Caring Responsibilities
Anne Milton Excerpts(13 years, 3 months ago)
Westminster HallRead Full debate Read Hansard Text Read Debate Ministerial Extracts
Westminster Hall is an alternative Chamber for MPs to hold debates, named after the adjoining Westminster Hall.
Each debate is chaired by an MP from the Panel of Chairs, rather than the Speaker or Deputy Speaker. A Government Minister will give the final speech, and no votes may be called on the debate topic.
This information is provided by Parallel Parliament and does not comprise part of the offical record
The Parliamentary Under-Secretary of State for Health (Anne Milton)
It is a pleasure to serve under your chairmanship, Mr Streeter. Time is very short. I have about seven minutes, so I say up front that I will ensure that hon. Members receive a note to answer the questions that I will not be able to address. As the hon. Member for Edinburgh East (Sheila Gilmore) knows, this is an important debate. Like her, I would like to feel that this is about more than just press releases this week. Indeed, we praise carers this week. We should praise them every single week and every single day—those we know about and those we do not.
As the hon. Lady knows, in her constituency the Scottish Government have overall responsibility for devolved budgets and I am sure that she will therefore take up some of the issues with them. I note the cautionary tale about ring-fencing—mentioned by a few other hon. Members—and also tracking funding. Local authorities, however, have a duty to provide community care to those who meet eligibility criteria. The Department has set out an eligibility framework, which is important to bear in mind.
Who cares for the carers? Somebody first said that to me a very long time ago—in fact, when I was a district nurse. Those with caring responsibilities need care themselves, so that they can maintain their own health and well-being. Although it has not been mentioned today, the figures on the physical, mental and emotional health of carers are shocking.
Care and support services from both the statutory and voluntary sectors face challenges, irrespective of funding, like never before. Demographic changes mean that most of us will either become carers or need care. Some of us already care for children with disabilities and are often lifetime carers. Others care for partners as they grow older; some for ageing parents, neighbours or friends. Carers come in all shapes and sizes, and with different needs. It is important, when government at any level tries to meet the needs of carers, to recognise that they need specialist and personalised help, which is why personalised budgets are an important step.
I will run through some of the money that is coming through, so that hon. Members can raise, with their local authorities, what is happening to it. The spending review allocated an additional £2 billion by 2014-15 to support the delivery of social care. Some of that funding is already getting through. Some £162 million went in during January, which was money transferred from NHS budgets to support care services that improve people’s health and support carers. A further £648 million will pass to local government in England in the same way. A further £1.3 billion is now supporting the transfer of funding and the commissioning of learning disabilities services from PCTs to local councils, which will help. One hon. Member raised the issue of integrating services. That is very important. It applies to several Departments, and it is also true at local authority level.
Taken together, that is the biggest ever transfer of hard cash from health to social care. That is an important development and comes on top of the £530 million for social care this year from the Department of Health, which we rolled up into the Government grant formula. The Department for Education is providing more than £800 million in the next four years for short breaks—they are absolutely critical; respite breaks are a lifeline to parents of children with disabilities—as part of the new early intervention grant.
We recognise that the current funding system needs overhauling. We cannot avoid the wider challenges that demography brings us. My hon. Friend the Member for Banbury (Tony Baldry) was 100% right about how the money is spent, and the hon. Member for Edinburgh East also mentioned monitoring. It is extremely important that we identify carers early, so that we can meet their needs early and they can continue to do what, essentially, they want to do, which is to care for those who live with them.
The Dilnot commission will report in July and will help us find new ways to modernise the funding of social care and ensure that it is more in line with the demands and expectations of the 21st century. The carers strategy, which we published in November 2010, sets out our priorities. Those priorities are important because we measure what central Government and local authorities do against them. They are: to support those with caring responsibilities to identify themselves as carers at an early stage, and involve them in designing local care provision and planning individual care packages; to enable those with caring responsibilities to fulfil their educational and employment potential, which is absolutely critical as young carers do not necessarily get to any step on any ladder as far as education and employment are concerned; to personalise support for carers, which is critical, and to support carers to maintain physical and mental wellness, because the physical burden of providing care for a friend or family member can be significant. Ideally, carers who are identified at an early stage can get the help that they need.
My hon. Friend the Member for Banbury mentioned the work that Sainsbury’s is doing. We should congratulate it. Of course, it is not a substitute for other things, but it is an important addition. Tomorrow morning, the Minister with responsibility for care services will launch a new e-learning tool for all GPs, developed in partnership with the Royal College of General Practitioners and the Princess Royal Trust for Carers. That will be an important tool in enabling GPs to do what we need them to do. The Department of Health has made a further £1.5 million funding available for other initiatives to support GPs to help carers further. Alongside the carers strategy, we published examples of how the principles of personalisation have been applied locally, emphasising the value of finding ways forward that make sense and work best locally.
I have to say to Opposition Members that the country is financially where it is because that is where we found it when we took over from the previous Government. The hon. Member for West Lancashire (Rosie Cooper) shakes her head. We cannot get away from the fact that we inherited a massive budget deficit that we are now having to tackle. Opposition Members look as if they are in denial. The hon. Lady, who is a sensible person, asked how we could look carers in the face, but how can members of the previous Government look carers in the face? We have been left with some difficult decisions. We have to ensure that every £1 of taxpayers’ money actually buys £1-worth of care, to support carers in the ways in which they need it.
