§ 6.20 p.m.
§ Lord Donaldson of Kingsbridge rose to ask Her Majesty's Government whether they have any plans to respond to the growing interest in the provision of family health clubs, along the lines of the pioneer Peckham Health Centre.
§ The noble Lord said: My Lords, it was two and a half years ago that I spoke on this subject to a House which was even emptier than it is tonight. However, I was consoled by the fact that Hansard for that day sold very well and I believe that it will do so again today. Many people are seriously interested in the problem, although this is not a good time of night to discuss it.
I shall not repeat what I said on the last occasion, beyond reminding your Lordships that for two years before the war I worked at the old Peckham health centre and I have been a trustee of the existing company ever since. I wish to begin by quoting from a letter which I received last week from a lady who was a member of the old centre. She writes:
I was so thrilled to hear the programme on Radio 4 about the Centre and to know that its spirit still lives on. The Centre had such a tremendous influence on my life. Our Family was among the first to join in 1935, when I was 10 years old. My mother learned to swim at 51 and went on to dive off the top diving boards until well into her 70s. My brothers and sisters all met their future partners at the Centre. At 71 now I am still diving and keep-fitting twice a week".
That experience is a tribute of which we can be proud, and it was shared by a large number of people.
§ After nearly 50 years of quiescence, the ideas of the old centre are bobbing up all over the place and I thought it right to ask the Government whether they are aware of the growing interest of more and more people in the idea of a family health centre. Now that both Tory and Labour parties, and of course the Lib Dems, are stressing the importance of arresting the observable decline in family values, it is encouraging that more and more people should be turning to the old Peckham principles. So I thought that it was time to make sure that the Government and their successor will pay attention to the growing desire to restore the happy family life which is the true basis for a happy and effective nation. And nothing is more likely to do so than the establishment of family health centres.
§ First, perhaps I may tell your Lordships of several developments which are on the way already. Southwark Council, which inherited the splendid old Peckham building, which was used first as an education centre and is now for sale, has planned and begun to build a fine new building next door. It is to be called the Peckham Pulse. For this it has got a large grant from the Sports Council and another from the Lambeth, 1247 Southwark and Lewisham Health Authorities, and building is already under way. The centre, like its original though much larger, will have a range of facilities surrounding the existing medical centre and including a 25 metre swimming pool, a fitness suite, an exercise development area, a children's soft-play area and a cafeteria. This is one of the first, and so far the most advanced and largest, new versions of the centre. It does not yet accept all our precepts, but that may come later.
§ Perhaps I may give the House a list of other centres which are on the way. I shall not give details tonight because I do not want to bore your Lordships more than is absolutely necessary. There are two centres at Sheffield, one backed by the health authority and one by an individual. There is one at Newcastle, which was recently and gloriously opened by Tony Blair. There is one at Castle Vale in Birmingham. There is one at Berwick Hill in Middlesbrough, which is in the Tees Health Authority area. There is a centre at the Chalkhill Estate in Brent, whose group is chaired by Mr. McFadyen. There is another at Beaconsfield, which is backed by the town centre and the health authority. There is one at Bruce Road in Bromley by Bow, and the chief executive is the Reverend Andrew Mawson. There are three at Epsom and Ewell: at Bourne Hall, a more or less exact copy called the Lifestyle Centre, and another called the Chris Lane Centre.
§ All those centres are in existence. One or two are functioning; the others are looking for money and making plans. I hope that increasingly they will turn out to be proper versions of our old centre. I am confident that they will succeed and will be used by families, old and young together, who will each be proud of their own centre.
§ The position is widening and growing. The success of the first few examples of the application of the Peckham principles, if they achieve success, each in their own way aiming to improve the quality of life and the stability of the family, will quite certainly lead to more and more efforts to do likewise. I want to be sure that the Government are ready for this. Local areas take time to decide that they want full attention concentrated on family health and opportunity, but once they have made up their minds to move in that direction it should be made easy for them. But success breeds success and there is no doubt in my mind that the efforts to which I have referred are only the beginning and will spread rapidly. Are the Government ready to back this movement to the hilt, as they certainly should? The noble Baroness has already shown her interest and given invaluable help but I am asking for more strength for her elbow.
