Contaminated Blood

Lord Lansley Excerpts

Monday 10th January 2011 Commons Chamber

[The Secretary of State for Health (Mr Andrew Lansley)]

With permission, I would like to make a statement on hepatitis C and HIV-infected blood.

What happened during the 1970s and 1980s, when thousands of patients contracted hepatitis C and HIV from NHS blood and blood products, is one of the great tragedies of modern health care. It is desperately sad to recall that during this period the best efforts of the NHS to restore people to health actually consigned very many to a life of illness and hardship. As the current Health Secretary, and on behalf of Governments extending back to the 1970s, may I begin by saying how sorry I am that this happened and by expressing my deep regret for the pain and misery that many have suffered as a result?

It is now almost two decades since the full extent of the infection was established and two years since the independent inquiry led by Lord Archer of Sandwell reported. The majority of Lord Archer’s recommendations are in place, as are programmes of ex gratia payments, which are administered by the Macfarlane Trust and the Eileen Trust for the HIV-infected and by the Skipton Fund for those with hepatitis C. However, significant anomalies remain and I pay tribute to Lord Archer, to other noble Lords and to hon. Members in this place from all parties for highlighting them.

In October, the Under-Secretary of State for Health, my hon. Friend the Member for Guildford (Anne Milton), announced a review into the current support arrangements —to look at reducing the differences between the hepatitis C and HIV financial support schemes and to explore other issues raised by Members during the recent Back-Bench debate, including prescription charges and wider support for those affected. We also asked clinical experts to advise on the impact of hepatitis C infection on a person’s health and quality of life and to consider whether an increase in financial support was needed. My hon. Friend the Under-Secretary has met representative groups to understand the impact that these infections were having on people’s lives and has also met many Members of both Houses who have been strong advocates on behalf of those affected.

We have now considered the findings of the clinical expert group and we accept that the needs of those with advanced liver disease from hepatitis C merit higher levels of support. At present, the amount of money paid to this group depends on the seriousness of the infection. There are two stages at which the Skipton Fund will make a payment, the first of which is when the person develops chronic hepatitis C infection. At this point, a person is eligible for a stage 1 relief payment—currently a lump sum of £20,000. Some may reach a second stage of developing an advanced liver disease such as cirrhosis or cancer, or of requiring a liver transplant; they then become eligible for a stage 2 payment, which is currently another lump sum of £25,000. Under new arrangements that we will introduce, this second stage payment will increase from £25,000 to £50,000. This will apply retrospectively, so that if a person has already received an initial stage 2 payment of £25,000, they will now get another £25,000 lump sum, bringing the total to £50,000.

In addition, we will also introduce a new, annual payment of £12,800 for those with hepatitis C who reach this second stage. This is the same amount as those who were infected with HIV receive. Those infected with both HIV and hepatitis C from contaminated blood will now receive two annual payments of £12,800 if they meet the stage 2 criteria—one payment for each infection—along with the respective lump sums. All annual payments that are made, both to those so infected with HIV and to those with hepatitis C, will now be uprated annually in line with the consumer prices index to keep pace with living costs.

We know that some of those infected with HIV or hepatitis C from NHS blood and blood products face particular hardship and poverty. Those infected with HIV can already apply for additional discretionary payments from the Eileen Trust and the Macfarlane Trust, but no equivalent arrangements are in place for those infected with hepatitis C, so we will now establish a new charitable trust to make similar payments to those with hepatitis C who are in serious financial need. These payments will be available for those at all stages of their illness, based on individual circumstances. Discretionary payments will also be available to support the dependants of those infected with hepatitis C, including the dependants of those who have since died. Again, this will echo the arrangements in place for those infected with HIV and will enable us to give more to those in the greatest need.

We must also ensure that those infected through NHS blood and blood products get the right medical and psychological support. I can therefore announce two further measures. First, those infected with hepatitis C or HIV will no longer pay for their prescriptions. They will now receive the cost of an annual prescription prepayment certificate if they are currently charged for prescriptions. Secondly, the representative groups raised the issue of counselling support for those infected through blood and blood products. We fully recognise the emotional distress that they have experienced. As a result, we will provide £300,000 over the next three years to allow for around 6,000 hours of counselling to help those groups.

While we focus on those still living with infections, we must also recognise the bereaved families of those who have died. At present, no payment can be made to those infected with hepatitis C who passed away before the Skipton Fund was established. That is a source of understandable distress to those who survive them, and that is something that we now want to put right. I can therefore announce that, until the end of March 2011, there will be a window of opportunity in which a posthumous claim of up to £70,000 can be made on behalf of those infected with hepatitis C who died before 29 August 2003. A single payment of £20,000 will be payable if the individual had reached the first stage of chronic infection. Another single payment of £50,000 will be made if their condition had deteriorated to the second stage, in which they suffered serious liver disease or required a liver transplant. We will work with the Skipton Fund and various patient groups to publicise this new payment to those who may benefit. Those new payments, which will go to the individual’s estate, should help more families to get the support that they deserve.

Taken together, these announcements represent a significant rise in the support available to those affected by this tragedy. Putting an exact figure on the package is difficult, as there is some uncertainty about how many people will be eligible, and how their illnesses may progress. However, we believe that the new arrangements could provide £100 million to £130 million-worth of additional support over the course of this Parliament. All payments will be disregarded for calculating income tax and eligibility for other state benefits, including social care. Although the changes apply only to those infected in England, I will be speaking to the devolved Administrations to see whether we can extend the measures across the United Kingdom.

Today’s announcements cannot remove the pain and distress that individuals and families have suffered over the years, but I hope that the measures can at least bring some comfort, some consolation, and perhaps even some closure to those affected. I commend the statement to the House.

[Ms Diane Abbott (Hackney North and Stoke Newington) (Lab)]

The Opposition welcome the review and today’s statement, and we note that Labour Health Ministers had agreed the review in principle before they left office. We are glad that the statement was made on the very first day back after the Christmas break, because we are aware that the statement was promised before Christmas. We appreciate it being made as soon as it could be made.

Does the Secretary of State agree that the House owes a tremendous debt of gratitude to the patient groups that have campaigned for more than 25 years on the issue? They include the Haemophilia Society, the Hepatitis C Trust, the Taintedblood group, the Manor House Group, and individuals such as Haydn Lewis, who unfortunately passed away before he could see this resolution. Without the campaigning of those groups and individuals over two decades, the issue would have been one of private misery and private suffering. It is because they campaigned and kept the issue before the public and before the eyes of politicians that we are able to move decisively towards a proper resolution today.

Many of the measures in the statement will be welcomed, particularly the help with prescription charges and the £300,000 for counselling—I have seen with my own eyes the awful mental effect of this tragedy on people—as well as the payments for dependants, the provision for posthumous claims, and above all, the move towards parity in the cases of HIV and hepatitis C. All that will be welcomed, but there will still be campaigners who will regret that we have not been able to achieve parity with the compensation that was offered and handed out in the Republic of Ireland. It would be silly to pretend that there will not be many people still saying today, “Why could we not achieve what was done in the Republic of Ireland?”.

Finally, when we remember that more than 4,500 completely innocent and trusting patients contracted HIV, hepatitis C or both as a consequence of tainted blood, and that more than 1,900 of those people have died, leaving thousands of dependants behind, should we not, as a House, resolve that it should never again take 25 years for perfectly innocent victims of errors and mistakes to have proper justice and recompense?

[Mr Lansley]

I am grateful to the hon. Lady and I entirely endorse her opening and closing remarks paying tribute to all the patient groups. My hon. Friend the Under-Secretary of State for Health has met many of those groups and individuals, and I know that she would heartily endorse what the hon. Lady said about how they have brought these issues time and again to the forefront of attention in the House and the other place. I do not want to underestimate the many in the House and the other place who responded to that and did so very well by bringing these cases forward. I hope that they will see in today’s statement a proper response.

We do not know whether there will ever be a similar case. I hope we can avoid it—it would be much better to avoid it—but if we were ever in a situation where such a consequence flowed from the NHS seeking to do its best to treat patients but such harm nevertheless occurred, I hope we would recognise that, be able to identify it and not allow decades to pass before proper recognition took place.

That brings me to the hon. Lady’s substantive point, which is the relationship between what we are doing and the compensation provided in the Republic of Ireland. As we explained in October, we do not regard these as comparable cases. In the Republic of Ireland, mistakes were made by the Irish Blood Transfusion Service which led to a recognition of liability, leading to a determination of compensation. In this country we are not providing compensation. We are recognising the harm that occurred, notwithstanding the fact that the NHS at the time sought to provide the treatment that it thought was in the best interests of patients.

That harm occurred. As an ex gratia payment and in recognition of the harm that occurred and the distress that followed, we have sought to ensure that there is proper support, financial and otherwise, for the victims and their families. I hope that by getting rid of the anomalies and recognising—in particular, through the work of the clinical expert group—the impact on those with hepatitis C, we are giving the support that those who were damaged should expect.

[Jonathan Evans (Cardiff North) (Con)]

Although I welcome my right hon. Friend’s statement, I should point out that Lord Archer recommended that there should be compensation along the Irish lines. That is a little of the context of what has taken place.

I take the opportunity of congratulating the Under-Secretary of State for Health, my hon. Friend the Member for Guildford (Anne Milton) on all the work that she has done on the matter, which I know has been welcomed across the House.

May I ask my right hon. Friend about the position in Wales? I was a little taken aback by the fact that he said that he intends to speak to fellow Ministers in Wales. I have a statement from the Welsh Minister indicating that as far as she is concerned, these issues come next to be considered by her in 2014, which was the previous agreement with the Department of Health. Many of my constituents will want to know what discussions have so far taken place and whether the arrangements will be replicated in the Principality.

[Mr Lansley]

The Under-Secretary will have heard what my hon. Friend said. I am grateful for it, too.

I am speaking on behalf of England in this respect. As the Department of Health, we administer the payments system. We had to reach the decisions and we have done so. We always intended to do so as rapidly as we could for England, but as I explained in my statement, these decisions have yet to be made by the devolved Administrations. It is reasonable for them to see the review report that I am publishing today, not least the clinical expert review that goes with it, in order for them to make their own decisions. Those are decisions that they must make, but if they wished us to continue to administer the system on the same basis across the United Kingdom, we would be happy to do so.

[Diana Johnson (Kingston upon Hull North) (Lab)]

In the debate on the subject in the autumn, the Under-Secretary of State agreed to speak to her colleagues in the Department for Work and Pensions about the changes to benefits and how those would affect people who had received contaminated blood products. Can the Secretary of State give any guarantee about passporting people affected by the changes in benefits so that they do not lose out and have to go through a further set of medicals?

[Mr Lansley]

I am grateful for that. This is not a response to precisely the question that the hon. Lady asks, but Lord Archer made a point about whether payments should be made through the Department for Work and Pensions. We do not see that any tangible benefit would flow from that.

[Chris Bryant (Rhondda) (Lab)]

That was not my hon. Friend’s question.

[Mr Lansley]

No, I acknowledged that. I will of course respond to the hon. Lady, but I think it better for us to administer all the payments through the system that I have set out. As I say, they will be disregarded for the purposes of calculation of benefits, so to that extent they will not impact adversely on current benefits.

[Jason McCartney (Colne Valley) (Con)]

Having spoken in the debate in October and having asked a question in Prime Minister’s questions in November, I very much welcome a number of elements in the Secretary of State’s statement, particularly those on free prescriptions and counselling help. Will he, however, promise to meet the Taintedblood campaigners and perhaps even to look at the overall level of compensation?

[Mr Lansley]

May I say two things to my hon. Friend? My hon. Friend the Under-Secretary has met those groups and will continue to meet them, because we want to ensure not least that those who are now eligible for enhanced payments and so on make proper applications. We have looked very carefully with the clinical expert group at the support that we ought to give. It is not compensation as such; it is an ex gratia form of support. We have made judgments, and if we were to go further, there would be significant additional costs. My hon. Friend the Under-Secretary and I have made it clear to the House in the past that to provide payments on the scale of the Republic of Ireland might involve up to, or perhaps even in excess of, £3.5 billion a year, so I am not in a position to say to my hon. Friend the Member for Colne Valley (Jason McCartney) that I expect to go beyond the support that I have set out today.

[Mr Andy Slaughter (Hammersmith) (Lab)]

It is to be regretted that the review’s terms of reference were so narrow, as it did not consider overall levels of compensation or HIV. If the Secretary of State believes that the Republic of Ireland case is simply too expensive, will he please say so and not rely, as the Department has, on either the idea that the Taintedblood campaigners and others are asking him to look at that and tying us to the Irish system, or the idea that they are asking us effectively to look at those levels of compensation because negligence was involved? That was not the case in Ireland. Is not the result likely to be more litigation? The levels of remuneration are still far too low.

[Mr Lansley]

With respect to the hon. Gentleman, in response to previous questions I made it very clear that the question was not simply about the amount of money. The situation in the Republic of Ireland is unique in respect of its determination of liability because of mistakes made by the Irish Blood Transfusion Service. To that extent, we are making ex gratia payments. The nature of our payments stands comparison to other countries, particularly now, in respect of hepatitis C and my announcements this afternoon.

[Jenny Willott (Cardiff Central) (LD)]

I really welcome today’s statement and, in particular, the apology, which will go a long way to ease some of the pain that some of the victims have suffered. Proper support for those infected with hepatitis C is also long overdue. Gareth Lewis, who was a leading Taintedblood campaigner—I believe he met the Under Secretary—tragically died just before Christmas, only a few months after his brother, Haydn, whom the hon. Member for Hackney North and Stoke Newington (Ms Abbott) mentioned. That highlights the urgency of my question. Governments are not known for moving quickly, particularly when it involves handing out money, so will the Secretary of State reassure us that everything that can be done will be done to ensure that the payments announced today are made as soon as is humanly possible?