Employment, Social Policy, Health and Consumer Affairs Council
Anne Milton Excerpts(13 years, 3 months ago)
Written StatementsRead Full debate Read Hansard Text Read Debate Ministerial Extracts
The Parliamentary Under-Secretary of State for Health (Anne Milton)
The Health Council met on 6 June in Luxembourg. Andy Lebrecht, deputy permanent representative to the EU, represented the UK.
Council conclusions were adopted on:
The European pact for mental health and well-being: results and future action;
Successes and challenges of European childhood immunisation and the way forward;
Towards modern, responsive and sustainable health systems; and innovation in the medical device sector.
The Commission provided an update on:
Progress of the proposals on information to the general public on medicinal products;
The active and healthy ageing partnership; and
The forthcoming evaluation of the EU health programme and the EU health strategy.
The Commission provided an update on the recent E. coli outbreak and the actions being taken to control it. There was also a discussion on the public health dimension of migration from the middle east and north Africa.
Cannabis and Psychosis (Young People)
Anne Milton Excerpts(13 years, 3 months ago)
Commons ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
The Parliamentary Under-Secretary of State for Health (Anne Milton)
I am grateful to my hon. Friend the Member for Broxbourne (Mr Walker) for raising an issue that is not only important, but seems to be attracting more attention in recent years. It was a pleasure to meet him and representatives of Cannabis Skunk Support, Mary Brett and Jeremy Edwards. In part, this greater attention is down to my hon. Friend’s work and that of the all-party groups on cannabis and children and on mental health.
I pay particular tribute to my hon. Friend because although he is always passionate, his passion for this issue shone through in his eloquent and, at times, moving speech. This issue affects us all. We have been young ourselves and he was very open about his personal experience. Many of us are parents and our children are growing up in an increasingly complicated world, and the problem cannot be ignored.
Cannabis is the most commonly used drug in England today, and its use is particularly common among younger people. One of the big problems is that of perception. Many people see cannabis as benign, harmless, a throwback to the ’60s—I am showing my age—’70s or ’80s, or a source of artistic inspiration, particularly when compared with other, harder drugs. That is a very dangerous misconception these days. For a start, when people talk about the cannabis smoked 50 years ago, they are referring to something very different from that which we see on the streets today.
As my hon. Friend mentioned, the most common form of cannabis used today is skunk, which is, on average, about four times stronger than herbal cannabis, the type with which some in this House might be familiar. It does not take a leap of faith to understand that regularly using cannabis of this strength could be very harmful indeed. It could result in dependence, for example, or in the development of serious mental health side effects. Those can be both short and long term, and can be devastating for anyone, including children and young people, causing a host of problems, including family breakdown and debt, and the sort of tragic stories that we heard about from my hon. Friend.
Questions still do exist about just how strong the link is between cannabis use and mental health problems, but there is without doubt a link—that much is certain. Using cannabis can lead to serious problems, such as psychotic episodes and other mental health issues. In the case of young people, whose brains are still growing and developing, that is a particular cause for concern. Any damage caused then could affect them for the rest of their lives. The fact is that the best way to prevent damage like that is to avoid cannabis in the first place, but we are not stupid and we know that many people, both young and old, will be put in situations where cannabis is offered to them, so we need to take some very clear action.
The drug strategy that we published in December 2010 outlined action that we will take to prevent and reduce the demand for drugs, by establishing a “whole life” approach to the problem. That involves breaking the intergenerational paths to dependency by supporting vulnerable families; providing good quality education and advice so that young people and their parents are provided with credible information actively to resist substance misuse; and, of course, intervening early with young people and young adults. My hon. Friend mentioned the need to educate the educators, and it is important that those giving support get continued support in their work.
The latest data show that almost 9% of 11 to 15-year-olds reported taking cannabis in the past year. Although that is a long-term decrease, it is still too many. Those data show us two things: that the situation is improving and that drug use is by no means normal behaviour among young people. That is an important fact for young people to take on board. The Department for Education is taking action to maintain that decline. A review is going on into personal, social, health and economic education, which includes drug education, to determine how schools can be better supported. Of course, schools are not the only setting in which we can undertake this sort of educational programme. I will also be meeting the Minister of State, Department for Education, my hon. Friend the Member for Brent Central (Sarah Teather) to discuss these issues soon.
My hon. Friend the Member for Broxbourne also mentioned FRANK. Our drug strategy highlights the important role that FRANK has to play in providing information and advice, both to young people and to their parents or guardians. A review of how FRANK is used showed that the vast majority of young people preferred accessing FRANK online. Based on that review, as I recently discussed with my hon. Friend, we are in the process of improving the FRANK service, making it easier to use the website. We are also updating the tone and style of its language, so that it is more relevant to young people and provides them with the information and advice they need in a way that is accessible and provides clear messages.
We are also taking other steps to help people who already have a problem. In March, the National Institute for Health and Clinical Excellence produced guidance on the assessment and management of people with psychosis and co-existing substance misuse. It will help providers and commissioners to ensure that services are appropriate for young people with psychosis and substance misuse problems. We recently published a mental health strategy to improve services for those who are affected by mental health problems. The strategy focuses on the importance of improving the quality and productivity of services and on making efficiency savings that can be reinvested back into the service to improve it still further.
Over the next five years, we will be putting around £400 million into psychological therapies in all parts of England for young people who are dependent on drugs. Those therapies will include talking therapies, supported where appropriate by family interventions. This issue affects not only individuals but whole families. The strategy will also address issues such as mental ill health and homelessness. Currently, 24,000 young people access specialist support for drug or alcohol misuse and the figures are good—97% of them are seen within three weeks of referral. However, we have to ensure that the quality of support stays high, so that every young person who needs help is given what they need. We will continue to improve the quality of that support and to make sure that it responds to the right people at the right time.
