Tuberculosis

Debate between Grahame Morris and Jim Shannon

Wednesday 27th November 2013 Westminster Hall

[Grahame M. Morris (Easington) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Dobbin.

In the last three Westminster Hall debates that I have attended—on the privatisation of the east coast main line, the privatisation of blood products laboratories and free schools—I have found myself at loggerheads with Government Members. Unusually, however, today I find myself nodding in agreement with the excellent contribution of the right hon. Member for Arundel and South Downs (Nick Herbert). I pay tribute to my hon. Friend the Member for Scunthorpe (Nic Dakin) for securing this timely, important and significant debate.

I echo the right hon. Member for Arundel and South Downs in paying tribute to the work of the all-party group on global tuberculosis and its members and officers, including the hon. Member for St Ives (Andrew George), who has been an absolute stalwart of the group for a number of years.

I will concentrate on one aspect of this terrible condition that is close to my heart. As Members know, I have the pleasure of representing Easington in east Durham. Easington is a coal mining constituency with a long and distinguished history as one of the great heartlands of the north-east coalfields. I thought it would be poignant in this debate to reflect on why our pits were closed and why Britain now imports more than two thirds of the coal burned in our power stations, when once we imported none.

The UK coal industry was modern, efficient and very health conscious. My right hon. Friend the Member for Neath (Mr Hain) spoke about the incidence of TB among South African miners, which is relevant. I have just come from the annual general meeting of the all-party group on coalfield communities, where we talked about the problems that we face in coal mining communities, the physical legacy of pollution and the ill health associated with mining. That is another reason why this debate is close to my heart.

Although, by its very nature, mining will never be completely safe—it is an extractive process—our mines were about as safe as they could be, and the health, safety and well-being of miners was paramount. There are those who would argue that that drove up costs.

Today, much of the world’s coal production has been offshored and outsourced to countries where health and safety standards are minimal and labour is cheap. There is still blood on the coal, but nowadays it is more likely to be the blood of miners in Colombia, China or South Africa. The price of the irresponsible pursuit of profit and cheap labour is the health and safety of mineworkers worldwide.

Mining is one of the biggest employers of men in South Africa. Tens of thousands of those miners are migrant workers, from neighbouring countries such as Mozambique, Lesotho and Swaziland, who work and live in crowded townships in mining areas. As has been said, diseases such as malaria, TB and HIV/AIDS are rife. South Africa’s mining industry has been the subject of intense international and national media scrutiny due to the recent industrial unrest. Members will be aware of the appalling shooting of striking miners by armed police in scenes reminiscent of the worst days of apartheid. Mining is one of the driving forces of the South African economy; it contributes some 20% of the country’s gross domestic product and is a major employer.

What has not been subject to the same degree of media attention is the devastation caused to miners and their families by TB. The disease remains the leading cause of death in South Africa today. One third of all cases in sub-Saharan Africa have a link to the mines. TB is an airborne disease, spreading through the air when people who have it cough or sneeze, and it is often fatal if left untreated. Rates of TB among South African mineworkers are estimated to be as high as 7,000 per 100,000. That huge figure is 28 times the World Health Organisation’s definition of a health emergency and is the highest such figure in the world.

As we have heard, TB is closely linked to HIV, which is also a challenge in the mines. It is estimated that people with HIV are 21 to 34 times more likely to develop active TB. As we approach world AIDS day, it is important to reflect on that and on the interactions between the two. Such high HIV infection rates, coupled with cramped living conditions and exposure to silica dust, which damages miners’ lungs, creates a perfect breeding ground for the disease. The effects are devastating not only for the families of the many miners who die from TB, but also for communities, companies and Governments.

From a commercial point of view, the disease dents productivity—the issues I am raising are relevant to the British mining companies involved in South Africa—puts a drain on health budgets and spreads far into the rural areas that miners migrate from. Migration also means that the problem is not exclusive to South Africa, which is one reason why sub-Saharan Africa is not on track to meet the target of reducing deaths from TB by half by the expiration of the United Nations millennium development goals in 2015.

[Jim Shannon (Strangford) (DUP)]

I apologise for not being here earlier; I had other business and could not get here any quicker.

The hon. Gentleman mentioned world figures for TB, but the exact number of TB sufferers is not known and many of them cannot be found. How does he think we can best address that problem?

