their comments in the same way—and they know it. My hon. Friend the Member for Slough (Fiona Mactaggart) gave the very clear example of a person who came to her constituency surgery and said that the single jabs must be better "because the man on the telly—Liam Fox—said so, and he's a doctor, isn't he?"

I have listened to what Conservative Members have said in the debate. They have been carefully dancing around the issue, but they know the medical evidence well. They also know well how their remarks are being interpreted, in the media and by parents. I caution them over their apparent promotion of s single jabs as a safer alternative, because they know that that is how their remarks are being interpreted.

Judy Mallaber

Did my hon. Friend the Minister note that, when one newspaper tried to raise a scare about the meningitis C programme, no other newspaper picked it up? That was because no one jumped on the bandwagon, with the result that the story was killed. However, the scare this time is being recycled time and time again. Does she agree that that must be because comments by other people are being used to support some of those fears?

Yvette Cooper

I acknowledge my hon. Friend's remarks. We all know that as parents we are very susceptible to worrying dreadfully about whether or not we are doing the best for our children. That is exactly why as politicians we have a responsibility not to manipulate parents' fears and to make sure that we give them absolutely accurate information—as much information as possible, but also access to the proper medical advice.

Mr. Hammond

I should like to give the hon. Lady, as a token of my commitment to the triple vaccine, the information that all three of my children aged under seven have been vaccinated with the triple-dose vaccine. That is the best commitment I can give the hon. Lady in public and on record.

Yvette Cooper

I am glad to hear that endorsement of the safety of the MMR vaccine. It clearly accords with what the medical experts and advisers are telling us.

All of us in the House have to be very careful about playing politics and trying to pronounce as politicians on the safety of medicines and on the safety of vaccinations. As many hon. Members have said, in this area as a result of previous health scares, and in particular the BSE issue, what politicians say is not necessarily taken seriously by the public, and certainly not by the media.

There are broader public health matters that I wish briefly to turn to, issues that many hon. Members have mentioned. Public health is about so much more than communicable disease. My hon. Friend the Member for Nottingham, East (Mr. Heppell) is absolutely right: the big killers in this country are cancer and heart disease, and the biggest public health issue is addressing the health inequalities that underlie the big killers.

The gap in life expectancy between rich and poor rose between the late 1970s and the mid-1990s, for men from 7.5 years to 9.5 years and for women from 5 years to 6.5 years. Those health inequalities have grown worse. That is a public health tragedy and outrage.

The hon. Member for Bromsgrove said that the gap was because the men all worked down the mines, and Labour should not have opposed closing the pits. I find it absolutely astonishing that the devastation of the coalfield community should be described as a positive public health measure. Does the hon. Lady have any idea of the impact on the health of entire communities suffering unemployment, poor and crumbling mining communities where depression and drug abuse are rife? What she said shows shocking ignorance about the public health problems that face this country.

This Government have set in place an entire programme to tackle all the dimensions of public health. The NHS plan and the White Paper on saving lives are to tackle the most deep-rooted causes of the problems. Perhaps the most important thing that we can do to improve public health is to meet our target to abolish child poverty. No other measure will do more to improve public health.

I should like to return to a point raised by my hon. Friend the Member for Corby (Mr. Hope) about the programme sure start. Sure start is perhaps the most important public health programme that we have. It will involve eventually spending £500 million a year on families with children under four in low-income areas, improving their access to health care, education and child care, and delivering what local parents want. My hon. Friend asked the Opposition whether they would match our spending on sure start, and they would not answer. They said that they would match our spending on health, but they have not said they will match our spending on sure start. On the biggest measure to tackle public health that we are introducing across this Government, for them not to be able to make a commitment to back sure start, providing health for families across the country, shows a pretty weak commitment to tackling public health.

The Government believe that at the beginning of the 21 st century it is morally wrong that our chances of a healthy life still depend on who we are, where we were born, what our parents do and how much they earn. Under the previous Government, health inequalities and child poverty rose. This Government are determined to bring health inequalities down and to tackle the fundamental, immoral divisions in our society. We will bring them down—a return to a Tory Government would push those health inequalities back up again. That would be a public health tragedy.

Question put, That the original words stand part of the Question:—

The House divided: Ayes 135, Noes 317.

