Health and Social Care Bill

Diane Abbott Excerpts

Tuesday 13th March 2012 Commons Chamber

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

The British public, as I think everyone here acknowledges, have a great care and concern for the national health service. That is not an idle superstition, as Conservative Members sometimes imply, but probably arises because we all interact with the health service when we are at our most vulnerable and at pivotal moments of our lives. Perhaps it happens when we are having our children or when a parent is dying or when we are ill and frightened. It is therefore unfortunate, to put it mildly, that no Government Members have been prepared seriously to engage with the depth of public concern about this Bill.

Let me quote a joint editorial, written by the editors of the British Medical Journal, the Health Service Journal and Nursing Times—publications that originally supported this Bill, to which fact I draw the Secretary of State’s attention. They describe the Bill as

“poorly conceived, badly communicated, and a dangerous distraction at a time when the NHS is required to make unprecedented savings.”

That is the consensus within the NHS. Ministers talk about the GPs involved in clinical commissioning groups. Of course GPs are moving forward and trying to engage with the changes—because they want what is best for their patients, not because most of them support the Bill in principle.

I have spoken about opinion within the NHS. As some Members know, my mother was a woman who gave her life to the NHS. She came to this country in the 1950s as a pupil nurse, and she ended her career working in a mental hospital just outside Huddersfield in West Yorkshire. She was part of that generation of men and women who built our NHS in the years after the second world war. In preparing for this debate and thinking about how to cut through the bluster, allegations, counter-allegations and politicking, I thought to myself, “Perhaps I should say what my mother would want me to say”. She was not a politician; she was not the head of a royal college; she was not a manager; she did not work for a glitzy Westminster think-tank: she was just an ordinary woman who was very proud indeed to say that she worked for the British NHS. My mother would have wanted me to say that the NHS is special and that from its earliest years it has been about change and adaptability. She would have wanted me to say, too, that politicians should handle it with thoughtfulness, not engage in party political games, but give the debate the care and thought that she always gave her patients.

I have to reinforce the point about the specialness of the NHS because part of the Secretary of State’s narrative, as this year has worn on, is that the NHS is somehow broken, and only his Bill can fix it. Well, we have heard that the Commonwealth Fund says that the NHS is one of the world’s leading health care systems for quality and value for money, and we know that it had the highest satisfaction ratings ever at 72%. Even the Secretary of State said on Second Reading that on a number of indicators,

“including mortality rates from accidents and self-harm, equity and access to health care—the NHS leads the world”.—[Official Report, 31 January 2011; Vol. 522, c. 606.]

This is far from a health care system that is broken.

My Labour Front-Bench colleagues and I need no reminding of how special the health service is and how we should respect the people who work in it at every level. We have spent the past year going up and down the country, shadowing workers in the NHS. We have met radiotherapists in Wirral, physiotherapists in Northumbria, ambulance crew in Cambridge, mental health nurses in Rochdale, cancer nurses in Birmingham, hospital porters in Leeds, paediatricians in Bristol and midwives in London. These were different people working at different places at different levels, but from every visit, we heard the same abiding message—“Our NHS is not for sale.”.

The second point that I am sure my mother would have wanted me to make is that from its earliest years the NHS has always been open to change and improvement, as I said. Workers are not opposed to change. Why would workers in the NHS be opposed to change? It is a service where people and science interact. Of course people are different first thing in the morning from how they are when they go to bed. Of course NHS workers are able to deal with change. No one needs to tell a nurse’s daughter that there have always been things in the NHS that could have been improved.

The Labour party is not opposed to change. It was our willingness to change and reform that drove down waiting times to unprecedentedly low levels. Some of the things we tried were so radical that some of us could not vote for them, but it is no discredit to my right hon. and hon. Friends that they were willing to try every lever they could to bring down waiting times and provide a service for the people who voted us here.

[Nicky Morgan]

Will the hon. Lady give way?

[Ms Abbott]

Time is against me, I am afraid.

The final thing that ordinary health service workers would wish me to say is that if anything has exemplified the unfortunate practice of politicians of saying one thing and doing another, it is the frequency and vehemence with which the Government decried top-down reorganisations when they were in opposition. In 2006, the right hon. Member for Witney (Mr Cameron), then Leader of the Opposition said:

“So I make this commitment to the NHS and all who work in it. No more pointless reorganisations.”

In 2007, the then shadow Health Secretary said:

“The NHS needs no more pointless organisational upheaval”.

In 2009, still as Leader of the Opposition, the right hon. Member for Witney said:

“But first I want to tell you what we’re not going to do. There will be no more of those pointless re-organisations”.

Then, the coalition agreement of 2010—I do not want to touch on private grief here for Liberal Democrat Members—said:

“We will stop the top-down reorganisations of the NHS that have got in the way of patient care.”

We are thus presented with a Bill that is based on a bizarre sort of life support—the arrogance of the coalition leadership.

Now we know that the doctors, the nurses, the midwives, the health visitors, the paramedics, the cleaners, the porters, and the scientific and technical workers will do their very best with this Bill if it becomes law. That is what Clare Gerada was saying this morning: if it becomes law, they will do their very best, but why should they have to see an already discredited Bill on the statute book? Why should they have to see more bureaucracy, which is what the Bill will mean, and why should they have to see billions of pounds wasted at a time when the health service is under unprecedented financial pressure? Government Members have sought to denigrate those who oppose the Bill by saying that their opposition is merely party-political. Of course it is not: we are proud to be part of a coalition of concern about the Bill.