[Mr Lansley]

May I pay tribute to my hon. Friend, who has on many occasions spoken up on behalf of her constituents and others who were affected by the tainted blood and blood products? The answer to her question is yes—absolutely we will. When we came into office, we were determined to implement the review. As she said, we sought to complete the review before Christmas—technically speaking, we did, but we were not in a position to announce it before Christmas. We are doing this at the first available moment, and we will do everything that we possibly can to ensure that potential beneficiaries are notified and reached as quickly as possible so that the payments are in place as soon as possible.

[Chris Bryant (Rhondda) (Lab)]

It would be one of the greatest catastrophes if what happened were able to happen again. That is why it is so vital that the Government constantly keep under review the policy on donating blood. As the Secretary of State will know, men who have had sex with men are one of the categories of people who are not able to give blood at the moment, and that seems intrinsically unfair and prejudiced. I urge the Secretary of State to look only at the scientific evidence in the ongoing review; that, and not any other political consideration, is the basis on which the decision should be made.

[Mr Lansley]

Yes, I entirely agree.

[Andrea Leadsom (South Northamptonshire) (Con)]

I have to say that I am a bit disappointed; I am not sure whether today’s announcement will give closure to many people. A constituent of mine told me about a very good friend of his who died in Spain over Christmas. Sadly, his family could not afford to bring the body home, so he had to be cremated in Spain. Under the circumstances, it is very important that the ex gratia payments, available through the new charity to be set up, take into account the tragic and particular problems of individual sufferers.

[Mr Lansley]

Yes, indeed. I know that they will; that is one of the reasons why, in addition to the lump sum payments and annual payments that I have announced, we wanted to ensure that there was scope for discretionary payments based on individuals’ needs.

[Mr Elfyn Llwyd (Dwyfor Meirionnydd) (PC)]

May I take the Secretary of State back to the point raised by the hon. Member for Cardiff North (Jonathan Evans)? It is rather surprising that there has not hitherto been any discussion with the devolved Administrations. If such payments are to be made in Scotland and Wales, is it anticipated that they will be made out of existing budgets? How will the matter be handled?

[Mr Lansley]

What I have announced today will, of course, be funded from the Department of Health’s budget in England and the matter would be a responsibility for the devolved Administrations in relation to their budgets —from within the budgets set through the spending review.

[David Tredinnick (Bosworth) (Con)]

I, too, congratulate my right hon. Friend. I also congratulate the Under-Secretary of State for Health on all the work that she has done. The statement deals with what Lord Archer called the worst treatment disaster in the history of the national health service. It has to be said that the last Labour Government could have dealt with this, but they did not.

Following the comprehensive package that he has announced, will my right hon. Friend assure us that he will take active steps to contact the families of the bereaved and that no stone will be left unturned in making sure that all those who should have payments receive them?

[Mr Lansley]

I give my hon. Friend that assurance. We will take all the steps that we possibly can, not least on behalf of the bereaved families of those who died before 29 August 2003. That anomaly, among others, ought to have been rectified long ago.

[Owen Smith (Pontypridd) (Lab)]

I, too, welcome the statement—in particular the serious and commendable way in which the Under-Secretary of State has dealt with this important issue. However, the people who really need to be congratulated today are the campaigners such as the family of my constituent Leigh Sugar.

I take the Secretary of State back to his comment that the measure will apply to England only. Will he explain the rationale for that? The previous schemes applied to England and Wales, although they predated devolution. Is he saying that no additional funds will be available for Welsh patients, under the Barnett consequentials, to provide similar funding in Wales?

--- Later in debate ---

[Mr Lansley]

I share the view of the hon. Gentleman. Today the people who should feel that we are expressing our support are those who have been harmed and their families. Those are the people whom we are really supporting today. I hope that they will feel that although not everything that they have hoped for is being provided, we are at least making very substantial progress and doing a great deal to show recognition of the harm that occurred to them.

At this Dispatch Box, I speak on health matters for England; I do not speak for Wales and I am not in a position to say what the decisions of the devolved Administrations are. I have set out what we are going to do in England. We are funding the measure from within allocated budgets, so no Barnett consequentials flow from it. These matters will be determined within each of the other Administrations in respect of whether they wish to share in the arrangements that I have described.

[Mr Adrian Sanders (Torbay) (LD)]

There cannot be a Member of this House who does not have at least one constituent who is affected or who knows someone who is affected by this. I am sure that every hon. Member would like to congratulate the Government on the statement. Will the Secretary of State give an assurance that the bureaucracy needed to process matters forward has been looked at, so that it is kept to a minimum?

[Mr Lansley]

Yes, we have done that. My hon. Friend is absolutely right: hon. Members will have met constituents or the families of constituents who have been harmed, or the families of those who died. I hope that hon. Members will take the opportunity to bring the terms of today’s statement to their attention, so that people can access the additional support at the earliest possible opportunity. We will seek to do what my hon. Friend mentions. What I am describing builds as far as possible on existing mechanisms and, with the exception of the new discretionary trust, will not create any additional bureaucracy.

[Several hon. Members]

rose—

--- Later in debate ---

[Mr Lansley]

My hon. Friend will know from the response that my hon. Friend the Under-Secretary gave to October’s Back-Bench debate that we intended to place a note in the Library. We have done so. She has had further occasions to discuss these arrangements with colleagues in the House. The discussions between my officials and officials in the Republic of Ireland have confirmed that a figure of about £750,000 is not inappropriate as an estimate of the level of compensation per individual paid in the Republic of Ireland. That would support the view that we took in the House that the cost of providing compensation, if one were to do so, on the scale required in the Republic of Ireland would be in excess of £3 billion. As I said to the hon. Member for Hammersmith (Mr Slaughter), it is not on the basis of cost alone that we have reached that view; it is on the basis that the circumstances in the Republic of Ireland are unique and do not apply in this country. Therefore, we have assessed the case for support on the basis of the circumstances here and on an ex gratia basis, not on the basis of liability and consequent compensation.

[Stephen Barclay (North East Cambridgeshire) (Con)]

I also thank the Minister for the welcome measures announced in the statement and for the progress that has been made after so long. May I return to the average figure of £750,000, because there is a concern that that figure could be confusing the average and the mean? If we take a figure between 500 and a million and say that it is the average, it does not provide an average figure. Such an approach is akin to saying that the price of a car ranges from £10,000 to £1 million and therefore the average price of a car is £500,000. In relation to the discussions that the Minister has had with officials in Ireland, will he confirm that the total paid in Ireland—the total payment in terms of Irish settlements on this matter—is less than £1 billion?

[Mr Lansley]

As I have said in response to previous questions, I pay tribute to the work that my hon. Friends have done in support of their constituents and others. It is not simply a question of trying to calculate what the level of compensation is in Ireland; that is not the issue. We are not making a comparison with Ireland; we are making a judgment. In this case, we have especially done so in relation to hepatitis C, on the basis of the report of the clinical expert group, to try to assess the level of harm and the consequences that have flowed from the transfusions that took place, albeit that in this country the NHS acted on the basis of its best efforts to provide the best possible care for patients. The Republic of Ireland is a unique, and quite distinct, case in that because of mistakes made, a finding of liability was arrived at which leads to compensation. In our case, we are not in that position. We are in the position of recognising the harm and distress that has occurred and, through an ex gratia scheme, providing support to those who have been harmed and their families.

[Duncan Hames (Chippenham) (LD)]

I thank the Secretary of State for bringing the Government’s deliberations on the issue to this conclusion. Will he reassure the House that those experiencing the symptoms of advanced liver disease who received contaminated blood will not in all cases be required to have a liver biopsy in order to demonstrate and establish their eligibility for these payments?

[Mr Lansley]

No, they will not. From our point of view, eligibility will simply be based on a diagnosis of their condition.

[David Mowat (Warrington South) (Con)]

I, too, welcome the statement, particularly the attempt to get better parity between HIV and hepatitis C. However, I remain slightly concerned about the definition of stage 2. What proportion of hepatitis C complainants does the Minister expect to progress to stage 2? He must have estimated that number in order to put a financial amount on the settlement.

[Mr Lansley]

I regret that I cannot give such an estimate to my hon. Friend. The estimate that I have given is a range that extends from £100 million to £130 million during the life of this Parliament. If one were to go beyond that period, the parameters of the range would widen, not least because we do not, and cannot, know to what extent this infection is likely to progress to the second stage of these diseases.

[Charlotte Leslie (Bristol North West) (Con)]

I very much welcome much of what has been said in the statement, particularly the fact that the decision has been made to force closure on an issue that has been going on for so long. One of the things that has upset so many of the sufferers is not only that such a scandal happened but the subsequent failings, as they would see it, not of Government but of the Department of Health in being clear and transparent during those years in providing information on exactly what happened. Will the Secretary of State give an assurance that he will have to provide information to help those people who are still affected when they ask questions, perhaps through freedom of information requests, about what occurred in the past?

[Mr Lansley]

May I once more express my thanks to my hon. Friend for having been a forceful advocate in these matters? The answer to her question is yes, not least because my hon. Friend the Under-Secretary has been very open and willing to talk to everybody concerned, and she will continue to be so, because we are determined to give people confidence that we have not only exercised what we believe to be a responsible and reasonable judgment in these matters but are doing so in an open and transparent fashion.

NHS South West

Lord Lansley Excerpts

Monday 10th January 2011 Written Statements

[The Secretary of State for Health (Mr Andrew Lansley)]

On 17 June 2010, I asked Sir David Nicholson, chief executive of the NHS in England, to initiate a review into the approach and behaviour of the NHS South West (the strategic health authority) in relation to Royal Cornwall Hospitals Trust (RCHT), in particular, to the dismissal of John Watkinson and, by association, the trust’s position in relation to the provision of upper gastro-intestinal services in Cornwall.

Verita, a specialist company that conducts independent investigations, reviews and inquiries, carried out the review. The report was published on the Department of Health website on Tuesday 4 January 2011.

In the written ministerial statement of 17 June 2010, Official Report, column 57WS, I committed to updating the House on the findings of the report and my response. The key findings of the report were:

the strategic health authority put appropriate pressure on the RCHT board to suspend John Watkinson but was not involved in the decision to dismiss him;

the strategic health authority was justifiably concerned about many aspects of RCHT’s performance in the period leading up to the RCHT board’s dismissal of John Watkinson;

the RCHT chair and non-executive directors were relatively inexperienced within the NHS and it was good practice for them to take advice from the more experienced strategic health authority before making their own decision what to do; and

NHS South West is considered to have acted appropriately given its performance management responsibilities for NHS organisations in the south west and the fact that RCHT was not a foundation trust.

The report has been placed in the Library. Copies are available to hon. Members from the Vote Office and to noble Lords from the Printed Paper Office.

Seasonal Influenza Update

Lord Lansley Excerpts

Monday 10th January 2011 Written Statements

[The Secretary of State for Health (Mr Andrew Lansley)]

Seasonal flu virus circulates each year and this year is no exception. This statement is to update Parliament following developments during recess.

Seasonal flu is different from the outbreak of pandemic flu in 2009, when a new flu virus emerged (H1N1, or “swine flu”) against which humans (particularly those aged under 65) had little or no natural immunity. When the pandemic flu virus emerged in 2009, our pandemic preparedness plans were triggered. These plans entailed the mass distribution of “antiviral” drugs, the launch of the “National Flu Line”, and a “Catch it. Bin it, Kill it” advertising campaign designed to help members of the public understand how they could limit the spread of flu.

There is no flu pandemic this year, so these plans have not been triggered. Although the H1N1 virus is circulating, it is now one of the seasonal flu strains. This is because when it circulated in 2009-10, it helped to establish a residual level of immunity in people exposed to it, which means that H1N1 now circulates like other seasonal flu viruses.

In the United Kingdom, the H1N1 and influenza B viruses are the strains of flu that are circulating widely. H1N1 is the predominant virus, and is behaving—as expected—as it did in 2009-10. This means that H1N1 is likely to infect younger people—particularly those with underlying disease—and pregnant women.

A seasonal flu vaccine is available this year, as in previous years. This vaccine protects against all three strains of flu which the World Health Organisation identified would be most likely to circulate this year. Surveillance data show that these strains are circulating and that the vaccine is a good match.

General practitioners (GPs) order seasonal flu vaccine direct from the manufacturers according to their needs. This system is different from the childhood vaccination programme where the Department procures vaccine centrally and distributes it free of charge to the NHS.

We are aware of some reports of flu vaccine supply issues in some areas in England. We are working with NHS at the local level to ensure available supplies of surplus vaccine are moved to where they are needed. If efforts to source seasonal flu vaccine locally are not successful, the H1N1 monovalent vaccine (Pandemrix) is now available to GPs, for patients who are eligible for the seasonal flu vaccine.

I have already agreed for a review of procurement options of the seasonal flu vaccine to be undertaken, including central procurement, although no decisions have yet been made.

As in previous years, and on the basis of procedures which have existed for decades, the Government take expert advice from the Joint Committee on Vaccination and Immunisation (JCVI). This year, as last year, the JCVI advised that those aged 65 and over, and those in clinical at-risk groups, should be vaccinated. Because of the specific characteristic of the H1N1 virus, the JCVI also advised for the first time that healthy, pregnant women should be vaccinated with seasonal flu vaccine. The JCVI has recently assured me that this advice is appropriate for this year’s flu season.

As in previous years, only certain groups are being targeted for vaccination. We have therefore focused our efforts on ensuring that these groups are vaccinated. Current information for vaccinations given up to 2 January 2011 shows that 70.0% of over 65s have been vaccinated and 45.4% of those in clinical at-risk groups have been vaccinated, which is broadly in line with previous years.

The latest data indicate that the rate of GP consultations for influenza-like illness (ILI) is currently 98 per 100,000 people but we need to be cautious about interpreting the data due to the holiday period. The highest recorded level this year was 124 per 100,000, which is lower than that recorded during the pandemic in 2009-10 and below the epidemic level of 200 per 100,000 people. Nevertheless, given that they reached these levels I have taken the decision to reinstate the “Catch it, Bin it. Kill it” campaign.