Division No. 86]	[9.59 pm
AYES
Ainsworth, Peter (E Surrey)	Hayes, John
Ancram, Rt Hon Michael	Heald, Oliver
Arbuthnot, Rt Hon James	Heath, Rt Hon Sir Edward
Atkinson, Peter (Hexham)	Heathcoat-Amory, Rt Hon David
Baldry, Tony	Hogg, Rt Hon Douglas
Bercow, John	Horam, John
Beresford, Sir Paul	Howard, Rt Hon Michael
Blunt, Crispin	Howarth, Gerald (Aldershot)
Body, Sir Richard	Hunter, Andrew
Boswell, Tim	Jack, Rt Hon Michael
Bottomley, Peter (Worthing W)	Jenkin, Bernard
Bottomley, Rt Hon Mrs Virginia	Key, Robert
Brazier, Julian	King, Rt Hon Tom (Bridgwater)
Browning, Mrs Angela	Kirkbride, Miss Julie
Burns, Simon	Laing, Mrs Eleanor
Butterfill, John	Lait, Mrs Jacqui
Cash, William	Lansley, Andrew
Chope, Christopher	Leigh, Edward
Clappison, James	Letwin, Oliver
Clark, Dr Michael (Rayleigh)	Lewis, Dr Julian (New Forest E)
Collins, Tim	Lidington, David
Cormack, Sir Patrick	Lilley, Rt Hon Peter
Cran, James	Lloyd, Rt Hon Sir Peter (Fareham)
Curry, Rt Hon David	Loughton, Tim
Davies, Quentin (Grantham)	Luff, Peter
Davis, Rt Hon David (Haltemprice)	Lyell, Rt Hon Sir Nicholas
Day, Stephen	MacGregor, Rt Hon John
Dorrell, Rt Hon Stephen	MacKay, Rt Hon Andrew
Duncan, Alan	Maclean, Rt Hon David
Duncan Smith, Iain	McLoughlin, Patrick
Emery, Rt Hon Sir Peter	Madel, Sir David
Evans, Nigel	Malins, Humfrey
Faber, David	Maples, John
Fabricant, Michael	Mates, Michael
Fallon, Michael	Mawhinney, Rt Hon Sir Brian
Flight, Howard	May, Mrs Theresa
Forth, Rt Hon Eric	Moss, Malcolm
Fowler, Rt Hon Sir Norman	Norman, Archie
Fox, Dr Liam	O'Brien, Stephen (Eddisbury)
Fraser, Christopher	Ottaway, Richard
Gale, Roger	Paice, James
Garnier, Edward	Pickles, Eric
Gibb, Nick	Prior, David
Gill, Christopher	Randall, John
Gillan, Mrs Cheryl	Redwood, Rt Hon John
Gorman, Mrs Teresa	Robathan, Andrew
Green, Damian	Robertson, Laurence (Tewk'b'ry)
Greenway, John	Roe, Mrs Marion (Broxbourne)
Grieve, Dominic	Rowe, Andrew (Faversham)
Hague, Rt Hon William	Ruffley, David
Hamilton, Rt Hon Sir Archie	St Aubyn, Nick
Hammond, Philip	Sayeed, Jonathan
Hawkins, Nick	Shephard, Rt Hon Mrs Gillian