My right hon. Friend the Member for South Shields (David Miliband), my hon. Friend the Member for Stalybridge and Hyde (Jonathan Reynolds), my right hon. Friend the Member for Manchester, Gorton (Sir Gerald Kaufman), my hon. Friends the Members for Stoke-on-Trent North (Joan Walley) and for Worsley and Eccles South (Barbara Keeley), my right hon. Friend the Member for Wentworth and Dearne (John Healey) and my hon. Friend the Member for Bethnal Green and Bow (Rushanara Ali) spelt out our concern about the Bill. It is extraordinary that we can proceed while the Government are still refusing to reveal the risk register. There is concern throughout the NHS about the fragmentation that will result from the Bill. Government Members say that we are scaremongering—[Hon. Members: “You are.”]—but private sector companies such as Humana and Capita are already advertising their willingness to take over GPs’ commissioning powers on their websites.

The NHS does not belong to the Secretary of State, and it does not belong to the Deputy Prime Minister. It belongs to the people of Britain who built it after the war. The NHS is not for sale, and I urge the House to support the motion.

Maternity Services: Expenditure

Diane Abbott Excerpts

Thursday 1st March 2012 Ministerial Corrections

[Ms Abbott]

To ask the Secretary of State for Health how much was spent on maternity services in each (a) region and (b) NHS trust in (i) 2010 and (ii) 2011.

[Official Report, 20 February 2012, Vol. 540, c. 695-98W.]

Letter of correction from Anne Milton:

Errors have been identified in the written answer given to the hon. Member for Hackney North and Stoke Newington (Ms Abbott) on 20 February 2012. The 2009-10 figure given for Barking and Dagenham PCT should be ‘8,335’; for Barnet PCT ‘21,662’; and for Bassetlaw PCT ‘5,114’.

The full answer given was as follows:

[Anne Milton]

This information is not collected in the format requested. The Department collects accounting data based on commissioning, of secondary health care by financial year. Information regarding expenditure on the purchase of secondary health care relating to maternity services by strategic health authority (SHA) region and primary care trust in 2009-10 and 2010-11 is set out in the following tables.

Oral Answers to Questions

Diane Abbott Excerpts

Tuesday 21st February 2012 Commons Chamber

[Mr Burns]

The straightforward answer is no, because everyone, including the right hon. Member for Leigh (Andy Burnham), accepts that the NHS has to evolve to keep up and meet its challenges. What matters to patients is not who delivers their care but the quality of the care that they receive, their experience of that care and the dignity and respect with which they are treated at all times. Cutting bureaucracy by a third to reinvest £4.5 billion in front-line services between now and 2015 is the way forward. Frankly, if one goes and talks to doctors around the country, one finds that they wish that Labour’s party political squabbling would stop so that they can get on with implementing the modernisation programme.

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

The Minister talks about party politics. Is he not aware that not a day goes past without an organisation representing doctors and nurses coming out against his Bill? Most recently, the Royal College of Physicians is having to hold an extraordinary general meeting because of pressure from its members. The Royal College of Paediatrics and Child Health is consulting its members. Why should anyone in this House support a Bill to which the men and women who work in the health service are so opposed and which even Tory Cabinet Ministers are briefing against?

[Mr Burns]

I suspect that the hon. Lady does not get out and about much to meet doctors who are beginning to commission care for their patients. If she did, she would know that the mantra she is repeating from organisations that are not representative of doctors in this country—[Interruption.]

Alcohol Strategy

Diane Abbott Excerpts

Tuesday 7th February 2012 Westminster Hall

[Dr Wollaston]

There is a simple reply to that question—it would not work. We have seen that clearly from the efforts at prohibition in the States. I myself enjoy a drink, as I am sure do most Members present. Everyone might like a drink, but nobody likes a drunk, and that is what this is about. It is not about stopping people drinking, but about asking at what point the state should step in to address the real harm. There is a balance to be achieved. I am not suggesting for one moment that my proposals will stop people drinking, and I would not want them to do so. I just want to do something about 22,000 people dying every year in this country.

I propose that we act on price and address availability, marketing, education and labelling, and that we take action on offending behaviour. We should also change the drink-drive limit. Crucially, if we are to put all those measures in place, we also need to help people who already have a problem, which means better screening and treatment in the health service for hazardous, harmful and dependent drinkers. It is also time to send a clear message that we have had enough of drunken antisocial behaviour and violent crime.

On availability—I will try to be brief, because I know that lots of Members want to speak—I welcome the consultation on dealing with the problem of late-night drinking. It is absolutely right that communities should have a greater say in the licensing hours, and I welcome the return from 3 am back to midnight and the idea that those who supply late-night alcohol should contribute to the clean-up cost. Will the Under-Secretary of State for Health, my hon. Friend the Member for Guildford (Anne Milton), go further and address whether supermarkets should face greater penalties? The problem for late-night premises and clubs is that their customers are already drunk when they arrive, having pre-loaded on very cheap alcohol. It is crucial that supermarkets should contribute to the clean-up cost.