Data indicate that this year’s flu has resulted in greater than usual numbers of patients requiring critical care. These patients have largely been infected with H1N1, and the pattern is consistent with H1N1’s characteristics last year. As a result, where necessary, local NHS organisations have increased their critical care capacity, in part by delaying routine operations requiring critical care back-up. This is a normal operational process which is initiated by NHS organisations at the local level; critical care capacity is not “fixed” but is always able to flex in this way according to local need.

In addition, over the last month we have increased the number of so-called “ECMO” beds—for patients with the most severe disease—from 5 to 22.

The number of deaths this winter from flu verified by the Health Protection Agency currently is 50, with 45 of these being associated with the H1N1 infection. The number of deaths from seasonal flu varies each year, with over 10,000 deaths from seasonal flu estimated in the winter of 2008-09.

Some have queried why statistics for the number of deaths in pregnant women are not available. The only reason the Health Protection Agency has not published the breakdown is to protect those individuals from being personally identifiable, the number of such cases being small.

When influenza is circulating, antiviral medicines can also help clinical at-risk groups who have either been exposed to or have contracted a flu-like illness. This season we notified clinicians that the use of antiviral medicines in these groups was justified, but also, as a higher than normal number of patients outside the clinical at-risk groups were becoming seriously ill with flu, general practitioners (and other prescribers) were recommended to exercise their clinical discretion so that any patient who they feel is at serious risk of developing complications from influenza may receive antiviral treatments on the NHS. In response, demand for these medicines continued to rise.

We have taken prompt action to ensure that all patients have access to appropriate antiviral medicines when they need them, and there is no shortage of antiviral medicines in the country.

There is always more pressure on the NHS during the winter, but the NHS is well-prepared and is coping well. In summary, we are taking the following action:

the first line of defence against flu is vaccination, and we want to see vaccination rates increase still further. That is why we are currently working with the BMA and RCGP to ensure everyone in an at-risk group who has not been vaccinated contacts their GP and books an appointment;

the second line of defence is to practice good respiratory and hand hygiene. That is why we reinstated the Catch it, Bin it, Kill it campaign. In addition, and in advance of the new school term, we are encouraging parents to educate their children to use good hand and respiratory hygiene; and

the third line of defence is a well-prepared NHS with the ability to treat those who do need help. That is why we are working with local NHS organisation to help them escalate critical care capacity where necessary, and have increased the number of ECMO beds available for patients.

We are making available a range of winter performance information publicly available. This is published on the Winterwatch section of the Department’s website at: http://winterwatch.dh.gov.uk/.

Funding and Commissioning Routes for Public Health

Lord Lansley Excerpts

Tuesday 21st December 2010 Written Statements

[The Secretary of State for Health (Mr Andrew Lansley)]

Today I am publishing a consultation document, “Healthy Lives, Healthy People: Consultation on the funding and commissioning routes for public health”, seeking views on proposals that were initially outlined in the White Paper “Healthy Lives, Healthy People: Our Strategy for public health in England” (Cm7985).

We are consulting on proposals for the commissioning and funding arrangements for delivery of public health services in the future. The consultation also asks questions about how the Department should implement some of our proposals.

The White Paper described a new era for public health, with a higher priority and dedicated resources. There will be ring-fenced public health funding from within the overall NHS budget. Local authorities will have a new role in improving the health and well-being of their population as part of a new system with localism at its heart and devolved responsibilities, freedoms and funding.

Directors of Public Health will be the strategic leaders for public health and reducing health inequalities in local communities, working in partnership with the local NHS and across the public, private and voluntary sectors. There will also be a new, dedicated, professional public health service—Public Health England—that will be part of the Department of Health.

This consultation is an opportunity to collect the views of public health professionals, NHS commissioners, local authorities, service providers—particularly the voluntary and independent sector—and all other interested parties.

The consultation will close at the end of March 2011.

The document has been placed in the Library. Copies are available to hon. Members from the Vote Office and to noble Lords from the Printed Paper Office.

Transparency in Outcomes

Lord Lansley Excerpts

Monday 20th December 2010 Written Statements

[The Secretary of State for Health (Mr Andrew Lansley)]

Today marks the beginning of an important shift in focus for the NHS and public health, away from focusing on politically motivated process targets, and towards what matters most: improving quality and delivering health outcomes that are among the best in the world.

I am publishing the first NHS outcomes framework, “The NHS Outcomes Framework 2011-12”, which will serve three purposes:

provide a national level overview of how well the NHS is progressing, so far as possible with international comparisons;

provide an accountability mechanism between the Secretary of State for Health and the NHS Commissioning Board: and

act as a catalyst for driving quality improvement and outcome measurement throughout the NHS by encouraging a change in culture and behaviour, including a renewed focus on tackling inequalities in outcomes.

This framework has been developed building on the proposals set out for consultation in “Transparency in outcomes—a framework for the NHS”, published in July, and the nearly 800 responses to the consultation.

This first NHS outcomes framework looks only to set the direction of travel for the NHS, and will not be used in this coming year for accountability purposes. No levels of ambition are attached to the indicators. For 2011-12, the business, finance and performance rules are set out in “The NHS Operating Framework for England 2011-12”. The NHS outcomes framework will be refined annually, and the next iteration, for 2012-13 will be published in 2011, and will be used to hold the proposed NHS Commissioning Board to account once it takes its statutory place (subject to parliamentary approval).

Alongside the NHS outcomes framework, I am publishing a formal Government response to the consultation “Transparency in outcomes—a framework for the NHS”, an impact assessment and equality impact assessment for the first framework and technical detail on the indicators presented in the framework.

Today I am also publishing “Healthy Lives, Healthy People: Transparency in Outcomes—Proposals for a Public Health Outcomes Framework”, which seeks views on a new strategic outcomes framework for public health at national and local levels. This document was proposed in the recent public health White Paper.

This consultation is an opportunity to collect the views of public health professionals, NHS commissioners, local authorities, service providers, particularly the voluntary and independent sector, and all other interested parties. The consultation will close at the end of March 2011.

Both outcomes frameworks have been designed so that where joint working and alignment is essential to improving outcomes, the NHS and Public Health England are held to account for working together.

All documents have been placed in the Library. Copies are available to hon. Members from the Vote Office and to noble Lords from the Printed Paper Office.

Work Force Education and Training Consultations

Lord Lansley Excerpts

Monday 20th December 2010 Written Statements

[The Secretary of State for Health (Mr Andrew Lansley)]

Today I am publishing a consultation document seeking views on proposals set out in the White Paper, “Equity and Excellence: Liberating the NHS” (Cm7881). We are consulting on proposals to create a new framework for education and training of the health care work force. Under these proposals, health care providers will be given responsibility for planning and developing the work force, while the quality of education and training will remain under the stewardship of the health care professions.

“Liberating the NHS: Developing the Healthcare Workforce” has been placed in the Library. Copies are available to hon. Members in the Vote Office and to noble Lords from the Printed Paper Office. The consultation is also available at www.dh.gov.uk/en/Consultations/Liveconsultations/DH_122590.

“Liberating the NHS: Developing the Healthcare Workforce” further develops the education and training commitments in the White Paper that:

Health care employers and their staff will agree plans and funding for work force development and training;

education and commissioning will be led locally and nationally by the health care professions; working with employers;

the professions will have a leading role in deciding the structure and content of training and quality standards;

all providers of health care services will pay to meet the costs of education and training with transparent funding flows supporting the level playing field between providers;

the NHS Commissioning Board will provide national patient and public oversight of health care providers’ funding plans for training and education, checking that these reflect its strategic commissioning intentions. GP consortia will provide this oversight at local level; and

the Centre for Workforce Intelligence will act as a consistent source of information and analysis, informing and informed by all levels of the system.

This consultation is an opportunity to seek the views of health care providers, health care professionals and the wider public to inform the development of a new framework for education and training and developing the health care work force.

The consultation period will close on 31 March 2011.

Value-Based Pricing (Consultation)

Lord Lansley Excerpts

Thursday 16th December 2010 Written Statements

[The Secretary of State for Health (Mr Andrew Lansley)]

I am launching today a consultation entitled: “A new value-based approach to the pricing of branded medicines”.

The consultation document sets out this Government’s proposals for introducing a system of value-based pricing for medicines, as stated in the coalition agreement. Such a system would enable patients to access the medicines and treatments their doctor advises they need by establishing a closer link between the price of a new branded medicine and the value which it offers in terms of benefits to patients, reflecting unmet need, therapeutic innovation, and where appropriate, benefit to society.

While the current system of pricing medicines has tried to achieve a balance between reasonable prices for the NHS and fair return for the industry to develop new medicines, it does not promote innovation or patient access in the way that we are looking for. We have committed to honouring the terms of the Pharmaceutical Price Regulation Scheme 2009 until its expiry, but there is a need to reform the way in which we pay for medicines from 2014 onwards. As we have made clear through the establishment of the cancer drugs fund prior to 2014, we are enabling NHS clinicians to have better access to the medicines required for their patients.

This consultation is an important opportunity to engage with different groups in order to gain their views on how we should best reflect the value of medicines in order to deliver the best health outcomes for patients. This consultation sets out the Government’s initial thoughts and invites engagement from interested parties in order that we can begin to develop a future model of medicines’ pricing.

Copies of the consultation document have been placed in the Library. Copies are available to hon. Members from the Vote Office and to noble Lords from the Printed Paper Office.

NHS Consultation, Operating Frameworks and PCT Revenue

Lord Lansley Excerpts

Wednesday 15th December 2010 Written Statements

[The Secretary of State for Health (Mr Andrew Lansley)]

Today I am laying before Parliament “Liberating the NHS: Legislative framework and next steps” (Cm 7993), the Government’s response to the consultation on implementing the White Paper reforms set out in “Equity and excellence: Liberating the NHS”. Sir David Nicholson, the NHS chief executive, is also today publishing the NHS operating framework and revenue allocations to primary care trusts (PCTs) for 2011-12. The operating framework and revenue allocations have been placed in the Library. Copies of all documents are available to hon. Members from the Vote Office and to noble Lords from the Printed Paper Office.

“Liberating the NHS: Legislative framework and next steps” shows how the Department has developed its plans in the light of consultation and sets out further detail on the reforms and a timetable for implementation. The document also sets out a timetable for implementation and explains how the consultation has shaped the health and social care Bill, planned for introduction in January. Overall, the document reaffirms the Government’s commitment to reforming the NHS so that it:

puts patients right at the heart of decisions made about their care;

puts clinicians in the driving seat on decisions about services; and

is focused on delivering health outcomes that are comparable with, or even better than, those of our international neighbours.

The Department received over 6,000 consultation responses from patients and members of the public, clinicians, voluntary organisations, patient representative groups, local authorities, local involvement networks (LINks), NHS organisations and staff, independent providers, pharmacists, academics, professional bodies and royal colleges, think-tanks and trade unions.

Responses contained a broad mix of support, suggestions for improvement and critical challenge. The insights and suggestions we have heard in consultation have not only strengthened our belief that the reforms are necessary but have also helped us refine our proposals in several areas. In particular, the Government have decided to:

significantly strengthen the role of health and well-being boards in local authorities, and enhance joint working arrangements through a new responsibility to develop a “joint health and well-being strategy” spanning the NHS, social care, public health and potentially other local services. Local authority and NHS commissioners will be required to have regard to this;

create a more distinct identity for Health Watch England, led by a statutory committee within the Care Quality Commission;

increase transparency in commissioning by requiring all GP consortia to have a published constitution;

change our proposal that maternity services should be commissioned by the NHS Commissioning Board;

extend councils’ formal scrutiny powers to cover all NHS-funded services, and give local authorities greater freedom in how these are exercised;

phase the timetable for giving local authorities responsibility for commissioning NHS complaints advocacy services, and allow flexibility to commission from other organisations as well as from local Health Watch;

give GP consortia a stronger role in supporting the NHS Commissioning Board to drive up quality in primary care; and create an explicit duty for all arm’s length bodies to co-operate in carrying out their functions, backed by a new mechanism for resolving disputes.

Equally important, the feedback we received through consultation has also helped us refine our approach to implementation, in order to create flexibility, empower local leadership, and support the significant cultural change and staff engagement that respondents highlighted would be needed to make our reforms a success. The Department has therefore decided to:

allow a longer and more phased transition period for completing our reforms to providers;

create a clearer, more phased approach to the introduction of GP commissioning, by setting up a programme of GP consortia pathfinders; and

accelerate the introduction of health and well-being boards through a new programme of early implementers.

To take forward these changes the Department has put in place a single, integrated programme for the whole of the transition across the health and care system. This will help sustain performance under the existing regime at the same time as building the leadership to implement the changes. Transition will occur through a carefully designed and managed process, phased over the next four years, to allow for rapid adoption, system-wide learning, and effective risk-management. It will be aided by the creation of a number of specific time-limited transitional vehicles, with a focus on sustaining capability and capacity.

Alongside “Liberating the NHS: Legislative framework and next steps”, the NHS chief executive, David Nicholson, has today published the NHS operating framework for 2011-12, which sets out the priorities for the next year. This includes how the NHS will go through a strong and stable transition over the next year to begin to deliver the vision of the White Paper. By the end of 2011-12 we expect NHS organisations to have made significant progress in moving towards a more liberated NHS. Organisations should be working across traditional boundaries to improve the quality of patient care while maintaining the quality and safety of NHS services.

I have also written today to every hon. Member in England detailing their PCT’s allocations for 2011-12, which PCTs will use to deliver our vision for reform and our national priorities as set out in the operating framework.

Total revenue investment in the NHS in 2011-12 will grow to over £102 billion. The allocations I am announcing today will provide PCTs with £89 billion to spend on the local front-line services that matter most, an increase of £2.6 billion, or 3%. This funding includes an increase of £1.9 billion in PCT recurrent allocations (including £150 million for re-ablement), £69 million in primary dental services, pharmaceutical services and general ophthalmic services non-recurrent allocations, and £648 million to support joint working between health and social care.