[Grahame M. Morris]

I am grateful to the hon. Gentleman for that relevant point. An estimated 3 million people with TB in southern Africa have not been reached, but programmes, such as TB REACH and those supported by the Department for International Development, exist to identify those people and to secure treatment for them. My point is about the incidence of known TB among miners in South Africa.

TB is curable with drugs, and the costs are relatively modest. Spending £15 a person should be easily affordable. Global underinvestment and indifference mean that the disease killed an estimated 1.3 million people globally in 2012. The failure to deal decisively with TB has allowed drug-resistant strains of the airborne disease to develop, which are much more difficult and significantly more expensive to treat.

Earlier this year, members of the all-party parliamentary group on global tuberculosis, including me, met the Secretary of State for International Development. I want to echo the words of Government Members and compliment the Minister and the Secretary of State for their commitment on this issue. We met them to put TB at the forefront of their dealings with major Anglo-American mining interests, particularly in the gold mining industry, which has a high incidence of TB as well as high rates of HIV. As my right hon. Friend the Member for Neath mentioned, an estimated 750,000 cases—I had to check that incredible figure, as I thought it was a printing error—of TB each year, 9% of the global total, come from South Africa’s gold mines.

Colleagues who represent former British mining communities, such as my right hon. Friend the Member for Rother Valley (Mr Barron), and I are determined to push the battle against TB up the political agenda here in the UK. Along with the South African mining unions, I want to see the British Government make the British mining companies involved in South Africa sign up to a new protocol launched by the South African Department of Health. That would help ensure that mining companies abide by a legal framework governing the treatment and compensation of occupational TB.

In the past, too many stricken miners simply returned to their towns and villages to die lingering and often painful deaths. In the 21st century, it simply cannot be acceptable that mining companies, or any other employers, should systematically endanger the health of their workers. Rates of TB in the mines have been estimated at 28 times the World Health Organisation’s definition of a health emergency. This is a global health emergency. We need Governments, employers and drug companies to act accordingly.

People do not have to live in a mining constituency to know that keeping the lights on should not come at the expense of the health and lives of South African miners and their families, or those in any other countries. That is simply wrong. Global mining operations headquartered in the UK must accept their social, moral and ethical obligations to address the issue as a matter of urgency.

Hepatitis C (Haemophiliacs)

Debate between Grahame Morris and Jim Shannon

Tuesday 29th October 2013 Westminster Hall

[Grahame M. Morris (Easington) (Lab)]

I congratulate the right hon. Member for Wythenshawe and Sale East (Paul Goggins) on securing a debate on this important issue.

What are the thoughts of the hon. Member for Strangford (Jim Shannon) on the role of specialist hepatitis C nurses in providing support to sufferers who are haemophiliacs and more generally? The NICE guidelines suggest a minimum of one specialist hepatitis C nurse for every 40 patients in the community and one such nurse for every 20 patients in a hospital setting. Does the hon. Gentleman think that the Government’s plans to transfer resources through the clinical commissioning group allocations will help or hinder the improvement of support for hepatitis C sufferers?

[Jim Shannon]

I thank the hon. Gentleman for helpfully highlighting the role of specialist nurses. I hope that the Minister will be able to give us an indication of the importance of the role of nurses and therefore the importance of retaining them and ensuring that the numbers are correct.

Just a few minutes spent reading the stories of victims and their families on the taintedblood.info website brings a lump to the throat. In this House, where we have the privilege to represent our constituents, we cannot continue to leave the families behind. I wholeheartedly support the removal of the two-tier system, which would entitle people to an annual sum to help them to cope with the side effects of this terrible disease and would take a little pressure off the families who are faced with watching their loved one fade away before their eyes. It is well past time that we do the right thing by those affected, and that will not be done by separating and segregating those infected by the same disease. I urge the Minister to take on board what is said today by the right hon. Member for Wythenshawe and Sale East and others and to do the obvious and right thing by providing the apology and response that we need.

Several hon. Members rose—

Firearms Controls

Debate between Grahame Morris and Jim Shannon

Wednesday 31st October 2012 Commons Chamber

[Grahame M. Morris]

I have no experience. I have never held or shot a gun, but I have experience of a terrible tragedy in my constituency on new year’s day. I am attempting to share my experience with Members and to advocate having a review in the interests of public safety.