On marketing, we currently spend £800 million a year on alcohol marketing, which dwarfs the budget given to the Drinkaware Trust, which is industry controlled. There is clear evidence that marketing encourages not only drinking earlier, but children to drink more when they do. Although it is encouraging that fewer children overall are drinking, we should still remember that, after the Isle of Man and Denmark, we are the country with the highest levels of binge drinking and drunkenness in our schoolchildren. The problem is that the current controls are complex and easily circumvented. There is an off-the-peg solution that is compatible with European Union law, namely to introduce similar measures to those in France under the Loi Évin. Rather than having a set of complicated measures saying what we cannot do, we would set out clearly where alcohol can be marketed and everything else would not be allowed. If we want to protect children, why do we allow alcohol advertising before screenings of 15-cetificate films? It is also confusing that, while we say that alcohol cannot be associated with youth culture or sporting success, we allow alcohol-related sponsorship of the FA cup and events such as T in the park. We need to protect children.

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

Does the hon. Lady agree that it is no coincidence that, between 1992 and 1996, when the advertising budget for alcohol products marketed at young people rose from £150 million to £250 million, the number of schoolchildren drinking alcohol doubled?

[Dr Wollaston]

That is a valuable point and clear evidence that marketing encourages children to drink, to start drinking younger and to drink more when they do. We should protect young people—that is an absolute duty of the state.

On education, the most important point is clear labelling. The drinks industry has made some progress, but if it does not meet its targets the issue should be mandated so that people can be clear about how many units they are drinking and receive advice on the sensible limits.

--- Later in debate ---

[Eric Joyce]

indicated dissent.

[Ms Abbott]

Will the hon. Member for Strangford (Jim Shannon) give way?

[Jim Shannon]

Let me just get this important point on the record. We have to address all the issues. There are different ways of doing so and one is to increase the price of alcohol.

[Ms Abbott]

Does not the hon. Gentleman agree that all the medical and research evidence shows that price is a key factor for two categories of drinker: young drinkers and problem drinkers?

[Jim Shannon]

I thank the hon. Lady for her wise words. That is exactly what we feel is important. We have to take on hard issues and address them early. We need a strategy that reflects an in-built protection for children and adults alike.

I urge that the points of view advanced by the hon. Member for Totnes and other hon. Members be considered and that we adopt a strategy that addresses the issues that plague society today.

--- Later in debate ---

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

It is always a pleasure to speak under your distinguished chairmanship, Miss Clark. Like many other hon. Members, I congratulate the hon. Member for Totnes (Dr Wollaston) on securing the debate, which is part of her campaigning work on what has almost come to be seen as her signature issue. It is a very important issue for us all.

I often speak in the House about things of particular relevance to inner-city communities such as mine, but no community is not touched by the scourge of alcohol abuse. That is true whether we are talking about the town centre or the accident and emergency department or even behind closed doors. This scourge is relevant to all of us as Members and is a proper subject for debate.

We have heard many very informed speeches. I shall touch on just three issues. I want to put the alcohol abuse problem in this country in an international context. I do not think that it is sufficiently understood how badly we are doing relative to other European countries. I want to touch particularly on what is happening to young people, because what is happening to them is particularly important. Finally, I shall talk about what would make up an effective alcohol strategy.

It is not sufficiently understood that whereas alcohol misuse is trending quite sharply up in this country, as hon. Members have said, in Europe it is trending down. The picture in this country is much bleaker than that in countries such as France, Italy and Spain. France, Italy and Spain historically had very high levels of alcohol consumption in the 1950s. However, since the 1980s, alcohol consumption in France, Germany and Italy has been reduced by between 30% and 50%. At the same time, it has gone upwards in the UK.

We have heard about the numbers of deaths related to alcohol abuse and the panoply of social ills and social disorder caused by alcohol abuse. Why is alcohol abuse as a problem trending upwards in the UK but going downwards in other European countries? That is because—I say this with all due respect to the free-marketeers on the other side of the Chamber—Governments have taken action. If we look at a graph of alcohol abuse, we see the line for European countries going down and being intercepted by a line that relates to UK alcohol abuse, which is going upwards. How can the sixth-richest country in the world be unable to take comprehensive action against this scourge? I would hate to think that that was because politicians and Governments listened too much to the drinks industry and not enough to the cries of people suffering from alcohol abuse, whether they are in our town centres or in A and E or the alcohol abuse is taking place behind closed doors.

I want to say a little about why this is a particular issue for young people. As we have heard, among young people aged 18 to 29, alcohol is a bigger killer than any other disease. They are being killed either by the use of alcohol itself or in alcohol-fuelled incidents. Government Members are laughing, but they would think it a serious matter if they were the parent of a young person who had died in that type of incident. I have had occasion to meet parents of children who have died either through alcohol abuse or in incidents fuelled by alcohol. They do not laugh; they think that it is tragic and they want the Government to do more.

It is a fact that the alcohol industry has, in recent years, specifically targeted younger audiences. What are alcopops about other than encouraging young people who might be put off by the taste of alcohol to begin drinking alcohol with drinks that more naturally resemble soft drinks and sweetened fruit juice? It is a fact that in the 1990s the industry consciously increased its advertising budget. It went from £150 million to £250 million and, as I said, at the same time the number of schoolchildren drinking alcohol doubled. Targeting young people is a very serious matter, because we know that heavy drinking in adolescence leads to greater addiction levels and dependency in later life. We have heard more than once in the debate that levels of drinking in this country have levelled off, but levels of drinking among young people continue to spiral upwards. It is that vulnerability and the onward costs of adolescent heavy drinking that it is important to target.

