Health White Paper

HL Deb 16 November 2004 vol 666 cc1304-19

3.19 p.m.

The Parliamentary Under-Secretary of State, Department of Health (Lord Warner)

My Lords, with permission I wish to repeat a Statement made in the other place by my right honourable friend the Secretary of State for Health. The Statement is as follows:

"I wish to make a Statement concerning the publication of a White Paper outlining the Government's policy on health improvement.

"Over the past eight months of the consultation we have seen speculation after speculation of the content of this White Paper and alleged leak after alleged leak. Some of it has, unfortunately, been relatively accurate. Most of it has been highly inaccurate and some of it has been sheer fantasy. Today I want to tell the House the reality.

"Last century saw undreamt of progress in the health of the people of England, gathering pace after 1948 as the establishment of the NHS enabled free universal provision of immunisation, screening and treatment to make inroads into ill health and premature death.

"It should be a matter of pride that a child born today is likely to live nine and a half years longer than one born on the eve of the formation of the NHS in 1948.

"However, the role of government in the prevention of ill health during this time was often characterised by a top-down approach.

"This White Paper is different. It is about enabling people to exercise their choice; it is about extending opportunity and offering security to those who want to choose a healthier life; and it is about people improving themselves.

"For in this White Paper it is the public, not Whitehall, who have for the first time set the agenda and identified what "for their own good" means. Over the past eight months we have consulted, discussed, listened, canvassed and calculated public opinion on a wider scale than ever before to get in touch with people's real concerns and to ask what they wanted and how they could be helped to realise their aims.

"They know that in recent years new opportunities have been opening up rapidly. But with them come growing inequalities, and, on the other hand, paradoxically, affluence and comfort bring their own health challenges—growing obesity, lack of exercise, more casual sexual relations.

"Faced with these many people want more opportunities to live healthier lifestyles. They know that they will become healthier only through their own efforts. However, they look to government to assist them with information about healthy and unhealthy choices—not to make the decisions for them, but to provide them with clear information to allow them to make the decisions.

"Now that the NHS is improving waiting times, reducing waiting lists and improving emergency care departments, that frees up the time, space and resources needed for effective action on prevention to help people make those changes.

"That is why this White Paper commits us to ensuring that health services such as sexual health services, NHS Stop Smoking Services and obesity services all now benefit fully from the same drive for modernisation and improvement that is spreading across the rest of the NHS.

"Our starting point is informed choice. That means an approach which respects the freedom of individual choice in a diverse, open and more questioning society. It also means addressing inequalities—the differences that locality and social conditions can make—so that everyone can have real choices. It is a sad fact that even today a male child born in Manchester lives at least seven years less than a child born in Kensington and Chelsea. Those inequalities cannot he tolerated any longer.

"To improve the nation's health we need everybody to have the chance to make more healthy choices—not just the better off.

"We will not be successful in tackling these inequalities unless we work in different ways. We need to reach people where they live their lives and provide services that are accessible to them but also derive from their own local communities.

"That is why the Deputy Prime Minister and I were determined that this White Paper would set out action that maximises the positive impact that local authorities and others can have to help people to make those healthier choices.

"For example, beginning this coming spring, the Communities for Health programme will bring all parts of the community together—statutory and voluntary organisations, businesses and individuals—in campaigns to improve local health.

"Working with local government we will be targeting funding to give greater priority to areas of high health need. New investment in primary care facilities for some 50 per cent of the population by 2008 will focus on the most deprived areas of our communities.

"In our widespread consultation people made clear that they often want to change but that they lack accessible help and advice. So, to help the public to make healthy choices we will provide them with clear information on those choices. Building on the success of NHS Direct, which received 7 million advice and assistance calls last year, we will introduce a completely new service—Health Direct—a telephone, online and digital TV information service to make advice on health, nutrition and diet available to everyone in this country, not just the better off.

"We will give special help to specific groups. Thirty years ago almost half the adult population of this country—46 per cent—smoked. Today it is 26 per cent. We will take another 2 million people off that figure over the next five years. Ultimately, people need to make this decision to improve their own health themselves, and to give up smoking everywhere, not only at work and in the pub, but at home as well. The Government cannot make this decision; it is a personal decision. However, we can help, as we helped 125,000 quitters last year through the NHS Stop Smoking Services. That is why we will be radically extending our campaign against smoking and why we will extend our smoking cessation services.

