Public Health (Bexley)

David Evennett Excerpts

Wednesday 26th October 2011 Westminster Hall

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

I am grateful for the opportunity to raise the important issue of public health and the situation in my borough of Bexley, which is of great concern to many of my constituents and, of course, to me.

Regrettably, there are vast health inequalities in Bexley and south-east London. The difference in life expectancy for two men living in different parts of Bexley could be as much as or more than seven years. The reasons for that situation, both locally and nationally, are complex and are affected not only by access to the NHS or social care services, but by diet, activity, education and employment. Public health is therefore a matter of fairness and social justice.

As well as causing serious long-term health issues, health inequalities have a wider impact. We all know that obesity can lead to problems with diabetes and heart failure, that smoking kills tens of thousands of people every year and that alcoholism can cause liver failure and increase a person’s susceptibility to other diseases. Those associated illnesses can cause productivity losses for business, reduce school attendance for children and lead to high treatment costs for the NHS. If those problems are not addressed, we could face greater problems in the future, as my hon. Friend the Minister will appreciate.

I am very worried about the increasing number of people who are being classed as obese. The long-term consequences for those individuals and their families can be catastrophic if they do not take action, because they may subsequently experience problems such as heart disease and diabetes. I am particularly concerned about the number of children who are alleged to be experiencing weight problems. According to the national child measurement programme, one in four reception age children in my borough of Bexley is considered to be obese or overweight. That is an incredible figure and, by the age of 11, it rises to one in three. I am sure that the Minister shares my concern about that problem.

There is also an issue among adults. Nationally, the number of obese people in England has doubled since 1993, and the number of obese women has risen by half. Locally, in Bexley, one in four adults is to be considered obese. With trends suggesting that most children who are considered to be obese will remain so well into their adult lives—particularly if their parents are obese, too—the consequences are of real concern to individuals, as well as to society.

I am pleased that my colleague the hon. Member for Erith and Thamesmead (Teresa Pearce) and my neighbour my hon. Friend the Member for Dartford (Gareth Johnson) are here today. The issue does not stay within borough boundaries, because it goes across our area.

[Gareth Johnson (Dartford) (Con)]

I congratulate my hon. Friend on securing the debate. He cares passionately about health care in the borough of Bexley. He has mentioned that some of my constituents rely on services provided in Bexley and that, vice versa, some of his constituents rely on services in the Kent area. Does he therefore agree that it is essential to ensure that the relevant local authorities are aware of their obligations to each other, so that there can be some certainty about funding and budget setting for the councillors in the respective areas that we represent?

[Mr Evennett]

I totally agree with my hon. Friend. There is much cross-border health care traffic both from Bexley into Kent and from Kent into Bexley. That is the choice that people have and should have. Such a situation also reflects people’s needs, which should be met, so I endorse entirely what my hon. Friend has said.

Obesity is responsible for nearly half of all cases of diabetes, a quarter of heart problems and, in some circumstances, more than a third of cases of some cancers. The National Heart Forum estimates that those problems could get much worse and suggests that the number of people getting diabetes as a result of their weight could double by 2050. Financial considerations and costs must also be taken into account. It has been estimated that obesity directly costs the NHS around £4 billion a year. Of course, that does not take into account the cost of treatments and the care required for associated problems, which could and will be even more. In Bexley alone, diabetes costs the NHS £353 per person per year.

Last week, I attended a reception in the House of Commons for Silver Star, a charity campaigning for greater awareness of diabetes. I was pleased to meet Silver Star and learn about its work. I took one of its simple diabetes tests, and I am pleased to report that my glucose level result was 4.9, so I was deemed to be okay.

All the statistics highlight the challenge that we face and the number of people whom we need to assist. First, we must assess the problem’s cause, of which there are many—for example, poor choices, portion sizes, insufficient exercise, inappropriate advertising or a lack of culinary skills can all contribute to an individual’s problems. According to the Association of Public Health Observatories, just 30% of Bexley adults eat healthily, and the statistics on physically active adults in Bexley are significantly worse than the national average. Of course, every individual’s circumstances are different.

In some respects, we are fortunate in Bexley, as we were one of the first boroughs to achieve national healthy schools status for all our schools. However, I am concerned that a minority of adults who eat badly may be setting a bad example for their children. The figures on physically active children in Bexley are also significantly worse than the national average. That is not helped by the fact that the number of children being driven to school has doubled over the past 20 years, which is a national issue that is not confined to Bexley.