[Jim Shannon (Strangford) (DUP)]

I thank the hon. Gentleman for the balanced way he is approaching this subject. I am concerned that the focus seems to be on legitimate firearms holders, the majority of whom are law-abiding. Will he reassure sporting Members and others throughout our local communities who enjoy the sport that this debate is not going down the road to remove firearms from those who have a legitimate right to hold them?

[Grahame M. Morris]

I hope I have made that point. I am not proposing that people with a legitimate need to hold firearms, such as farmers and so on—there is a whole list of such people—not be allowed to hold them. That need should be declared as a reason for holding a certificate, and the police or the licensing authority would take it into account.

In a case in my constituency in 2008, Michael Atherton had his weapons revoked following threats to self-harm, and issues relating to mental health and gun ownership were also a factor in the case of Christopher Foster, who shot his wife, his daughter and himself after confessing suicidal thoughts to his GP.

I understand that the Association of Chief Police Officers and the British Medical Association have an agreement whereby the police alert GPs to any new applications for and renewals of firearms licences. However, concerns remain where an applicant fails to disclose full and accurate medical information at the time of application or renewal. Applicants are required to provide a number of medical details, including whether they suffer from any

“medical condition or disability including alcohol and drug…conditions”.

They also have to declare whether they have ever suffered from epilepsy or been treated for

“depression or any other kind of mental or nervous disorder”.

However, that information is not routinely checked. Licensing officers approach medical professionals only when there are doubts about an applicant’s medical history, although Dr John Canning—again, giving evidence to the Home Affairs Committee on behalf of the BMA—stated that GPs are “not very often” asked to provide medical evidence, although it happens “from time to time”.

Following the case of Christopher Foster, the Independent Police Complaints Commission proposed in 2008 that the licensing force should be required to approach the applicant’s doctor in each case, in order to obtain confirmation that the medical information provided in the application was correct. The omission of information from a firearms application was also an issue in the case of Mark Saunders in 2006, which ended in his being killed by the Metropolitan police. Mr Saunders failed to declare during the application process that he had been treated by a consultant for depression and for his tendency occasionally to drink more than was sensible—indeed, he had been referred by his GP. Unfortunately, on his application for a firearms licence he stated that he had no such health problems.

In my view, the solution is to ensure that each applicant knows that licensing officers will approach their GP as a matter of course to verify statements made on their application about their health, to ensure they are correct and accurate. My proposal would address failures by an applicant to disclose any medical problem that raises questions about their suitability to own and have free access to a firearm. Finally, I call for greater consultation between the licensing authority and those who are or have been a domestic partner of a potential applicant. A similar system is already in place in Canada, where all citizens applying for a firearms licence are required to have their present and past partners in the previous two years sign their application. Refusal to sign for any reason does not automatically mean that the police and licensing authorities will veto an application, but it will trigger further investigation by law enforcement officers. The Canadian requirements merit further exploration, and I would appreciate it if the Minister informed the House of any progress made on this matter.

There has been no knee-jerk reaction. These proposals are considered, practical measures that, if implemented, could allow the consistent application of firearms legislation, strengthen existing safeguards and ensure public safety while maintaining the rights of the shooting fraternity to have access to firearms where there is a good and legitimate purpose for their use.

Health and Social Care Bill

Debate between Grahame Morris and Jim Shannon

Tuesday 20th March 2012 Commons Chamber

[Grahame M. Morris (Easington) (Lab)]

I want to make a few points on Lords amendment 2, which deals with the Secretary of State’s duties. This has been the subject of one of the most fundamental debates during the course of the Bill. The Lords still have grave concerns about whether the Secretary of State does indeed have a duty to

“provide or secure the effective provision”

of health services in England. In addition, concern remains over exactly what the Secretary of State will remain accountable to the House for.

In Committee, the Lords agreed not to amend clause 1, or clause 4, in regard to the duty to promote a comprehensive health service and the Health Secretary's accountability to Parliament. Instead, they preferred to engage in negotiations with the Minister with a view to bringing back proposals before the Report stage. The Lords Constitution Committee also proposed amendments on ministerial accountability for the NHS. The Committee’s concern was that, even after the months of debate here and in the other place and the amendments that had already been tabled, the Bill still posed an undue risk to maintaining adequate ministerial and legal accountability for the NHS. Given the number of amendments that had been tabled, it was a remarkable achievement still to have such uncertainty.

