HL Deb 11 April 1994 vol 553 cc1365-78

8.35 p.m.

Lord Donaldson of Kingsbridge

asked Her Majesty's Government: Whether they have studied the findings of the pioneer health centre at Peckham, and whether those findings of the 1930s could have a useful application to the family problems of the 1990s.

The noble Lord said: My Lords, during the debate on the family on 23rd February, your Lordships discussed with insight and sympathy the increasing disintegration of the family, its effect on the health and happiness of its members and its dire consequences for the surrounding community and for the country. No fewer than 28 noble Lords took part in that debate, and I was astonished, in reading the debate carefully the next morning, to find that not one of the speakers mentioned the work of the Peckham experiment. I should have done so; but I was prevented from attending on that day, appropriately, for family reasons.

In the noble Viscount's reply to the debate, he claimed that the Government's role is to empower families to help themselves. I was very glad to hear that. The intention is something with which we can all agree; but it will not be easy to bring it about. It certainly will not just happen of itself. A study of the findings of the Peckham experiment would go a long way towards helping the Government to turn their good intentions into reality. That is the point of my Question today.

The centre was the child of two remarkable doctors —Dr. Scott-Williamson and Dr. Innes Pearse. They regarded health as something quite different from the mere absence of disease. They wanted to know more about it. They regarded the family as the biological unit of society, and they wanted to study it in health. Therefore, they took a small house and garden in Peckham, which was an area of mixed society, and they recruited a number of interested families. That was in 1926.

However, they found none which they could call "healthy". All needed treatment and wider opportunity before they could be studied as healthy. Therefore, they closed the small experiment after three years, in 1929, and spent the next five years designing a project with a building which would give whole families outlet for all their members. They tried to raise enough money to set that up. Eventually enough cash was found, at least to begin the project, and the centre finally opened in 1935.

It flourished splendidly. It grew to close on 1,000 families. It closed during the war and reopened afterwards. It finally shut up shop in 1950 because of lack of finance. At first the Government had shown interest, but they were later diverted by the huge plans for a national health service, with all its excitements, complications and controversies. In the end, no government money was forthcoming. The building was eventually sold to the LCC, and at present it is still in use as a college of adult education, although it has been greatly altered. If anybody wishes to pursue the subject, there is a copy of the book The Peckham Experiment in the Library, and I can provide other written information. However, we cannot go into too much detail this evening.

As to its relevance to today's conditions, I should like to quote a few words from a new book by Professor Goodwin, a professor of biology at the Open University. The book is called How the Leopard Changed its Spots, and your Lordships cannot read it until August. I have read part of it, and I believe that that part is extremely relevant to the problem which I am trying to put before your Lordships. The professor says: There is no denying the momentum of change that is now developing. There is a sense of a break-up of many conventional institutions run on regulatory lines in areas of health, education, business, economics, government and politics. This break-up often feels like a break-down because alternatives do not often exist, and individuals are left holding the fragments of disrupted lives, with insufficient communal or social cohesion to create appropriate new forms... Some structure is required for this, such as the physical and social framework provided by the Centre building in the Peckham Experiment. Individuals do not have the resources to create such Centres, so there has to be community investment, and hence community-based resources, not regulatory, centralised, political authority that makes uniform decisions for the country as a whole". As regards the Peckham Centre building and the opportunities which it provided, an excellent site was eventually found in St. Mary's Road, and a fine building was erected by the brilliant engineer Sir Owen Williams which was designed to meet the directors' demands for space for all ages to be provided. It contained a splendid swimming pool, separated by glass only from the rooms which surrounded it; a gymnasium which was equally observable as were the cafeteria and dance hall; a billiard room, small theatre, a card room, not to mention a babies' swimming pool, nurseries and a children's playground. Finally, there were medical consulting rooms and a small laboratory.