The letters my hon. Friend read out were moving and evocative. They demonstrate the human story behind this problem. Child and adolescent mental health services have a part to play, but we need to do a great deal more. We need to get the prevention right and we need to get support in when those preventive measures have not helped. He talked about moving from harm reduction to harm prevention and I could not agree more. We need to ensure that young people grow up with the skills they need to make what are sometimes difficult decisions about the choices they face. Addressing legalisation is not enough; we all know about the legal highs. What we need is for young people to make good decisions about the choices they face. I commend my hon. Friend and those who have written to him on sharing those experiences with us today.
Our position on cannabis use is clear: we will continue to focus on young people because if they are protected right from the start, they will be safer throughout their lives. Not only will their mental health be safeguarded, but their exam results and social development will benefit, their future options will remain open and their chances will remain bright. It is terrible to hear about young people who are struck down by poor decisions that are often made through ignorance. I am sure that position is shared by my hon. Friend and all hon. Members present. Let me assure him that his call for action is being answered in full. I was pleased to hear his complimentary remarks about me so far—I noticed the slight equivocation—and I assure him that I do not think he will be disappointed in the future. I will do all I can in my position to ensure that we do everything possible to protect the health of young people.
Question put and agreed to.
Oral Answers to Questions
Anne Milton Excerpts(13 years, 3 months ago)
Commons ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
Mr Gary Streeter (South West Devon) (Con)
7. What plans he has for access to NHS speech therapy services for children.
The Parliamentary Under-Secretary of State for Health (Anne Milton)
As my hon. Friend knows, speech and language therapy services are critical for children and young people who need help to develop their speech, language and communication skills, and who have conditions such as swallowing difficulties. We have published a Green Paper on special educational needs and disability, which includes proposals to develop a new co-ordinated assessment for education, health and care plans by 2014 and for the option of a personal budget for all families with such plans. That will offer families more choice and ensure that children get the support that they need.
Mr Streeter
Does my hon. Friend agree that when a child needs to access speech therapy, often it is to unlock vital early years education and is therefore time critical? The west country has known waiting times of three, six or even nine months. Will she assure me that the coalition Government can do better than that?
Anne Milton
We most certainly can do better than that. I agree with my hon. Friend that such problems are often a barrier, and that therapy can unlock so much more. I refer him to service redesigns that have happened, such as at the Cambridgeshire Community Services NHS Trust, which redesigned its clinical pathways with the result that the number of children waiting longer than 18 weeks from referral to treatment fell from 409 in May 2010 to eight at the end of January 2011. That is a fantastic improvement in the service. This is not all about money, but about the way in which services are designed.
Mr Kevin Barron (Rother Valley) (Lab)
The Minister will know that more than 60% of inmates in young offender institutions have speech and communication problems. Can we ensure that the Green Paper addresses this matter not just within the national health service, but in education and wider, so that we can begin to tackle this problem, which has lain dormant in this country for decades?
Anne Milton
The right hon. Gentleman is right that we are not talking just about children. A number of people have languished and failed to achieve their potential, particularly their educational potential, for the lack of speech and language therapies. I take this opportunity to commend the work of Jean Gross, the communication champion, in raising and highlighting these issues.
Annette Brooke (Mid Dorset and North Poole) (LD)
10. What recent representations he has received on the future of NHS Blood and Transplant; and if he will make a statement.
The Parliamentary Under-Secretary of State for Health (Anne Milton)
Since February 2011, we have received about 60 representations on the future of NHS Blood and Transplant, including from MPs, Unison and the public. Representations continue to come in. I am happy to meet the hon. Lady if she would like. I should make it clear that the current review is not considering the sale of any part of NHSBT.
Annette Brooke
I wonder whether the Minister can give further assurances to address the great concern that voluntary donations of blood and organs might be put at risk if it is perceived that profits are being made in any part of the operation.
Anne Milton
My hon. Friend is right. The altruistic donor system is one of the rocks on which the NHS is built, and we will do nothing to jeopardise public confidence in it. I am alarmed at some of the scare stories that have been circulating. They serve nobody any good, least of all those who need the necessary donations that are made.
Andrew Stephenson (Pendle) (Con)
11. What recent representations he has received on the operation of the cancer drugs fund.
Jo Swinson (East Dunbartonshire) (LD)
As the public health White Paper recognises, building positive self-esteem is important for children’s health and well-being. Yesterday, the Bailey review highlighted many parents’ concerns that exposure to very sexualised imagery in our visual culture fuels children’s anxieties about their bodies and reduces self-esteem. How do the Government plan to tackle that as a growing public health issue?
The Parliamentary Under-Secretary of State for Health (Anne Milton)
I thank the hon. Lady for her question. She raises an important point about children’s exposure to such imagery from a variety of media sources. It is crucial for the future public health of our country that children get help and support over this and are able to learn the skills they need, and we are determined to get that right. Many of our plans are laid out in the White Paper, and we look forward to seeing them become a reality.
Debbie Abrahams (Oldham East and Saddleworth) (Lab)
Can the Secretary of State or the Minister confirm whether they will take up the offer from my Front Bench for bipartisan discussions about the future of adult social care—or will he put political interests before the public interest?