"We will introduce action to put hard-hitting picture warnings on cigarette packets; further restrictions on tobacco advertising; tough action on shops that sell cigarettes to children; improvements in the way the NHS helps people to stop smoking and to stay stopped; further reductions in tobacco smuggling; and, as I will outline later, we will see smoke-free environments becoming the norm both at work and at leisure.

"Others have told us that they would like help too. Many people today, such as busy mums, have told us that they want their families to eat more healthily, but that they need more, easily accessible and simple information to guide them.

"That is why, together with the Food Standards Agency, retailers and the food industry, we will develop a simple code for processed food to indicate fat, sugar and salt content for shoppers to help people choose what they need for a healthy and balanced diet.

"Our general approach is, of course, to recognise the right of adults to make their own informed choices. However, people, particularly parents, feel differently about children. Parents know that their children's health is primarily their responsibility. but they told us during our discussions that government, businesses and anyone who has an influence, also share that particular responsibility to protect children from premature exposure to a world of adult choices. Parents want the security of knowing that will be done.

"That is why, along with the Secretary of State at the Department for Culture, Media and Sport, we will be asking Ofcom to consult on advertising to children on television and why we will work with the industry to limit other forms of advertising to children outside television. That is also why, led by the Education Secretary, we will develop our approach to health in schools which looks at the effect of everything the school does—lessons, sport, food, school nurses, personal, social and health education—to ensure that these are brought together in a co-ordinated "whole school" approach to health to start children on the right path to a healthy life.

"That is why we will increase activity for children in schools. The Government are investing an unprecedented amount—over £1 billion to 2006—in PE and school sport; developing more sports specialist academies; strengthening the protection for school playing fields; and helping more children to walk or cycle safely to school. This is an age when obesity has trebled in a generation, and where, if the number of obese children continues to rise, we face the prospect of children having a shorter life expectancy than their parents.

"To be effective, support has to be tailored personally to the realities of individual lives, with services and support personalised sensitively and flexibly and provided conveniently.

"That is why—by new technology and investment—we intend to offer everyone in England the opportunity to develop their personal health guide and, starting with the areas of greatest disadvantage, we will provide people with NHS health trainers to support people's motivation in making the difficult decisions to choose healthy lifestyles. That has been limited to the well off, but it ought to be available to everyone in England.

"Healthy living starts at a young age. That is why we have decided to provide funding so that, by 2010, every primary care trust will be resourced to have at least one full-time school nurse working with each cluster of primary schools and secondary schools in their area.

"One of our greatest challenges is in the field of sexual health. It is a staggering fact that no fewer than one in 10 sexually active young women is today infected with chlamydia. We have to bring this problem out of the shadows and into the forefront of our attentions. We therefore intend to: launch a new national campaign targeted particularly at those at risk of catching sexually transmitted infections or of unplanned pregnancies; accelerate the implementation of our chlamydia screening programme to cover the whole of England by 2007; and offer the same fast access to high-quality genito-urinary medicine services that patients expect of other NHS treatment. In other words, by 2008 everyone referred to a genito-urinary medicine clinic should be able to have an appointment not within weeks, but within 48 hours. We will make that a priority.

"We recognise the damage that excessive alcohol can have on individuals, families and society at large. That is why we will work with the Portman Group to cut down on binge drinking, and with industry to develop a voluntary social responsibility scheme for alcohol producers and retailers, to protect young people. We will support Ofcom to strengthen the rules on broadcast advertising of alcohol, particularly to protect the under-18s; and we will invest to improve services to help the NHS to tackle alcohol problems at an early stage.

"There is another area where people want a greater degree of security and protection in maintaining a healthy lifestyle for themselves and their families. I have stressed that our approach has been guided by informed choice on the part of individuals, with government playing our role in providing information, encouragement and support in order to assist individuals in making the healthy choices. We do that because we believe that, in a free society, men and women ultimately have the right within the law to choose their own lifestyle, even when it may damage their own health.