The wording of amendments remained an issue, and on 2 February 2012, the Government tabled 137 amendments to the Bill covering a range of areas, including changes to clarify the responsibility of the Secretary of State for the health service. There were two key amendments: one sought to ensure that the Secretary of State

“retains ministerial responsibility to Parliament for the provision of the health service in England”.

The other sought to place the duty to promote a comprehensive health service and to exercise functions to secure the provision of services above that of promoting autonomy.

[Jim Shannon (Strangford) (DUP)]

The hon. Member used the term “comprehensive health service”. Does he feel that the changes to the NHS will deliver a comprehensive health service, or does he feel that what we will see is some people being able to access services while others are not? Is that not the sort of health care service that he would be against and to which the people of this country would object?

[Grahame M. Morris]

I am grateful for that intervention and I share the hon. Gentleman’s concern that this amendment, which deals with the Secretary of State’s powers, and, indeed, the whole thrust of the Bill, are likely to lead to a fragmented service, when what we all want to see is co-operation and integration. I am concerned about the direction of travel in that respect.

The point about autonomy is relevant, because Lords amendment 2 reiterates that

“The Secretary of State retains ministerial responsibility to Parliament for the provision of”

health services. Lords amendments 4 and 17 would further amend clauses 4 and 20 in order to downgrade the duty to promote autonomy even more, through the idea that the Secretary of State must only

“have regard to the desirability of securing”

autonomy instead. When it comes to ministerial accountability for the Secretary of State, we have a yearly mandate to the NHS Commissioning Board, which will remove the Secretary of State—and therefore Parliament—from being involved in or interfering in the running of the NHS. In that case, I ask the Minister: what would be the point of Health questions? As private health care interests take over the provision of health services, they will not be subjected to freedom of information requests or other forms of accountability to which NHS providers are subjected.

Health and Social Care Bill

Debate between Grahame Morris and Jim Shannon

Tuesday 13th March 2012 Commons Chamber

[Grahame M. Morris (Easington) (Lab)]

I want to pay tribute to all the hard-working individuals who work in the national health service, and to Dr Éoin Clarke and Dr Clive Peedell, who have been supportive of the coalition, for highlighting the dangers of the Health and Social Care Bill. I suspect that this will be my final opportunity to speak up on the Bill. I understand that there are only about seven days before its Third Reading debate in the House of Lords. It terrifies me that the Bill, which I have studied intently during its 40 Committee sittings, is going to become law. The Secretary of State is introducing a new health system. It is a system that no one voted for, and it will be unrecognisable in comparison with the NHS that cared for an entire population from the cradle to the grave.

[Jim Shannon]

Does the hon. Gentleman share the concerns of many Members on the Opposition Benches—and, I suspect, many people outside the House—that the Government will create a two-tier health system consisting of those who can afford to pay and those who cannot? Does not that fly in the face of what the NHS was originally set up to do?

Stereotactic Body Radiotherapy

Debate between Grahame Morris and Jim Shannon

Wednesday 8th February 2012 Commons Chamber

[Grahame M. Morris (Easington) (Lab)]

I pay tribute to and congratulate the hon. Member for Wells (Tessa Munt) on securing this important debate. I want to put on the record the appreciation of myself and the whole House for the work that she has done in this important area.

Last August, the Department of Health released the first ever England-wide analysis of patient access to radiotherapy treatment. For those of us who represent constituencies outside London and the south-east, the results were shocking. The disparity in treatment levels for cancer patients living in and around London, compared with the rest of the country, is nothing short of disgraceful. Access to advanced radiotherapy should not be a postcode lottery. The data on each of England’s 28 cancer networks show that the further someone moves away from London, the smaller their chance is of receiving radiotherapy. North-west London tops the list, with radiotherapy provision at 94%, whereas the north-east—my region—came last, at 27%. In fact, the bottom five networks were all north of the River Trent.

[Jim Shannon (Strangford) (DUP)]

The benefits of SBRT are well proven in many cases and clear in numerous cases. Does the hon. Gentleman agree that it should be available more extensively across the whole of the NHS, and that it is time for the Minister to work alongside the devolved Administrations to ensure that the treatment is available for patients in Northern Ireland, as well as other parts of the United Kingdom?