It was no ordinary leisure centre. Families were only accepted as members on the condition that there was a medical overhaul for each family member once a year. The staff did not run the leisure activities; it was up to the members—the parents and children of all ages—to find out and do what they wanted to do. That was another condition of membership. After opening, it took some months for the project to settle down and for the chaos to subside. But it did and things ran themselves smoothly, actively and creatively for the young and old alike. The atmosphere on a Saturday night, with the centre's own dance band led by the local bookmaker visible and audible across the swimming pool to the parents drinking their beer or coffee in the cafeteria, is something that I shall never forget.

I cannot go into detail now, but an improvement in health in physical and in social capabilities was achieved for people of all ages. The centre also saw the development of heightened individuality and an incredible community integration; in other words, it worked. Moreover, it also saw the development of parenthood and of the family unit throughout the membership of hundreds of families, with almost total disappearance of family breakdown. So many of the individual family and community qualities and values which were raised in your Lordships' debate were achieved right across the membership. I can say with confidence that many of the things that noble Lords want to see achieved were achieved at Peckham. The way to achieve them is open to study and implementation today.

I must add to that picture the role of the doctors in that project. They provided every family with an annual health check-up which was a condition of membership. The information gained by the doctors was then given by them to the parents in a consultation and was discussed and explained with questions answered fully, including reference to the growth and development of children, and indeed of the parents, as experienced in their activities and relationships in the centre both at home and in the outside world. Any action that might then be taken was the responsibility of the parents. It was left to their decision and initiative, for example, to turn to what in those days we used to call their panel doctor, and no treatment was given by the centre.

In addition to the annual check-up, other check-ups were available for pre-marital and pre-conceptual information, for pregnant women and for mothers after the delivery of their babies, and so on. All of that was given on the basis of providing information on which the individual, the parents, would make their own decisions and take their action about treatment, diet, activities and many other aspects of life. The doctors were insistent on good quality food in the cafeteria. After the war, they started a farm run on organic lines on a patch of land near Bromley lent to them by Victor Cazalet, the MP—but that is another story. The centre, and the community using it, became for many an extension of their home, offering friendship, know-ledge, stimulus, action and satisfaction. The young learnt from the older people; and the older people learnt about the young.

One can see how that sort of place improved the quality of life. It helped to avoid many of the problems that might otherwise cripple a family, and it helped to produce citizens of the future who had respect for people and their property. All of that, Scott-Williamson observed, was part of the total pattern of health and of the cultivation of health.

The financial difficulty has always been due to the cost of an adequate and comprehensive building. Now, all around us, large sums of money are being spent, and wisely spent, by local authorities on leisure centres. Those buildings could be used, each in its own way, as the Peckham Centre was used, by the people themselves for their pleasure and benefit. One current example is the leisure centre at Hailsham i:n Sussex. The manager, Mr. Osborne, has recognised the lessons of Peckham and has developed projects which focus on the elderly, the lonely and on local families. That approach is gaining momentum steadily and successfully. I know that the Minister who is to reply has visited the centre, and I believe that she was as impressed by it, as I was. However, Mr. Osborne is not the only one. Various local authorities are already showing serious interest in the Peckham approach to health and to family community. I can name one or two at this moment; for example, Sheffield, north Birmingham, Middlesbrough and Newcastle; and, indeed, there are others. I. believe that a good many leisure centres are working well below capacity.

After 40 years, I believe that things are again on the move. It is in that hope that I raise the Question. My recommendation is that the Government should encourage and support a serious examination of the findings and methods of the Peckham Experiment, and the ways in which that knowledge can be used in producing conditions helpful to family development and stability and be effective against family disintegration. When I say "encourage and support", I do not mean merely with kind words, but with something more determined, even including some cash.

8.49 p.m.

Lord McNair

My Lords, I am delighted to have the opportunity to speak in support of my noble friend Lord Donaldson of Kingsbridge. Rather than being disap-pointed at the small number of speakers participating, I must say how pleased I am that I am able to Join my noble friend in bringing such glad tidings to a wider audience than they have had heretofore.