"But people do not have the right to damage the health of others, or to impose an intolerable degree of inconvenience or nuisance on others. We therefore intend to shift the balance significantly in favour of smoke-free environments. From 2006, we propose to introduce changes to ensure that all government departments will be smoke free; all enclosed public places and workplaces—other than licensed premises, which are dealt with separately—will be smoke free; all restaurants will be smoke free; and all pubs and bars preparing and serving food will be smoke free. Other pubs and bars—about 20 per cent of those in England—and membership clubs will be free to choose whether to allow smoking or to be smoke free, but smoking in the bar area will be prohibited everywhere.

"We will therefore ensure that people will be able to go to their workplace or choose to go out for a meal or a drink without the damage, inconvenience or pollution from second-hand smoke. However, we will try to do that in a way which, while protecting that right of the majority, still allows a degree of choice—albeit a much more limited one than before—to the minority. This is a sensible solution, which balances protection for the majority with personal freedom for the minority in England.

"This White Paper promotes the opportunity for healthy living in a mariner and on a scale unseen before. It envisages investing at least £1 billion over the next three years in public health. It treats our fellow citizens as adults capable of making their own decisions, while providing advice, information, encouragement, resources and personal support for those who want to make the healthy choices. It provides protection from the effects of those who do not wish to make healthy choices.

"It begins the transition of our healthcare away from just a national treatment system for illness, towards a true national health service. It offers the opportunity for healthy living to everyone who wants to take it and, for those who do, the security of knowing that a degree of protection will be afforded to them and their families. In doing so, it begins to fulfil at last the founding vision of a true national health service. I commend it to the House".

My Lords, that concludes the Statement.

3.34 p.m.

Earl Howe

My Lords, I thank the Minister for repeating the Statement. I welcome it as a long-awaited recognition by the Government that public health can no longer remain the poor relation, as I fear that it has tended to be during the past seven years, in the priorities that Ministers have set themselves in health policy-making. As the White Paper spells out, we are as a nation facing very considerable challenges under every main heading to which the Minister referred. We badly need a concerted programme of action to reverse some very damaging trends.

I remember very well listening to the noble Baroness, Lady Hayman, when she was a health Minister, announce the publication of the Government's previous public health White Paper, Saving Lives: Our Healthier Nation, five years ago. I fear that the shortcomings of that document are now apparent for all to see. Despite very clear indications even in 1999 of the growing threat from obesity, diabetes, alcohol misuse and sexually transmitted diseases, it contained no targets and no milestones for reducing any of them. Instead, we heard a lot about local partnerships—as we do again today—and suggestions for "possible" action plans in local areas. The tone then was neither ambitious nor urgent, and we are paying the price of that now both in human life and in statistics that are getting progressively worse across the board. The only ambitious and urgent initiative in 1999 was that of health action zones; goodness knows what has happened to them.

The tone has changed, and I think that we can all be genuinely glad of that. In other areas of health policy, I may sometimes criticise the Government for being too quick and too ready to set targets for the NHS, but public health, it seems to me, is a completely different case. It is an area for which the Government themselves shoulder direct responsibility and need to be held accountable in ways that are measurable and meaningful. The unfortunate thing is that, as a result of the recent reorganisation of the NHS, the means of delivering the public health agenda have been fragmented across PCTs, and it is that much more difficult to retain an adequate focus.

There is not time to do more than scratch the surface of the White Paper's proposals, but I shall mention some of its welcome features. I am glad to see the emphasis on greater investment in deprived areas; co-ordinated action in schools; a national sexual health campaign; and better information about healthy lifestyles. Developed properly, those initiatives could produce worthwhile results.

I question some other features, however. We all agree that action to protect non-smokers from inhaling tobacco smoke is necessary. However, I cannot understand why the Government did not elect for a course of action that could have been taken more speedily. Our work in the area suggests that it would have been easier and quicker for the Government to adopt the voluntary approach rather than the statutory one, because progress to reduce passive smoking could have been made without the inevitable delay associated with bringing in legislation. As it is, the Government's proposals look somewhat bitty and complicated, as the BMA has observed. How will it be possible to enforce a smoking ban in, for example, the bar area, whatever that means? If the emphasis in the White Paper is on choice—I do not argue with that as a general approach—why have the Government not looked at the problem of passive smoking from the point of view of those unable to make choices? By that, I mean children. I cannot quite see the logic of making distinctions between licensed premises according to whether or not they serve food.