Shepherd, Richard	Tyrie, Andrew
Simpson, Keith (Mid-Norfolk)	Viggers, Peter
Soames, Nicholas	Walter, Robert
Spelman, Mrs Caroline	Waterson, Nigel
Spicer, Sir Michael	Wells, Bowen
Spring, Richard	Whitney, Sir Raymond
Stanley, Rt Hon Sir John	Whittingdale, John
Streeter, Gary	Widdecombe, Rt Hon Miss Ann
Swayne, Desmond	Willetts, David
Syms, Robert	Winterton, Mrs Ann (Congleton)
Tapsell, Sir Peter	Winterton, Nicholas (Macclesfield)
Taylor, Ian (Esher & Walton)	Yeo, Tim
Taylor, John M (Solihull)	Young, Rt Hon Sir George
Taylor, Sir Teddy	Tellers for the Ayes:
Tredinnick, David	Mr. James Gray and
Trend, Michael	Mr. Geoffrey Clifton-Brown.
NOES
Abbott, Ms Diane	Clarke, Charles (Norwich S)
Adams, Mrs Irene (Paisley N)	Clelland, David
Ainger, Nick	Clwyd, Ann
Ainsworth, Robert (Cov'try NE)	Coaker, Vernon
Allan, Richard	Coffey, Ms Ann
Allen, Graham	Cohen, Harry
Anderson, Rt Hon Donald (Swansea E)	Coleman, Iain
	Colman, Tony
Anderson, Janet (Rossendale)	Connarty, Michael
Armstrong, Rt Hon Ms Hilary	Cook, Frank (Stockton N)
Ashton, Joe	Cooper, Yvette
Atherton, Ms Candy	Corbett, Robin
Atkins, Charlotte	Corbyn, Jeremy
Bailey, Adrian	Cousins, Jim
Banks, Tony	Crausby, David
Barron, Kevin	Cryer, John (Hornchurch)
Bayley, Hugh	Cummings, John
Beard, Nigel	Cunningham, Rt Hon Dr Jack (Copeland)
Beckett, Rt Hon Mrs Margaret
Begg, Miss Anne	Darling, Rt Hon Alistair
Beith, Rt Hon A J	Darvill, Keith
Bell, Martin (Tatton)	Davey, Valerie (Bristol W)
Bell, Stuart (Middlesbrougt)	Davidson, Ian
Benn, Hilary (Leeds C)	Davies, Rt Hon Denzil (Llanelli)
Bennett, Andrew F	Davies, Geraint (Croydon C)
Benton, Joe	Dawson, Hilton
Bermingham, Gerald	Dean, Mrs Janet
Berry, Roger	Denham, John
Blackman, Liz	Dobbin, Jim
Blears, Ms Hazel	Dobson, Rt Hon Frank
Blizzard, Bob	Donohoe, Brian H
Boateng, Rt Hon Paul	Doran, Frank
Borrow, David	Dowd, Jim
Bradley, Keith (Withington)	Drew, David
Bradley, Peter (The Wrekin)	Dunwoody, Mrs Gwyneth
Breed, Colin	Eagle, Maria (L'pool Garston)
Brinton, Mrs Helen	Edwards, Huw
Brown, Russell (Dumfries)	Efford, Clive
Browne, Desmond	Ellman, Mrs Louise
Buck, Ms Karen	Ennis, Jeff
Burden, Richard	Ewing, Mrs Margaret
Burstow, Paul	Fearn, Ronnie
Byers, Rt Hon Stephen	Field, Rt Hon Frank
Caborn, Rt Hon Richard	Fisher, Mark
Campbell, Mrs Anne (C'bridge)	Fitzpatrick, Jim
Campbell, Rt Hon Menzies (NE Fife)	Fitzsimons, Mrs Lorna
	Flint, Caroline
Campbell, Ronnie (Blyth V)	Follett, Barbara
Campbell-Savours, Dale	Foster, Rt Hon Derek
Caplin, Ivor	Foster, Don (Bath)
Casale, Roger	Foster, Michael Jabez (Hastings)
Caton, Martin	Foulkes, George
Cawsey, Ian	Gapes, Mike
Chaytor, David	Gardiner, Barry
Chidgey, David	George, Andrew (St Ives)
Clapham, Michael	George, Rt Hon Bruce (Walsall S)
Clark, Rt Hon Dr David (S Shields)	Gerrard, Neil