The objects of the Halley Stewart Trust, mentioned in the book The Peckham Experiment., include the following: For every individual, by furthering such favourable opportunities of education, service, and leisure as shall enable him or her most perfectly to develop the body, mind and spirit". That philosophy and the practical application of those aims were mirrored precisely in the Pioneer health centre. It was one of a number of very interesting and thoughtful approaches to various aspects of human life which flourished in the years between the. First and Second World Wars, perhaps partly as a reaction to the First World War and also in the hope of preventing a second.

What these approaches had in common was an awareness of the essential goodness of human beings. Unlike the destructive and oppressive doctrine of original sin, this awareness was rooted in good science and empirical research. Names such as Homer Lane and A. S. Neill should be remembered, as well as others less well known including Theodore Faithfull, who ran the Priory Gate School in Suffolk and who happened to be my maternal grandfather. All these pioneers found that if one creates the conditions in which human beings can be offered and can accept responsibility, they accept it gladly and graciously.

Homer Lane's "delinquents" and A. S. Neill's pupils and the families that joined and became members of the Pioneer health centre all thrived on the simple joy of being treated as equal, intelligent human beings. Visitors to these places of natural personal growth and development were struck by the innate courtesy and common sense of the members of each community. The same characteristics were observed in the pupils of Risinghill School in London while Mike Douane was the head teacher. In a poor and run-down part of London with many social problems, the inspired leadership and humanity of Mike Douane created an oasis of calm where children with low expectations were able to develop much more of their potential, both socially and intellectually.

Anyone wishing to obtain a flavour of this broad spectrum of human development initiatives should read books by Leila Berg and Alison Stallibrass. My noble friend gave a broad overview of what the Peckham Experiment at the Pioneer health centre actually was and there are some aspects that I wish to look at as well. First, though, I must express my appreciation and gratitude to those stalwarts who have kept the flame of the idea alive for half a century and more. Among those is my noble friend who, although he was too modest to tell us, helped to run, or rather to facilitate, the Pioneer health centre in the years after the Second World War. The other person who deserves mention is Alan Pepper who, I am sure, will read with keen interest what the Minister has to say in reply to the debate.

The Pioneer Health Centre Limited is now an educational charity promoting the concepts and the practice of the idea. The centre itself closed down, as my noble friend said, as the brave new world of the National Health Service came into being. The centre was an organic, evolutionary approach—or it followed an organic, evolutionary approach—but antibiotics had recently been invented. The government of the day wanted a National Health Service that was up and running from day one. They did, after all, have elections to fight and that kind of thing.

But things are changing. For example, we now know that antibiotics are not all they were cracked up to be and people are spontaneously taking responsibility for their health as witnessed by the great increase in the use of non-allopathic medicine. Alan Pepper has in the last two years found that health promotion experts around the country are showing a keen interest in implementing Peckham-type initiatives in their areas. These are serious inquiries from people keen to make a start. They have realised that merely treating illness or even simply preventing it are not enough.

One hurdle that needs to be confronted and overcome is that "Peckamisation", if your Lordships will permit me to coin a word, involves a high degree of interdepartmental liaison, for example among health care workers, leisure centres, libraries and so on. With this, the basic philosophy is also one of devolution, so the whole process runs counter to the trends we see today of increasing centralisation and increasing compartmentalisation.

As my noble friend observed, the basic organic unit of society, from a biologist's point of view, is that of the family. But could it be that what we are seeing in our newspapers, or on our televisions and indeed in our own lives as the implosion and disintegration of this basic unit is in fact the result of the separation of these basic units one from another? Could it be that the family is not enough, that families need other families for the process of socialisation and personal integration to take place satisfactorily? At this point I should like to clarify the use of the word "experiment". To some people it may smack of social engineering or some such thing. Nothing could be further from the truth. The original Peckham Experiment was established by biologists, not politicians, who simply wanted to see what would happen if they created the best conditions possible for the healthy development of mind, body and spirit. They then observed the results.