On tobacco consumption more generally, the Minister mentioned that action was to be taken to reduce tobacco smuggling. What is that to be?

On sexual health, why is the chlamydia screening programme not to be rolled out nationally for another three years? What is the reason for that delay in the face of the truly appalling statistics on chlamydia that have been published recently?

Regarding healthy eating, I am sceptical about the Government's proposals in terms of the advertising of fast foods. On what basis do the Government believe that such advertising restrictions will work, bearing in mind that Ofcom has described such measures as ineffective and disproportionate?

I am also sceptical about the suggested system of colour coding on processed foods. How is it possible to devise a code for individual foods that is not inherently misleading and simplistic? It is not individual foods that are good or bad, it is a person's overall diet and his or her lifestyle. Can the Minister assure me that nothing will be done in this area without the advice and approval of the Food Standards Agency, the Food and Drink Federation and the medical profession, so that we achieve a system which people can understand and rely on?

Lastly, I should mention alcohol misuse. The section in the White Paper on alcohol is the weakest of any. A voluntary social responsibility scheme does not sound all that inspiring. What plans are there to tackle hinge drinking? What plans do the Government have for improved labelling on alcoholic drinks, particularly with regard to pregnant women? What public information initiatives are being considered? The Minister will know that there has been criticism of the recent Alcohol Harm Reduction Strategy for England, in that it proposes little real action or delivery.

We all have an interest in seeing such initiatives succeed. I wish the Government well in their objectives, even if along the way I may be occasionally critical of the precise means by which they are seeking to reach them.

3.41 p.m.

Lord Clement-Jones

My Lords, I, too, thank the Minister for repeating the Statement made in the other place. The White Paper represents a considerable body of work, although it is rather belated, as the noble Earl pointed out. But I welcome it. We on these Benches welcome it as a clear statement of Government policy and, personally, it was worth returning to these Benches yet again to comment on it.

It is clear that public health is now, finally, a major priority for the Government. It took time—in fact, it has taken seven years. But, spurred on by Derek Wanless, who highlighted the £30 billion cost that would be incurred if nothing was done until 2020, the Government have started to grasp the nettle. But have they made a real estimate of the reduction of those costs that would result from the action set out in the White Paper? That would be telling.

There is much to welcome in the White Paper—and I shall not comment at length about those areas of common ground—but certainly the additional expenditure on a sexual health strategy, which has been underfunded for some considerable time, is much to be welcomed. Regrettably, despite the Prime Minister's words in October that the biggest advances have always been due to the boldest reforms, this public health White Paper does not live up to that.

The manner in which the White Paper proposes to tackle smoking is, in the view of many of us, the litmus test. The scientific evidence that second-hand smoke damages health is overwhelming. There are many, many questions that arise from the Government's proposals in that regard. I visited Eire in October this year and saw for myself the success of the Irish experience. Anecdotally, the total ban on smoking in public places in New York has been extremely successful. Perhaps the Minister can answer these questions: will not the proposal in the White Paper fail to protect the single group of employees that has been identified as most at risk—namely, staff in pubs and bars? Will not these proposals be legally unstable due to the certainty of civil actions for compensation from employees who have been made ill by exposure to tobacco smoke when working in those bars that will be exempt? Will the proposals not be highly complicated to operate and enforce?

The ability of the Irish authorities to enforce has been superb. There has been some 90 per cent compliance with the legislation. This proposal will be very complicated to apply. The Statement referred to the "calculation- of public opinion. In this case, I believe that the Government are miscalculating the level of public support that there would be for a total ban on smoking in public places.

There a number of important other areas. Obesity is a major problem, particularly among children. We need to recognise the environment in which children are now growing; where fast food is glamourised—food that is high in fat, sugar and salt is advertised heavily on television at times when children are watching. I very much welcome the Government's proposals regarding advertising in terms of its initial voluntary nature. But I hope that if agreement is not reached with the manufacturers the Government will consider adopting a compulsory approach. In that context, the response of Ofcom has been extremely unhelpful in the past few days.