[Grahame M. Morris]

Absolutely. I thank the hon. Gentleman for that intervention, and I agree completely. All 28 cancer networks should have equal access to this advanced radiotherapy.

In practical terms, cancer patients in the Minister’s London constituency are three times more likely to receive the radiotherapy treatment that they need than those residing in northern England and twice as likely as those living in the south-west of England. Believe it or not, however, when the general radiotherapy dataset is analysed further—by that I mean looking at radiotherapy centres offering conventional radiotherapy and those offering the more effective SBRT—the picture is far worse.

The conventional method of radiotherapy delivery is unable to distinguish between healthy and unhealthy tissue, so the treatment is delivered in short doses—often every day for four or five weeks—to avoid too much damage to the healthy tissue. As the hon. Member for Wells said, SBRT uses small, multiple and highly focused beams of energy to deliver radiation directly to the tumour, ensuring that a minimal dose is received by the surrounding healthy tissue. Consequently, there are little or no treatment-related side effects. SBRT allows the patient to be treated over five days, as opposed to five weeks, as with conventional radiotherapy. Because of its accuracy, SBRT can be used to treat tumours that might be surgically inaccessible or in close proximity to critical organs of the body, such as the heart.

When we look at the postcode lottery that the dataset report presents, we should also ask where SBRT is available and where it is not. The Minister must understand how important the comparison is. For cancer patients in my constituency, the difference between having access to SBRT and having access to conventional radiotherapy—for prostate cancer, for example—is a 50-mile car journey every day for five weeks and the treatment lasting just five days, with a rapid return to normal life. As well as the benefits to the individual, the cost savings to the NHS of using SBRT compared with conventional radiotherapy are obvious for all to see.

Like the hon. Lady, I, too, was approached, just before Christmas, by a constituent whose cancer needed SBRT. His tumour could be treated only using the accuracy of the robotic CyberKnife system, but there are only three CyberKnife systems in the NHS, and they are all in London. However, thanks to the incredible co-operation of my constituents’ clinicians and the clinicians from St Bartholomew’s hospital in London, as well as the understanding of County Durham PCT—the commissioners, who, in a timely fashion, agreed funding —he starts his treatment here in London in two weeks. My constituent is very happy that he is set to receive the treatment in an NHS hospital, but is it not a scandal that he has to travel more than 260 miles to do so? What is equally scandalous is that the reason why there are only three CyberKnife systems in NHS hospitals is that those hospitals needed to raise the money to purchase them from charitable donations. I have since learned that in Birmingham, as well as in Newcastle, in my region, the Bear appeal is seeking to raise the money for a CyberKnife system from charitable sources.

What an indictment of the NHS under this coalition government! The NHS should not have to go begging for charitable funds to buy the latest life-saving equipment, especially when we know that the Department of Health is currently holding back £300 million in capital allocations, in Whitehall coffers. This resource is for capital equipment, but is not given to the hospitals in regions like the north-east where it is most needed. If the Minister is serious about reducing health inequalities in the north-east, and, indeed, in the south-west, we should have this equipment and not be left to linger at the bottom of the radiotherapy dataset, which the Minister himself said is the benchmark for future provision. I ask the Minister to make a commitment to investing some of this £300 million in the capital equipment needed to reduce these disparities in the provision of radiotherapy in general and SBRT in particular.

Health and Social Care (Re-committed) Bill

Debate between Grahame Morris and Jim Shannon

Tuesday 6th September 2011 Commons Chamber

[Grahame M. Morris]

I am grateful for my hon. Friend’s contribution, as that is an excellent point. If hon. Members will bear with me, I shall discuss new clause 6 and what I believe the implications of the Government’s proposal would be for the Bill and for health inequalities. I was intrigued by the Secretary of State’s assurances in his opening statement about the responsibilities being conferred on him in the Bill that did not apply when Labour was in power. I believe he said that those powers were devolved to primary care trusts, but if PCTs are disappearing or clustering and strategic health authorities are disappearing over time or being clustered, surely it is right that the Secretary of State, as an accountable politician, should have these powers clearly defined in the Bill. I did not mean to digress, Mr Deputy Speaker. Those remarks related to clause 1 and I shall confine myself to the provisions before us.

As I have said, many concerns have been raised about the approach being taken to this cherished institution, not least those set out by my right hon. Friend the Member for Holborn and St Pancras about patient perception.