The results were remarkable. They have, in best scientific tradition, been replicated in the Lagoon leisure centre at Hailsham, Sussex. That project is the fruit of collaboration between the centre manager, Mr. Osborne, and the local doctor, Dr. Hanratty, from the local NHS practice. Lagoon was already a first-class leisure centre but, as my noble friend said, it was experiencing a lack of demand. Even so it had already won a second prize nationally and it was a centre of excellence. At Peckham the facilities were designed so that, for example, a badminton court could become a theatre. Flexibility was built into the design whereas leisure centres at present tend to be strongly compartmentalised and follow strict timetables. Leisure centres tend to have, for example, badminton courts, indoor hockey courts and that kind of thing. In the Pioneer health centre, it was possible, as my noble friend said, for people to see other activities than the ones they were currently engaged in.

The results of the collaboration at Lagoon have exceeded all expectation. What happens is that a person consults his GP with some ache or pain. In addition to appropriate medical treatment, the GP will prescribe, say, six to nine sessions of activity at the leisure centre. The person who is now a participant rather than a patient goes there and discusses with the manager what activities would be appropriate and chooses one that appeals. In addition to great improvements in physical health and wellbeing, as the word gets around there is a social aspect to these health improving activities. A family membership has also been introduced and is proving very popular—in fact so popular that there is now a waiting list for family membership.

Finally, perhaps I can tie these ideas into the idea of back to basics. Some Ministers made the mistake of setting members of the Government up as paragons of virtue and were miffed to find that many of them, like many of us, were idols with feet of clay. Too much of the back to basics idea rested on primitive enforcement or at best empty exhortation. The Peckham Experiment achieved for those who participated that which is lacking in so many today: a sense of community and a sense of themselves as valid individuals empowered to contribute and to create a life for themselves.

8.57 p.m.

Lord Carter

My Lords, the House is extremely grateful to the noble Lord, Lord Donaldson, for tabling this Question. I must admit that I had not heard of the Peckham Experiment before I saw this Question but having now researched the matter I have discovered that it is an extraordinarily interesting concept which is certainly relevant to the problems of today. The Peckham Experiment laid emphasis on the positive definition of health as something more than just the absence of disease.

One thing we can learn immediately is that even the apparent absence of disease does not mean that people are healthy. The difference between apparent good health and a truly healthy existence was clearly revealed in Peckham in the 1930s and I am quite sure that the situation would be no different now. As the noble Lord, Lord McNair said, the work of the Peckham centre has been kept alive by Pioneer Health Centre Limited. In passing, I must say that I was extremely grateful to Mrs. Elven, who was a member of the centre as a child, for sending me information and an extraordinarily interesting video on the work of the centre. However, when I watched the video I was slightly amused to see a family undergoing its annual health check while the father of the family smoked a cigarette.

We must appreciate that Peckham was not a health centre in the sense of a medical centre. There was no attempt to provide treatment. As one of the founders of the centre, Dr. Inner Pearse, said, Our intention was neither to cure nor to prevent disease. It was to find a practical means, based on scientific knowledge, of releasing hitherto unexpressed biological potentialities of the human organism for living". Perhaps the main reason for the success of the Peckham Experiment was that it was so much more than just a centre for diagnosis. It truly was a laboratory for the study of health in all its facets.

We know that there were many factors which contributed to the success of the experiment: the social club atmosphere, family membership, the annual health checks and the general openness and freedom which have been commented upon by all who were associated with it. However, there were perhaps two fundamental factors in its success: the study of health rather than disease, based on the belief that health is much more than just the mere absence of disease, and the truly holistic approach, bringing together all the factors—physical, psychological, social and spiritual—which go to make up true well being.