We have heard many important facts about the results of alcohol abuse in this country, so what action should be taken? No one believes that pricing alone is a magic bullet. No one puts that forward—not the British Medical Association and not the alcohol campaigning organisations. However, there is no question but that an effective strategy against alcohol abuse must have pricing as part of the package.

Last year, I visited Newcastle at the invitation of the leader of the Labour council, Nick Forbes, and I chaired a round table discussion on alcohol and tobacco, at which I heard about the impact of alcohol abuse in the north-east. I also heard about the work that Balance North East is doing on alcohol abuse. I heard that alcohol is sold for as little as 12p per unit in the north-east and that the NHS spends a very large amount of money dealing with alcohol harm.

The problem is that, in the midst of the reorganisation that is taking place, innovative programmes such as Balance North East are at risk because they are funded jointly by several local primary care trusts. I would be interested in what the Minister has to say on how regional programmes such as Balance North East, fighting alcohol harm, may be able to continue operating under the new commissioning arrangements that she proposes in the Health and Social Care Bill. How does she, under the new organisational arrangements, intend to see alcohol services improve? How does she intend to make them a public health priority? Does she intend to consider the specific recommendations made by the British Society of Gastroenterology? Those recommendations include the establishment of multidisciplinary alcohol care teams in hospitals linked to the community; alcohol specialist nurse services; co-ordinated policies of care in A and E and acute medicine units, including alcohol specialist nurses, liaison psychiatry and alcohol link workers’ networks; outreach alcohol services; and integrated alcohol treatment pathways.

As I have said, there is a real issue about alcohol and young people. I think it was the hon. Member for Southport (John Pugh) who said that he did not think that education had much of a role to play. One way in which we can learn is by looking at successful public health campaigns of the past. There is no question but that, along with Government action, education in schools has a lot to do with the fact that levels of smoking among young people are dropping. That was not an immediate answer, but we do know that education played an important part in relation to tobacco abuse, and I believe that education can play an important part in relation to alcohol abuse.

In the debate hon. Members have queried whether there is any evidence that price plays a role. I refer hon. Members to something that was referred to earlier—a study undertaken over 20 years in British Columbia, Canada. That showed that a 10% increase in the minimum price of a given alcoholic beverage leads to a 16.1% decrease in consumption relative to other drinks. As I said, that was a 20-year survey. No hon. Member has brought evidence that will counter that.

We have heard about the social ills and the health problems caused by alcohol abuse. We know, because of our experience with tobacco, that these are not trends that we can stand, King Canute-like, and watch rising. There are things that Government and communities can do. Having waited so long for the Government’s alcohol strategy, I await with interest the Minister’s comments about the action that the Government plan to take and how it will fit with the changes in the organisation of the health service.

Health Inequalities (North-East)

Diane Abbott Excerpts

Tuesday 24th January 2012 Westminster Hall

[Ian Swales]

I bow to the hon. Lady’s knowledge in this area. She certainly has a great deal more than I do. I do not know the answer to her question.

In 2003, the Government identified 12 cross-Government headline indicators and 82 cross-Government commitments, but sadly overall it was effective action that was the problem. In 2005, the Government identified 70 spearhead local authority areas for special attention, and credit to them for that. One third of those areas were in the north-east. However, only in London did those spearhead areas see a narrowing of health inequalities.

I know that this issue is complex, but some things are basic. The NAO report showed that more deprived areas had fewer GPs. Some had significantly fewer. They were also paid less. I was shown barely believable figures showing that Redcar and Cleveland had only half the average GP resource of the most deprived 20%. Clearly, that is not a good position to be in.

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

How does the hon. Gentleman think that forcing through NHS reforms that are vehemently opposed by both the British Medical Association and the Royal College of General Practitioners will encourage GPs to go and work in deprived areas that have a shortage of GPs?

[Ian Swales]

I believe that the wider issue of NHS reforms is outside the scope of this debate, but certainly I see a growth in the number of GPs already.

--- Later in debate ---

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

It is always a pleasure to serve under your distinguished chairmanship, Mrs Riordan.

I congratulate my hon. Friend the Member for Newcastle upon Tyne Central (Chi Onwurah) on securing this debate. Its importance to the north-east is exemplified by colleagues’ high level of attendance this morning, but it is also important because the lifestyle issues and the social and, if I might say so, class determinants behind health inequalities lie at the heart of bringing down levels of acute diseases such as cancer and heart attacks. Until we tackle the range of public health issues that underlie health inequalities in the north-east, we have no hope of building a healthier Britain overall, or of containing the cost of the national health service.

My colleagues have comprehensively dealt with the data on health equalities in the north-east, and I do not plan to repeat most of them. I want to talk specifically about smoking and alcohol, which are big issues in the region, and to pose some questions to the Minister. I was very pleased to visit Newcastle last year, at the invitation of the then, and current, leader of the city council, Councillor Nick Forbes. I chaired a round table on tobacco and alcohol, and heard about the work of Fresh under the leadership of Alisa Rutter, and saw a presentation by Balance North East. On the same day, I visited Newcastle Royal Victoria infirmary and discussed the devastating impact of the excessive alcohol consumption in the local community with a top north-east liver specialist and consultant gastroenterologist, Dr Chris Record. He kindly gave me a chart of alcohol units, and I have it up in my office because I need reminding that the average glass of wine nowadays contains 2.5 units. How many people know that?