Of course, physical activity alone is not enough to address the problem. We need to think more carefully about what we eat and what we feed our children. England’s chief medical officer, Professor Sally Davies, recently said:

“Most of us are eating or drinking more than we need to and are not active enough. Being overweight or obese is a direct consequence of eating more calories than we need. Increasing physical activity is a part of the equation, but reducing the amount of calories we consume is key.”

This is why the Change4Life campaign is important. It provides helpful tips on all the changes that we could make to improve our lifestyles, and it is already directing help to nearly 500,000 people. The campaign’s core ideas—encouraging physical activity, cutting portion sizes, swapping particular foods, discouraging snacking, drinking less alcohol and reducing fat intake—are all sensible and manageable. I hope that more people will take advantage of those resources and take action themselves. I urge my hon. Friend the Minister and the Government to prioritise that approach.

Another issue of health concern is the problems caused by smoking. Smoking rates have remained broadly the same during the past few years. Tobacco consumption remains the greatest single cause of preventable illness and early death, and it is also a big contributor to health inequalities. I am encouraged that, nationally, more people are using NHS stop smoking services. The number of people who registered a quit date has increased in the past year, with an increase in success rates, too. That shows that people are willing to take action to help themselves, which should be encouraged.

I put on the record my support for the award-winning Bexley stop smoking service, which has been doing some excellent work to help my constituents quit smoking and lead healthier lives. The Bexley stop smoking service is led by Jo Woodvine and helps hundreds of people quit smoking every year by using a variety of different methods. I commend the work that it is doing, because its efforts are having an impact. One in five Bexley residents smoke, which is slightly below the national average. However, I am concerned that 17% of women in Bexley smoke through pregnancy, which, worryingly, is above the average. Smoking during pregnancy increases the risk of complications such as stillbirth, miscarriage, premature birth and low birth weight.

There are also age-related problems with smoking. Tobacco consumption is still most prevalent among the under-50s. Every year, more than 300,000 under-16s try smoking for the first time. By the age of 15, some 15% of children in England are reported as being regular smokers, which is incredibly worrying. I accept that action has been taken on this issue. The minimum age at which one can purchase cigarettes has been increased to 18 and the sale of cigarettes from vending machines has been banned. The Government have introduced a tobacco control plan to help reduce smoking, which takes account of the problems that I have highlighted relating to the prevalence of smoking among adults, children and pregnant women. I agree that steps must be taken to reduce the promotion of tobacco and to improve regulation to ensure that children are not drawn into starting smoking. If more is done to highlight the diseases that can result from smoking, then adults may be persuaded to quit.

The substantial cost to society from smoking is estimated to be more than £13 billion a year, which includes NHS treatment, productivity losses and clear-up costs. However, only £11 billion is raised in taxes from tobacco. The Government are therefore right to consider ways of making smoking less affordable, as a disincentive. Most importantly, the Government need to ensure that NHS stop smoking services continue to be properly supported. The all-party parliamentary group on smoking and health has highlighted how cost-effective those services are, estimating that the Government benefit by as much as £1.7 billion a year through the prevention of serious and costly diseases.

Alcohol dependence is another area of great concern, and it is a major public health issue. Dependent drinkers are the drinkers at greatest risk of admission to hospital for a range of illnesses. There are an estimated 4,000 dependent drinkers in my borough of Bexley, and as many as one in seven people are putting their health at risk by binge drinking. While those figures are not as high as in some other areas of the country, they are symptomatic of the wider problems facing our nation. The latest alcohol statistics for England show that one in four men and one in five women are drinking more than the recommended number of units in an average week. On average, children—yes, children—consume 11.6 units a week.

Excessive drinking also has a significant impact on our health service. For example, since the introduction of the Licensing Act 2003, which allowed 24-hour drinking, the number of hospital admissions due to acute alcohol intoxication has doubled and the number of admissions wholly attributable to alcohol has increased by 70% locally, which is broadly in line with national trends. Between midnight and 5 am, the majority of hospital admissions are alcohol related. I was, and remain, opposed to the liberalisation of the drinking hours in the 2003 Act, which was a grave mistake.

Many long-term problems—alcoholic liver disease, hepatitis and cirrhosis—can be caused by excessive consumption over a long period of time, and they can lead to organ failure. Deaths from alcohol-related liver diseases have doubled in the past 20 years, with the overall cost of alcohol-related harm now standing at £2.7 billion a year. It is therefore vital to address the situation. There are simple steps that individuals can take, such as tracking alcohol intake, ordering smaller quantities or reduced-strength drinks, or swapping their drinks for alcohol-free versions. While retailers and drinks manufacturers promote the Drinkaware campaign, the industry needs to do more.