Gibson, Dr Ian	McCafferty, Ms Chris
Gidley, Sandra	McCartney, Rt Hon Ian (Makerfield)
Gilroy, Mrs Linda
Godman, Dr Norman A	Macdonald, Calum
Godsiff, Roger	McDonnell, John
Goggins, Paul	McIsaac, Shona
Golding, Mrs Llin	McNulty, Tony
Griffiths, Nigel (Edinburgh S)	MacShane, Denis
Griffiths, Win (Bridgend)	Mactaggart, Fiona
Grocott, Bruce	McWalter, Tony
Grogan, John	McWilliam, John
Hain, Peter	Mahon, Mrs Alice
Hall, Mike (Weaver Vale)	Mallaber, Judy
Hall, Patrick (Bedford)	Marsden, Gordon (Blackpool S)
Hamilton, Fabian (Leeds NE)	Marshall, David (Shettleston)
Hanson, David	Marshall, Jim (Leicester S)
Harman, Rt Hon Ms Harriet	Marshall-Andrews, Robert
Harris, Dr Evan	Martlew, Eric
Harvey, Nick	Maxton, John
Healey, John	Meacher, Rt Hon Michael
	Merron, Gillian
Heath, David (Somerton & Frome)	Michael, Rt Hon Alun
Henderson, Ivan (Harwich)	Michie, Bill (Shef'ld Heeley)
Hendrick, Mark	Michie, Mrs Ray (Argyll & Bute)
Hepburn, Stephen	Milburn, Rt Hon Alan
Heppell, John	Miller, Andrew
Hesford, Stephen	Mitchell, Austin
Hewitt, Ms Patricia	Moonie, Dr Lewis
Hill, Keith	Moore, Michael
Hodge, Ms Margaret	Moran, Ms Margaret
Hood, Jimmy	Morgan, Ms Julie (Cardiff N)
Hoon, Rt Hon Geoffrey	Morley, Elliot
Hope, Phil	Mowlam, Rt Hon Marjorie
Hopkins, Kelvin	Mudie, George
Howarth, Rt Hon Alan (Newport E)	Mullin, Chris
Howells, Dr Kim	Murphy, Denis (Wansbeck)
Hughes, Kevin (Doncaster N)	Naysmith, Dr Doug
Humble, Mrs Joan	Norris, Dan
Hutton, John	O'Brien, Bill (Normanton)
Iddon, Dr Brian	Olner, Bill
Illsley, Eric	Öpik, Lembit
Jackson, Helen (Hillsborough)	Pearson, Ian
Jamieson, David	Pickthall, Colin
Jenkins, Brian	Pike, Peter L
Johnson, Alan (Hull W & Hessle)	Pond, Chris
Johnson, Miss Melanie (Welwyn Hatfield)	Pope, Greg
	Powell, Sir Raymond
Jones, Rt Hon Barry (Alyn)	Prentice, Ms Bridget (Lewisham E)
Jones, Helen (Warrington N)	Prentice, Gordon (Pendle)
Jones, Jon Owen (Cardiff C)	Prescott, Rt Hon John
Jones, Dr Lynne (Selly Oak)	Primarolo, Dawn
Joyce, Eric	Prosser, Gwyn
Keeble, Ms Sally	Purchase, Ken
Keen, Alan (Feltham & Heston)	Quinn, Lawrie
Keen, Ann (Brentford & Isleworth)	Raynsford, Nick
Kemp, Fraser	Rendel, David
Kennedy, Jane (Wavertree)	Robertson, John (Glasgow Anniesland)
Khabra, Piara S
Kidney, David	Robinson, Geoffrey (Cov'try NW)
Kilfoyle, Peter	Rogers, Allan
King, Andy (Rugby & Kenilworth)	Rooker, Rt Hon Jeff
Kirkwood, Archy	Rooney, Terry
Kumar, Dr Ashok	Ross, Ernie (Dundee W)
Lammy, David	Rowlands, Ted
Lawrence, Mrs Jackie	Ruane, Chris
Laxton, Bob	Ruddock, Joan
Leslie, Christopher	Russell, Bob (Colchester)
Levitt, Tom	Russell, Ms Christine (Chester)
	Ryan, Ms Joan
Lewis, Ivan (Bury S)	Salter, Martin
Lewis, Terry (Worsley)	Sanders, Adrian
Linton, Martin	Sarwar, Mohammad
Lloyd, Tony (Manchester C)	Savidge, Malcolm
Lock, David	Sawford, Phil
Love, Andrew	Sedgemore, Brian
McAvoy, Thomas	Shaw, Jonathan

Sheerman, Barry	Timms, Stephen
Sheldon, Rt Hon Robert	Todd, Mark
Short, Rt Hon Clare	Tonge, Dr Jenny
Simpson, Alan (Nottingham S)	Trickett, Jon
Skinner, Dennis	Turner, Dennis (Wolverh'ton SE)
Smith, Rt Hon Andrew (Oxford E)	Turner, Dr George (NW Norfolk)
Smith, Angela (Basildon)	Turner, Neil (Wigan)
Smith, Rt Hon Chris (Islington S)	Twigg, Stephen (Enfield)
Smith, Jacqui (Redditch)	Tyler, Paul
Smith, John (Glamorgan)	Tynan, Bill
Smith, Llew (Blaenau Gwent)	Walley, Ms Joan
Smith, Sir Robert (W Ab'd'ns)	Watts, David
Soley, Clive	Webb, Steve
Southworth, Ms Helen	White, Brian
Spellar, John	Wicks, Malcolm
Squire, Ms Rachel	Williams, Rt Hon Alan (Swansea W)
Starkey, Dr Phyllis
Steinberg, Gerry	Williams, Alan W (E Carmarthen)
Stewart, David (Inverness E)	Williams, Mrs Betty (Conwy)
Stewart, Ian (Eccles)	Willis, Phil
	Wills, Michael
Strang, Rt Hon Dr Gavin	Wilson, Brian
Straw, Rt Hon Jack	Winnick, David
Stuart, Ms Gisela	Wood, Mike
Stunell, Andrew	Woolas, Phil
Sutcliffe, Gerry	Worthington, Tony
Taylor, Rt Hon Mrs Ann (Dewsbury)	Wright, Anthony D (Gt Yarmouth)
	Wright, Tony (Cannock)
Taylor, David (NW Leics)	Wyatt, Derek
Taylor, Matthew (Truro)
Temple-Morris, Peter	Tellers for the Noes:
Thomas, Gareth (Clwyd W)	Mr. Don Touhig and
Thomas, Simon (Ceredigion)	Mr. Clive Betts.