The recurrent allocations are based upon a revised weighted capitation formula that includes improvements, such as a new mental health formula. This lays the groundwork for the switch to allocations to GP consortia and local authorities from the NHS Commissioning Board and Public Health England respectively for 2013-14. These organisational changes will free the NHS from political interference, support the transfer of decision making and responsibility for local health services to the front line, and ensure that public health programmes are safeguarded.

PCTs and local authorities will use the funding for re-ablement and joint working to agree a work plan based on local joint strategic needs assessments to deliver services which may include current services, in particular telecare, re-ablement packages and home adaptations.

The allocations announced today place PCTs in a strong position to deliver the coalition Government’s vision for reform, as originally set out in “Liberating the NHS” and today reaffirmed in “Liberating the NHS: Legislative framework and next steps”. and our national priorities, today set out in the NHS operating framework.

Oral Answers to Questions

Lord Lansley Excerpts

Tuesday 7th December 2010 Commons Chamber

[Alun Cairns (Vale of Glamorgan) (Con)]

12. What recent representations he has received on the operation of the interim cancer drugs fund; and if he will make a statement.

[The Secretary of State for Health (Mr Andrew Lansley)]

Clinically led arrangements are in place in all strategic health authorities for determining the best use of the additional funds that we have made available for cancer drugs from 1 October 2010. Information provided by SHAs shows that, as of 15 November, funding had been agreed for the treatment of more than 250 patients in England. I have received representations from hon. Members, noble Lords, and members of the public on how the interim arrangements for cancer drugs funding are operating. Many of those representations have welcomed the additional support we are giving to cancer patients in need.

[Nigel Adams]

I am grateful to the Secretary of State for his response. Last week, my constituent, Trudy Cusworth, received the news that she is to be given the cancer drug Avastin, despite the panel at St James’s university hospital, Leeds initially refusing to do so. In this case, the emergency cancer drugs fund has done its job, but what can the Secretary of State say to assure other cancer patients in North Yorkshire who are also in desperate need of such life-prolonging drugs and who are currently being denied access to them?

[Mr Lansley]

I am grateful to my hon. Friend for his question. Indeed, I want to thank him for the support he has given to Trudy Cusworth. I am very pleased that she was able to take her case, with her clinicians, to the panel and that it has been approved. There are a number of people in the York and Selby area for whom that is true. The panels are working across the country to ensure additional access to cancer drug treatments where a clinical case is made for that.

[Alun Cairns]

My constituents are pretty angry and disappointed that the cancer drugs fund will not apply to them because health matters have been devolved to the National Assembly for Wales. Will the Secretary of State give an assurance that he will champion the merits of the policy in the hope of convincing the Welsh Assembly Government to follow the lead that he is offering?

[Mr Lansley]

I agree with my hon. Friend, who is obviously an advocate for his constituents to the Welsh Assembly Government. These are matters for the devolved Administrations and they must decide how to allocate their resources. In this instance we have shared with the devolved Administrations the consultation on the cancer drugs fund, which will start next April, although the policy proposed will apply in England alone.

[Toby Perkins (Chesterfield) (Lab)]

2. What recent representations he has received on the effect of the abolition of primary care trusts on the co-ordination of preventive health care.

--- Later in debate ---

[Mark Lancaster (Milton Keynes North) (Con)]

13. What recent progress he has made on the introduction of GP-led commissioning consortiums.

[The Secretary of State for Health (Mr Andrew Lansley)]

On 21 October, I invited general practice-led commissioning consortiums to put themselves forward as pathfinders, and I have been absolutely delighted by the response. The pathfinder consortiums will be announced shortly. They have formed in response to the needs of local communities, and there is, sensibly, variation around the country to take account of those differing needs. Some consortiums map on to local authority boundaries; others organise themselves around catchments for hospitals or smaller populations. This bottom-up, locally determined approach is exactly in line with what we envisaged in the policy framework.

[Henry Smith]

Under the previous Government, Crawley hospital saw the removal of services such as accident and emergency and maternity. Can my right hon. Friend explain how, under the new GP-led consortiums, doctors will have the freedom and the flexibility to be able to refer their patients to local services if they so choose, as well as to new services?

[Mr Lansley]

That is exactly what our reforms will allow. We are putting not only the freedom to refer in the hands of general practices but choice in the hands of patients, and allying that to the power on the part of commissioners to commission services that meet the needs of their local community. That is precisely the change that will empower front-line clinicians and patients.

[Mark Lancaster]

Having consulted widely in Milton Keynes, I am pleased to say that the Government’s plans have been broadly welcomed. However, one area of concern that has been raised with me by patients, in particular, is the amount of time that they will get to spend face to face with their GP. Can the Secretary of State reassure my constituents and outline the administrative support that GPs will get in fulfilling their new functions?

[Mr Lansley]

I am grateful to my hon. Friend. In Milton Keynes, GP Healthcare MK and Premier MK consortiums are shaping their services in order to be able to deliver better and improved services for their patients. We do not intend that all GPs individually should become managers, by any means; there will be clinical leadership, but the consortiums should have commissioning support. The primary care trust in Milton Keynes has had some good commissioning support arrangements, as I know from having visited it in the past. It is open to the new commissioning consortiums to take teams from the primary care trust into their new consortium support arrangements, but they can go elsewhere. They can look to the local authority and to the independent sector to provide them with the commissioning support that they need so that clinicians provide leadership but continue to be responsible for clinical care.

[Mr Ben Bradshaw (Exeter) (Lab)]

What impact does the Secretary of State think that this change and the rest of the upheaval that he is inflicting on the health service will have on hospital waiting times?

[Mr Lansley]

I think that the reforms will have a positive impact on performance right across the NHS, because they will enable patients who want to exercise choice to see the quality and standard of services, including waiting times. Unlike in the past, they will be able to see waiting times for individual hospitals, rather than just a single target. They will be able to make choices based on information about the quality of services.

[Derek Twigg (Halton) (Lab)]

If the reforms are so good, why have they been criticised by the chairman of the Royal College of General Practitioners, Dr Clare Gerada? She said:

“I think it is the end of the NHS as we currently know it, which is a national, unified health service”.

The British Medical Association has expressed concerns about competition, and we hear in this morning’s edition of The Independent from an unnamed “ally” of the Secretary of State that

“There is no wobble. No 10 and the Treasury are fully behind the principle of the reforms”—

obviously a very brave ally. Why has the Prime Minister asked the Cabinet Office Minister who is in charge of Government policy to review the plans? Is it because the Secretary of State is the only one who believes in them?

[Mr Lansley]

The hon. Gentleman should not believe all that he reads in the newspapers. The curious thing is that the Minister with responsibility for Government policy is engaged with Government policy. That is a good and positive thing. The hon. Gentleman referred to the Royal College of General Practitioners and to Dr Gerada. In response to the White Paper, the RCGP said:

“General Practice is the central plank in our world-class healthcare system. The College thoroughly agrees that it makes a great deal of sense to give GPs, with their unique patient-centred perspective, a central role in commissioning and directing healthcare services.”

Dr Gerada said:

“I fully support placing clinicians at the centre of commissioning decisions”.

[Mr Stephen Dorrell (Charnwood) (Con)]

I very much welcome the steps that my right hon. Friend is taking to encourage the early emergence of pathfinder consortiums, so that the shape of the new commissioning structure is made clear as quickly as possible. Given the nature of the quality, innovation, productivity and prevention challenge—QIPP—that the health service faces, does he agree that the process must be carried forward as quickly as possible so that the new framework is clear for all concerned as quickly as possible?

[Mr Lansley]

Yes, I do. I was delighted by the response of general practice to the emerging consortiums, because one of the central reasons it wants to make progress quickly is to shape clinical service redesign, which is at the heart of delivering the efficiency savings that will enable us all to improve outcomes.

[David Miliband (South Shields) (Lab)]

The Secretary of State has said that GPs are the best people to manage the health service. Will he confirm that in the eight years of GP training, not a single hour is dedicated to the commissioning work that he has described?

[Mr Lansley]

The right hon. Gentleman should understand that what I said was that GPs are the best people to commission services. Commissioning and management are not the same thing. GPs are already responsible for commissioning most services in the NHS, but they have no power over resources and contracting. I intend to ally clinical leadership and commissioning decisions with commissioning support that involves management. The people who should determine the shape of local services to meet the needs of patients are those who are already at the heart of designing services and referring patients.

[Andrew Stephenson (Pendle) (Con)]

4. What recent representations he has received on management and administration costs in the NHS; and if he will make a statement.

--- Later in debate ---

[Annette Brooke (Mid Dorset and North Poole) (LD)]

7. What assessment he has made of the Health Protection Agency’s recent report on the incidence of tuberculosis.

[The Secretary of State for Health (Mr Andrew Lansley)]

I welcome the Health Protection Agency’s recent report on tuberculosis in the UK. There were 8,286 cases of TB in England in 2009, an increase of 4.3% on 2008. The rise has occurred mainly in people infected in countries where TB is common, who go on to develop active TB disease later in life.

[Annette Brooke]

I understand that that is a 30-year high. Evidence from New York shows that a co-ordinated approach across the city has made a real impact in controlling TB. How will the Secretary of State ensure that such co-ordination takes place, especially in cities, when GP-led commissioning is introduced?

[Mr Lansley]

The treatment services for individual patients will be commissioned through GP consortiums, but the identification and preventive work on TB is a public health responsibility. To that extent, I believe that we will be better placed to deal with it in future. Many local authorities—for example, in Birmingham, Manchester or Leeds—will be well placed as cities to respond to any incidence or outbreaks of TB on a preventive basis, using their powers as public health authorities.

[Ms Gisela Stuart (Birmingham, Edgbaston) (Lab)]

In response to my question on the publication of the White Paper about the more than 500 TB cases in Birmingham the Secretary of State confirmed that there would be no changes to what such cities could do to control TB outbreaks. Will he elaborate on his answer? What more can Birmingham do under the new arrangements to prevent such exceedingly high numbers?

[Mr Lansley]

We can do a number of things. For example, the Department has funded TB Alert, which is the UK’s national TB charity, to raise awareness of TB among public and primary health care professionals, which will help. In London, we have supported a find-and-treat outreach service. In a similar vein, that could happen in cities where there is a rising prevalence of TB. TB is not general across the country, but likely to occur in particular areas. Those kind of initiatives enable us to identify TB outbreaks, and we can then structure services around that.

[Penny Mordaunt (Portsmouth North) (Con)]

8. What assessment he has made of the merits of steps to increase the standard of end-of-life care in an acute setting; and if he will make a statement.

--- Later in debate ---

[Mr David Blunkett (Sheffield, Brightside and Hillsborough) (Lab)]

10. What decisions he has reached in respect of additional funding for the purpose of the tariff applying to specialist children’s hospitals.

[The Secretary of State for Health (Mr Andrew Lansley)]

Following a very constructive meeting with the specialist children’s hospitals on Friday 3 December, I am pleased to be able to tell the House that we are working on a proposal to set the top-up payment for specialised services for children at 60%, over and above tariff prices. In addition, I intend to help the trusts by extending the number of procedures that will attract the top-up payment in 2011-12. I believe that the children’s hospitals will find that entirely acceptable.

[Mr Blunkett]

I would like—uniquely—to thank the Secretary of State for signing off the technical agreement from last Friday, and to say that the specialist children’s hospitals will welcome his announcement this afternoon. Is it not time to take the uncertainty away from the children’s hospitals and have a system that allows them to put in place a forward plan that does not result in this annual farrago? Would it not also be nice to congratulate the staff of the children’s hospitals on their terrific work, not least the dedicated way in which they will be working with these children over Christmas?

[Mr Lansley]

Yes, I am very glad to do so. I have visited Sheffield children’s hospital, and I very much applaud the work that it does. I am sure that those at the hospital are grateful to the right hon. Gentleman, as I am, for the way in which he has represented their interests. I entirely agree with him: the purpose of developing the payment-by-results system is to arrive at a point where it is predictable and delivers a relevant payment, related to the costs that are genuinely incurred in the provision of that treatment. We are not in that position yet. The specialist top-up was put in place to reflect that, but I hope that it is temporary rather than permanent.

[Mr John Leech (Manchester, Withington) (LD)]

11. What progress has been made on improving the provision of specialist neuromuscular physiotherapy for people with muscular dystrophy and related neuromuscular conditions; and if he will make a statement.

--- Later in debate ---

[Gareth Johnson (Dartford) (Con)]

14. What recent assessment he has made of the adequacy of provision of IVF treatment across the country.

[The Secretary of State for Health (Mr Andrew Lansley)]

Many primary care trusts have made good progress towards meeting NICE guidance recommendations on the provision of IVF treatment. However, I am aware that a small number of PCTs with historical funding problems have temporarily suspended local NHS provision of IVF services. I have already expressed my concerns about that approach. I expect all PCTs to have regard to the current NICE guidance and to recognise fully the significant distress and impact that infertility has on people’s lives.

[Gareth Johnson]

I am grateful to my right hon. Friend for his answer. He will be aware that Robert Edwards, the British inventor of IVF treatment, is due to receive the Nobel prize this week for his work. I am sure that Professor Edwards would be dismayed that PCTs have suspended their IVF provision, so would my right hon. Friend join me in urging those PCTs that have taken that step to reconsider their decision on this important issue?

[Mr Lansley]

Yes, I am indeed aware of that, not least because the Bourn Hall clinic, where Robert Edwards and Patrick Steptoe did their groundbreaking work, is in my constituency. As a former vice-chair of the all-party infertility group, I feel strongly that the reason the NICE guidance was written as it was, way back in 2004, was to recognise both the distress and the extent of the difficulties that couples face, and the need for them to be assured not only of good-quality investigation, but of good quality follow-up provision in fertility services throughout the NHS. I urge PCTs to have regard to the NICE guidance in their commissioning decisions.

[Mr Kevin Barron (Rother Valley) (Lab)]

If this unfair situation in the commissioning of infertility services continues, and if the reconfiguration goes ahead, would it be the responsibility of the national commissioning board to address it?