So what can we learn from an experiment which can still be applied today? The first lesson is the crucial difference between what we define as medical care and health care. We know that medical care is based on a purely medical model of provision, while health care is a combination of health education, health promotion and medical care.

Secondly, and equally important, nothing has really changed since Peckham in the 1930s. There is still a health divide. Inequalities in health are still the result of differences in income, housing conditions, race, gender, nutrition and working conditions. Indeed, whether or not a person has a job is still a major determinant of health. There might not now be the iron deficiency in 57 per cent. of females and 36 per cent. of males, and the worm infestation of 9 per cent. of females and 12 per cent of males that was found in Peckham But in February 1993 there were 462,000 children in the south London region in families receiving income support out of nearly three million children in families receiving income support in Great Britain as a whole. In 1930 infant mortality rates for the poor were twice those of the rich. The relative proportion is almost exactly the same today with 11.7 per 1,000 of the babies dying in social class five compared with 6.2 per 1,000 in social class one. A recent survey on low income families found that none were eating a healthy diet while one in eight of the children in families on family income support were regularly going hungry.

Therefore, I would argue that social deprivation is still a major, if not the major, cause of ill health. We know that studies in this country, Italy, Denmark, Finland and Sweden have all confirmed the relationship between unemployment and ill health. An article in the British Medical Journal in March, 1991, put it extremely clearly. It states: The evidence that unemployment kills—particularly the middle-aged—now verges on the irrefutable". Douglas Black, chairman of the group which produced the Black Report in 1980, stated that the surest way to alleviate the effects of poverty must be to alleviate the factor of poverty itself. Since the millennium is not at hand, except purely in the chronological sense, it must be worth improving health care. That brings us full circle to the Peckham Experiment.

It has been pointed out that the Peckham health centre was in many ways the most important development in health promotion of its time. Its view of health in its totality indeed made it unique. It had an effect on our thinking about health care and there is now increasing interest in the application of its central ideas to health policy today. I am sure that the Minister will wish to refer to The Health of the Nation document which we can all support. A lot of the thinking in that document owes much to Peckham.

The importance of health promotion compared with health education is now recognised. Holistic health care that addresses the whole person can be seen in hospices and in some of the cancer care centres. As we have heard already, there is now increasing interest in community health projects, family centres and parent networks. However, to some extent all those initiatives continue the stratification of health care into different ages or medical conditions. They do not constitute the truly holistic approach of the Peckham Experiment. We know that good health is not just a matter of working through the client group, to use the jargon, from babies to pensioners. We know that such an approach, although convenient for the bureaucrat, does not deal with the family as a unit. We all agree that health is much too important to be left to doctors, bureaucrats or indeed the department itself. To quote from the excellent video produced recently by the Pioneer health centre, Health is as infectious as disease". If that is the case, it is essential that cross-infection is positively encouraged.

I conclude by asking whether the Minister can tell us what the Government are doing to encourage developments in policy along the lines pioneered at Peckham. It so happens that I spent the first seven years of my life in a solidly working class environment just a few miles from Peckham. I say immediately that it might be difficult to reproduce the exact environment of the Peckham health centre now. In those days leisure was the part of the social environment that could be reached and that was used as the gateway to the other factors that the Peckham Experiment produced. The advent of car ownership and television, the change in the nature of family life, and the very different social customs and relationships of today compared with 60 years ago might make it difficult to reproduce an identical Peckham health centre today.

However, if we compare what we have heard about the centre at Hailsham with what happened at Peckham in the late 1930s and 1940s it seems that it is possible to adapt the ideas to today's conditions. But I would say that the holistic approach to health promotion, treating individuals as a part of a social unit—be it the traditional family or some other relationship—and the whole emphasis on mutual support is still the core of good health and should be at the heart of our health and social policies. If Peckham has taught us anything, it has certainly taught us that.

9.6 p.m.