§ Your Lordships will see that I am confident that the idea will spread in areas which can afford it. However, the inner cities, which are in the worst trouble, will not be able to afford such centres. Therefore, they must receive special treatment, and I want the Government to realise that in inner city areas only such centres will produce a solution. Nothing else will do so because 1248 families break up and disperse. If one can once bring the families together there is hope. I had intended to say more about that but I shall not do so.
§ Families need other families and somewhere to meet one another. The old need to meet the old, the young need to meet the young, and all ages need to mix and to have facilities for healthy exercise and amusement. In a short time the effect of young children insisting on going to a gymnasium is that their parents then join. First the older children go, then the younger children and then the parents are brought in. They then begin to take exercise and, if necessary, to pay for that. The setting up of such centres would be cheaper than allowing things to go wrong and trying to put them right afterwards. It would cost infinitely less than trying to deal with the unhappiness and misery that follows from the present gradual disintegration.
§ We in PHC Limited sold our building and had a small capital sum which we used to keep the community going. We have engaged a skilled and energetic young man—he is 37, which is my idea of young—to answer inquiries and spread information to all who need it. Experience suggests that if proper plans are made many of the endeavours will raise the necessary money, helped no doubt sometimes by money from the lottery, and will gradually spread all over the country. If anyone wishes to ask questions, please ring our secretary, Pam Elven, who is herself a product of Peckham. Her number is 01483 893266—and that will appear in Hansard!
§ I am speaking of the future, of tomorrow, not of today. I shall not be here to see it, but I visualise a Great Britain with a better quality of life, with happier families and happier children than we have today. I believe that the way will be hastened and helped by the spread of the family health centres that we have been discussing. It has begun, and it must go on. I now call upon the noble Lord, Lord Carter, to tell your Lordships about his work with Loughborough University. He spoke in our last debate and made sufficient impression upon us that we bullied him into becoming our president.
§ 6.30 p.m.
§ Lord Carter
My Lords, the House is extremely grateful to the noble Lord, Lord Donaldson, for tabling this Question and for allowing us to have this short debate. I am not sure what the Companion to the Standing Orders says about the quoting of telephone numbers during one's speech, but I am sure that that number will appear in Hansard.
As the noble Lord said, today's debate follows a similar Question which was tabled by the noble Lord on 11th April 1994. I must say that the noble Lord has been highly successful in promoting the ideas, ideals and principles of the Peckham centre as kept alive by the pioneer health centre. Moreover, as the noble Lord said, it has been kind enough to make me its president. There has also been an excellent programme on Radio 4 within the past 12 months on the subject.
When we had the debate in 1994 I must admit that, before I saw the Question on the Order Paper, I had never heard of the Peckham centre, despite the fact that 1249 I was born at the Elephant and Castle and spent the first seven years of my life living only a mile or two from the place. Therefore, I have gone from ignorance to president in 12 months.
However, when researching for that debate I became quite fascinated by the concept of the Peckham approach as it related exactly to another interest that I should declare; namely, that I am chairman of the United Kingdom Co-operative Council. It seemed to me that the Peckham centre was an early "community health co-operative". With the increased interest that we have now in finding new structures to deliver good health, it seemed to me that the Peckham ideas might be worth investigating to test their relevance against today's requirements.
Here I must pay a warm tribute to the noble Baroness, Lady Cumberlege. I believe that the noble Baroness was as intrigued as I was when, following the debate in 1994, I approached her in my capacity as chairman of the United Kingdom Co-operative Council and suggested that the Department of Health should sponsor a report on the subject. The Minister gave the idea very enthusiastic backing and, indeed, the Department of Health duly sponsored the report prepared by the Centre for Research in Social Policy at Loughborough University entitled, The Potential Contribution of the Co-operative Movement and Community Well-Being Centres to Health of the Nation Activities.
I should perhaps point out that the term "community well-being centres" was coined by the Minister herself. We were all anxious to avoid the term "health centre", with its overtones of medical care, conjuring up pictures of X-ray machines, electro cardiograms and the like and, as I am sure the Minister will remember, she actually said at one of our meetings, "Why not call them community well-being centres?" So the name was born.