[Mr Lansley]

Beyond 2012 it would indeed. The reason we are in this position is not least because when NICE produced its guidance, my predecessor, John Reid, in effect told PCTs that they should not feel obliged to have regard to it and arbitrarily changed it. It is precisely that kind of political interference with what should be a clinically-led decision about the appropriate structure of commissioning services that I am proposing to do away with.

[Chris White (Warwick and Leamington) (Con)]

15. What support his Department plans to provide for front-line services in adult social care.

--- Later in debate ---

[Jonathan Reynolds (Stalybridge and Hyde) (Lab/Co-op)]

T1. If he will make a statement on his departmental responsibilities.

[The Secretary of State for Health (Mr Andrew Lansley)]

My responsibility is to lead the NHS in delivering improved health outcomes in England, to lead a public health service that improves the health of the nation and reduces health inequalities and to lead the reform of adult social care, which supports and protects vulnerable people.

[Jonathan Reynolds]

The Secretary of State will be aware that primary care trusts across the country are being asked to cut between 35% and 50% from their management costs. This inevitably leads to job losses, but can he confirm that he is confident that the jobs being lost as a result of this policy are purely management roles and that there are no losses of jobs that combine some management role with front-line clinical responsibilities?

[Mr Lansley]

We have been very clear that we are asking the whole of the NHS administration—we are applying the same discipline inside the Department, to arm’s length bodies and across the whole of government—to secure a reduction by a third of real-terms administration costs over four years. In the NHS in particular, I am looking for a reduction in management costs of 45% in cash terms. By that, I mean specifically the costs of managers and senior managers. By definition, that does not include clinical staffing.

[Ian Swales (Redcar) (LD)]

T3. In the light of the recent damning report by the Care Quality Commission into Redcar and Cleveland council’s adult social care services, what steps is the Secretary of State taking to improve adult social care and will he meet me to address the issues raised in the report?

--- Later in debate ---

[John Healey (Wentworth and Dearne) (Lab)]

May I welcome the Secretary of State’s sensible rethink and change of mind on the funding of specialist children’s hospitals after Labour Members raised concerns during the previous Health questions? During those questions he also got his NHS funding figures in a twist, so what has he got to say about the updated inflation forecasts on page 83 of last week’s Office for Budget Responsibility report? They show that for the next four years the inflation increase will be bigger than the cash increase in the NHS—in other words, the NHS will get a real cut in funding, not a real increase. Does he accept the OBR figures? Does he accept that they are hard proof that the Government are breaking their promise to protect NHS funding?

[Mr Lansley]

Let me tell the right hon. Gentleman that it is not a change on specialist children’s hospitals. The previous Government initiated a study by York university, which reported. I made it clear, when we discussed it last, that we were examining the results of that together with the specialist children’s hospitals. We have reached what I regard, as I hope they do, as a very acceptable outcome.

The spending review gave a real-terms increase in NHS funding. That was the commitment we gave and it was set out in the spending review, and it remains true that revenue funding for the NHS continues to rise in real terms.

[John Healey]

Perhaps I should have asked the Secretary of State whether he has even seen the OBR report. Let me try to help him. The OBR’s inflation figures mean that the NHS will not get the 0.4% real increase that he bragged about and that was stated in the spending review; the NHS will get a 0.25% decrease—a cut—in funding, as has been confirmed today for me by the House of Commons Library. No wonder the Prime Minister is rattled and is asking what on earth the Health Secretary is doing with the NHS. Does the Health Secretary accept that this confirms that the coalition’s pledge to guarantee that health spending rises

“in real terms in each year of the Parliament”

is being broken? How does he explain that to the Prime Minister and how does he explain it to the public?

[Mr Lansley]

No, I do not accept that for a minute. At the spending review we set out what met our commitment. I am very clear that, as I just told the right hon. Gentleman, revenue funding for the NHS will increase in real terms. It will do so because we did not listen to the advice of the Labour party in the run-up to the spending review, which was to cut the NHS budget. We did not do that and we were committed at the spending review to an increase in real terms. The gross domestic product deflator will move from time to time, but the commitment that we set out was clear and will continue.

[Mr Speaker]

Just as the answers from the Minister of State, the hon. Member for West Chelmsford, were too long, those questions were too long as well.

--- Later in debate ---

[Michael Ellis (Northampton North) (Con)]

T6. Every day, ambulance service staff in my constituency and around the country deliver life-saving care to our constituents, but they are themselves occasionally put in harm’s way. What steps are Her Majesty’s Government taking to ensure that the protection that our ambulance staff get in my constituency and around the country is the best that we can provide?

[Mr Lansley]

I join my hon. Friend in paying tribute to the staff in ambulance service—in the current circumstances, with the winter pressures being what they are, we should especially do so. But those staff can come under particular threat from time to time and we have to prepare for all eventualities. For example, if an attack involving firearms takes place, as it did recently in Cumbria, it is possible that ambulance staff would be working alongside other emergency services in responding to it. It is only right, therefore, that they are offered as much training and equipment as possible to carry out that work.

[Paul Goggins (Wythenshawe and Sale East) (Lab)]

T2. This morning, the Justice Secretary said that he was working with the Health Secretary on plans to divert more mentally ill offenders away from prison. I broadly welcome that, but could the Health Secretary tell us how much new money will be made available for that initiative, especially given the comments made by my right hon. Friend the Member for Wentworth and Dearne (John Healey) about the cut in the real value of health spending?

[Mr Lansley]

The right hon. Gentleman is in no position to make that point, given that his party wanted to cut the NHS budget. What my right hon. and learned Friend said this morning about our working together is indeed true. However, this is not a case of our diverting patients; it is about ensuring that people who have mental health problems are dealt with appropriately rather than there being a failure to deal with them. That applies whether they are in prison or in hospital. We are working together on that, and I know that my right hon. and learned Friend will be making a statement shortly.

[Richard Graham (Gloucester) (Con)]

T8. Can Ministers reassure me that, given the relative health deprivation in Gloucester, the ring-fenced funding promised in the White Paper on public health will in fact benefit people there?

--- Later in debate ---

[David Tredinnick (Bosworth) (Con)]

Is my right hon. Friend aware of the rally being held here in Westminster tomorrow by qualified herbalists who are coming to lobby for statutory regulation, which my right hon. Friend is obliged to provide under European law? When will he do that, please?

[Mr Lansley]

I am indeed aware of that, as my hon. Friend would expect. He will know that we are considering how we can give effect to the proper regulation of herbal practitioners and we will make an announcement shortly.

[John Mann (Bassetlaw) (Lab)]

T5. If a hospital service’s reconfiguration is demonstrably and overwhelmingly rejected by a local population, what notice will the Secretary of State take of the patients’ voice?

[Mr Lansley]

It was only under this Government, after the election, that tests were set out that such reconfigurations should meet. Those tests clearly included recognition of the voice of the public and of the local authority as well as current and prospective patient choice. To that extent, for the very first time, reconfigurations are not being dictated by an NHS administration but are responding to the views of patients and clinicians.

[Duncan Hames (Chippenham) (LD)]

The NHS Litigation Authority estimates an outstanding liability for clinical negligence claims of £15 billion, a sum that increased by £2 billion in the last year alone. How will the Minister bring that spiralling cost to the NHS to a halt?

[Mr Lansley]

I understand exactly my hon. Friend’s point. The increase in liabilities was, in part, an expression of the change in the discount rate rather than necessarily an increase in the number of cases coming through. It is a worrying figure and costs the NHS not far short of £1 billion a year through contributions to the clinical negligence scheme for trusts. My noble Friend Lord Young, in the course of his review of health and safety and other issues, made recommendations on dealing with conditional fee arrangements and clinical negligence. It set out that we would consider, for example, how we implement NHS redress arrangements, including whether there should be a fact-finding phase before any question of legal intervention. We will do that and report back to the House.

[Pat Glass (North West Durham) (Lab)]

T7. My local hospital, Shotley Bridge hospital in Consett, has faced a degree of certainty over its future in recent years. However, with the demise of the local PCT, which owns the hospital and the land, uncertainty has returned. Is the Minister prepared to meet me and a delegation from the hospital to consider the future?

[Mr Lansley]

I am sure that I or one of my hon. Friends will be happy to meet the hon. Lady. I do not know why she thinks that the abolition of the PCT will make that change. We have yet to set out how PCT assets will be dealt with when they are abolished. She must talk to her local GPs as I know that GPs in Durham have come together in a consortium and they will be well placed to give precisely the kind of assurance about the security of services in the future that she is looking for.

[Nick de Bois (Enfield North) (Con)]

The Secretary of State will be aware that the Barnet, Enfield and Haringey clinical review has been concluded. It notes that the Secretary of State’s four tests have been passed, despite health scrutiny establishing that they have not. In addition, the majority of Enfield GPs do not support the proposals. Will the Secretary of State therefore conclude that the four tests have not been passed?

[Mr Lansley]

My hon. Friend will know that all that has not yet come to me, so I will not prejudge this issue. However, I have made it clear, not least in a letter I recently sent to Baroness Margaret Wall, who is the chair of the Barnet and Chase Farm Hospitals NHS Trust, that I expect us to examine not only the Barnet, Enfield and Haringey proposals, but any other proposals that the trust might put forward about the level of acute services provided through Chase Farm.

[Toby Perkins (Chesterfield) (Lab)]

T9. The Secretary of State seemed to suggest, in his answer to the shadow Secretary of State, that his definition of a real-terms increase includes changes in inflation. If he does not accept the Office for Budget Responsibility verdict that the increase in inflation means a real-terms cut in 2012, which definition of inflation is he using?

[Mr Lansley]

What I said to the shadow Secretary of State was entirely accurate.

[Gordon Birtwistle (Burnley) (LD)]

Does the Secretary of State agree that the abolition of unelected quangos such as primary care trusts and strategic health authorities will bring an end to the decisions they are taking to remove services from local hospitals against the wishes of GPs and local residents?

[Mr Lansley]

The reforms we propose will bring far greater accountability not only through local authorities but through patient choice and through front-line clinicians being able to commission services.

Let me also tell my hon. Friend that I have today referred to the independent reconfiguration panel, for initial appraisal, the question referred to me by Lancashire county council about the children’s ward at Burnley hospital.

[Steve McCabe (Birmingham, Selly Oak) (Lab)]

Will the Secretary of State join me in deprecating the outrageous behaviour of the Prime Minister’s aides who told the Financial Times that the Secretary of State, on his reorganisation, has all the answers—unfortunately to all the wrong questions?

[Mr Lansley]

The hon. Gentleman should not believe what he reads in the papers and when he is trying to quote from them, he should do so accurately.

[Caroline Dinenage (Gosport) (Con)]

Blake maternity unit in Gosport is temporarily shut and its long-term future is by no means 100% secure. In conversations with local health care bosses, I have learned that it is not because of cost but because of a national shortage of midwives. Are there any policies or plans to address this issue?

[Mr Lansley]

I do not know the particular circumstances in Gosport, but I shall happily write to my hon. Friend. Nationally, we have more midwives than we have ever had—[Interruption.] I am being provoked by those on the Opposition Front Bench. There was a 16% increase in the number of live births in this country, but only a 4.5% increase in the number of midwives. That is the point I was about to make. The Government of whom the hon. Member for Halton (Derek Twigg) was a member failed to invest in midwifery when there was an increase in live births. That is why hospitals across the country have too few midwives, and that is why we are putting the investment in—because we did not listen to the Labour party when it said, “Cut the NHS budget.”

[Fiona Mactaggart (Slough) (Lab)]

Will waiting times for in-patient treatment in hospital increase or decrease next year?

[Mr Lansley]

They will respond positively to patient choice and GP referral.

[Joseph Johnson (Orpington) (Con)]

I am grateful to the Secretary of State for agreeing to visit Queen Mary’s, Sidcup, tomorrow, recognising the strength of local opinion there about the closure of accident and emergency and maternity services temporarily over the winter period. I hope that on his return he will reassure my constituents in Orpington that the closure will not mean that the review of reconfiguration of local NHS services will be prejudged and will not put neighbouring hospitals such as those in my constituency under undue pressure.

[Mr Lansley]

I am grateful. Tomorrow, I hope to assure myself, among other things, that the closure is temporarily demanded by virtue of the inability to secure enough staff to maintain a safe service for the time being and that it will not and does not pre-empt the question of availability of services at Queen Mary’s, Sidcup, on which a decision has not yet been reached locally or referred to me.

[Mr Dennis Skinner (Bolsover) (Lab)]

On the NHS campaign against obesity, does the Secretary of State welcome the magnificent support of the thousands of schoolchildren who have come down to demonstrate for school sports funding outside No. 10 Downing street? Will he fight in the Cabinet against the Education Secretary’s silly proposal, which will damage children’s health?

[Mr Lansley]

The Secretary of State for Education rightly believes in schools making decisions about how they should best use their resources, including for school sport. I hope the hon. Gentleman will welcome the fact that through my Department we have supported school sports clubs under Change4Life and intend to expand them.

Public Health White Paper

Lord Lansley Excerpts

Tuesday 30th November 2010 Commons Chamber

[The Secretary of State for Health (Mr Andrew Lansley)]

With permission, Mr Speaker, I would like to make a statement on public health. Today, the Government have published a public health White Paper with two clear aims: first, to protect and improve the health of the nation; and secondly, to reduce health inequalities by improving the health of the poorest fastest.

The need for this White Paper is beyond question. Britain currently has among the highest rates of obesity and sexually transmitted infections in Europe. Smoking still claims 80,000 lives a year. Alcohol-related admissions to hospital have doubled in the last seven years. In recent years, inequalities in health have widened, rather than narrowed.

Professor Sir Michael Marmot’s review to my Department said that

“dramatic health inequalities are still a dominant feature of health...across all regions.”

There is a seven-year gap in life expectancy between the richest and poorest neighbourhoods, but a gap of nearly 17 years for disability-free life expectancy. About a third of all cases of circulatory disease, half of all cases of vascular dementia and many cancers could be avoided by reducing smoking, improving diet and increasing physical activity.