Employment, Social Policy, Health and Consumer Affairs Council (Luxembourg 6-7 June 2011)
Anne Milton Excerpts(13 years, 4 months ago)
Written StatementsRead Full debate Read Hansard Text Read Debate Ministerial Extracts
The Parliamentary Under-Secretary of State for Health (Anne Milton)
The Employment, Social Policy, Health and Consumer Affairs Council will meet on 6 and 7 June.
The presidency is likely to ask Ministers to debate the sustainability of care systems and health issues related to migration.
The presidency is also expected to propose the adoption of Council conclusions on the following:
the European pact for mental health and well-being: results and future action;
successes and challenges of European childhood immunisation and the way forward;
towards modem, responsive and sustainable health systems; and
innovation in the medical device sector.
The UK supports the adoption of these Council conclusions.
Under any other business, information will be provided from the presidency on antimicrobial resistance and on a number of conferences that took place under their presidency. The Polish delegation will give information on the priorities for their forthcoming presidency, which will run from July 2011 until the end of the year.
Public Health Observatories
Anne Milton Excerpts(13 years, 4 months ago)
Commons ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
Ian Lavery
The Marmot review, published in 2010, stated clearly, as one of its nine objectives:
“Economic growth is not the most important measure of our country’s success. The fair distribution of health, well-being and sustainability are important social goals. Tackling social inequalities in health and tackling climate change must go together.”
The Parliamentary Under-Secretary of State for Health (Anne Milton)
I am grateful to the hon. Member for Easington (Grahame M. Morris) for raising the subject of public health observatories, and I should probably declare an interest, because my husband is a public health physician. Anybody who has an interest in public health knows how important the observatories are, but time is very short, and I will not get to all the points that the hon. Gentleman made.
The public health observatories have been around for more than a decade, and they produce a whole series of high-quality data. Annual health profiles, for instance, of local areas allow for those comparisons that are so important, and there is no doubt about the importance of reducing inequalities. The reports of Sir Douglas Black, Peter Townsend and more recently Sir Michael Marmot are all key documents.
It is important to remember that over the past decade or so health inequalities have become worse, but I point no fingers, because it is testament to the fact that it is extremely difficult to reduce inequalities. The hon. Gentleman mentioned several issues that contribute to that. There are a range of factors, not least changing people’s behaviour, which is not easy. The Government’s contribution of £12 million to the observatories is testament to how important it is that we get good intelligence. He will have read the public health White Paper, in which he will see our commitment to this. For the first time, we will ring-fence funds for public health.
The movement of public health into local authorities has been fairly widely welcomed. There are transitional arrangements that we need to get right, but it will be based on a direct line of sight from the Department of Health, as we need to bring some things together. We need clear responsibilities and a clear outcomes framework to ensure that local authorities give us what we need, with all that based on good and sound intelligence. Although the public health observatories have done a very good job, there are some areas—for instance, changing behaviour—where the intelligence is not good and we have not collected it together.
We want the data and evidence from the observatories to be used to improve the health of everybody, regardless of age, ethnicity, gender, income or sexuality. The public health White Paper sets out a clear life-course approach to that. It is impossible to make these changes without good intelligence and information. Despite the wealth of data, the evidence of what works is not necessarily being used as effectively as it could be, nor is it as widely available as it could be, and it remains only part of the information that we need. In any system where there are numerous stand-alone organisations, there are always dangers of overlap and duplication, and we want to eliminate that as much as possible. In short, we want to move from a system where we have a complex web of information functions performed by multiple organisations towards a system where that information is fully integrated into the public health system.
As the hon. Gentleman said, this is not about one Department—the Department of Health—doing it alone, but about public health being absolutely everybody’s business. The difference can be made from the top to the bottom in Government and right across the different Departments; it is an issue for us all. If we are truly to make inroads into these very persistent, difficult to move inequalities in health, we have to approach it in that way. There is no question of losing the main functions of the observatories; on the contrary, in fact. By transferring those functions to Public Health England, we will improve how they are used.
The hon. Gentleman will be aware that we have consulted for several months on the new public health system, and we are continuing to listen. It is very interesting to see what we are getting back, with a warm welcome for many of the changes. There are always anxieties about difficult periods of transition. We have convened a working group on information and intelligence for public health, which is chaired by the regional director of public health for South Central Strategic Health Authority, Professor John Newton. It has representatives from the Department, the Health Protection Agency, the public health observatories and the cancer registries, and it is meeting fortnightly to develop our approach to public health information and intelligence. This is an opportunity to get it absolutely right.
The future of the observatories is being very closely managed, and that includes their locations. Department of Health funding for the observatories has been agreed for 2011-12. Although there has been a reduction in the core contribution for each observatory, the Department of Health funding set aside as the core public health information and intelligence budget remains similar to previous years, and that will be supplemented by additional Department of Health grants, so overall funding will be about the same.
I should like to thank the north-east public health observatory for its contributions, including in relation to the national library for public health and the learning disability specialist observatory. Its strong strategic relationship with the academic sector through its host, the university of Durham, has been particularly beneficial. Officials in the Department are in regular contact with both institutions so that financial and other pressures are addressed as they arise. Like most of its counterparts, the north-east observatory receives income from the Department of Health, the NHS and others. I understand that it currently has a working capital of about £1 million, which is not insignificant.
The university’s human resources policies require it to alert staff at least six months before any changes in employment, which is important for staff at this uncertain time. We are making sure that the university is aware of the ongoing need for the observatory’s work, and hence its expert staff. It is important that we do not see any loss in that.