Question accordingly negatived.

Question, That the proposed words be there added, put forthwith, pursuant to Standing Order No. 31 (Questions on amendments):—

The House divided: Ayes 315, Noes 133.

Division No. 87]	[10.16 pm
AYES
Abbott, Ms Diane	Boateng, Rt Hon Paul
Adams, Mrs Irene (Paisley N)	Borrow, David
Ainger, Nick	Bradley, Keith (Withington)
Ainsworth, Robert (Cov'try NE)	Bradley, Peter (The Wrekin)
Allan, Richard	Breed, Colin
Allen, Graham	Brinton, Mrs Helen
Anderson, Rt Hon Donald (Swansea E)	Brown, Russell (Dumfries)
	Browne, Desmond
Anderson, Janet (Rossendale)	Buck, Ms Karen
Armstrong, Rt Hon Ms Hilary	Burden, Richard
Ashton, Joe	Burstow, Paul
Atherton, Ms Candy	Byers, Rt Hon Stephen
Atkins, Charlotte	Caborn, Rt Hon Richard
Bailey, Adrian	Campbell, Mrs Anne (C'bridge)
Banks, Tony	Campbell, Rt Hon Menzies (NE Fife)
Barron, Kevin
Bayley, Hugh	Campbell, Ronnie (Blyth V)
Beard, Nigel	Campbell-Savours, Dale
Beckett, Rt Hon Mrs Margaret	Caplin, Ivor
Begg, Miss Anne	Casale, Roger
Beith, Rt Hon A J	Caton, Martin
Bell, Martin (Tatton)	Cawsey, Ian
Bell, Stuart (Middlesbrough)	Chaytor, David
Benn, Hilary (Leeds C)	Chidgey, David
Bennett, Andrew F	Clapham, Michael
Benton, Joe	Clark, Rt Hon Dr David (S Shields)
Bermingham, Gerald	Clarke, Charles (Norwich S)
Berry, Roger	Clelland, David
Blackman, Liz	Clwyd, Ann
Blears, Ms Hazel	Coaker, Vernon
Blizzard, Bob	Coffey, Ms Ann