We need to do better, and we will not make progress if public health continues to be seen just in terms of NHS provision and state interventions. Two thirds of our potential impact on life expectancy depends on issues outside health care. Factors such as employment, education, environment and equality are all determinants of health. They are, as Michael Marmot put it,

“the causes of the causes”—

the underlying factors leading to poorer health. Unhealthy behaviours, such as drinking too much, smoking or taking drugs, are part of a complex chain of individual circumstances and social causes, typically rooted in poor aspiration, adverse peer pressure and low self-esteem.

The human cost of poor health is obvious, and so too is the financial one. Alcohol abuse costs an extra £2.7 billion and obesity an extra £4.2 billion each year to the NHS alone. Although there are things we can do to help, we cannot resolve all the difficult issues from Whitehall. Hence the White Paper has one clear message above all others: it is time for politicians to stop telling people to make healthy choices, and start helping them to do it. There will be a profound shift in tone, attitude and outlook. Rather than nannying people, we will nudge them by working with industry to make healthy lifestyles easier; rather than lecturing people about their habits, we will give them the support they need to make their own choices; and rather than dictating policies from the centre, we will support leadership from communities, by giving local authorities more power to develop the right approaches for their communities.

The White Paper is a genuine cross-Government strategy. Through the Cabinet Sub-Committee on Public Health, we will put good health and well-being at the heart of all our policies. To do so, we will recognise that we need to provide support at key times in people’s lives. We will not only measure general well-being; we will seek to achieve it. For instance, because we know a mother’s health is key to a child’s health and development, we are investing in 4,200 more health visitors working with Sure Start children’s centres to give families the support they need; because we know those who are unemployed for long periods are more likely to be admitted to hospital and more likely to die prematurely, we are transforming the welfare system, ending the benefits trap and making sure that work always pays, through a single universal credit; and because we know more people would cycle to work or school more often if there were safer routes for them to use, the Government are investing £560 million in sustainable transport.

Subject to parliamentary approval, there will be a new dedicated public health service—Public Health England—which will provide the resources, the ideas, the evidence and the funding to support local strategies. Public Health England will bring together, within the Department of Health, expertise from a range of public health bodies, including the Health Protection Agency, the National Treatment Agency for Substance Misuse and the chief medical officer’s department. It will work with industry and other Government Departments to shape the wider environment as it affects our health. It will also develop health protection plans and screening programmes to protect people from health risks.

The foundations of good health are rooted in the community, often at a neighbourhood level, so we must strengthen and renew local leadership to ensure that these efforts reach deeply into communities and match their unique circumstances. Under the White Paper, the lead responsibility for improving health will pass to local government for the first time in 40 years. We intend to give local authorities new powers to plan, co-ordinate and deliver local strategies with the NHS and other partners, and to embed the foundations of good health in ways that fit local circumstances. Directors of public health will provide strong and consistent leadership within local councils. We also intend to establish the new local statutory health and well-being boards as a way of bringing together the NHS and local government.

Whereas before, public health budgets were constantly raided by other parts of the NHS, we will prioritise public health spending through a new ring-fenced budget. We will look to the highest standards of evidence and evaluation to ensure this money is spent wisely. The new outcomes framework for public health, on which we will consult shortly, will provide consistent measures to judge progress on key elements across all parts of the system—national and local. The framework will emphasise the need to reduce health inequalities, and will be supported by a new health premium, incentivising councils that demonstrate progress in improving the health of their populations and so reducing health inequalities.

We have learned over the last decade that state interventions alone cannot achieve success. We need a new sense of collective endeavour—a partnership between communities, businesses and individuals that transforms not only the way we deliver public health, but the way we think about it. Through the public health responsibility deal, the Government will work with industry to help people make informed decisions about their diet and lifestyle, to improve the environment for health, and to make healthy choices easier. Through greater use of voluntary and community organisations, we will reach out to families and individuals, and develop new ways to target the foundations of good health. Reflecting the framework in the ladder of interventions developed by the Nuffield Council on Bioethics, we will adopt voluntary and less intrusive approaches, so that we can make more progress more quickly and resort to regulation only where we cannot make progress in partnership.

This is a time when the NHS and social care are under intense pressure from an ageing population and higher costs—a time when we must therefore put as much emphasis on preventing illness as we do on treating it. In the past, public health has been a fragmented and forgotten branch of the health service. This White Paper will make it a central part of everything that we do, and we will bring forward legislation in the new year to enact these changes. By empowering local authorities, strengthening our knowledge of what works, and establishing the right incentives to drive better outcomes, this White Paper will deliver the strategy and support needed to reduce health inequalities and improve the nation’s health. I commend this statement to the House.

[John Healey (Wentworth and Dearne) (Lab)]

I thank the Secretary of State for advance sight of his oral statement. I am sure that the House will also thank him for the advance copies of the White Paper, which were available before he made his statement.

On Sunday the Health Secretary promised a White Paper that would

“take a radical new approach to public health”.

Today he has published the White Paper, and it falls far short of his hype. He has had six years in opposition and six months in government to prepare for this White Paper, but it will disappoint many of those who are most committed to better public health in this country and most concerned that we still have a great deal further to go. For the most part, this White Paper is not new. It is not clear how it will help to improve public health, and it is not a guarantee that the big gains made in the last decade—in cancer screening, healthy food in schools, stopping smoking and free flu vaccines, as well as the big cut in deaths from heart disease—will be continued.

However, in the spirit of responsible opposition, let me tell the Health Secretary that we can offer general support for his aims, which are very similar to those that we set out in our White Paper in 2004. I can promise him close scrutiny of his actions and those of his Government, because as the White Paper says, good public health depends on much more than what the NHS does. As he said in his statement, education, employment, environment and equality are the causes of the causes of poor health. However, the Government’s wider policies, which will lead to higher unemployment, poorer housing, greater poverty and an end to the Sport for All programme in schools, will do more damage to public health than his White Paper will do good, and more to increase health inequalities than his plan will do to reduce them.

So what did the Health Secretary say to the Chancellor about policies that will see a third of a million public sector staff on the dole? How hard has he argued against the Education Secretary’s plan to axe the school sports partnerships, which have seen three times as many children playing competitive sport than six years ago, and nine out of 10 children playing more than two hours of sport each week? Why is it that everyone else in the Government is set to make announcements affecting public health—on alcohol taxation or pricing, for example —except the Health Secretary? Far from being, as he said, a genuine cross-Government strategy, the White Paper—like his last one, on NHS reform—shows that this a Health Secretary working alone and operating largely in isolation from the rest of Government.

There is nothing new in “nudge”, except the soundbite and how hard the Secretary of State is pushing it. We set out the importance of individual decisions and incentives, alongside the need for support services and Government action, in our White Paper on public health in 2004. The test for the Health Secretary is whether the Government will act when they can and when they are needed, especially to protect children. The legislation is in place to end point-of-sale displays of cigarettes. The evidence is there and the experts are clear. Cancer Research UK says that

“we need to put tobacco out of sight and out of mind to protect all young people. The Government has the opportunity to act with conviction and reduce the devastating impact that tobacco has on so many lives.”

Will the Secretary of State do that: yes or no?

There is little new in this White Paper, and little is clear about how its plans will improve health and reduce health inequalities. It is 96 pages long but short on detail. We welcome in principle the lead responsibility for improving health being passed to local government, but can the Secretary of State guarantee the powers and the funds that it will need to do the job? Will he confirm that public health outcomes will also be part of the operating frameworks for the NHS and social care, because it would be a disaster if the NHS were now to decide that public health was not its job?

We are concerned about the Secretary of State’s responsibility deals. What exactly does he mean by that? What influence will industry have over future health policy? What does he say to the Liverpool health expert and Tory adviser, Professor Simon Capewell, who said that health experts on the public health commission

“were outnumbered and outvoted by people from Tesco, Diageo, and other food and drink manufacturers—and the Commission went with what the industry wanted…which is a scandal”?

What does he say when one of his own advisers offers that view?

We welcome the health inclusion board and the new national public health service, although we thought that this Government were committed to cutting, not creating, quangos. But is not the fact that the inclusion board will tackle the health needs of groups such as homeless people, drug users, alcoholics and sex workers an admission that GPs on their own do not know, and will not commission, what they need for the future?

Is not this one of the first in a series of bodges that will be needed to make the Secretary of State’s massive reorganisation plans for the NHS actually work? Whatever he says, we and the public will judge him on what he does. Will he ensure that his £3 billion internal reorganisation of the NHS does not damage public health? Will he take tough decisions about Government action on tobacco? Will he make and win the big arguments in government about the damage to health that comes from no work, poor housing and bad education? In government, it is deeds that count, not words.

--- Later in debate ---

[Mr Lansley]

I am grateful to the right hon. Gentleman for his support for the strategy that is set out in the White Paper. However, he then proceeded to aim off in every other direction. He said that I was in opposition for six and a half years, and, indeed, I made it very clear six years ago that when we came back into government, we intended to ring-fence the public health budget, to create directors of public health who were accountable to the NHS and to local authorities, and to establish a public health service that was more independent and more effective. His Government could have adopted those proposals six years ago, but they simply did not do so.

What was the record of the right hon. Gentleman’s Administration? Obesity rates in this country are way above average; in fact, they are among the highest in Europe. Alcohol-related admissions to hospital have doubled in seven years. Sexually transmitted infections are up by more than two thirds in the last decade. Even smoking rates have not changed. Parliament approved a smoking ban in public places, but in the most recent years, there has been persistent prevalence of smoking. It has not gone down in the past year. One in five of the population are experiencing mental ill health at any given time. Those are the records of the Labour Government on public health. Inequalities have widened. In life expectancy, the gap has widened. In infant mortality, the gap has widened. On their own measures, the Labour Government failed in public health, and we are going to put in place a strategy that is truly effective.

Some of the leading international experts, including Sir Michael Marmot, have welcomed what is in the public health White Paper today. The public health profession also welcomes it, because it knows that we are committed to addressing the wider determinants of health. My colleagues across Government are direct participants in the Cabinet Sub-Committee that is delivering this strategy, which is the starting point for public health delivery. Not all the details are in here. We are going to move on to a tobacco control strategy, a physical activity plan, an obesity strategy, alcohol strategies and a range of other responses to the public health threats that we face, and we are going to do that across Government. Only today, my right hon. Friend the Chancellor of the Exchequer announced that we would do what we said we would do, and increase duty on the strongest beers while reducing it on some of the weaker ones, thus beginning the process of incentivising and nudging.

The right hon. Gentleman asked about the responsibility deal. Let me give him an example. In 2004, the last Labour Government said that they would introduce front-of-pack food labelling. They wanted to introduce a single traffic-light system. All that fell apart in utter confusion. There was never a consistent front-of-pack food labelling system. The last Government never worked with industry; they worked against industry, and what was the result? A variety of different systems, and nothing consistent for the public to look at.

Only by working together on a voluntary approach will we start to make progress more quickly, whether it is on labelling, reformulation or activity with employers in the workplace. We will make progress, we will do it more quickly, and we will regulate only when necessary, rather than resorting to regulation and, as the Labour Government did, failing to make any progress and failing to regulate. That is not a basis on which we can deliver the public health improvements that we need.

This is a starting point for a public health strategy that will deliver the improvements in public health that the country requires. We are a Government who are committed to those improvements. They are central to improving well-being, and our strategy will deliver them.

[Several hon. Members]

rose—

[Mr Stephen Dorrell (Charnwood) (Con)]

I congratulate my right hon. Friend the Secretary of State on a White Paper that redeems his pre-election pledge to raise public health to a higher level of priority than was accorded to it not merely by the last Labour Government, but by the Conservative Government in which I held my right hon. Friend’s responsibilities. I congratulate him on delivering the first step towards that commitment, and particularly on the transfer of public health responsibility to local government. The White Paper proposals will fulfil the promise to make public health a cross-Government responsibility, and will deliver what has been described as the “fully engaged scenario”. That is the only way in which we can deliver our broader public health objectives.

[Mr Lansley]

I am grateful to my right hon. Friend for his comments. Derek Wanless said that we needed an “engaged” scenario back in 2002, but it simply did not happen. I know that many in public health feel that the transfer giving local government the lead responsibility on public health—which is radical and new—will, in many respects, bring public health back home. It allies the public health initiative and resources to the responsibilities of local government on economic development, the environment, planning, housing and education in precisely the ways that will influence the wider determinants of health.

[Frank Dobson (Holborn and St Pancras) (Lab)]

I welcome the Secretary of State’s proposal to return public health to local authorities, from which a Tory Government took it away, but why did he not mention housing in his statement? It is widely accepted that homelessness, poor-quality housing, overcrowding and insecurity of tenure are major causes of both mental and physical ill health, and a major cause of inequalities in health.

[Mr Lansley]

I am grateful to the right hon. Gentleman for his support. In fact, I did mention housing. However, I have also established in the Department a health inclusion unit—derided by those on the Labour Front Bench as a quango, although it is not one—whose purpose will be to focus specifically on some of the most excluded communities, such as the homeless and Traveller groups. Life expectancy in some of those groups can be in the 40s, and the gap in life expectancy and the health inequalities are a scandal. I have appointed Professor Steve Field, formerly of the Royal College of General Practitioners, to lead it, and I think that he will do a fantastic job in ensuring that the NHS, as well as local authorities, reaches out to deliver the health improvement that is needed.

[Stephen Williams (Bristol West) (LD)]

I welcome the White Paper in general, and particularly welcome the commitment to rigorous and evidence-based policy-making. I commend to the Secretary of State the latest report of the all-party group on smoking and health, which I chair, entitled “Inquiry into the effectiveness and cost-effectiveness of tobacco control”. May I give the Secretary of State and his ministerial colleagues a strong nudge to implement as soon as possible the orders on control of the display of tobacco that were passed in the last Parliament?

[Mr Lansley]

I am grateful to my hon. Friend for his comments. As in a number of other areas I have mentioned, we will publish a strategy in due course, and a tobacco control strategy will be published in the new year. Parliament voted for the display regulations and we are looking into that, but we have to balance the evidence on health improvements with the impact of such a measure, particularly the burdens on small retailers. We are also currently examining the option of plain packaging of cigarettes, which the last Government did not do. That might in itself be an important measure to reduce both the visibility of cigarettes and the initiation into smoking of young people in particular.