We are lucky in this country to have such a rich source of expertise. We must ensure that we maximise the benefit of that expertise, knowledge and intelligence. I hope that I have reassured the hon. Gentleman. I thank him for raising this issue and giving me an opportunity to say how much we value the work of observatories. Their functions remain indispensable, but they must adapt to the new system. We want to streamline the system and do what we set out to do, which is to reduce inequalities in health. We will base any action we take on sound evidence.
Ms Abbott
Will the Minister explain how, under the proposed system, we can make the free-standing GP commissioning consortia, some of which may be managed by private-sector organisations, pay attention in their commissioning decisions to the issues raised by public health observatories and others? It seems to me that without PCTs and other regional structures, it will be perfectly possible for the commissioning structures to ignore what public health observatories say.
Anne Milton
I thank the hon. Lady for raising that point. In fact, we inherited that system. Time and time again, budgets for public health have been raided to meet short-term commitments. One point of ring-fencing public health funding is to ensure that public health is central to the work that the local authority does and that it informs the commissioning arrangements in a local area. It is not good having just one area looking at public health. We are ring-fencing that money and will have a clear outcomes framework that sets out what the Government expect.
We will ensure that the consortia have regard to the public’s health. When we say “public health” it can sound a bit jargonistic. We are talking about the public’s health and about reducing the inequalities that have dogged society up to now and which successive Governments have failed to reduce. We have to do something different. We are moving from a system in which public health got sidelined and in which the work of public health observatories, although valuable, was not mainstream, to a system where that work is brought into the mainstream and into the direct line of sight. All those who make commissioning decisions and all local authorities should hear the clear message from Government that public health is everybody’s business.
Question put and agreed to.
Addiction to Medicine
Anne Milton Excerpts(13 years, 4 months ago)
Written StatementsRead Full debate Read Hansard Text Read Debate Ministerial Extracts
The Parliamentary Under-Secretary of State for Health (Anne Milton)
I am pleased to inform the House that two reports on addiction to prescription and over-the-counter medicines are being published today. Recognising that there was a lack of information on this subject, the Department of Health commissioned two reports in 2009-10:
The National Addiction Centre was asked to conduct a literature review to bring together the published evidence on the scale of the problem and how best to respond to dependence on medicines; and
The National Treatment Agency for Substance Misuse was asked to contact primary care trusts and treatment providers to investigate prescribing patterns and the help that is currently offered to people who develop problems.
These two reports will play a role in informing the future development of policy and services. In the Government’s drug strategy, which we launched in December, we set out an ambition to tackle dependence on all drugs, including prescription and over-the-counter medicines We need to do all we can to prevent people becoming dependent in the first place and to offer people appropriate support to recover when it does occur.
I will be leading work to involve relevant organisations and interested individuals to discuss the future action that is necessary in the light of the information contained in the reports. I look forward to discussions with Members of both Houses who have shown a long interest in this important area.
I am placing the reports in the Library. Copies are available to hon. Members from the Vote Office and to noble Lords from the Printed Paper Office.
Childhood Obesity
Anne Milton Excerpts(13 years, 5 months ago)
Westminster HallRead Full debate Read Hansard Text Read Debate Ministerial Extracts
Westminster Hall is an alternative Chamber for MPs to hold debates, named after the adjoining Westminster Hall.
Each debate is chaired by an MP from the Panel of Chairs, rather than the Speaker or Deputy Speaker. A Government Minister will give the final speech, and no votes may be called on the debate topic.
This information is provided by Parallel Parliament and does not comprise part of the offical record
The Parliamentary Under-Secretary of State for Health (Anne Milton)
May I say what a pleasure it is to serve under your chairmanship, Ms Dorries? I have not had the pleasure before. I congratulate my hon. Friend the Member for Brentford and Isleworth (Mary Macleod) on securing the debate. I thank her and other Members for their contributions. I noticed that the hon. Member for West Ham (Lyn Brown) stayed on from the previous debate because she was so riveted by my hon. Friend’s contribution. It is good to see that, because we perhaps do not see it as much as we would like in this Chamber.
My hon. Friend eloquently highlighted not only the scale of the problem and its costs in her constituency, but the individual consequences and the health impact. She was absolutely right, however, to say that this is not just a health issue, and if we need to get one thing across today, it is that. The Prime Minister set up a Cabinet Sub-Committee on Public Health because we need sign-up from all Departments. This is everybody’s business; it is about local government, education, transport and the Department for Culture, Media and Sport, and it requires action on every level.
I was not in the country for the royal wedding on Friday, sadly, because I was attending a World Health Organisation conference in Moscow on non-communicable diseases. Along with smoking, alcohol and lack of exercise, obesity is one of the major issues facing the world, and it was interesting to hear some of the interesting ideas that are coming forward.
There is no doubt that tackling the problem of obesity, particularly in children, is key. The hon. Member for Hackney North and Stoke Newington (Ms Abbott) was right to raise the associations between obesity and deprivation. Obesity was, and still is in some developing countries, a problem for wealthier people, but we are now seeing a switch, with obesity now being associated with deprivation.
My hon. Friend and other Members mentioned MEND. She also mentioned the importance of the Olympic legacy and food labelling, and I will deal with those points in my remarks.
As Members are aware, the Government published their public health White Paper last year. It set out the scale of the public health challenge ahead of us and the Government’s approach to improving health and well-being.
The hon. Member for Hackney North and Stoke Newington mentioned parenting, which involves some really complex issues. There is the issue of what constitutes a good parent. Am I not a good parent if my fridge is not full? The hon. Lady rightly touched on that. Am I not a good parent if I do not make my children clean their plate at every meal? My generation was brought up on the idea that what children do not eat one day, they have cold in their sandwiches for tea the next day. We need to approach such attitudes.