The debate today is particularly appropriate. I believe that the date is not accidental; indeed, the noble Lord, Lord Donaldson, is not as innocent as that. However, as I said, today's debate is particularly appropriate as the Minister has kindly agreed to address the annual forum of the United Kingdom Co-operative Council on the subject in Manchester on Friday. There is a major conference at the Co-operative College at Stanford Hall in Loughborough next Tuesday to discuss the CRSP report. I have heard this afternoon that the uptake of that conference is extremely good.
Time does not allow me to analyse the report in detail, but it is likely to be the first of many incentives in the area. The emphasis in the report is on a holistic approach to good health which is built on the core Peckham principles, as set out in the report, which are:An orientation towards health, interpreted in a broad, holistic way; member participation and self-determination; multi-generational membership"—that is jargon for family membership—and a range of opportunities and integrated activities. Co-operative approaches in health and welfare, as elsewhere, are characterised by democratic organisation and ownership, with open and voluntary membership and a fair division of investment and distribution. They provide the expression of and the means to member participation and empowerment".1250 The report identifies nearly 300 initiatives, a number of which were mentioned by the noble Lord. It is clear, as I said earlier, that this whole area of health care will receive increasing attention. Perhaps I may give your Lordships just one more quotation from the report. In its summary it also says:Participation and ownership are seen as the key, strategic objectives. Success is associated with holistic approaches which encourage, enhance or maintain a high degree of user and community involvement, and engage and empower members. Success is related to the willingness of agencies to make a more or less equal commitment and to develop appropriate organisational supports to working in alliance. The source and security of financial support are crucial".We should also recognise that the area in which these centres will be working—and, indeed, the background—is very different from the Peckham phase. I have in mind the idea of the nuclear family and, for example, the problems with single-parent families, ethnic minorities, and so. I suggest that these are areas which the Health of the Nation has still to reach properly. I know that the Government are concerned in that respect and we support them in their attempts to try to get over the argument contained in the Health of the Nation to the population generally.
When the Minister replies, I am sure that she will say that the Government are not yet satisfied—nor, indeed, are any of us—with the way in which we have been able to get over the message contained in the Health of the Nation to those communities which most need it, especially those in inner cities. As I said, the concept of the Peckham centre still applies, but we must realise that it must be approached in a different way.
The report emphasises the way in which there are plans, initiatives and centres actually in being or being planned all over the country which attempt to deal with the problem. Indeed, on a lighter note I shall repeat a point which I made in the debate of April 1994: things have changed. An excellent video has been made by the pioneer health centre which describes the history of Peckham. It is extremely interesting. While watching that video I was most amused, as I know was the Minister, who has also seen the video, to see the family together—that is, the mother, father and two children—having their annual consultation with the doctor at the Peckham centre during which session the father was smoking a cigarette. I do not believe that that would happen now.
As I said, there has been a change. The noble Lord, Lord Donaldson, has made a real contribution to this. He was one of the pioneers who was actually at the centre. Indeed, we have had someone listening to the debate who is a member of the centre. I believe that the pioneer health centre should be congratulated on the way in which it has kept the idea alive. The report shows that there is much to be done, but the initiative of the noble Lord both today and in 1994 in raising the subject has been instrumental in ensuring that such an important subject remains firmly on the health agenda.
§ 6.37 p.m.
§ Baroness Cumberlege
My Lords, I, too, am grateful to the noble Lord, Lord Donaldson of Kingsbridge, for introducing the debate again this evening. I thought that it was very fitting that, as a former trustee of the original pioneer health centre, he should have raised the subject as he did in your Lordships' House in April 1994. On that evening we not only had an interesting and constructive debate, but the debate actually stimulated a whole range of activities, not least the report by Loughborough University referred to by the noble Lord, Lord Carter. In the intervening period I have noticed with enormous interest a whole range of new initiatives that have been developing, many of which are referred to in the report.
But, thankfully, we are a much healthier nation than we were when the pioneer health centre was built in 1926. At the beginning of the 1920s, average life expectancy for men was only 56 and for women 60. Today, we are living around 20 years longer. Fifty years ago, on average, for every 100,000 births, 400 women died in pregnancy or childbirth—a shocking figure, a huge toll on marital and family life. Today, that 400 has been reduced to six. Today the number of babies dying in their first year of life is at the lowest level ever recorded. Death rates from coronary heart disease, stroke, cancers and accidents are falling steadily.