Baroness Cumberlege

My Lords, I too, would like to thank the noble Lord, Lord Donaldson of Kingsbridge, for introducing the subject this evening. Like the noble Lord, Lord Carter, I found it a very interesting piece of research to do for tonight's debate. I know that the noble Lord has long been an advocate of innovation, not only for preventing disease but in improving the quality of people's lives, not only through science but also through the arts—a truly holistic approach.

The Peckham Experiment, the brainchild of Doctors Scott Williamson and Innes Pearse, was indeed, like the noble Lord, innovative and in advance of its time. As the noble Lord told us in his fascinating speech, those involved in the project correctly realised that it is not enough simply to treat the symptoms of a medical condition but to identify factors which might lead to ill health. Patients registered with the Peckham health centre received an annual health check-up, advice on a healthy diet and the importance of exercise in order to keep fit and active. That emphasis on care for the whole family over time produced an improvement in the overall health of the patients registered at the Pioneer health centre.

While the nature of society as a whole and local communities in particular has changed since the time of the Peckham Experiment, the basic principles of prevention of ill health rather than simply treating disease continues to be as true in the 1990s as it was in the 1930s and 1940s when living conditions were not so sophisticated and in some areas were positively wretched.

Since the introduction of the National Health Service in 1948, the first point of contact with the NHS for the vast majority of people has been through their GP. Today we recognise the very important role that the family doctor plays in not only providing or arranging treatments for patients but also in giving advice on how to avoid ill health. The new GP contract introduced in 1990 set out to underpin this basic principle and to provide a foundation for further improvement in the general health of the nation. Under the new GP contract, patients like those in the Peckham Experiment are entitled to receive a consultation with their GP which includes regular physical examinations, particularly for elderly people. It enables women to be tested for cervical and breast cancer and encourages GPs to vaccinate children against certain diseases. In addition, it provides advice for all members of the family on healthy eating, exercise, giving up smoking and sensible drinking. Encouraging GPs to adopt this holistic approach for all members of the family can only, as in the Peckham Experiment, improve their health and quality of life.

The GP contract and other measures introduced by the Government in 1990 are already producing results which are showing benefits to people. I am delighted to tell your Lordships' House that 90 per cent. of GPs are reaching their targets for childhood immunisation, which means that we are well on course for covering 95 per cent. of all children by 1995; 97 per cent. of GPs have reached their cervical screening targets and deaths from cervical cancer have reduced by nearly 16 per cent. in the past five years. Since 1979, the number of nurses employed by GPs has increased from less than 1,000 whole time equivalents to over 9,000, a massive rise of over 900 per cent. No one should underestimate the impact nurses have on promoting health and reducing disease.

Finally, the new GP contract enables doctors to employ other appropriately qualified staff so they too can provide a wider range of services from the GPs' premises. These additional services include certain minor surgery procedures, contraceptive and maternity advice, chiropody, physiotherapy, counselling and complementary therapies such as acupuncture and homoeopathy.

But we recognise that by simply adding to the basic services provided by family doctors is not enough to develop GP practice for the 21st century. A more radical approach is needed. People should have access to the health service in a way which is more convenient to them as individuals, to their families and to the community as a whole. In 1991 we saw the introduction of the first wave of GP fundholders, who through innovative contract negotiations achieved better services, better value, with greater benefit to the people on their lists.

For perhaps the first time in the history of the NHS, some GPs are now able to arrange for consultant sessions to be regularly held in their surgeries. They have also been instrumental in ensuring that a wide range of surgical and medical treatments can be provided locally rather than patients having to travel great distances to hospital. Nevertheless, when people do need to go to hospital for treatment, GP fundholders are able, after listening to patients, to influence when and where those patients should be treated. Despite its early detractors, the, scheme now benefits 36 per cent. of the population. This represents 8,800 GPs in over 2,000 practices who recognise the improved quality of care that they can give to patients by joining the scheme.