Cohen, Harry	Hesford, Stephen
Coleman, Iain	Hewitt, Ms Patricia
Colman, Tony	Hill, Keith
Connarty, Michael	Hodge, Ms Margaret
Cook, Frank (Stockton N)	Hood, Jimmy
Cooper, Yvette	Hoon, Rt Hon Geoffrey
Corbett, Robin	Hope, Phil
Corbyn, Jeremy	Hopkins, Kelvin
Cousins, Jim	Howarth, Rt Hon Alan (Newport E)
Crausby, David	Howells, Dr Kim
Cryer, John (Hornchurch)	Hughes, Kevin (Doncaster N)
Cummings, John	Hughes, Simon (Southwark N)
Cunningham, Rt Hon Dr Jack (Copeland)	Humble, Mrs Joan
	Hutton, John
Darling, Rt Hon Alistair	Iddon, Dr Brian
Darvill, Keith	Illsley, Eric
Davey, Valerie (Bristol W)	Jackson, Helen (Hillsborough)
Davidson, Ian	Jamieson, David
Davies, Rt Hon Denzil (Llanelli)	Jenkins, Brian
Davies, Geraint (Croydon C)	Johnson, Alan (Hull W & Hessle)
Dawson, Hilton	Johnson, Miss Melanie (Welwyn Hatfield)
Dean, Mrs Janet
Denham, John	Jones, Rt Hon Barry (Alyn)
Dobbin, Jim	Jones, Helen (Warrington N)
Dobson, Rt Hon Frank	Jones, Dr Lynne (Selly Oak)
Donohoe, Brian H	Joyce, Eric
Doran, Frank	Keeble, Ms Sally
Dowd, Jim	Keen, Alan (Feltham & Heston)
Drew, David	Keen, Ann (Brentford & Isleworth)
Eagle, Maria (L'pool Garston)	Kemp, Fraser
Edwards, Huw	Kennedy, Jane (Wavertree)
Efford, Clive	Khabra, Piara S
Ellman, Mrs Louise	Kidney, David
Ennis, Jeff	Kilfoyle, Peter
Ewing, Mrs Margaret	King, Andy (Rugby & Kenilworth)
Fearn, Ronnie	Kirkwood, Archy
Field, Rt Hon Frank	Kumar, Dr Ashok
Fisher, Mark	Lammy, David
Fitzpatrick, Jim	Lawrence, Mrs Jackie
Fitzsimons, Mrs Lorna	Laxton, Bob
Flint, Caroline	Leslie, Christopher
Follett, Barbara	Levitt, Tom
Foster, Rt Hon Derek	Lewis, Ivan (Bury S)
Foster, Don (Bath)	Lewis, Terry (Worsley)
Foster, Michael Jabez (Hastings)	Linton, Martin
Foulkes, George	Lloyd, Tony (Manchester C)
Gapes, Mike	Lock, David
Gardiner, Barry	Love, Andrew
George, Andrew (St Ives)	McAvoy, Thomas
George, Rt Hon Bruce (Walsall S)	McCafferty, Ms Chris
Gerrard, Neil	McCartney, Rt Hon Ian (Makerfield)
Gibson, Dr Ian
Gidley, Sandra	Macdonald, Calum
Gilroy, Mrs Linda	McDonnell, John
Godman, Dr Norman A	McIsaac, Shona
Godsiff, Roger	McNulty, Tony
Goggins, Paul	MacShane, Denis
Golding, Mrs Llin	Mactaggart, Fiona
Griffiths, Nigel (Edinburgh S)	McWalter, Tony
Griffiths, Win (Bridgend)	McWilliam, John
Grocott, Bruce	Mahon, Mrs Alice
Grogan, John	Mallaber, Judy
Hain, Peter	Marsden, Gordon (Blackpool S)
Hall, Mike (Weaver Vale)	Marshall, David (Shettleston)
Hall, Patrick (Bedford)	Marshall, Jim (Leicester S)
Hamilton, Fabian (Leeds NE)	Marshall-Andrews, Robert
Hanson, David	Martlew, Eric
Harman, Rt Hon Ms Harriet	Maxton, John
Harris, Dr Evan	Meacher, Rt Hon Michael
Harvey, Nick	Merron, Gillian
Healey, John	Michael, Rt Hon Alun
Heath, David (Somerton & Frome)	Michie, Bill (Shef'ld Heeley)
Henderson, Ivan (Harwich)	Michie, Mrs Ray (Argyll & Bute)
Hendrick, Mark	Milburn, Rt Hon Alan
Hepburn, Stephen	Miller, Andrew
Heppell, John	Mitchell, Austin