Our children are an inch and a half taller than their counterparts of even 30 years ago, and with effective vaccination and immunisation programmes some childhood diseases have almost disappeared. Last year there were only 57 confirmed cases of measles and in 1992 we introduced a new vaccine which has almost completely eliminated Hib meningitis in young children.
Those are health statistics. I appreciate that the noble Lord has been talking about social health as well as medical health, if I can put it like that. One has to take into account how radically the world has changed since those early visionaries set up the Peckham experiment, as the noble Lord, Lord Carter, said. Certainly if we look just at health, it has changed for the better. But of course your Lordships are right to say that we cannot be complacent. There is still a great deal of avoidable ill health and too many premature deaths. There are stubborn variations in health between men and women, regions of the country, different ethnic groups and different social groups. Those are issues that the Government and others need to address.
This evening's debate has drawn attention to a great deal of interest in the way that the Peckham experiment approached the aim of improving health, and a feeling among many people that some of its lessons are still relevant today. Stimulated by the interest, enthusiasm, persistence and determination of the noble Lord, Lord Carter, the department has, as he said, recently funded research looking at exactly this issue. The research examined how the concept of community well-being centres—the Peckham model—was being put into practice in the 1990s and how such activities could contribute to the Health of the Nation, the Government's strategy for improving health across the population.
1252 The result of what is a fascinating report, produced by the Centre for Research in Social Policy at Loughborough University, needs to be widely disseminated. I have placed copies in the Library for all your Lordships who might be interested in reading it. If any Members of your Lordships' House are feeling in need of a tonic, or a pre-winter pick-me-up, I strongly recommend reading it because it is full of interest, innovation, achievement and hope.
The majority of the report is devoted to a review of existing activities, broadly described as community well-being centres, which draw on the principles underpinning the Peckham experiment. These are an holistic and positive view of health, rather than a focus on disease; an attempt to influence the wider determinants of health; to involve interests outside health services and health professionals; and to involve individuals and communities in taking responsibility for their own health.
Many of the projects mentioned emphasise the active involvement of local people in setting priorities and in finding their own solutions for local problems. I have visited and been impressed by several of the projects which are described within the report. The Life Project in the Wirral was a national winner of the Health Alliance Awards in both years the awards have been held. The judges were impressed not only by its comprehensive range of services and the populations covered, but by its thorough evaluation. Set up in 1993 because of concern about high rates of coronary heart disease, the Metropolitan Borough of Wirral, Wirral Health Authority and the University of Liverpool worked in support of local people, and with a wide range of partners in a programme of six projects. These included a GP exercise referral scheme, health checks in pubs and shopping centres, healthy schools, exercise training, and rehabilitation following heart attacks and strokes. Some 42 per cent. of people registered on the GP exercise referral scheme have been able safely to reduce their medication.
Another example which mirrors much of the original Peckham experiment is the Blackthorne Medical Centre in Kent. Urged by my very good noble friend Lady Faithfull to visit the centre, I found a place full of inspiration, dynamically led by Dr. David McGavin and his partners. The centre has not only the full range of skills and expertise patients would hope to find in any top rate primary health care team, but it promotes art, music, eurhythmics, massage and counselling for patients with any condition. The market garden, cafe and bakery provide essential employment for those suffering from long-term mental illness. It is one of the most inspiring places I have ever visited and talking to the patients, and the local community, including an army of volunteers, I have no doubt whatsoever that they value its therapeutic properties.
I hope that the Loughborough report will be of interest to a wide range of people and organisations, not only health and local authorities but also voluntary organisations, manufacturing and commercial interests, police, probation, the business community, universities, schools, colleges and others. We are taking active steps to disseminate it widely, as I have said. We have paid 1253 for the production of a short summary of the report which is available free to anybody who may he interested. Both the report and the summary have been widely publicised in our newsletters, which have a huge circulation across the NHS and other organisations. The researchers themselves are looking for opportunities to place articles in newspapers and journals.