Nevertheless, the way that GPs provide services is only one part of the equation. The NHS reforms also saw the introduction of hospital and community trusts. Free from restrictions which previously existed, they too have been able to respond more speedily and directly to the needs of patients. Small hospitals which are part of community trusts have been able to focus on the medical and other support needs of the family through a variety of health services, while working closely with GPs; for example, by providing antenatal, postnatal and paediatric facilities; advisory and treatment services to control the effect of diabetes and asthma; schemes to reduce the incidence of coronary heart disease and strokes and enhance the dental, ophthalmic and audiology services which they provide. Many health authorities are examining ways in which other services traditionally provided by hospitals can be transferred to GPs' surgeries, health centres and community premises. This strategic shift of services and resources will enable people to receive diagnostic and treatment services closer to home.

Much has been done by this Government to improve the range of health services and the way in which they are provided. The main focus of the NHS reforms has been to deliver a better National Health Service by obtaining better value for money in order that patients can achieve a better and healthier lifestyle. For example, no child of any social class has died of measles-related illness since 1989 and only one child has died of whooping cough. Perinatal and infant mortality has halved since 1978 and the rate of sudden infant death has fallen by more than two-thirds since 1988. The rate of patients being treated in general and acute specialties has increased by more than 40 per cent. in the last 10 years. Over 90 per cent. of GPs provide health promotion activities aimed at reducing incidence of coronary heart disease and strokes and the same number provide disease management programmes for diabetes and asthma, often through the practice nurse.

In 1991 there were 3,600 community psychiatric nurses, an increase of 227 per cent. in 10 years. To ensure that this momentum continues the Government took the important step of publishing the Health of the Nation White Paper in July 1992 —as was mentioned by the noble Lord, Lord Carter. The White Paper details for the first time in this country a strategic: approach to achieving better health. Since publication it has achieved two important objectives. It has focused attention on the importance and benefits of maintaining good health and preventing ill-health, and it has set in train much intense activity to take forward an initiative widely welcomed in this country and regarded by the: World Health Organisation as a model for other countries to follow. In having a strategy to promote health, we lead the world. I have no doubt that our foundations were laid long ago, albeit subliminally, in schemes such as the Peckham Experiment.

Our strategy for the 1990s and beyond is built around five key areas. These were selected because they are areas where the need for improvement is greatest and where genuine long-lasting success is most likely to be achieved. They are all major causes of premature illness and early death and offer scope for action. The selected areas are: coronary heart disease and stroke; cancers; HIV/AIDS and sexual health; mental illness; and accidents.

In each of these key areas, a total of 27 challenging but, we believe, achievable targets have been set to the year 2000 and beyond. These targets provide clear and tangible goals for which to aim. The targets will be reviewed on a regular basis and new key areas may be added or substituted over time.

As the noble Lord, Lord McNair, stressed, the Peckham Experiment identified the correlation between environmental factors in the community and the overall health of its population, particularly for individual families. This Government believe in the family, in the role and responsibilities of parents and in their duties towards their children. We agree with the views expressed by noble Lords tonight that families are the individual components of a community and if the family network is strong, that strength will be reflected in the community as a whole.

The noble Lord, Lord Carter, drew some fascinating comparisons between the social conditions of 40 years ago and those of today. The improvements are of course immense today. But social conditions still affect people's health. I think that the noble Lord will take comfort from the fact that since we published the Health of the Nation White Paper we have underpinned it by publishing guidance material for the nursing professions; for ethnic groups; for dieticians; and for environmental health officers. We are in the process of developing guidance for primary health care teams to reduce the variations in health. Much of that work is being overseen by the Wider Health Working Group, which I chair.