Moonie, Dr Lewis	Smith, Jacqui (Redditch)
Moore, Michael	Smith, John (Glamorgan)
Moran, Ms Margaret	Smith, Llew (Blaenau Gwent)
Morgan, Ms Julie (Cardiff N)	Smith, Sir Robert (W Ab'd'ns)
Morley, Elliot	Soley, Clive
Mudie, George	Southworth, Ms Helen
Mullin, Chris	Spellar, John
Murphy, Denis (Wansbeck)	Squire, Ms Rachel
Naysmith, Dr Doug	Starkey, Dr Phyllis
Norris, Dan	Steinberg, Gerry
O'Brien, Bill (Normanton)	Stewart, David (Inverness E)
Olner, Bill	Stewart, Ian (Eccles)
Öpik, Lembit	Strang, Rt Hon Dr Gavin
Pearson, Ian	Straw, Rt Hon Jack
Pickthall, Colin	Stuart, Ms Gisela
Pike, Peter L	Stunell, Andrew
Pond, Chris	Sutcliffe, Gerry
Pope, Greg	Taylor, Rt Hon Mrs Ann (Dewsbury)
Powell, Sir Raymond
Prentice, Ms Bridget (Lewisham E)	Taylor, David (NW Leics)
Prentice, Gordon (Pendle)	Taylor, Matthew (Truro)
Prescott, Rt Hon John	Temple-Morris, Peter
Primarolo, Dawn	Thomas, Gareth (Clwyd W)
Prosser, Gwyn	Thomas, Simon (Ceredigion)
Purchase, Ken	Timms, Stephen
Quinn, Lawrie	Todd, Mark
Raynsford, Nick	Tonge, Dr Jenny
Rendel, David	Trickett, Jon
Robertson, John (Glasgow Anniesland)	Truswell, Paul
	Turner, Dennis (Wolverh'ton SE)
Robinson, Geoffrey (Cov'try NW)	Turner, Dr George (NW Norfolk)
	Turner, Neil (Wigan)
Rogers, Allan	Twigg, Stephen (Enfield)
Rooker, Rt Hon Jeff	Tyler, Paul
Rooney, Terry	Tynan, Bill
Ross, Ernie (Dundee W)	Walley, Ms Joan
Rowlands, Ted	Webb, Steve
Ruane, Chris	White, Brian
Ruddock, Joan	Wicks, Malcolm
Russell, Bob (Colchester)	Williams, Rt Hon Alan (Swansea W)
Russell, Ms Christine (Chester)
Ryan, Ms Joan	Williams, Alan W (E Carmarthen)
Salter, Martin	Williams, Mrs Betty (Conwy)
Sanders, Adrian	Willis, Phil
Sarwar, Mohammad	Wills, Michael
Savidge, Malcolm	Wilson, Brian
Sawford, Phil	Winnick, David
Sedgemore, Brian	Wood, Mike
Shaw, Jonathan	Woolas, Phil
Sheerman, Barry	Worthington, Tony
Sheldon, Rt Hon Robert	Wright, Anthony D (Gt Yarmouth)
Short, Rt Hon Clare	Wright, Tony (Cannock)
Simpson, Alan (Nottingham S)	Wyatt, Derek
Skinner, Dennis
Smith, Rt Hon Andrew (Oxford E)	Tellers for the Ayes:
Smith, Angela (Basildon)	Mr. Clive Betts and
Smith, Rt Hon Chris (Islington S)	Mr. Don Touhig.
NOES
Ainsworth, Peter (E Surrey)	Chope, Christopher
Ancram, Rt Hon Michael	Clappison, James
Arbuthnot, Rt Hon James	Collins, Tim
Atkinson, Peter (Hexham)	Cormack, Sir Patrick
Baldry, Tony	Cran, James
Bercow, John	Curry, Rt Hon David
Beresford, Sir Paul	Davies, Quentin (Grantham)
Blunt, Crispin	Davis, Rt Hon David (Haltemprice)
Body, Sir Richard	Day, Stephen
Boswell, Tim	Dorrell, Rt Hon Stephen
Bottomley, Peter (Worthing W)	Duncan, Alan
Bottomley, Rt Hon Mrs Virginia	Duncan Smith, Iain
Brazier, Julian	Emery, Rt Hon Sir Peter
Browning, Mrs Angela	Evans, Nigel
Burns, Simon	Faber, David
Butterfill, John	Fabricant, Michael
Cash, William	Fallon, Michael