The White Paper signalled the Government’s commitment to addressing the current trend. This is not about just the governmental costs, but the social costs and the burden of disease. The latest figures show that 61% of adults and 28% of children aged between two and 10 in England are overweight or obese. Those figures are enormous. My hon. Friend the Member for Brentford and Isleworth mentioned the publication of a report by the London assembly. We know that in her area nearly a quarter of children in year 6 are obese—one quarter, one out of every four children, is obese. The risks of being overweight include the increase of a range of diseases, such as heart disease and type 2 diabetes.
An analysis by the National Heart Forum has predicted that, by 2050, the number of people getting diabetes because of their weight will nearly double, and that those with heart disease caused by obesity will rise by 44%. Obese and overweight people place a significant burden on the NHS and the direct costs are estimated to be £4.2 billion. However, the indirect costs are massive, such as the impact of early death on families, poverty due to not being able to work, and so on.
The White Paper sets out our vision and general approach. There are three underlying principles. First is individual responsibility: we want to encourage people to take responsibility for their own health. My hon. Friend the Member for Bosworth (David Tredinnick) commented on an anecdote about losing weight by eating less. That is old-fashioned and simple, but a message that we need to get across. It is about individual responsibility.
The second principle is working together, to which I have referred. That is about the problem being everybody’s business—every part of society, focusing on developing partnerships across the board, with third sector organisations, social enterprises and business. Everybody has a role to play. The third aspect is the role of local communities, about which we heard a lot from my hon. Friend the Member for North Swindon (Justin Tomlinson), who talked about local initiatives and what can be done at that level.
We will publish before the summer a document on obesity, which will set out how we will tackle the matter in the new public health and NHS systems, and the role of key partners. The Department has recently held two events with key organisations involved in reducing obesity, to help develop the document. We will also consider comments from the consultation exercise on proposals for a public health outcomes framework, which has just come to an end. That framework includes two possible indicators relating to adults and children, to measure progress relating to obesity.
Experts from the Foresight team described the UK as having an “obesogenic environment”. That is probably right in many ways. There are a number of factors that drive people towards overweight and obesity. As I have said, it is clear that too many people eat too much and exercise too little, and are storing up big health problems. We all need to play our part. It is for local and central Government, business and other partners to make it easier for people, and remove the sort of barriers—mentioned by my hon. Friend the Member for North Swindon—which include irritating matters such as insuring minibuses to get people to sporting events.
The Government cannot compel people to eat less food. We can encourage people and make it easier for them to make better choices. There is already a lot of action under way to do that. Many products in the UK voluntarily provide front-of-pack nutrition labelling, which provides more information. The regulations surrounding front-of-pack labelling are an EU competence. The EU is not dragging its feet, but it is incredibly complicated to get all member states to sign.
We would like to see as light a regulatory burden as possible, to allow different member states to have different front-of-pack labels, because, as a number of hon. Members have said, all systems—guideline daily allowances are one example, traffic lights another—have upsides and downsides. Some can be difficult to understand and some can be misleading. We have all seen claims on the front of packets indicating low fat, but the sugar content is another problem staring one in the face. Indicating calories is attractive to some people but is a problem for those with an eating disorder and are underweight. We need maximum flexibility. Discussions are very active in the EU at the moment and we will start to see some suggestions coming forward.
The Change4Life programme is encouraging people to make simple changes: eating more fruit and vegetables, cutting down on fatty and sugary food and being more active. The national child measurement programme, started under the previous Government, provides feedback to parents about the weight status of their children, enabling them to take action where necessary. My hon. Friend the Member for Bosworth mentioned clothes sizing, which indicates that being fatter has become the norm. The child measurement programme is an important part of giving information to parents.
The Department has also been working with the Association of Convenience Stores to increase the availability of fresh fruit and vegetables in convenience stores across the country. That initiative has been expanding incredibly quickly. I recently had the pleasure of visiting a scheme. This development is particularly important for areas of high deprivation; convenience stores are often the first port of call for many to do their shopping. Some participating stores have seen a dramatic 47% increase in sales of fruit and vegetables.
As part of the public health responsibility deal, a number of organisations have made a series of pledges, which will provide better information to consumers about food. Let me make it clear that the Government are the only people to decide Government policy. However, the responsibility deal currently involves 180 organisations and businesses, and there are 19 collective pledges available online, which I urge hon. Members to view. The idea is to capitalise on the reach of many of these organisations—both businesses and voluntary bodies—so that we can tap into the unrealised potential of a wide range of resources that can promote healthier lifestyles and give people information.
Calorie labelling in out-of-home venues is intended to give information and has been quite successful. We have talked about the half-pint latte and a muffin. It is dramatic and astounding to discover that one has probably had the daily allowance just in a snack on the way to work.
We talked about physical activity. We are currently reviewing the chief medical officer’s guidelines, and are looking at evidence in relation to the health benefits of physical activity. There is also an important psychological benefit, because it makes one consider how one feels and what one is eating and doing, and to be more conscious of overall general physical and mental health.
While much of the focus is on preventing problems from arising, we are also working to meet the needs of those at most risk of becoming obese, including those who are already overweight. Weight management providers will continue to play a role in tackling obesity. In future, the move of public health into local councils is going to be an important and significant step.