The proposals for a traffic light labelling scheme are welcome. We would prefer to see a mandatory scheme for labelling, but it remains to be seen how well that voluntary scheme will operate. What proposals do the Government have to monitor that voluntary scheme? How will they test whether it is working?

It is clear that schools have a vital part to play in reinforcing healthy habits of diet and exercise. I much welcome the pledge on action in schools. But vending machines in schools are a particular issue. What proposals do the Government have regarding them?

Generally, the White Paper says very little about poverty, poor housing, poor environment and the role of inter-departmental work across government in developing health-promoting policies. I hope that those will be expanded upon in time. Are there no plans to audit across the board the impact of government policy on people's health? The health gap between the richest and poorest in this country has widened in the past seven years, particularly with regard to life expectancy. Male life expectancy can differ by up to 10 years between different parts of the country.

I somewhat question whether the White Paper will be hold enough to make inroads into the enormous health problems that we face. I very much hope that this does not turn out to be a missed opportunity.

3.47 p.m.

Lord Warner

My Lords, I am grateful for the broad welcome from the Benches opposite and in the end I shall see the noble Lord, Lord Clement-Jones, make almost as many returns as Frank Sinatra.

We need to look forward, not backwards, and that is what the White Paper does. I am pleased to see that Members on the Conservative Front Bench have recently had a Damascene conversion to targets. I should also draw the attention of the noble Earl, Lord Howe, to the fact that on the ground we do have directors of public health. Whatever other organisational changes have been made, they are there and constitute a robust system. They are a major part of the local network that will take forward this agenda.

We accept that there are issues in deprived areas. Perhaps I may say, in response to the noble Lord, Lord Clement-Jones, that the Statement drew attention to the fact that primary care trusts in the most deprived areas would be first in line for the increased resources.

I was not expecting to receive fulsome accolades regarding second-hand smoke from everyone. So I decided to get my retaliation in first. We must draw attention to the fact that we have consulted everyone about this matter. The support for a total ban is different in this country as a result of that consultation. It showed that people clearly distinguish between places which serve food and those that do not. Even among non-smokers there is a fair degree of support for continuing to allow smokers, in a controlled manner, to exercise their right to smoke in pubs. After all, we live in a democracy. If you consult people and take their views seriously, you act on that evidence. We are trying to ensure that about 80 per cent of pubs—that is my right honourable friend's estimate—are smoke-free. In the remainder, controlled smoking will be allowed. People will not be able to smoke in the bar areas. There is scope for legislation in that regard, together with consultation on how "bar areas" are to be defined. But we are taking a major step towards ensuring that smoking is banned in the great majority of pubs where food is prepared and served.

Ultimately, people have a choice. They will be able to go to the 80 per cent of pubs which are totally smoke-free or they will be able to go to the small minority of pubs where smoking is permitted in a controlled way. I suggest that that is what democracy is about.

We are taking the issue of chlamydia very seriously. In response to the point raised by the noble Earl, Lord Howe, it takes time to build up resources in genito-urinary medicine. We have to put those resources in place to ensure that a full response within 48 hours is possible. So there will be a build-up during that three-year period.

I say to the noble Earl that we have already substantially reduced the level of tobacco smuggling. In 2002, about 18 per cent of cigarettes in this country were smuggled. Our target is to reduce that figure to 13 per cent by 2007.

I detected a slightly muted welcome for the idea of an easy-to-understand coding system for labelling food. We have to accept that the present arrangements for understanding the precise health risks from food products are extremely demanding. We shall he working with the Food Standards Agency and the industry to produce a workable system that is simple to understand. There would be no point in introducing a system that was doomed to failure, and so we shall consult widely and take advice from the Food Standards Agency in carrying out that work.

With regard to staff in pubs where smoking will be permitted, their employers will still have obligations under health and safety legislation. Staff will have the opportunity to choose not to work in those environments and to work in pubs and clubs where smoking is not permitted. Therefore, people will have a greater choice than they do at present.