Flight, Howard	Mates, Michael
Forth, Rt Hon Eric	Mawhinney, Rt Hon Sir Brian
Fowler, Rt Hon Sir Norman	May, Mrs Theresa
Fox, Dr Liam	Moss, Malcolm
Fraser, Christopher	Norman, Archie
Gale, Roger	O'Brien, Stephen (Eddisbury)
Garnier, Edward	Ottaway, Richard
Gibb, Nick	Paice, James
Gill, Christopher	Pickles, Eric
Gillan, Mrs Cheryl	Prior, David
Gorman, Mrs Teresa	Randall, John
Green, Damian	Redwood, Rt Hon John
Greenway, John	Robathan, Andrew
Grieve, Dominic	Robertson, Laurence (Tewk'b'ry)
Hague, Rt Hon William	Roe, Mrs Marion (Broxbourne)
Hamilton, Rt Hon Sir Archie	Rowe, Andrew (Faversham)
Hammond, Philip	Ruffley, David
Hawkins, Nick	St Aubyn, Nick
Hayes, John	Sayeed, Jonathan
Heald, Oliver	Shephard, Rt Hon Mrs Gillian
Heath, Rt Hon Sir Edward	Simpson, Keith (Mid-Norfolk)
Heathcoat-Amory, Rt Hon David	Soames, Nicholas
Hogg, Rt Hon Douglas	Spelman, Mrs Caroline
Horam, John	Spicer, Sir Michael
Howard, Rt Hon Michael	Spring, Richard
Howarth, Gerald (Aldershot)	Stanley, Rt Hon Sir John
Hunter, Andrew	Streeter, Gary
Jack, Rt Hon Michael	Swayne, Desmond
Jenkin, Bernard	Syms, Robert
	Tapsell, Sir Peter
Key, Robert	Taylor, Ian (Esher & Walton)
King, Rt Hon Tom (Bridgwater)	Taylor, John M (Solihull)
Kirkbride, Miss Julie	Taylor, Sir Teddy
Laing, Mrs Eleanor	Tredinnick, David
Lait, Mrs Jacqui	Trend, Michael
Lansley, Andrew	Tyrie, Andrew
Leigh, Edward	Viggers, Peter
Letwin, Oliver	Walter, Robert
Lewis, Dr Julian (New Forest E)	Waterson, Nigel
Lidington, David	Wells, Bowen
Lilley, Rt Hon Peter	Whitney, Sir Raymond
Lloyd, Rt Hon Sir Peter (Fareham)	Whittingdale, John
Loughton, Tim	Widdecombe, Rt Hon Miss Ann
Luff, Peter	Willetts, David
Lyell, Rt Hon Sir Nicholas	Winterton, Mrs Ann (Congleton)
MacGregor, Rt Hon John	Winterton, Nicholas (Macclesfield)
MacKay, Rt Hon Andrew	Yeo, Tim
Maclean, Rt Hon David	Young, Rt Hon Sir George
McLoughlin, Patrick
Madel, Sir David	Tellers for the Noes:
Malins, Humfrey	M r. James Gray and
Maples, John	Mr. Geoffrey Clifton-Brown.

Question accordingly agreed to.

MR. SPEAKER forthwith declared the main Question, as amended, to be agreed to.

Resolved, That this House condemns the widening health inequalities between 1979 and 1997 and the failure of Conservative governments to acknowledge health inequality or address the growing health gap between rich and poor; and supports initiatives to improve public health and tackle health inequalities, including new vaccination programmes for influenza and Meningitis C, the allocation of an extra £450 million to improve cancer and coronary heart disease services in England, the extension of the breast screening programme to women aged between 65 and 70, the strategy to reduce teenage pregnancies, the largest-ever investment in smoking cessation services and the proposed ban on tobacco advertising and sponsorship.

Mr. Nicholas Soames (Mid-Sussex)

On a point of order, Mr. Speaker. In view of the Prime Minister's announcement today about an inquiry into the events surrounding the resignation of the right hon. Member for Hartlepool (Mr. Mandelson), and the point of order raised by my hon. Friend the Member for Aylesbury (Mr. Lidington) about whether questions tabled subsequent or previous to that may be sub judice, would you, Mr. Speaker, give a ruling as to whether questions asked by Members about the Minister of State, Foreign and Commonwealth Office, the hon. Member for Leicester, East (Mr. Vaz), relating to his conduct and any relation that he might have had with Hinduja brothers will come under the same rules as those relating to the inquiry and to the right hon. Member for Hartlepool?

Mr. Speaker

I have already given a ruling but, perhaps to clarify the situation, I would say that it is not the type of inquiry that would be covered by the sub judice rules. However, the contents of any ministerial reply have nothing to do with the Speaker.

Mr. Soames

Further to that point of order, Mr. Speaker. Does that mean that the Table Office will accept any parliamentary question relating to the conduct of the Minister of State. Foreign and Commonwealth Office, the hon. Member for Leicester, East, in relation to that event?

Mr. Speaker

The Table Office will accept any question that is in order. If the hon. Gentleman is refused, I am sure that he will come back to me.

Mr. Douglas Hogg (Sleaford and North Hykeham)

Further to that point of order, Mr. Speaker. As I understand it, the fact that an inquiry is taking place does not raise any procedural difficulty in respect of the tabling of questions. Will you confirm that that is correct?

Mr. Speaker

Absolutely no problem is raised as far as procedure is concerned.