There is no question but that we did not achieve all we wanted to on health inequalities under the previous Labour Government, but we did make progress, and I hope that the Minister will acknowledge that. Drilling down into the overall figures shows that we made progress in specific areas, and the Minister acknowledged during a speech to a fitness industry conference in London that the previous Government were indeed firmly committed to reducing health inequalities. As colleagues have said, and as the North East Public Health Observatory tells us, the health of people in the north-east generally is worse than that of people in England as a whole, and that is largely to do with the social determinants I referred to earlier, and also the region’s industrial legacy.

I now want to talk specifically about tobacco. Work in this area is an example of good practice and partnership, but it is the sort of public health work that is potentially threatened by some of the changes the Government are bringing forward. Smoking remains the major cause of premature death and disease in the north-east, killing more than 5,000 people a year. It costs the region £174 million, the NHS £104 million—£35 million through passive smoking—and businesses £34 million in absence days alone. The average age at which people start smoking in the north-east is 15. The region has historically had the highest smoking rate in England, but, as we have heard, the rate has come right down due to the activity of Fresh.

Fresh has won all sorts of awards, including the gold medal in the inaugural chief medical officer’s public health awards, and it delivers work across eight key strands, but it is concerned about the changes in public health that are coming forward. It is currently funded on an annual subscription basis by all 12 north-east PCTs, and the PCTs are worried about what will happen when they finally fold. I understand that discussions are under way to secure the continued commissioning of the Fresh programme by local authorities. Is the Minister aware of those discussions? Can she update the House on what progress has been made to secure funding for this important and successful initiative, which is leading the nation?

Fresh is also concerned about the loss of the regional tier of tobacco control programmes in England as a whole, and the advent of the localism agenda might make it more difficult for local authorities to co-ordinate, and to attack some of the public health issues. How will the Government ensure that all local authorities prioritise tobacco issues? How does the Minister plan to ensure that there is no fragmentation or duplication of resources and efforts when the PCTs go? How will she ensure that localities work together to achieve economies of scale and have a population-level impact, as we have seen happen so successfully with Fresh? Can the Minister tell the House today when the new tobacco marketing strategy will be published? Will the Government ensure that there is a clear focus on tobacco?

Alcohol is another major cause of health inequalities in the north-east. We know that generally the affluent tend to consume the most, but for a variety of reasons the health effects of disproportionate alcohol consumption are felt most keenly among the poorest, and in areas such as the north-east. We also know that although in a recession levels of drinking tend to level off, among young people they go up, and we are seeing evidence that levels of self-harm are going up among young people. Alcohol is therefore a worrying issue, not just because of the physical health issues, but in relation to mental health and public order. The north-east continues to have the highest rate of alcohol-related hospital admissions, and in the past nine years alcohol-related liver disease has increased, sadly, by 400% among 30 to 34-year-olds, which is the highest rate in the country. I want, therefore, to know from the Minister about the Government’s alcohol strategy. Is she content that the constituents of my hon. Friend can buy two litres of cider for £1.34? That is less than the cost of an equivalent quantity of a soft drink.

On my recent visit to the region, I found that availability was a genuine concern, with alcohol available 24/7 and many off-licences centred in the more deprived areas. I see that in Hackney; we have more off-licences and bookies than shops where we can buy fresh food.

[Guy Opperman]

Will the shadow Minister give way?

[Ms Abbott]

I would love to, normally, but I have to try to get through my speech so that we can hear from the Minister.

Last September, the leader of Newcastle city council, Nick Forbes, amended a motion calling for the introduction of a minimum price for alcohol. He made the motion more comprehensive, calling for a wider range of measures to address the availability of alcohol. They included more powers for the council to refuse or withdraw licensing applications, following a report last year that linked under-age drinking to areas with a high density of licensed premises. Nick Forbes said:

“Figures show that alcohol is being sold for pocket money prices in Newcastle. Cider is available for 16p a unit…Most pubs back the idea of a minimum price for alcohol, as it would only affect the loss-leading deals offered by some supermarkets and wouldn’t have any impact on the price of a pint. It’s a controversial step, but there’s evidence that more and more people are ‘pre-loading’—downing cheap spirits at home before going out on the town. Minimum pricing would reduce this, and thereby reduce the overall figures for anti-social behaviour and hospital admissions”.

What decisions are being made at a national level to support local leaders such as Nick Forbes, who are committed to reducing health inequalities overall, and are taking strong action on issues such as alcohol?

The figures show that NHS North East has been told to set aside £143,350,133 to pay for the Government’s plans over the next two years. The NHS operating framework published in November requires health trusts to set aside 2% of their budget to pay for the Health Secretary’s changes in the Health and Social Care Bill. County Durham PCT has to set aside the greatest amount, followed by Sunderland and Northumberland. It is wrong to force local health trusts to set aside money to pay for bureaucracy and redundancies, when patients in the north-east, and constituents up and down the country, are waiting longer for treatment.

The Minister will know that the Heath Committee, chaired by not just a Tory Member of Parliament but a distinguished former Health Minister, the right hon. Member for Charnwood (Mr Dorrell), has raised a number of concerns about public health. It is concerned about whether the so-called responsibility deals can help alcohol and obesity problems, and about whether the health premium will just involve money going to people in regions where they are managing to tackle the problems, perhaps because they do not have the underlying social and class issues of other regions, at the expense of regions with genuine problems. The Health Committee also raised concerns about the closure of public health observatories in regions including the north-east.