As the noble Lord, Lord Carter, said, we are also funding a conference to be held on 26th November which is being organised by the researchers and at which the noble Lord will give, I have no doubt, an arresting keynote speech. The aim of the conference is to give people working in the field the opportunity to share experiences and debate lessons learnt from community well-being activities. It will be an excellent opportunity to harness the growing interest and to apply it to today's circumstances.
Finally, on the subject of follow-up to the research project, on 22nd November, at the invitation of the noble Lord who is chairman of the United Kingdom Co-operative Council, I am to take part in the national forum on the theme Co-operating for Health. This, I hope, will provide me with an excellent opportunity to introduce to a wider audience this important subject.
The thrust of the research highlights the fact that community well-being activities and the Government's Health of the Nation strategy are not in conflict, or even distinct from each other—far from it. To a great extent, the Health of the Nation strategy is supportive of and in tune with the growing interest in these innovative approaches.
Like the pioneers of the Peckham experiment, the Health of the Nation aims to prevent ill health and promote good health. The World Health Organisation has described it as a model for other countries to follow. Led by a Cabinet sub-committee chaired by the Lord President of the Council, the success of the strategy depends not only on leadership from the top but on the commitment and involvement of anyone who can have a positive effect on health.
One of the key themes in the Health of the Nation and one which is particularly relevant to the principles underlying the pioneer health centre is that of partnerships or alliances. Alliances are based on the age old principle that organisations and groups working together can achieve so much more than by working in isolation. Many of the projects quoted in the research report are based on health alliances and a number of them have had their excellence recognised through the national alliance awards scheme.
The concept of joint working is not easy for it demands respect for the values, views and traditions of others. However, when knowledge and resources are pooled, health alliances are a highly effective means of tackling specific problems. They can be especially effective when they work within a defined geographical area—in cities, neighbourhoods, schools, places of work and so on. They can also help target the difficult to reach groups which have been highlighted in tonight's debate and which include some of those most at risk such as elderly people or those whose lifestyles are problematical or those who have no wish to contact 1254 traditional health and social services. Again, there are parallels with the Peckham experiment which focused on a community with many material disadvantages and placed great emphasis on involving people of all ages.
The research demonstrates that there is ample opportunity within the Health of the Nation strategy to build on the growing interest in community well-being activities. At the same time we need to recognise that measures to improve health in the 1990s and beyond may not look quite the same as what was felt to be the answer in the 1920s, 1930s and 1940s. But there are common threads between then and now. They include the need actively to involve individuals and communities in approaches to improve health and a belief that the promotion of good health is not the sole preserve of health professionals.
Your Lordships will be aware that this afternoon the National Health Service Primary Care Bill was given its First Reading in your Lordships' House. This piece of legislation is designed to give members of the primary health care team the opportunity to work in new ways if they so wish. We recognise that the quality of service for some groups of people is not always of the best and that the rewards and incentives of a single national contract can inhibit doctors and dentists in their wish to introduce new and flexible services.
The Bill, if enacted, will allow new approaches to general practice to be piloted and evaluated. It is intended to encourage local people to develop and put forward their own ideas for improving services.
Finally, while supporting and encouraging local activities on the lines of those outlined in the research report, we need also to have a broader vision still. The Health of the Nation strategy calls upon us to work together with all those who have an impact on health. We have worked with industry and major employers to develop a strategy for improving health in the workplace. We are working with food producers, manufacturers, retailers and caterers to help promote healthy and enjoyable eating. Clothing manufacturers are interested in producing clothes which help protect against the sun. A national cycling strategy can help reduce the volume of motor traffic and increase peoples' level of physical activity. We are consulting widely on the introduction of a sixth key area in our Health of the Nation strategy, focusing on the environment.
So while we recognise the importance of local imagination, determination, motivation and the ability to improve health, we also recognise that government too have a role to play. As Sir George Young once said:For many of today's medical problems, the answer may not be cure by incision at the operating table - but prevention by decision at the Cabinet table".I would add to that, not only at the Cabinet table but also the dining table, for health cannot be divorced from the rest of life. It is part and parcel of it, as the Peckham Experiment all those years ago showed us so clearly.
House adjourned at nine minutes before seven o'clock.