I think it was my hon. Friend the Member for North Swindon who mentioned playing in the street and street parties. Interestingly, when I was in Moscow last week, the Minister of Health for Columbia talked about a scheme they have there. On Sundays they close certain streets so that everybody can play in them. That is an outstanding idea. Before constituents e-mail to complain about their streets closing, I should say that I accept it would not work everywhere. It could, however, work in some places.
We have heard today of the huge opportunity for local action; we cannot work in silos any more. Government cannot tackle obesity alone and we want to work with the widest range of providers. Government can and must do their part, but we rely on the compliance of the public as individuals. We have to facilitate and help more people to want to lose weight and stay at a healthy weight. The truth is that no single solution will make a difference; the issue is about using all the ideas raised in this debate to turn round the supertanker. There is a tendency to refer to an epidemic, to suggest that it is something that happens to us. We are like—
Medical Students
Anne Milton Excerpts(13 years, 5 months ago)
Westminster HallRead Full debate Read Hansard Text Read Debate Ministerial Extracts
Westminster Hall is an alternative Chamber for MPs to hold debates, named after the adjoining Westminster Hall.
Each debate is chaired by an MP from the Panel of Chairs, rather than the Speaker or Deputy Speaker. A Government Minister will give the final speech, and no votes may be called on the debate topic.
This information is provided by Parallel Parliament and does not comprise part of the offical record
The Parliamentary Under-Secretary of State for Health (Anne Milton)
I congratulate the right hon. Member for Oxford East (Mr Smith) on securing this debate on what I know is an area of great importance. He is right to say that it is about recruitment, skills and the development of the profession. I would also like to thank him for his praise of access officers at Oxford, and for highlighting the summer school. It is important to see universities doing what they can to ensure that participation is widened, and that people who might not have felt able to apply to such universities as Oxford, or who might not have felt that they had the necessary skills, are given the greatest opportunity to do so. It is good to hear the right hon. Gentleman raise the point that this is something that schools have to take on board. We often discuss the issue of universities widening participation, but we also want to ensure that our schools prepare young people, and have the skills to prepare young people, to apply to all universities. Young people should not feel as though they are excluded from any opportunity.
There is no doubt that training for medical students in this country is some of the best in the world, and we want to keep it that way. That means that funding must be at a level that allows for the best training. The consultation paper “Liberating the NHS: developing the healthcare workforce” sets out our proposals for a new framework for education and training, and the right hon. Gentleman raised particular issues that I will come back to in more detail. The proposals would see health care providers take the lead. They would plan and develop their own work force, and take on many of the responsibilities that were previously held by the strategic health authorities. A new statutory body, health education England, would provide national leadership for education and training, with a strong clinical focus from top to bottom. The proposals for health education England have been widely applauded—it is very important to have that leadership in education and in that strong clinical focus. We now have an opportunity to review and reshape our work force and what it is designed to do, so that it can respond to the challenges of the future while still providing excellent care. We sometimes lag behind, trying to solve the problems of tomorrow with the solutions of yesterday.
For patients, of course, but also for staff and students, there must be a secure, diverse work force that has full access to education, training and opportunities to progress. That must be transparent, so that we can see how it is working and help ensure that we all get value for money, students included. The Government have consulted to see how that can happen. We have involved a wide range of people, because the new framework is about giving some of the power to those people. The central pillar is the transfer of greater responsibility to health care providers, escaping the one-size-fits-all approach that has been too prevalent in the past. Those providers will need to work together to co-ordinate the development of their local work force, so that it is tailor-made for the individual pressures of individual areas, which vary widely. That means building strong partnerships with universities and colleges to put the skills of educators to the best possible use and strengthening those relationships, which I do not think have been strong enough. There has been a general recognition among health care providers that those relationships have not been strong enough in the past.
I know that those involved with both the medical profession, including the BMA, and the education sector, want to ensure that medical education is protected and improved. They also want to know that the role of the postgraduate medical and dental deaneries, which currently form part of the strategic health authorities, will continue, so that medical students and trainees continue to be well-supported. Medicine, like many other professions, does not end at the end of training—continuing professional development is an important part of it.
Anne Milton
I am happy to—so that the right hon. Gentleman does not feel I am ducking his questions, I will deal with them once I have finished with the deaneries.
We want to retain and build on the important functions of deaneries as we build the new framework for education and training. We know how important that is, because any transition not only makes the participants feel nervous but is a significant operation for any Government. The transition is when we can let the baby slip out with the bath water.
The right hon. Gentleman raised the issue of bursaries in particular, but I have to disappoint him, in that I cannot make an announcement today. We are acutely aware how long awaited it is. No one could be more frustrated than me with the slowness of government at times, but it is important that we get it right. I thank my hon. Friends the Members for Oxford West and Abingdon (Nicola Blackwood) and for Totnes (Dr Wollaston) for their contributions. My hon. Friend the Member for Totnes also raised the issue of some of the indirect costs of training, to do with the length of the course. We will be making announcements soon but, as I said, it is important that we get it right and that we involve other Departments.
The right hon. Gentleman also asked if I would make representations via the Treasury to other organisations about supporting training schemes. It is important that we continue to do that—perhaps we do not see enough of that in this country. At this point, I should mention that Julie Moore, the chief executive of University Hospitals Birmingham NHS Foundation Trust, is leading some of the work we are doing with the NHS Future Forum, as part of the ongoing listening exercise on the health reforms. Julie will continue the debate started in the consultation, so there will be further opportunity for input. I urge him and the other Members present to get involved, to ensure that their views and the particular issues faced by medical students are taken on board.
Our responsibility is held jointly with the Department for Business, Innovation and Skills, so the right hon. Gentleman should ensure that any comments made today also go as directly to it. The two Departments are working closely together, so that the specifics of medical education can be recognised.