I am concerned about tuberculosis in London and about the current guidelines on prevention. A report published by London Health Programmes in June stated that, between 1999 and 2009, the number of TB cases in London rose by 50%. London now has the highest TB rate of any capital city in western Europe and accounts for 40% of all cases in the UK. Those trends are worrying. In Bexley, there are currently less than 20 cases of TB per 100,000 of population each year. However, during the same 10-year period, the Department of Health issued new guidelines to primary care trusts that recommended the withdrawal of the universal BCG vaccine. TB is an infectious disease that can affect any part of the body. It is curable, but detection is crucial. Early detection can mean relatively simple and cheap treatment. If left undetected or untreated, as in 12% of cases, the disease can become drug resistant, meaning more complex treatment at a hugely increased cost. The approach to prevention and treatment of TB therefore needs to change.

I am concerned that family travel is not given enough consideration. Many Bexley children are taken on holiday to the Indian subcontinent or to sub-Saharan Africa during school breaks, particularly in summer, and might be exposed to the disease. Consequently, there is a potential risk that, when the family returns to the UK, others might come into contact with the disease. I appreciate that prolonged exposure is required in order to transmit the disease, but this might happen and I am concerned.

As London Health Programmes has identified, targeting has been inconsistent. High risk groups, such as the homeless and those with lower immune responses caused by other problems such as drug taking or alcoholism, have not been given enough attention. The recommendations made in the draft London TB plan, which aims to improve the early detection of TB and the effectiveness of treatment as well as to reduce the risk of transmission, must be carefully considered. In particular, the Government should seek to implement the proposal that all newborn children should be vaccinated within six weeks of birth to protect them from TB. This welcome suggestion could be an effective measure to prevent cases of the disease. However, it would not address the problem for children in my borough, who have still not received the BCG vaccine because the Department of Health felt that we did not have enough cases per 100,000 of population. I would like to see a limited programme in the next few years for children in London boroughs who have not received the vaccination.

Bexley is a very good place to live and work. I do not want to say that it is all negative, because it is not. There is a huge amount going on in Bexley that is to be commended, and I put that on the record. The vast majority of people in our borough are really good people—moderate, reasonable people—and educating, helping and advising them is the way forward. However, Bexley is not immune to increasing health issues. I hope that the Minister and the Department will support— I know this is not her brief, but I cannot resist the temptation to include this in my remarks—plans for a health and well-being campus to be established at Queen Mary’s hospital in Sidcup. If approved, this could begin in 2014 and provide vital services, such as primary and community care, GP services and hospital services, all on one site. As part of the plans, Bird college, a dance, music and theatre performance centre, hopes to be on the site as well, which could provide real benefits for public health. The strategic outline case has been submitted, and I hope that that important project can progress.

I also urge the Minister to consider the role that community pharmacies can play in helping to reduce health inequalities and public health problems. At the heart of the local communities that they serve, they are uniquely placed to offer advice to significant numbers of people. They can sometimes be more accessible than GP services, and they can be found in retail settings.

In conclusion, I congratulate my hon. Friend the Minister on all the tremendous work that she is doing on public health. The Government are right to prioritise public health and to ring-fence finance. I support strongly the transfer of increased responsibilities to local councils on public health issues. Fundamentally, I believe that education and awareness are vital. If public health problems are to be properly addressed, we need to ensure that everyone plays their part—schools, parents, businesses, charities, and local and national government—otherwise we could be storing up huge problems in our country, including Bexley. I am grateful for the opportunity to make these few points today, because it is very important to address public health issues for the future.

Oral Answers to Questions

David Evennett Excerpts

Tuesday 18th October 2011 Commons Chamber

[The Parliamentary Under-Secretary of State for Health (Anne Milton)]

The right hon. Gentleman has a long-standing interest in this subject. We are working on a number of areas, but I think that the extension of public health duties to local authorities will open up many opportunities to persuade parents to think carefully about where they smoke, whether it is in cars or in their own homes.

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

There is real concern throughout the country about the health inequalities left by the last Government. Will the Minister confirm that funding for areas with relatively large health inequalities will not be raided, as it has been in the past under Labour?