[Mr David Blunkett (Sheffield, Brightside and Hillsborough) (Lab)]

Not so much nudge as fudge on this issue. Why will the Secretary of State not accept that giving those displaying tobacco and cigarettes time to adjust by allowing them to implement the regulation this time next year is good common sense? Is it not the case that the Government’s refusal to acknowledge the implementation of this regulation passed by Parliament can only be explained by there being an ideological objection to protecting young people in particular from the incitement to buy?

[Mr Lansley]

I am afraid the right hon. Gentleman is simply wrong about that: we have made no announcement, and I have said we are considering it. More to the point, I have said we are also considering the question of plain packaging of cigarettes, which is being pursued by a Labour Administration in Australia, and which his Administration did not pursue.

[Nadine Dorries (Mid Bedfordshire) (Con)]

The White Paper states that we are going to provide easy access to confidential non-judgmental sexual health services. Will that include better counselling for women seeking an abortion, and will that counselling include the information that has so far been withheld from women seeking a termination?

[Mr Lansley]

The support for women seeking the termination of a pregnancy should include the fullest possible information about the nature of that procedure and its consequences. Consent should always be fully informed.

[Mr Kevin Barron (Rother Valley) (Lab)]

There is much merit in what the Secretary of State has announced. Will the new outcomes framework, which will provide consistent measures to judge progress on key elements, include smoking cessation figures? As he well knows, 50% of our health inequalities in this country are created by tobacco use.

--- Later in debate ---

[Mr Lansley]

We will publish a consultation on the outcomes framework soon, but smoking cessation and the absence of initiation into smoking are clearly very important. Smoking is still the single largest avoidable cause of early mortality, and we must try to reduce further the prevalence of smoking. It has not been reduced in the last couple of years, and we need to reduce it.

[Julian Smith (Skipton and Ripon) (Con)]

May I urge the Secretary of State to ensure that councils serving very rural communities do not lose out under the new regime?

[Mr Lansley]

All councils will be supported to develop health improvement strategies. When we come to publish the consultation on the funding of the public health budget, that will set out how, in addition to the resources used nationally, there will be significant resources in a ring-fenced budget for local authorities. Because of the nature of the health premium, that budget will be significantly weighted towards areas of greatest disadvantage and poorest health outcomes.

[Joan Walley (Stoke-on-Trent North) (Lab)]

Whatever Government were in power, I would welcome an enhanced role for environmental health officers in improving public health policy. Given the depth of the coming cuts to local authority budgets, however, there is real concern, regardless of the ring-fencing statement we have had, as to whether there will be sufficient resources and capacity for environmental health officers. Does the Secretary of State intend to have an environmental health officer at chief officer level inside the Department of Health?

[Mr Lansley]

I have had discussions with environmental health officers and they are enthusiastic about the opportunity for much greater synergy between their work and public health responsibilities. They see their role as integral to the achievement of public health. Indeed, some of the greatest public health improvements of the past were initiated in local government and through responsibilities that are currently within environmental health legislation, so I am looking to the health and well-being boards to bring these responsibilities together more effectively.

[Dr Sarah Wollaston (Totnes) (Con)]

Is my right hon. Friend aware that about 30,000 people a year in this country die as a result of alcohol, and that Department of Health modelling has shown that if we were to increase the minimum price per unit to 50p we would save over 2,000 lives a year? Will he look at the proposals published in the British Medical Journal to have variable rates of VAT so we can increase the price without penalising the on-licence trade?

[Mr Lansley]

My hon. Friend will know that the Chancellor of the Exchequer made an announcement today about the level of duty on beers, in particular. We have made it clear, in the coalition agreement and since, that we will act to ban the below-cost selling of alcohol. I think that that will make a significant difference. We will also in due course publish an alcohol strategy, through which we will examine a range of ways in which we can not only enforce the current legislation more effectively, but create an environment in which we progressively reduce the abuse of alcohol. It is very important for us to understand that we must distinguish between our relationship with tobacco, whose use we want to minimise—we want to encourage people never to use tobacco—and our relationship with alcohol, where we are seeking its responsible use, rather than seeking to penalise people who engage in responsible drinking.

[Alex Cunningham (Stockton North) (Lab)]

Which part of the health service or the Sure Start budgets will be cut to fund the new army of health visitors, and where are they going to come from?

[Mr Lansley]

The health visitor programme is not funded by cutting anything else; it comes from within the NHS budget, because we regard providing support to families when babies first come home and offering a universal health visiting service that signposts other resources to help families as absolutely integral to the improvement of health in the future. That is funded from within what was an historic commitment from this Government to protect the NHS budget and to increase it in real terms over the next four years. We are going to fund this from within the NHS resources.

[Paul Maynard (Blackpool North and Cleveleys) (Con)]

Males in the Blackpool part of my constituency have only a 56% probability of reaching the age of 75. Can the Secretary of State tell me what measures in the White Paper will help to promote the act of ageing and allow more of my constituents to reach a milestone that many of us take for granted?

[Mr Lansley]

I am grateful to my hon. Friend for his question. Many aspects of the White Paper and subsequent strategies relate to these issues. In the long run, his constituents will find that the measures that have an impact early in life or which work through early intervention will make the biggest difference, as was made clear in Sir Michael Marmot’s review, in which he talked of a universal proportionality. Such measures include, for example, our universal health visiting service and family nurse partnerships, which are intervening at that stage. If we have not succeeded through early intervention, however, or many people have chronic ill health, we will continue to ensure through our screening programmes and local health improvement plans that people are identified early and opportunities are created for them to make lifestyle decisions that will improve their chances of disability-free life expectancy thereafter.

[David Cairns (Inverclyde) (Lab)]

I welcome the acknowledgement in the White Paper that about 25% of HIV cases in this country are currently undiagnosed. Will the Secretary of State therefore lend his support to the “Halve It” campaign, which is being launched tonight by the all-party group on HIV and AIDS, which I chair, with the Terrence Higgins Trust and others? The campaign aims to halve that number by 2015. That will mean fewer early deaths, fewer cases of HIV being spread and, ultimately, significant savings for the NHS.

[Mr Lansley]

I agree with the hon. Gentleman. Almost 22,000 people with HIV are unaware of their condition. We need to ensure, through the sexual health services, that people have consistent access to HIV testing and are encouraged opportunistically to ensure that they are HIV tested so that we can deliver the services they need. What he describes is one of the opportunities that we can examine when considering how the outcomes framework will measure the performance of local health improvement plans.

[Mr Charles Walker (Broxbourne) (Con)]

I have just learned that for the past year Hertfordshire primary care trust has been plotting to close the enormously successful urgent care centre in Cheshunt. If that happens, can the local authority step in, if its finances allow, to run the urgent care centre?

[Mr Lansley]

I was not aware of what my hon. Friend describes, and strictly speaking it does not relate to the White Paper. None the less, it will remain the case that local authorities, through current overview and scrutiny arrangements or future scrutiny arrangements, have the ability to ensure that major service changes of that kind are subject to scrutiny. If such changes are not justified in the interests of local people, they can be referred to me and I can seek the independent reconfiguration panel’s advice.

[Emma Reynolds (Wolverhampton North East) (Lab)]

The Health Secretary rightly underlined in his statement the importance of tackling obesity. Is there any truth in the suggestion that he has expressed concerns that plans to dismantle the school sport partnerships will exacerbate the problem of tackling childhood obesity and has he discussed those concerns with the Education Secretary?

[Mr Lansley]

No; the hon. Lady should not believe what she reads in newspapers. The Education Secretary is not scrapping the school sport partnerships; he is providing the resources directly to schools so that they can make the decisions on how they promote sport. From my point of view, I have always made it clear—this has been the burden of my conversation with my colleagues—that we are already supporting school sports clubs in secondary schools through Change4Life. We intend to maintain that and to expand the role of Change4Life, linking in to primary schools so that we stimulate activity and exercise for young people overall. That is entirely complementary to how schools, using their own resources, stimulate sport. With regard to competitive sport, they will be assisted additionally through infrastructure funding for the new school Olympics.

[Dr John Pugh (Southport) (LD)]

I congratulate the Secretary of State on his long-standing and personal commitment to public health as the best way of dealing with health inequalities. How do we stop GPs operating in silos and prescribing pills where they might prescribe exercise? How do we join up the pieces?

[Mr Lansley]

I am grateful for that question. The answer has two parts. First, the general practice-led commissioning consortiums will be members of the new health and well-being boards in local authorities to which I referred. They will participate in the joint strategic needs assessments and strategies through the commissioning framework, the outcomes framework and the quality and outcomes framework, which applies directly to general practice. The less we focus on processes, and the more we focus on outcomes for patients, the more general practice will be focused on preventive solutions, because they will deliver good outcomes at relatively low cost. To that extent, the preventive agenda in general practice and community health services will be incentivised through a focus on outcomes.

[Simon Danczuk (Rochdale) (Lab)]

What proportion of the NHS budget will go to local authorities to provide for public health and how will the funding reflect local health inequalities?

[Mr Lansley]

I must disappoint the hon. Gentleman. We will publish shortly—I hope before Christmas—the consultation on the funding arrangements. We started by establishing the baseline spend for public health, which was never identified under the last Government. It has taken months even to get to the point where we can establish what it looks like—[Interruption.] The hon. Member for Leicester West (Liz Kendall) mentions Julian Le Grand from a sedentary position. He did good work, but it included the whole of maternity services as a public health service. Julian Le Grand and Health England’s work arrived at the figure of £4 billion. In fact, the baseline is in excess of £4 billion, but its composition is completely different. We will set out shortly the structure and proposals for funding local authorities’ public health activity.

[Mike Weatherley (Hove) (Con)]

Given my right hon. Friend’s voting record in the last Parliament, and indeed that of most Government Members, will he advise the House what specifically he is looking to achieve through the tobacco display ban analysis?

[Mr Lansley]

Through our tobacco control strategy, I am looking to achieve, as we will set out, a continuing reduction in smoking prevalence. In particular, I want to identify how we can substantially reduce the initiation into smoking among young people.

[Kate Green (Stretford and Urmston) (Lab)]

I genuinely welcome the Secretary of State’s recognition of the importance of a cross-Government approach to tackling health inequalities. He will be aware that Sir Michael Marmot identified income as one of the most important determinants of health. Will the Secretary of State make representations to his colleagues the Chancellor and the Secretary of State for Work and Pensions to ensure that everyone can have an adequate income, from those reliant on out-of-work benefits to those who are in employment?

[Mr Lansley]

I understand the hon. Lady’s point. Sir Michael Marmot has generously welcomed the White Paper’s proposals and its thrust. He made a specific proposal about a specific standard of living related to health—effectively a basic income proposal. That is not the Government’s proposal, but we intend to act on the other five domains in his report, the effect of which, among other things, will be to ensure that the welfare to work programme—the most ambitious and comprehensive programme ever initiated by any Government in this country to take people off benefits into work—will support people not only through better disability benefit assessments, which will help in health assessments, but by ensuring that people in work are healthier because they are less likely to be poverty and more likely to be free of the distress associated with unemployment.

[Mrs Anne Main (St Albans) (Con)]

In St Albans we are lucky that people live for quite a long time, but often elderly care packages are not put in place to allow elderly care patients to come out of hospital and into adult social care services. Will the proposals in the White Paper to give local government more control help to ease this problem?

[Mr Lansley]

As my hon. Friend may know, we are acting already. Through the spending review we have made very clear the NHS commitment to support local authorities in the delivery of adult social care responsibility, particularly through the integration of health and social care. That includes £70 million this year for re-ablement, £150 million in the next financial year for more re-ablement activity and nearly £650 million in the next financial year in direct support from the NHS for preventive and other activities to support social care. That will make a big difference to her constituents.

[Diana Johnson (Kingston upon Hull North) (Lab)]

Hull city council’s recent record is of raising sports charges, blocking free swimming, axing free healthy school meals, dragging its feet on smoking and allowing junk food outlets to open near schools. In the light of that record, I am concerned about local authorities taking control of public health. What safeguards will there be regarding local authorities whose public health agenda is more from the era of “Life on Mars”?

[Mr Lansley]

There we have it: the Labour party as the opponent of local government. I am sure that people will recognise that when we arrive at local government election time. The Labour party has never trusted local government but we are going to trust it. We are going to give it not only greater freedoms but greater powers and responsibilities. Not every local authority will be brilliantly successful, but at least local authorities are directly accountable to the people who elect them—those for whom the authorities will deliver services.

[Philip Davies (Shipley) (Con)]

Many of the measures that my right hon. Friend proposes, such as the plain packaging of tobacco, forcing responsible drinkers to pay more for alcohol in supermarkets than they otherwise would and, bizarrely, forcing employers to allow women to breastfeed at work are a triumph not for public health but for the nanny state—something that we thought had gone out with the previous Government. Why is he still so wedded to the nanny state?

[Mr Lansley]

I am wedded to achieving improvements in public health. Interestingly, today I have been accused both of being an exponent of the nanny state and of having abandoned it in favour of “nudge”. The truth is that, as one sees in the White Paper, there is a clear philosophy here that we will pursue a voluntary approach, regulate only where necessary and seek to have less intrusive and less interventionist approaches in order to make more progress more quickly. If we do not make progress through voluntary approaches, we will of course still have to protect the public’s health and we will seek other measures to do so, but they have been tested to destruction by the previous Administration. It did not happen—they did not succeed and they did not improve public health—but we are determined to do so.

[Clive Efford (Eltham) (Lab)]

The Secretary of State consistently comes to the House and announces policies that seem to have been written on the back of a fag packet from the Minister of State, Department of Health, the hon. Member for Chelmsford (Mr Burns), but in his explanation on this morning’s “Today” programme the Secretary of State could not even make his mind up about the fag packet. Does he understand that the time allowed for the implementation of legislation that has been passed by the House was meant to allow people who are consequential in delivering that policy enough time to plan for it? The delay that he has introduced has made it more difficult for people such as the newsagents whom he spoke about in his statement because they have to prepare. Are we going to have branding or not? Will packets be on display or not? What is the Government’s policy?