We have also set up under the chairmanship of the chief medical officer a group to advise how the department and the NHS cart make best use of existing information about health variations, including what is known about effective interventions. We are also studying what further research is needed. So we have not been dilatory on this issue. We recognise its importance and we are very anxious to make headway. But it is difficult. The issue is not simple. For instance, if we take a disease such as breast cancer, the incidence of breast cancer is 11/2 times greater in Social Class 1 than it is in Social Class 5. Coronary heart disease is 20 per cent. higher in Asian men and 30 per cent. higher in Asian women than it is in the population as a whole. The prevalence of diabetes and some diseases—for instance, sickle-cell anaemia—affects particular ethnic groups but not others. So we recognise that we need to have more research in these areas.

The Government also recognise that the rapidly changing work and social patterns of the 1980s and 1990s mean that some parents might need support networks in order that their families can grow and develop in a positive way. We also have to recognise that the children of today become the adults and parents of tomorrow. If we can provide a loving and supportive environment in which they can grow up, then they can positively contribute to the way our society develops in the future. To this end, we introduced the Children Act in 1989 which provides the framework in which the principles of parental responsibility can be supported.

Under the Act, local authorities have a general duty to make provision for advice, guidance, counselling, assistance and home support services. There should be a variety of day care facilities such as playgroups, nurseries and childminding services which not only provide a good environment for pre-school children to grow and develop but also provide support to parents who cannot be at home during the day through work or other commitments.

I was interested to hear the noble Lord, Lord Donaldson, mention, I believe, a billiard room, a dance hall and a dance band. So far as I am aware, social services authorities do not provide those. But Age Concern has done remarkable work in organising tea dances. I highly commend them to those who are interested.

We should not, however, confine ourselves to thinking of the family as only young children and their parents. More often than not, the family includes grandparents, uncles and aunts, who are elderly and themselves need support. Our community care initiatives have enabled services to be provided which allow elderly people to remain as part of the community through the appropriate provision of day care and domiciliary services. Local authorities have responsibility to identify local needs and develop services to meet those needs. Those services should, however, recognise that carers are the cornerstone of community care and they should be supported by placing their needs high on local authority agendas. In that way joint local authority and health authority initiatives can meet the expected increases in the elderly population, particularly those over 75 years, who wish to continue to live in the community.

The Question asked by the noble Lord, Lord Donaldson, was whether the findings of the Peckham Experiment might have a useful application in the 1990s. As I said at the beginning, those involved with the work of the Peckham health centre were visionary. Long ago they realised that no country can simply afford to react to the needs of those who are ill. The Peckham Experiment correctly deduced that the best way forward is to provide strategies that also focus on the promotion of health and the prevention of disease.

There are many schemes now in the country which are not identical or as comprehensive but which embody the philosophy pioneered by Dr. Scott Williamson and Dr. Innes Pearse. Last summer the noble Lord, Lord Shackleton, invited me to visit the Hampshire village of Brockenhurst where, under the dynamic leadership of local GPs, an entire therapeutic village is being established. I, too, am a fan of the Lagoon Leisure Centre in Hailsham, which was mentioned by the noble Lords, Lord Donaldson of Kingsbridge and Lord McNair. I know that it is working with local practices of GPs, who prescribe exercise, swimming and relaxation to combat depression, reduce obesity, ischaemic heart disease and asthma. What is exciting about that scheme is that the results which are being evaluated by Sussex University are very impressive. We know that it works. The Healthy Cities Campaign pioneered by Dr. John Ashton in Liverpool is even more ambitious and equally impressive. It is a movement that has rapidly spread to other cities.

All that innovation is backed and supported by the Government through The Health of the Nation White Paper, the Children Act and the NHS reforms, particularly GP fundholding. But while all that is positive, we cannot and will not be complacent. The momentum which is being created will be maintained. But the Government do not have a monopoly of wisdom and understanding. Many others also have a role to play. By empowering individuals, supporting families and strengthening communities, we can all enhance the nation's health and be the proud successors of the Peckham Experiment.

House adjourned at twenty-three minutes past nine o'clock.