[Jim Shannon (Strangford) (DUP)]

Is the hon. Gentleman aware of the survey carried out among the 50,000 members of the Chartered Society of Physiotherapy? It indicated that 81% do not agree with the proposals for NHS reform—that touches on the issue that he just raised. It also indicated that 89%—almost nine out of 10 of those who work in the health service—believe that patient care will suffer and that 84% do not believe that the Government have considered these changes. Does he believe that the level of concern among those workers in the health service, and among the general public, means that whenever the vote takes place tonight hon. Members should be very careful and should oppose the Bill?

[Grahame M. Morris]

I am grateful for that information. I know that other hon. Members have spent a day with the health service and I am sure that Ministers take soundings, but I can honestly say that what the hon. Gentleman describes is the feedback I have received from talking to health professionals, patients and so on. I recognise that the Secretary of State has said on numerous occasions that a substantial body of GPs support this approach. When I tuned in to this morning’s “BBC Breakfast” I saw Professor Chris Ham of the King’s Fund being interviewed. He is an eminent and respected commentator on health service issues who has given evidence to the Public Bill Committee and the Health Committee. He gave his view that it was a small cohort of GPs who were signed up and committed to these reforms. I agree with his assessment.

These provisions deal with the role of Monitor, the relevant implications and changes to the failure regime. A “Panorama” documentary on the BBC featured Sir Gerry Robinson, who has some standing in the business community and for previous journalistic investigations into the NHS. The conclusion of his report was that he thought that these reforms could mean

“the end of the NHS.”

That is his conclusion. Even after meeting the Secretary of State he remained unconvinced of the value of the reforms.

The Secretary of State has failed to persuade the public and he has failed to persuade NHS staff of his approach. That has been illustrated by various surveys, through the British Medical Association, by personal contacts and in other ways. Even elements of the business community recognise the level of public opposition and concern. It seems that the principal backers are overseas US-style private health groups, whose interest is not philanthropic. They see the prospect of substantial profits and unprecedented access to billions of pounds soon to be available from NHS coffers. We hear Ministers and Government Members saying that the NHS was open to private sector providers under the previous Administration, and a very small figure—5% or so—was cited in the Public Bill Committee proceedings.

Public Health Observatories

Debate between Grahame Morris and Jim Shannon

Tuesday 17th May 2011 Commons Chamber

[Grahame M. Morris (Easington) (Lab)]

I am grateful to have this opportunity to raise the very important subject of the future of our public health observatories, which are an integral part of the national health service. They are responsible for public health intelligence work—collecting the evidence base and directing how different agencies work to improve public health. It might be useful if I give a definition of public health. The best definition I have been able to find is one from the World Health Organisation’s expert committee on public health administration that was published as long ago as 1952. It defined public health as

“the science and art of preventing disease, prolonging life, and promoting health and efficiency through organized community efforts for the sanitation of the environment, the control of communicable infections, the education of the individual in personal hygiene, the organization of medical and nursing services for early diagnosis and preventive treatment of disease, and the development of the social machinery to ensure for every individual a standard of living adequate for the maintenance of health, so organizing these benefits as to enable every citizen to realize his birthright of health and longevity.”

The Association of Public Health Observatories represents and co-ordinates a network of 12 public health observatories in Scotland, Wales, England, Northern Ireland and the Republic of Ireland. That body brings together joint public health intelligence work from all its organisations across the United Kingdom and Ireland and also works in collaboration with its counterparts across Europe. Without that range of high-quality and trustworthy knowledge, expertise and support from public health observatories, much of the work carried out by practitioners and, indeed, local authorities, policy makers and the wider community, would be carried out in the dark. That would, without doubt, result in a less focused and less effective service delivery. All that makes public health observatories central to both local and central Government health policy and decision making.

Public health observatories were set up to monitor the state of the public’s health and the causes of poor health and health inequalities, with the information being used by a range of organisations involved in providing health care, including the NHS. The White Paper, “Saving Lives: Our Healthier Nation”, which was published by the Department of Health in 1999, proposed the establishment of the public health observatories that were then set up in 2000 by the Labour Government. The Association of Public Health Observatories was also established in 2000. That umbrella group provides a link between regional public health observatories and national arrangements. It comprises representatives from all the regional public health observatories, the Department of Health and other partners, and one concern that I wish to raise is the fact that its funding has been removed this year.