We shall monitor the effects of all these changes. It is worth drawing noble Lords' attention to the fact that, in the new national standards for the NHS, one of the seven domains relates to public health. The Healthcare Commission will monitor adherence across the National Health Service to the standards in that domain.

I think that I have dealt with most of the points raised by noble Lords. I shall read Hansard carefully and, where I have not responded, I shall write to noble Lords.

3.54 p.m.

Lord Clinton-Davis

My Lords, can my noble friend explain why the examples of Ireland and Scotland, where profound research has been undertaken, have been totally ignored? Why has the advice of the BMA, the Royal College of Physicians and, indeed, the department's own chief adviser, Sir Liam Donaldson, to axe all smoking in enclosed public places also been totally ignored?

Lord Warner

My Lords, the Chief Medical Officer regards the action that is being taken as representing significant progress in tackling the epidemic of smoking-related disease.

We have not ignored people's advice and, in addition, we have consulted the public. If, when consulting the public, you sometimes do not get the answer you expect or particularly like, it is still democratic to listen to those views and take them into account. We have not ignored all the advice that has been put forward by the medical profession or other people. In these proposals, we shall be taking very firm steps drastically to reduce the number of places where people are exposed to second-hand smoke.

Lord Walton of Detchant

My Lords, perhaps I may ask the Minister a question in relation to the smoking issue. There is no doubt that smoking is now one of the greatest health hazards of the age—if not the greatest. There is no doubt, too, that the evidence relating to the inhalation of second-hand smoke as a serious danger to health is now incontrovertible. But, in the Statement, the Minister said that all restaurants and all pubs and bars preparing and serving food will be smoke-free.

Like the noble Lord who has just spoken, I should have much preferred to follow the advice of the Royal College of Physicians and the BMA to make all pubs and bars smoke-free. But the next sentence in the Statement makes it clear that other pubs and bars and membership clubs will he free to choose whether to allow smoking or to be smoke-free. Is there not an incompatibility here? What is the position with regard to bars and restaurants in private membership clubs? Surely the ban should apply to them if all restaurants and all pubs and bars preparing and serving food are to be smoke-free. Can the Minister clarify that point?

Lord Warner

My Lords, the position is much as I set out in the Statement. If food is prepared and served in pubs, that means that smoking will not be allowed. With regard to membership clubs, by definition people make a choice to belong to a club where smoking is permitted. It is absolutely open to all people not to go to clubs where smoking is a feature. I acknowledge the noble Lord's views on this area but, as I said earlier, we are responding to what people told us in the consultation.

Lord Fowler

My Lords, does the Minister agree that one of the worst aspects of public health policy over the past few years has been the failure to deal with the enormous rise in sexually transmitted disease, particularly among young people? Obviously I welcome the promise of a new national campaign but, frankly, we do not need a White Paper for that. What was to prevent this being done at any stage over the past seven years? Had we done so, would we not have prevented some of the crisis that we see today?

Lord Warner

My Lords, I remind the noble Lord, to whom I pay tribute for his energetic work in this area, that in 2001 we published The national strategy for sexual health and HIV, and £54 million has been invested. A very effective national campaign—the Sex Lottery—has targeted 18 to 30 year-olds. We have recommended standards for HIV treatment and we have extended HIV testing and awareness campaigns for communities. This White Paper is building on that work to take forward what we all acknowledge is a serious problem of our time.

Baroness Andrews

My Lords, noble Lords may have noticed that the clock stopped during the power cut, so we shall continue until it shows 17 minutes, which I believe will give the House the full 20 minutes. I know that many noble Lords wish to speak.

Baroness Gould of Potternewton

My Lords, I declare an interest as the chair of the Independent Advisory Group on Sexual Health and HIV. I welcome that part of the White Paper and the efforts that the Government are making to counter the great concern about sexual health. The agenda is moving in the right direction. I would not put it any stronger than that, but I welcome the new national campaign and the increased sources of information for young people who are at risk from teenage pregnancy and STIs.

I am pleased also that there is to be an area roll-out of chlamydia services and faster access to GUM clinics. However, like the noble Earl, Lord Howe, I hope that the dates can be brought forward. I would appreciate my noble friend giving more detail of the financial support that will be given to make those events happen.

