Public Health

Baroness Thornton Excerpts

Tuesday 30th November 2010 Lords Chamber

[Baroness Thornton]

My Lords, I thank the Minister for repeating the Statement, which as we know was well trailed on the “Andrew Marr Show” on Sunday and on the “Today” programme this morning. There are some things that we would like to welcome and support in the Statement, and there are some that we think are a cause for concern. My overall impression is slight disappointment at the insubstantial nature of this Statement. Much of it is common sense and much of it picks up where the previous Government left off, but the Government have had quite some time to think about and to decide on the direction for public health. I believe that this White Paper is short on strategy. Therefore, I look forward to more substance as we move forward.

I think that we would agree that local authorities have an important role to play in the delivery of the public health agenda. Presumably, the new public health service will take on some of the responsibilities of the Health Protection Agency. I have to say to the noble Earl that I wonder why it was necessary to announce the abolition of the HPA, except to make a political point, which is disappointing, when a new agency is being created. The appointment of the new directors of public health will be very important in this programme of delivering a public health agenda. For them to be effective, they will need to be independent. How do the Government intend to ensure that directors of public health in local authorities have the necessary independence and power to deliver an agenda, which sometimes a local authority may not want to hear and may find expensive to deliver?

I am disappointed at the cheap gibes in the Statement, which I can only assume were the idea of the Minister’s bosses—that the nanny state ruled during the Labour years and that Mr Lansley’s “nudge-nudge” public health strategy will be more effective. We need to get past that sort of name calling. The evidence shows that by taking a lead, as Labour did, in the diagnosis of public health issues based on evidence and in taking some of the big decisions on, for example, smoking, exercise and diet—the noble Earl has not ruled out that this Government might need to do that too—we provided a good framework for people to take responsibility for their health and to start to change their habits. I hope that this Government will continue to support families where it is needed.

I do not think that nudging would have got us the ban on smoking in the workplace. “Nudge” will not replace the brilliantly successful schools sports programme. I am not sure that nudge will deliver the national screening programme mentioned in the Statement. I am certainly sure that nudge will not deliver healthy meals in schools or fruit for schoolchildren. So I am sceptical about the nudge part of this Statement.

However, we can all agree that factors such as unemployment, education, environment and equality are important determinants of health. The Statement is correct in saying:

“Unhealthy behaviours, like drinking too much, smoking … are … rooted in poor aspiration, adverse peer pressure and low self-esteem”.

As Marmot puts it, and as the noble Earl has said, they are the “causes of the causes”. That is absolutely correct.

I disagree with this Statement where it puts forward a cross-government initiative; that is, joined-up government. The noble Earl needs to explain how throwing somewhere between 400,000 and 500,000 people on the dole will help their self-esteem and their family’s prospects. He would need to explain the joined-up bit of the Government that led his right honourable friend the Secretary of State for Education to get rid of the successful school sports scheme that got our nation’s children playing sport. Ditto housing benefit cuts, which may put some families’ homes at risk or move them away from where they can earn a living. That is not going to provide the right environment. Finally, we have the abolition of the education maintenance allowance, which has allowed thousands of children from low-income families to stay on at school after 16. If, as Marmot says, life chances and opportunities are an important part of people’s well-being and health, how can the Minister explain the contribution of this initiative to public health?

I want to turn to the regulation of tobacco. This House has debated this issue at length and over quite some time, and by several large majorities it supported the introduction of point-of-sale tobacco regulation and the banning of tobacco products in vending machines. Just this morning, on the “Today” programme, the Secretary of State confirmed that he accepted the evidence that the visibility of cigarettes is a factor that leads to the initiation of smoking. He also mentioned the issue of plain packaging and the Government’s intention to consult on this. We all know that such a consultation will take years and that any action to put tobacco into plain packaging, following on from such a consultation, will take years to come into force. This cannot and should not be seen as an alternative to the legislation to ban tobacco displays. The display legislation is on the statute book. It will protect this generation of children from brightly coloured displays in shops. I should like to ask the Minister this: will cigarettes no longer be on display in supermarkets from October next year? Further, if the Government intend to consult on plain packaging, how long will the consultation take, who will run it and how much will it cost?

I have two or three more questions for the Minister. I warmly welcome the Government’s intention to invest in Sure Start children’s centres and in more health visitors. I also support the development of health protection plans and screening programmes, but I have to ask the Minister: is this nudge or is this target? How are the Government going to decide whether enough people are being screened, because that aim needs a target rather than a nudge? The ring-fencing of public health budgets is going to be a challenge. How will the Government decide what is going to be included in those budgets and what will be excluded? Moreover, how are they going to stop hard-pressed local authorities from raiding them? That will indeed be a challenge. We support the Government in doing this, but we will need to address how it will be possible to deliver that ring-fencing.

Finally, I certainly welcome the greater use of voluntary and community organisations. We worked with many organisations in different health fields, and that is exactly right. However, the funding and support for these organisations needs to be maintained.