What we are debating is not just a matter for the north-east. The underlying social issues apply to the health service all over the country. Even the north-east, with all the challenges posed by its industrial past, has examples of excellence and of path-breaking partnership work. We want an assurance from the Minister that the proposed changes—the confusion, chaos and cuts—will not hold back that work, and that she will not confine herself to discussing Labour’s record in general terms but will address the issues that affect the day-to-day lives, life expectancy and life chances of millions of people throughout the country, including in the north-east.

Care of the Dying

Diane Abbott Excerpts

Tuesday 17th January 2012 Westminster Hall

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

First, I congratulate the hon. Member for Enfield, Southgate (Mr Burrowes) on securing the debate. We have lived through an era when MPs have been seen as irrelevant, not to say venal, and when Parliament has been seen as remote. However, increasingly, in this Parliament, we have found that we are seriously debating issues at the centre of current political debate. The present debate is one of them. I want to touch on policy issues that relate to palliative care and to say a little about assisted dying, but I will begin by saying that in a busy, urban 21st century society people seem increasingly reluctant to talk about death or even to face the possibility of death.

At the risk of generalising, I will mention that, as many hon. Members know, my family come from rural Jamaica. In such rural communities, people make a point of talking about death. People stay up all night with bereaved families, night after night. That may seem strange to some, but it is a way of saying, “Death is a reality, and we will support you through it. Your community is here for you.” In a way, the rather hurried, perfunctory and frightened way that we deal with death in modern urban Britain is not necessarily an advance on the way people deal with it in rural communities around the world.

End-of-life care is of course an important issue, not just because death will come to us all, but because it is a major issue for the NHS. It represents billions of pounds of NHS spending—a fifth of NHS costs and a total of £20 billion altogether. Yet, as hon. Members have said, whereas most people would prefer to die at home, most do not have that privilege. It has been a concern of successive Governments to find out how we can give people the range of choice that they want for end-of-life care and how we can improve the level and type of care that is available.

Among the published reports on the issue, the King’s Fund report identified improving the primary care management of end-of-life care as one of the top 10 priorities for new commissioners. We have heard about the unevenness of funding of hospices and end-of-life care, even within the same part of the country, so I should like to ask the Minister whether it is the Department of Health’s view that end-of-life care should be a national priority and how she proposes to deal with the considerable variation in quality, efficiency and funding. What is the Department doing to ensure that the NHS can support the voluntary sector hospices and other specialist palliative care providers? Can the Minister give the House some reassurance that the Government’s proposed commissioning arrangements in the Health and Social Care Bill, which is being considered in the other place, will ensure that there is planned 24/7 provision of community support, including care co-ordination, nursing and symptom control?

As I have said, we know that most people would prefer to end their life at home, but most cannot. We also know that half of all complaints to the NHS involve criticism of the circumstances in which someone died. Often the time when a relative is dying is one of the rare occasions when a whole family come together and perhaps watch the process minute by minute. Therefore, a focus on and concern with end-of-life care comes to us all, and we will all have a view on it. The Minister will be aware of the Demos report, “Dying for Change”. Demos made a number of recommendations and said:

“Unless we can devise ways to get people to talk about how they want to live while they are dying, our efforts to improve services will be like groping in the dark.”

That is a reminder of the need to talk about and face death and to say, while still well enough to give an unconstrained opinion, how we want things to happen. Demos referred to training in palliative care and the important question of linking hospices to groups of care homes, so that hospice skills and values can migrate to care homes. It said that services need to be commissioned in an integrated way. The Minister will also be aware of Age UK’s public policy proposals on those issues.

The House would expect me to say a word about Labour’s record. Under the previous Labour Government, the NHS end-of-life care strategy was launched in 2008. It covered all adults with advanced progressive illnesses and care in all settings. The 10-year strategy was backed by an extra £268 million. There is no question but that progress was made, as I am sure that the Minister will acknowledge. The number of staff using models of care specifically designed for the end of life rose. Those models are now used by 75% of GP practices and hospices and 85% of acute hospitals.

Is the Minister aware that the King’s Fund has warned of the dangers of losing momentum in the drive to improve end-of-life care? Is she also aware of the report of Dr Rachael Addicott, “Implementing the End of Life Care Strategy: lessons for good practice”? Dr Addicott expresses concern

“that the decision not to hold a review until 2013 risks losing momentum and missing the opportunity to build on the progress already made.”

I have been fortunate, as a Hackney MP, to have a close relationship with St Joseph’s hospice, which was set up in 1900 by five Sisters of Charity and is the place where, in the 1950s, Cicely Saunders developed the principles of modern hospice care. My respect for the men and women who run hospices cannot be bettered by anyone in the Chamber today.

As for assisted suicide, I do not want to take a position one way or another. I have great respect for colleagues who advance the case for it and for people in the media who earnestly want to be able to decide how and where they end their lives. However, I have represented a busy, kaleidoscopic urban constituency for 25 years. In Hackney, the best of life and the worst of life can be seen—and the best and the worst of people. I have seen what fantastic support families can give, even when the state lets people down; but in a tiny fraction of cases, I have seen how venal families can be.