[Anne Milton]

As my right hon. Friend the Secretary of State said earlier, the Health and Social Care Bill proposes the introduction of the first ever legal duty for the Secretary of State to have regard to the reduction of health inequalities. That covers both NHS and public health functions. We are also addressing the health needs of some of the most vulnerable people through the “Inclusion Health” programme.

Oral Answers to Questions

David Evennett Excerpts

Tuesday 12th July 2011 Commons Chamber

[Paul Burstow]

The right hon. Gentleman raises a very important point. We need to ensure that we have the right data to understand prescribing practice properly, so that we can both challenge bad practice and ensure that the NICE guidance is properly followed. I would like to look more closely at his points and then write to him in detail.

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

Will my right hon. Friend join me in congratulating advisers working for Bexley stop smoking service, who helped more than 1,600 people stop smoking last year? Does the Minister agree that helping people stop smoking should remain an important public health priority?

[The Parliamentary Under-Secretary of State for Health (Anne Milton)]

I am happy to join my hon. Friend in congratulating those who are making efforts locally. As he will be aware, public health services will move to local authorities, and I am sure those efforts will continue. Some 80,000 people a year die of smoking-related disease, and 320,000 young people are taking up smoking each year. We must not only help those who are smoking to stop but prevent young people from taking it up.

Oral Answers to Questions

David Evennett Excerpts

Tuesday 26th April 2011 Commons Chamber

[Anne Milton]

Families of children with disabilities and special needs will welcome the single, co-ordinated assessment. We have to see health and social care working more closely together, because those families bear a considerable burden of care. I would point the hon. Lady towards the consultation, and I suggest that she points her constituents towards it as well, as it is extremely important that we get their feedback.

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

22. What steps he is taking to extend the choice that patients have over the treatment they receive from the NHS.

[The Minister of State, Department of Health (Mr Simon Burns)]

The Government have consulted on proposals to give patients greater choice and control over their care and treatment. We have deferred publication of our response to take into account the results of the listening exercise.

[Mr Evennett]

I thank my right hon. Friend for that answer and refer him to the King’s Fund paper, “Patient choice”, which was published in March 2010. Does he agree that people value being able to choose and that the exercise of choice raises standards and encourages NHS providers to design services around patients and their needs?

[Mr Burns]

My hon. Friend is absolutely right. I am certainly aware of the King’s Fund publication. The report was cited as a key source of evidence in the consultation document, “Liberating the NHS”. The Department of Health welcomes this significant contribution to the evidence base, which will inform how we implement the choice commitments set out in the White Paper, “Equity and excellence: Liberating the NHS”.

NHS Reform

David Evennett Excerpts

Monday 4th April 2011 Commons Chamber

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

I welcome my right hon. Friend’s statement. Does he agree that reduced bureaucracy and better local scrutiny and accountability will ensure a better NHS for all?

[Mr Lansley]

Yes, my hon. Friend is absolutely right. Locally, he can see how that is happening as GP leaders—including Dr Howard Stoate, whom Members will fondly remember, as the chair of the clinical cabinet in Bexley—are coming together to look at issues that the previous Government never dealt with, including those relating to the South London Healthcare NHS Trust and to Queen Mary’s hospital in Sidcup. They are coming forward with proposals to improve services for local people, and I applaud that kind of clinical leadership.

NHS Reorganisation

David Evennett Excerpts

Wednesday 16th March 2011 Commons Chamber

[John Healey]

The hon. Gentleman needs to read some of the material for himself, rather than just reading the briefings provided by his Whips and his Front-Bench team. Some of the 52 organisations that this Government and the Health Secretary claim supported the Bill have written to me saying that far from supporting the principles of the Bill, they have “grave concerns” about the White Paper; that was said by the Patients Association. The Chartered Society of Physiotherapy has said:

“We have been very clear that we have grave concerns about the scope and speed of the structural changes proposed”.

Diabetes UK, Cancer Research UK, the Royal College of Speech and Language Therapists and others do not take kindly to being misrepresented by Ministers as supporting this Bill when they have such grave concerns.

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

I always thought that the right hon. Gentleman was a reformer at heart, but he obviously is not, given what he is saying today. Why did productivity in our hospitals decline by 15% during the 13 years of the Labour Government, while bureaucracy increased?

[John Healey]

One of the problems—we all know this, and the new Government will be faced with it in exactly the same way—is exactly how to measure productivity in the NHS. Given the complexity of what is provided for patients—and the requirement to put together packages of care to help people recover from serious illness and live independently is so complex—it is hard to do that. The NHS just is not like a commercial business, which is what this Government want to turn it into.