[Mr Lansley]

I think that I have already answered that question. The hon. Gentleman at least among Opposition Members seems to have understood what it is to be in opposition: the point is simply to oppose and that is all he is doing. This is a positive statement and he should address it in that light.

[Mr Edward Timpson (Crewe and Nantwich) (Con)]

Does the Secretary of State agree with local GPs in my constituency that one way to help reduce health inequalities and spend money in the NHS better is to review reporting mechanisms in the NHS and how they impact on referral decisions, particularly in-house referrals?

[Mr Lansley]

Yes. I know that the GPs in Cheshire are a very go-ahead group and I am looking forward to seeing how they take on these responsibilities. I have seen GPs recently make presentations showing that they can really take a grip on referral patterns. They can see referrals not just in terms of trying to interpret patterns and numbers, but on the basis of clinical judgment. The combination of clinical judgment and understanding and knowledge of commissioning and contracting leverage is the basis from which we can improve overall the commissioning of activity for patients.

[Andrew Gwynne (Denton and Reddish) (Lab)]

The Secretary of State mentioned that the Government are investing £560 million in encouraging sustainable forms of transport, such as walking and cycling, but given that the Department for Transport is systematically un-ring-fencing many of the transport budgets for local government, what guarantees can he give that that pot of money will be spent on that specific purpose?

[Mr Lansley]

We have been very clear in the spending review and subsequent announcements that we will take the ring fence off many of the grants provided to local government, because we trust local government and we expect those in local government who are responsible for such things to be accountable to their electors. Where public health is concerned—this is separate from the point the hon. Gentleman makes—NHS money will be ring-fenced in the hands of local authorities for health gain. There will be many appropriate uses, so the ring fence will in no sense, I hope, have a constraining effect.

[Dr Daniel Poulter (Central Suffolk and North Ipswich) (Con)]

I am sure that, like me, the Secretary of State recognises that different population groups offer and present different public health challenges; for example, the Asian community has higher rates of cardiovascular disease. Does he agree that the White Paper presents an excellent opportunity for local authorities to address specific local concerns that are relevant to their NHS populations?

[Mr Lansley]

Yes, I do. My hon. Friend is absolutely right. The structure proposed in the NHS reform White Paper in July was to bring local authorities and the NHS together to undertake joint strategic needs assessments leading to a combined strategy. Understanding the causes of ill health, and understanding where ill health is occurring and where the greatest areas of unmet need are in a community, will impact positively both on NHS commissioning and on local authorities.

[Fiona Mactaggart (Slough) (Lab)]

I welcome the proposal to give public health responsibility to local government, but will the Secretary of State assure the House that his intention is to build on proven successful initiatives, such as the family nurse partnership that works with teen mothers in my constituency, and health advocates? In contrast to GPs who, when offered an opportunity to give out membership of slimming clubs, managed to give only one in six months, health advocates managed to gain about 2,000 regular participants in slimming clubs, thus helping to deal with the obesity problem in Slough.

[Mr Lansley]

I am grateful to the hon. Lady. At least I know that she supports the proposal to transfer the responsibility to local government—not something I discovered from the reply of the right hon. Member for Wentworth and Dearne (John Healey). The short answer is that I have already announced that over the next four years we will double the number of family nurse partnerships, so we shall indeed support them. More than that, as Sir Michael Marmot made clear, it is vital that we combine the targeted support that the FNPs can give and a restored universal health visiting service to help every family as they start out.

[Mark Lancaster (Milton Keynes North) (Con)]

One of the clearest indicators of health inequalities is life expectancy. In two near-neighbouring wards in Milton Keynes, there is a variation of 12 years, which is a staggering figure. How can we address this problem?

[Mr Lansley]

My hon. Friend is absolutely right. The truth is that we know we have to take action nationally, and we will, not only through health protection but through much more effective health screening, immunisation programmes and an early start in the health visitor programme, for example. It will be for his local authorities and communities to get together to ask how they can address the inequalities. That will be vital to achieving health improvement in his community.

[Ms Gisela Stuart (Birmingham, Edgbaston) (Lab)]

Last year, Birmingham had about 500 confirmed cases of tuberculosis and there were calls for the city council to have compulsory city-wide inoculation programmes. Under the Secretary of State’s newly conferred powers, is that something that local authorities could now do?

[Mr Lansley]

No; the response to infectious diseases will continue to be the responsibility of the Department of Health, with a more integrated Public Health England incorporating the responsibilities of the Health Protection Agency and recommendations from the Joint Committee on Vaccination and Immunisation and others. There was a lot of important debate about the discontinuation of the BCG inoculation. My view is that targeted action in areas with high prevalence of TB—as there is in a small number of places—is more appropriate than the introduction of any generalised inoculation at this stage.

[Charlie Elphicke (Dover) (Con)]

But when and how will action be taken on the evil of cheap supermarket booze?

[Mr Lansley]

My hon. Friend will not have to wait long for announcements from hon. Friends of mine in the Government.

[Pat Glass (North West Durham) (Lab)]

Is not part of the problem the way in which Departments continue to operate in silos, so the Secretary of State for Education can cut the school sports initiatives with no impact on educational outcomes, but massive impacts on health? The Department of Health can consistently underfund children’s health services such as speech therapy and mental health, with very little impact on the Minister’s Department but massive impact on education outcomes. Is the statement not just evidence of more silo working?

[Mr Lansley]

That is all complete nonsense. On sport and activity in schools, my right hon. Friend the Secretary of State for Education is supporting schools and mainstreaming funding for sport and physical activity into school budgets; my right hon. Friend the Secretary of State for Culture, Olympics, Media and Sport is working to support competitive sport and the sport Olympics; and I am working to stimulate physical activity through Change4Life school sports clubs, increasingly in the primary sector as well as in the secondary sector. We are working on all that together and it is entirely complementary.

[Dr Julian Lewis (New Forest East) (Con)]

Given the commitment to popular choice, can my right hon. Friend confirm that when responsibility for putting fluoride into drinking water is taken away from strategic health authorities, the people who have the final say on the matter will be the people who drink the water?

[Mr Lansley]

The responsibility will be transferred to local authorities, and they will have the same obligation to consult their population as exists in the present legislation. In my view, local authorities are more accountable to the population that they serve than strategic health authorities have been in the past.

[Catherine McKinnell (Newcastle upon Tyne North) (Lab)]

The Secretary of State said in his statement that politicians need “to stop telling people to make healthy choices” and actually help them to do it. He said that they need to stop nannying people, but nudge them “to make healthy lifestyles easier”, and that “rather than lecturing people…we will give them the support they need to make their own choices”. Can he explain how failing to implement the tobacco display policy is forwarding those aims?

[Mr Lansley]

The hon. Lady does not seem to understand. We have made no announcement in relation to the tobacco display regulations—[Interruption.] They were approved by Parliament before the election. We have made it clear that we are looking at a tobacco control strategy. I made it clear just now at the Dispatch Box that, beyond anything done by the previous Government, I am considering the question of the plain packaging of cigarettes, which in itself could be a significant additional weapon in our armoury to reduce the initiation of smoking among young people and the visibility of cigarettes. When we publish a tobacco control strategy, we will weigh up the wide range of such factors.

[Robert Halfon (Harlow) (Con)]

Harlow parents will welcome the extra support for Sure Start, particularly after the scares from the Opposition at the last election. Will my right hon. Friend set out the measures that the White Paper takes to support other local charities that do so much to combat drug and alcohol abuse in my constituency and elsewhere?

[Mr Lansley]

I entirely agree with what my hon. Friend says. I appreciated visiting a children’s centre in Roehampton just this morning to see how it was bringing together all the opportunities. Important among those was the relationship with health visitors and their signposting role in relation to that service and others. Through the White Paper, we will, in a number of respects with which I shall not detain the House now, focus on how we can work with social enterprises, the voluntary sector and charities in order to deliver health improvements. As that will involve factors such as behaviour change, the ability of charities to work with people at a personal level and to be highly innovative will be important in making it successful.

[Margot James (Stourbridge) (Con)]

I welcome the liberation of public health from its ivory tower. It will be able to do much more good in the real world. Can my right hon. Friend say a little more about how the health and well-being partnerships might work with businesses, the police and other relevant agencies to reduce alcohol-related admissions to hospital?

[Mr Lansley]

When we publish the alcohol strategy, there will be more to say about that, but it is already clear that we can do much more on local community alcohol partnerships, which have demonstrated their success in places such as St Neots in Huntingdonshire, so that enforcement and work to prevent young people from purchasing alcohol when they should not do so is much more successful. We can also work much more effectively on improving alcohol labelling, and we are working through the responsibility deal to look at those opportunities, too.

[James Morris (Halesowen and Rowley Regis) (Con)]

I welcome the Secretary of State’s statement. Does he agree that in local areas it is important for local government to work closely with the voluntary sector, particularly on preventive mental health services?

--- Later in debate ---

[Mr Lansley]

Yes, I entirely agree. The extent to which charities and the voluntary sector can initiate new ideas is woefully underestimated. This is not just about local authorities, and still less about central Government saying, “Here is a programme, would charities like to bid to run it?” Even more importantly, we must be clear that charities should now come forward to anticipate the resources needed to improve public health, and to suggest their own innovations to deliver better health for their communities.

[Mr David Burrowes (Enfield, Southgate) (Con)]

My right hon. Friend will recognise the description of alcohol treatment as a Cinderella service, which is sadly not just a seasonal description but often the soft target of cuts by PCTs. I therefore welcome the opportunity in the White Paper for pooled budgets and for co-ordination between public health service directors and children’s services directors to prevent and tackle alcohol misuse.

[Mr Lansley]

I am grateful to my hon. Friend, because I think that through these measures we will help to integrate drug, alcohol and sexual health services, rather than see them in silos. Even in primary care trusts, those services have often been treated as completely discrete activities, because they have been related to specific targets that central Government have set, rather than part of an holistic community view of how we improve health.

Inside the NHS we are shifting public health to that degree of protection, because back in 2005 when the Labour party was in charge, the Chief Medical Officer said:

“There is strong anecdotal information from within the NHS which tells a…story for public health of poor morale, declining numbers and inadequate recruitment, and budgets being raided to solve financial deficits in the acute sector.”

Under Labour, public health was raided and denigrated; under this Government, public health will be given the place it deserves.

[Andrew Percy (Brigg and Goole) (Con)]

I support any moves to reduce the use of tobacco throughout the country, and that is why I support the smoking ban so much, but will the Secretary of State assure us that when we look at the tobacco display ban we will consider all the international evidence from countries such as Canada and Ireland, which have found that the ban has not been the slightest bit effective in reducing the number of people who smoke?

[Mr Lansley]

Yes, and I believe very strongly that we must work on the basis of evidence in public health, rather than simply on anecdote and assumptions.

[Mr David Evennett (Bexleyheath and Crayford) (Con)]

I welcome my right hon. Friend’s statement and, in particular, the ring-fenced public health budget and the increased role for local authorities. Is he aware that under the previous Government many PCTs cut funding for public health and plugged gaps elsewhere?

[Mr Lansley]

My hon. Friend makes a very important point, and that was not all that happened. On the money available to primary care trusts for what is termed the healthy living programme, there is no correlation between how much trusts spend relative to health deprivation, so in places with the poorest health outcomes trusts on average do not spend any more on discretionary health improvement activity. That is why our proposed health premium is so important. The places with the poorest health outcomes will clearly have the money they need to undertake specifically preventive work to raise health outcomes.

[Bob Blackman (Harrow East) (Con)]

I warmly welcome the proposals to transfer public health to local authorities and, indeed, the ring-fencing, but will my right hon. Friend clarify how we will enforce the spending of that money on public health, so that there are no blurred edges and local authorities cannot fund their other services from within that ring-fencing?

[Mr Lansley]

I bow to my hon. Friend in his understanding of local government. My experience and understanding of local government is such that I know that the people involved are very concerned about improving health in their communities, and these resources will be available for that. Those people will not only be accountable to the people who elect them but accountable through the incentive mechanism of the health premium for the delivery of improving outcomes in the reduction of health inequalities. They will have an in-built incentive in the funding system to use those resources to deliver the outcomes that are collectively agreed, co-produced with local government. If they do not do so—if they spend the money elsewhere—they will not see the increase in resources that would otherwise flow.

[Anne Marie Morris (Newton Abbot) (Con)]

Given the Secretary of State’s support for Sure Start, will he clarify his plans for Home-Start, as several families in my constituency are concerned that it will lose funding?

[Mr Lansley]

I will write to my hon. Friend about that. We are very clear that we are going to introduce a universal health visitor service, which has been lost in recent years. That element of universal support to all families when babies first come home is an absolutely integral part of getting them on the right path. We think that not just targeted but early support for all families will have disproportionate benefits in the long run.

[Andrew Griffiths (Burton) (Con)]

I applaud the Secretary of State’s commitment to tackling alcohol misuse and his determination to ban below-cost selling. However, does he share my concern that a definition of below-cost selling that is duty plus VAT, which would still allow supermarkets to sell a bottle of wine for £1.90 or a can of lager more cheaply than a can of Coca-Cola, will fail to deliver the outcomes that he is looking for?

[Mr Lansley]

My hon. Friend tempts me to pre-empt announcements which properly fall to my colleagues in the Home Office. I will leave it to them, if I may, to make those announcements, and we will debate the issue then.

[Mr David Nuttall (Bury North) (Con)]

Is my right hon. Friend aware that in Bury people will be happy and prepared to take responsibility for their own health provided that there are fully functioning children’s and maternity, and accident and emergency, departments at Fairfield hospital?

--- Later in debate ---

[Mr Lansley]

My hon. Friend and I have shared visits to Fairfield hospital on a number of occasions. I know how strongly his constituents feel about their access to services at Fairfield hospital and how well he has represented those at the hospital in their case for the retention of those services.