My concern about assisted dying would be for that tiny handful of cases involving elderly people who did not want to be a burden—and how many times have hon. Members sat in advice sessions and heard elderly people say that? I would worry about the cases—tiny in number, but still representing the lives of actual people—in which, if we were to provide a legal framework to make assisted dying possible, such people might feel almost an obligation to move forward. I stress to the House that that is a personal view. It comes, as I have said, from seeing the best of people, but also the worst of people, in more than 20 years of being a Member of Parliament.

End-of-life care is one of those issues that is at the centre of people’s debate and concern, because death comes to us all. Advances have been made in recent times, partly through what has happened in the voluntary sector—in hospices all over the country, such as St Joseph’s, which is a wonderful hospice—and partly through conscious Government policy. I am interested in what the Minister has to say on policy going forward.

Oral Answers to Questions

Diane Abbott Excerpts

Tuesday 10th January 2012 Commons Chamber

[Mr Lansley]

I am grateful to my hon. Friend. I not only laid before the House a written statement this morning, but will, with permission, make a statement on the subject tomorrow. We have been very clear about the support the NHS will give to women who have had implants through the NHS, and we expect private companies to do the same. Not all will do so, and to that extent I make it clear that the NHS is there to support women in their clinical needs, whatever their circumstances.

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

The Secretary of State will be aware that thousands of women are worried and frightened about this issue. The statements he has made are welcome, but what practical help can he offer women whose private providers have not yet committed to offering free replacements?

[Mr Lansley]

This is important, as the hon. Lady says. All the way through we have wanted to be absolutely clear that any woman who is worried should be able to go to her general practitioner. The NHS is there to support any women in their clinical needs, whatever their circumstances. I have made it clear that I expect private providers to match the NHS support through information and access to specialist advice, imaging and investigation, as necessary, and through the removal of implants if it is decided that that is necessary. If private providers will not do that, let me be clear, as I will explain further tomorrow, that the NHS remains available to support women in their clinical needs.

Epilepsy

Diane Abbott Excerpts

Tuesday 29th November 2011 Westminster Hall

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

It is a pleasure to serve under your chairmanship, Mr Scott. I congratulate the hon. Member for Birmingham, Selly Oak (Steve McCabe) on securing this important debate.

I am epileptic. I have nocturnal epilepsy. I have tonic-clonic seizures, which, as the hon. Gentleman explained, are the severest form of epilepsy and the form that we all associate with the condition. I am, at least for another fortnight, between the ages of 20 and 35. I am single and, for the avoidance of doubt, I should make it clear that I sleep alone. I am also male, for the avoidance of any further doubt, and it might surprise people outside this Chamber to learn that I work long hours in a stressful occupation—at least I think it is stressful. I therefore tick every box for being at risk of sudden unexpected death due to epilepsy. I go to bed every night knowing that there is an infinitesimally small chance that I might not wake up again. That is, of course, a great concern.

I realise that anyone with epilepsy has a 24 times greater chance of sudden death than the normal population. Those particularly at risk of SUDEP are 23 times more likely again to experience sudden death. That understandably preys on the mind, but what concerns me more than anything else is the fact that I did not learn of all the risks at the time of my diagnosis; I discovered them because I happened to Google my condition. I sat at my computer with a chill going over me, thinking, “My goodness, I never knew any of this could possibly occur.”

I know that that is a wider concern from meeting many people, including a constituent of mine, Avril Walker, who lost her son Christopher to SUDEP when he was aged 19. I have also met many families through Epilepsy Bereaved and Jane Hanna. They all say the same: they have a sense of anguish at the loss of a loved one, which is natural and entirely understandable, but many of them have a much greater sense of frustration that at the time of diagnosis no one explained the risks of SUDEP to them. If they had known, they could at least have sought to undertake mitigating activities to reduce their risk.

I know what those activities can involve. Before my diagnosis, when my epilepsy was not controlled, I managed to throw myself down the stairs. I woke up with my head in a fridge, a washing machine and an oven, which thankfully was not turned on. I threw myself out of bed and hit my head on my bedside cabinet, making a large gash only just above my eye. When I went to accident and emergency, I was told, “Oh, you’ve just been drinking too much.” The irony, of course, is that the treatment for my epilepsy involves the avoidance of any alcohol. That is what makes it so difficult to control: if any alcohol is used in any food that I inadvertently eat, I will have a seizure in the night.

Thankfully, I adhere to my medicine. The diagnosis is so important because there is no greater impetus to adhere to medication than the knowledge of what might happen if one does not. The most sacrosanct thing in my life is ensuring that I have my medicine. I live what is essentially a double life—I am down here half the week and up in Blackpool the other half—so it can be quite difficult to ensure that I have the little packet of pills that I usually carry around with me. If I am without them, panic ensues and I have to rush down to the Victoria walk-in centre to get an extra prescription. May I complain to the Government about its being shut in a month’s time?

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

I am listening with great interest to the hon. Gentleman’s personal experience; our debates are always enhanced by such contributions. Does he think that there is any particular reason why doctors are unwilling to tell people diagnosed with epilepsy about the risk of sudden death?

[Paul Maynard]

I thank the hon. Lady for that pertinent intervention. I was intending to come to that. I think that all doctors dislike dispensing bad news. It is perhaps the least fulfilling part of the job. I am sure that some of the doctors to whom I have spoken think that the moment of diagnosis is not necessarily the appropriate moment for a detailed discussion starting, “Oh, and by the way, you’re 23 times more likely to die now, so you need to do this, this and this.” However, it underlines the importance of epilepsy specialist nurses, who can have a more structured conversation one or two weeks later, after people have got over the shock of the diagnosis.