Public Health White Paper

David Evennett Excerpts

Tuesday 30th November 2010 Commons Chamber

[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.

NHS Reorganisation

David Evennett Excerpts

Wednesday 17th November 2010 Commons Chamber

[John Healey]

If two thirds of the GPs the hon. Gentleman met are in favour, one third are obviously not convinced, but they will be forced to do this anyway. That is part of the problem, and I will come to that in a moment.

It is no wonder that the head of the NHS Confederation, the body that is there for those who run the NHS, told the Health Committee last month that

“there is a very, very significant risk associated with the project”.

Even the Secretary of State’s right-wing supporters in the Civitas think-tank tell him that he is wrong. They have said:

“The NHS is facing the most difficult…time in its history. Now is not the time for ripping up internal structures yet again on scant evidence”.

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

I have been listening to the right hon. Gentleman with great interest. I know his moderate views on many things, but he misrepresented what my hon. Friend the Member for Enfield North (Nick de Bois) said about the numbers of GPs. Now that targets and top-down management—the centrepiece of the last Labour Government’s policies—are being discarded even by those on the right hon. Gentleman’s own Front Bench, does he not agree that giving significant freedoms to front-line professionals is a better way forward?

[John Healey]

Yes, of course; we had been doing that for some years before the election and we had plans to do it after the election, but the fact is that we did not win the election, and the Secretary of State is in power now. He is making the decisions and he is the one who is entrusted with the future of our NHS. He is the one who needs to answer to the House for his plans.

The problem with broken promises is worse than I have already suggested. The coalition agreement promised:

“The local PCT will act as a champion for patients and commission those residual services that are best undertaken at a wider level, rather than directly by GPs.”

The Secretary of State’s plans will do precisely the opposite. He is abolishing the PCTs, not building on the best of what they do.

--- Later in debate ---

[Mr Lansley]

No; I am addressing the point that the hon. Lady made. That cut in formula grant does not mean a corresponding cut in council tax, so that revenue is available to local authorities. In addition, the NHS is going to support social care activity in the ways I have described, such as through telehealth, re-ablement and equipment adaptations. We are transferring the learning disability transfer grant and other adult social care grants collectively representing £2.7 billion a year from the NHS to local authority funding, without reductions in those grants. I am afraid the hon. Lady is just simply wrong, therefore.

[Mr Evennett]

I congratulate my right hon. Friend on his determination to improve our national health service, and on the initiatives that he is proposing. However, does he agree that in enabling the NHS and social care services to work more closely together, it is vital to have integrated cost-effective services, and make sure that the patients get the best out of the system?

[Mr Lansley]

My hon. Friend is absolutely right. The Minister of State, Department of Health, my hon. Friend the Member for Sutton and Cheam (Paul Burstow), and I are very impressed that the local NHS and local authorities are, sometimes for the first time, sitting down together and discussing how they can use their resources. Even this year we managed to save £70 million from the budget that we inherited from the Labour party. That money can be invested in re-ablement, and in bringing local authorities and the NHS together to improve the service to people who are going home.

Oral Answers to Questions

David Evennett Excerpts

Tuesday 29th June 2010 Commons Chamber

[Mr Burns]

I am a bit perplexed by the hon. Gentleman’s comments, because I have answered the specific narrow question that he asked—but let me try to cheer him up, if I can. We understand that he has been a redoubtable campaigner for the hospital, and we support the principle of community hospitals. The Department, as the hon. Gentleman knows, allocated £4.58 million to help the community hospital in Eltham and has already given about £1.9 million to NHS Greenwich, the primary care trust, for it. I hope that the hon. Gentleman will not have to come back to me with another question, because I trust that I am now going to cheer him up: I can announce today that the balance of the money will be paid and made available during the current financial year.

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

I congratulate my hon. Friend on that announcement, which will bring considerable pleasure to people in south-east London. He is well aware that proposals are being made within our area of south-east London to reorganise health provision, which are causing considerable concern. Will he ensure that vital services are maintained in our area for patients?

[Mr Burns]

I am grateful to my hon. Friend. As he rightly says, I am aware of the situation. As he will be aware, we believe that local people, local clinicians and local GPs should have an input into any reconfiguration of health care provision. As my right hon. Friend the Secretary of State said when he announced the changes to the criteria, there will be an assessment of whether they apply to the reconfiguration to which my hon. Friend refers. Once that has been done and decisions have been reached, we will be able to move forward in the proper way.