Will my noble friend also give more information about the role of the school nurse? I was interested to hear that there is to be a school nurse in each PCT. Will that school nurse also look at matters such as PSHE and SRE?

Lord Warner

My Lords, I pay tribute to the work that my noble friend has carried out in this area. I do not have the figures on the money available, but I shall investigate that and write to her. As I said in the Statement, there will be a school nurse for each cluster of primary or secondary schools. One of the areas in which they will be involved is the personal, social and health education curriculum which will include sexually transmitted infections and contraception issues.

Lord Addington

My Lords, I congratulate the Minister on presenting a document which draws attention to the link between sporting activity and health. Does he have a firm figure on the extent to which the Government want to increase sporting activity? Does he have any idea yet of the amount of resources required for physical facilities and trained personnel? On 4 November, I asked the noble Lord, Lord McIntosh, a similar question but he declined to give me any form of answer.

Lord Warner

My Lords, the White Paper will lead to the investment of £1 billion for sport in schools. We shall develop more sport specialist academies; we shall invest in successful initiatives to promote physical activity by young people; and we shall help more children to walk or to cycle safely to school.

Lord Chan

My Lords, I welcome the White Paper on behalf of the primary care trust of which I am a non-executive director with particular interest in public health. We have waited a long time to tackle health inequalities but at last it has come about. For that we congratulate the Government and look forward to the extra money that will be given—the £1 billion.

Will the Government give primary care trusts autonomy so that the money can be used to suit local needs and to work across boundaries with other primary care trusts and local authorities? In the north-west, for example, there are several areas of deprivation where people require and are in favour of the complete banning of smoking in public places. We would want to push for that, despite the advice in the White Paper. Can the Minister give his view on that as well as on other issues such as eating, exercise and alcohol consumption?

Lord Warner

My Lords, as the noble Lord knows, we are shifting the balance of power. PCTs, along with the rest of the local health economy and related services, can adapt the resources that they have to their local circumstances and adopt policies that meet the particular needs of their communities. I draw the noble Lord's attention to the fact that I mentioned health trainers in the Statement. They will be drawn from local communities, they will be people with whom the local communities can identify and they will he accredited, but they will be able to give a particular local dimension to the services and advice provided.

Lord Geddes

My Lords, I wonder whether the Minister has read the article in today's Sun which states: smoking in pubs should be a matter of choice—with smoking areas and non-smoking areas provided". I declare an interest as a proud member of the Lords and Commons Pipe and Cigar Smokers' Club. Why should smoking not be allowed in separate ventilated rooms when hot food is served on premises or at times when hot food is not served?

Lord Warner

My Lords, there is good evidence that ventilation systems do not guarantee that an area stays smoke-free. As I said in response to other noble Lords, once one consults people, one has to listen to them. That is what democracy is all about. There is an overwhelming wish to move away from being exposed to second-hand smoke where people eat.

Lord Faulkner of Worcester

My Lords, I declare an interest as a trustee of the Roy Castle Lung Cancer Foundation. My noble friend will be aware that Roy Castle died of lung cancer having not smoked a single cigarette in his life. He contracted the disease as a result of working in smoke-polluted clubs for the whole of his career. I recognise that the Statement is a very considerable step forward in terms of public health, but how will it protect those who work in bars and clubs from the effects of second-hand smoke?

Picking up a point made by the noble Lord, Lord Chan, can the Minister give an assurance that Her Majesty's Government will not seek to block, water down or undermine Private Bill legislation sponsored by local authorities, such as Liverpool City Council, to introduce a complete ban on smoking in public places and places of work in their areas? One has to bear in mind that such Bills arise as a result of the wishes of local people and democratic decisions taken by the councils and that they are designed to deal with particular problems of smoking-related diseases in their areas.

Lord Warner

My Lords, on the latter point, when I last looked, Liverpool was part of the country called England. It is on that basis that we legislate across the country. As regards banning smoking in public places, it is for the Government to take the necessary action on legislation at the appropriate time. There is nothing in the White Paper that stops people entering into voluntary arrangements in anticipation of that legislation and withdrawing smoking from particular pubs and clubs or any other public place. People can see which way the policy is going. The policy direction is very clear.