I hope that the Minister will accept that improving the knowledge and evidence base behind health care was a key element of the previous Government’s policy and was instrumental in making progress in tackling health inequalities. The changes outlined by the Health Secretary in the Health and Social Care Bill move us away from a co-ordinated health service towards a competition-based health service. The public health White Paper, “Healthy Lives, Healthy People”, published on 30 November 2010, set out a new structure for public health in England. Its aim was to shift the balance of responsibility away from central Government to local authorities. There has also been much greater emphasis on the need for people to be supported in taking more responsibility for their own health—the so-called nudge philosophy.

There are many public health issues that I would like to discuss but unfortunately do not have time to develop tonight because of the shortage of time. I want to press on and put some points to the Minister, particularly about public health observatories, and I hope she will have the opportunity to respond to them.

[Jim Shannon (Strangford) (DUP)]

Prevention is key to having a healthier nation and perhaps this issue should be reconsidered in the NHS review, as it might help to improve the nation’s health.

[Grahame M. Morris]

I am grateful for that and I agree. It is fundamental to have a solid evidence base on which to plan health interventions.

As I mentioned, the Government propose in the Health and Social Care Bill to transfer health improvement functions from PCTs to local authorities, and to create a new body, Public Health England, to be rooted in the Department of Health. Public Health England is expected to take on full responsibility for overseeing the local delivery of public health services, as well as dealing with national issues such as flu pandemics and other population-wide health threats from next year. The majority of public health services will be commissioned by local authorities. However, the revolution under way in the NHS is just as important to the future of public health in England.

The Bill, which proposes the abolition of strategic health authorities and primary care trusts, raises more questions than it answers. The responsibilities currently held by PCTs could be moved to local authorities, to the Department of Health, to commissioning consortia or to the NHS commissioning board. How the important work of public health observatories will be safeguarded for the future is still unknown. The decision to divide public health responsibilities between the Department of Health and local authorities will fragment any cohesive approach to tackling health inequalities. Whether new commissioning consortia will carry out some functions is at this stage unknown.

There are further concerns about whether Public Health England should be outside the Department of Health to protect its independence. If it was placed within the NHS, perhaps as a special health authority, surely that would better meet the Government’s own aim, often stated, of liberating the NHS from political control.

The Minister will be aware of the response to the White Paper by the public health observatories in March 2011. That response calls for a sub-national level of organisation of Public Health England to be created, with sufficient critical mass to ensure that the outputs of Public Health England continue to be valuable locally as well as nationally. There are many examples where that is the case, not least in my own region, the north-east, where the public health observatory has done excellent work on addressing inequalities that affect people with mental health issues and inhibit their ability to access services. The lessons of that can be rolled out across the country.

The important work of the observatories over the past decade has been self-evident. On 24 June 2008 the health profiles for every local authority and region across England were published jointly by the Department of Health and the Association of Public Health Observatories, an organisation which, as I mentioned earlier, has lost all its funding. Using key health indicators, public health observatories were able to pinpoint national health statistics at a local level, providing valuable information to address health inequalities and improve health outcomes.

As the Minister at the time, my right hon. Friend the Member for Bristol South (Dawn Primarolo), now the Deputy Speaker, noted, the importance of those statistics was

“to target local health hotspots with effective measures to make a real difference.”

In my constituency, Healthworks, an excellent clinic established in Paradise lane in Easington and opened by Sir Derek Wanless, is a prime example of how that information collected by the observatories was used to great effect to target the areas in greatest need.

The Association of Public Health Observatories, with the Department of Health, also published a health inequalities intervention toolkit to enable every English local authority to model the effect of high-impact interventions on the life expectancy gap. As far back as 1977, the Department of Health’s chief scientific adviser, Sir Douglas Black, was asked to produce a report on the extent of health inequalities in the UK and how best to address them. The report proved conclusively that death rates for many diseases were higher among those in the lower social classes. It acknowledged that the NHS could do much more to address the situation. It called for increases in child benefit, improvements in maternity allowances, more pre-school education, an expansion of child care and better housing. A further report was subsequently produced by Professor Peter Townsend. Indeed, only last week I attended a seminar, in which the principal speaker was Sir Michael Marmot, on the impact of cold homes on health outcomes. The report indicated that the cost to the NHS of illness resulting from poorly insulated houses and cold homes is £2 million a year.