Mr Smith
I wanted the assurance that, as part of the Department of Health’s collaborative work with the Department for Business, Innovation and Skills, the long-awaited higher education White Paper, which it would have been better to have had before the fees increase rather than after, will address the specific position, challenges and opportunities of medical students.
Anne Milton
Very much so. To some extent, the health of the nation rests on the skills of the professions that deal with the consequences of poor health. Medical students and doctors are part of that, so it is important that we get the system right. We need to maintain a competitive edge if we are to continue to produce medical graduates of the highest calibre. We shall not fail in our duty to make representations to other Departments, although working together is not always as easy for government as it sounds. However, we have made significant progress, and I think our words are being heard loud and clear.
As the right hon. Gentleman knows, universities will be able to charge a basic threshold of £6,000 a year for courses, and up to £9,000 a year for some, but subject to much tougher conditions on widening participation and fair access, which he mentioned in particular. There are still many such challenges, not only for universities but for our education system and at a wider societal level, if we are truly to get participation as wide as it can be. We need to look at all sorts of other drivers in the system directing young people to their choices.
We are shifting the balance of contributions from taxpayers to graduates, who benefit most from higher earnings over the course of their working lives. It is important to recognise that, after medical students have gone through the system and become consultants, they are probably among the top few percent of wage earners in this country. Contribution from them, therefore, is important. For poorer students, who might feel that the burden is too high, there is a balance or tipping point at which active participation in a fees scheme becomes a barrier. We have done a lot of work to ensure that that is not the case, and we continue to do so.
Many of the subjects associated with medicine cost more to teach, and we want a system in which anyone with the ability can access university and study such courses without being put off by the cost. That is why we will continue to provide additional funding for science, technology, engineering and medical courses.
The NHS bursary, which is in recognition of the length of time it takes to study medicine, will continue, helping students with their tuition fees and supporting those from low to middle-income families—sometimes, the middle-income families get squeezed in the middle. We have undertaken a review of the bursary, and will make some announcements shortly. In the review, we considered the views of the British Medical Association, which played an active part, ensuring that the perspective of medical students was considered.
In addition to the NHS bursary, last year an additional £890 million were invested by the NHS to provide clinical placements to medical students, ensuring that NHS providers continue to deliver high-quality clinical placements, which are an important part of such training.
The central investment in 2011-12 is £4.9 billion, a 2% increase on 2012-13. It is important that the funding mechanisms provide the right incentives and allow funding to be transparent, to drive quality and to be value for money, supporting a level playing field between providers. Any bursary schemes included should be easy to use and to access—sometimes, the mechanisms by which one can get support are only available to those at the top end of the IQ scale, because they are so complicated. Such complexity can be another significant barrier.
Current funding for clinical education and training is based on local agreements between strategic health authorities and providers. It can result in inequities in the funding of similar placements in different parts of the country. To resolve that, we have been working with others to develop proposals for a tariff-based approach to clinical education and training funding. Such tariffs would enable a national approach to funding all undergraduate clinical placements, including placements for medical students, as well as postgraduate medical training programmes. That will support a much more level playing field between providers. The variation in current funding arrangements means that the introduction of tariffs would have a bigger impact on some providers than others.
Anne Milton
We are looking at that issue at the moment. We have received about 500 consultation responses, so I am sure that it will be highlighted—it is something we need to look at. The other important thing we are looking at is proposed levies on private health care providers. Certainly, when I trained as a nurse—many years ago—that was an issue, and it remains so today.
The tariff ought to mean a more even and equitable system throughout the country. We will continue to work with SHAs and providers, and we will consider all the views expressed, to build understanding of what the tariffs will do and of how to manage the transition.
I assure the right hon. Gentleman that the Government recognise the importance of medical education and of continuing medical education. The new arrangements will take on board many of the issues he has raised, to ensure that we have a health care work force fit for the future.
Question put and agreed to.
Written Parliamentary Question (Correction)
Anne Milton Excerpts(13 years, 5 months ago)
Written StatementsRead Full debate Read Hansard Text Read Debate Ministerial Extracts
The Parliamentary Under-Secretary of State for Health (Anne Milton)
In answering a parliamentary question from the hon. Member for Worthing West, (Sir Peter Bottomley), 1 March 2011, Official Report, column 379W, I provided details of the protection afforded by the two HPV vaccines licensed for use in the United Kingdom. These are Cervarix manufactured by GlaxoSmithKline and Gardasil manufactured by Sanofi Pasteur MSD.
However, my answer also referred to the cross-protection afforded by Cervarix, but I omitted to provide equivalent information on Gardasil and in doing so may have presented an incomplete view to the House.
In the case of Gardasil, the “Summary of Product Characteristics” states that
“statistically significant efficacy against disease was demonstrated against HPV types…related to HPV 16 (primarily HPV31) whereas no statistically significant efficacy was observed for HPV types ... related to HPV 18 (including HPV 45). For the 10 individual HPV types, statistical significance was only reached for HPV 31”.
To ensure clarity and completeness of information about the efficacy of both vaccines, I have placed copies of their “Summary of Product Characteristics” in the Library. Copies of the SPCs for Cervarix and for Gardasil are available for hon. Members from the Vote Office and for noble Lords from the Printed Paper Office. They can also be seen at:
www.medicines.org.uk/emc/medicine/20204/SPC/Cervarix/
www.medicines.org.uk/EMC/medicine/19016/SPC/GARDASIL/