As regards the staff who work in pubs and clubs where smoking is permitted, there will be provision to ensure that smoking does not take place in the bar areas where they serve. There will be many more opportunities in the hospitality and entertainment industry to work in environments where one is not exposed to second-hand smoke.

Baroness O'Cathain

My Lords, I welcome the White Paper and the Statement. I thank the Minister and the usual channels for making the White Paper and Statement available to noble Lords some considerable time before the Statement was delivered in the House. My first question relates to the fact that the Statement given by the Minister varied from the written Statement by emphasising that it referred to England only. What will happen in Scotland, Wales and Northern Ireland?

Secondly, on a point of clarification, the Minister spoke of £1 billion to be spent on PE for schools, but the summary says that there will be an extra £1 billion spent on public health. Is that the same £1 billion? I suspect not. It would be useful to know whether the total is £2 billion.

The Portman Group is to get involved in consultation on alcohol, but it is not exactly disinterested. On passive smoking, 20 per cent of pubs and bars—the Minister has added that, compared with the printed Statement—will not be smoke-free, but that is a big no-no for those of us who are very concerned about passive smoking.

Finally, I should like to know how the Government will organise local groups to become the protagonists of this provision. It is going to be very difficult, I am sure.

Lord Warner

My Lords, the Government are trying to set a clear direction of travel in this area—smoking—and across the patch in terms of public health. We are giving clear signals on the future direction of policy. It is clear from the consultation that there is a good deal of public support for this particular direction of travel. People want more information and support.

We are working with the Portman Group, which has a reasonable track record in corporate social responsibility. We want to take forward those discussions in the context of this White Paper, which makes the Government's position extremely clear.

The £1 billion for sports facilities is over a three-year period and the money for public health is also over a three-year period. So there are two figures.

Lord Williamson of Horton

My Lords, I declare an interest as a non-executive director of Whitbread, which is the biggest hotel company in Britain, one of the largest restaurant companies in Britain and one of the market leaders in health and fitness clubs. Does the Minister agree that the industry is now making an effort on one of the important points which was mentioned in the White Paper? That is the question of fat, salt and sugar in foods. I make the point because this morning I visited a development kitchen, which has considerably reduced those products in foods in a huge number of restaurants across the United Kingdom. The issue is not only for government; unless the industry takes these practical steps we are not going to get any of the improvements we want. But I think we can do it.

Lord Warner

My Lords, I would agree that there has been movement within the industry in this area. We are faced with trying to find a signposting system that is easy for people to understand, so that when they are buying processed food they can understand what they are getting and what the health risks are. Clearly, we need to work with the industry and the Food Standards Agency to get a practical labelling system in operation as quickly as possible.

Baroness Hayman

My Lords, my noble friend will not be surprised to know that I, like many others who have spoken, believe that clarity and simplicity have a great deal to commend themselves in the area of passive smoking and smoke-free workplaces. I think that there will be grave problems in defining what is not the bar area of a bar and on the issues relating to the serving of food in private clubs and many other areas. However, perhaps I should confine myself to welcoming substantial progress in this area.

Perhaps I may ask the Minister about a separate issue. Paragraph 101 of the White Paper deals with further education settings and the support that young people need as they go through the transition into adult life. The rest of the section is very thin when compared with the progress that is being suggested in schools. Is it not true that in further education settings young people very often make extremely unhealthy choices about their sexual health, alcohol use and on diet, and, indeed, are at risk of mental health problems? Is not there a need for coordinated services in further education settings as well as in schools?

Lord Warner

My Lords, I suppose there may well be. The main focus of the White Paper is to bring home the point that you need to work much earlier with children in making them aware on all these issues, so that by the time they get to further education they are well steeped in the needs and information about healthy lifestyles.

Lord Maclennan of Rogart

My Lords —

Lord Forsyth of Drumlean

My Lords—

Baroness Andrews

My Lords, I am extremely sorry. Noble Lords have had slightly over the normal 20 minutes we allow for Back-Benchers. I know that this is an important debate, but we will have other opportunities for it.