The diagnosis is a shock. When I was diagnosed in my early 20s, I had no idea when I went to the doctor’s that morning that he would tell me that I had epilepsy. I was stunned by the news. That might not have been the most appropriate time to say, “And by the way, you’ve got all this to deal with as well.” None the less, it is vital that that structured conversation occurs at some point soon after diagnosis, because it is possible to do things to mitigate the condition, even if it is just blunting the sharp corners of one’s bedside cabinet, lowering the height of the bed or fitting a child gate above the stairs. If one knows what is likely to occur, one can at least try to mitigate it.

It also underlines the dramatic importance of adhering to medication. Many of the young people who are most susceptible live what one might call chaotic lives. They do not always pick up their medication. If they are away at university, they are not under parental control and one cannot monitor their medicinal intake precisely. If they are aware of the risks, a degree of self-discipline might be brought into play to ensure that they stick to their medication regime. I have heard time and again that sudden deaths seem to occur particularly in a university setting. That concerns me. Self-discipline is necessary as early as possible, and the diagnosis and explanation process are fundamental.

When the worst occurs—tragically, it will occur, because one can never iron out the risks entirely—a much better post-death process is needed. It is natural for the family to be shocked, particularly if they were not expecting it and had not been made aware of the risk factors. There is a lack of awareness in the coroner service and among the police. There can be nothing worse than finding one’s child’s bedroom turned into a crime scene because police are not aware of the potential for sudden death from epilepsy. All that could be much better handled with instructions from on high. The coroner service in particular needs to make a list of national charities dealing with sudden death to which families can turn for help. That would be of great assistance, because many people simply do not know where to turn.

I beg the Minister to encourage the medical profession to ensure that some medical professional has a conversation either at diagnosis, if they feel it appropriate, or within a fortnight or so, to explain the risks. That alone would make a difference, rather than a conspiracy of silence that leaves those with epilepsy to find out about it for themselves. If that conversation occurs, at least people can try to take the actions necessary to protect themselves. That would make the most difference.

--- Later in debate ---

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

It is a pleasure to serve under your chairmanship for the first time, Mr Scott. I congratulate my hon. Friend the Member for Birmingham, Selly Oak (Steve McCabe) on securing this debate and on the work that he and the all-party group on epilepsy are doing to spread awareness in Parliament of the nature of epilepsy and to raise the profile of epilepsy and its related problems.

As we have heard, epilepsy currently affects almost 500,000 people in the UK. It is one of those conditions that, I think, excite a certain fear among people who are not familiar with it. One of the important aspects of the all-party group’s work is to get past that fear barrier, so that people understand and the climate is created in which services can be commissioned properly.

We have heard about the danger of sudden unexpected death in epilepsy and that it affects the younger age demographic in particular. I understand that an information resource has been issued in Wales and Scotland on the risks and prevention of SUDEP. Is such a resource currently available in England?

Certain factors can increase the risk of SUDEP, and hon. Members have referred to them, drawing on their personal experience. The total number of people dying needlessly of epilepsy each and every year is more than the total of AIDS-related deaths and cot deaths combined, yet for some reason SUDEP deaths have never had the same prominence in the public imagination and public debate as issues such as cot death and AIDS. It is also most unfortunate that the death rate in Britain for SUDEP is 25% higher than the average for the European Union. This is a difficult topic and I understand that doctors may have a certain reticence about discussing the risk with young people at the point of diagnosis, but if our death rate is 25% higher than that of the EU, it shows that more can be done.

A straightforward and important suggestion has been made that medical practitioners should be required to have that discussion with people soon after diagnosis. As we have heard, it is young people between the ages of 16 and 35 who are at greatest risk. That is the age, certainly if my life between 16 and 35 is any example, at which people are least inclined to listen, behave sensibly or take advice. That makes it doubly important that there is a formal requirement for a medical practitioner to sit with young people and explain exactly what the risks are.

In preparing for this debate, I looked at the National Institute for Health and Clinical Excellence guidelines on epilepsy. They recommend that all people with suspected epilepsy should be seen by a specialist, but I understand that half of acute trusts—49%—do not employ one. NICE guidelines also state that people with suspected epilepsy should be seen urgently within two weeks, but I understand that the waiting lists of most trusts—more than 90%—are longer than that. Will the Minister comment on what action his Department is taking to ensure that people diagnosed with epilepsy are seen more promptly in the future?

A further recommendation from NICE relates to epilepsy specialist nurses. NICE guidelines state that they should be an integral part of the medical team providing care to people with epilepsy, but more than half of acute trusts and PCTs in England do not have one. How will the Minister ensure that trusts in England and, of course, clinical commissioning groups use NICE guidelines to plan and commission epilepsy services? Will the Department of Health agree to treat the matter as a priority and put an end to the current situation, where people with epilepsy continue not only to have a poorer quality of life, but to face a greater risk of dying? As I have said, there is a 25% higher death rate here than in the rest of the European Union.

We know and respect the fact that the Prime Minister has personally pledged to raise the profile of epilepsy and to tackle the stigma that surrounds the condition, to which I referred earlier. I understand that the Prime Minister has met my hon. Friend the Member for Walsall South (Valerie Vaz) to discuss her ten-minute rule Bill on epilepsy. We know from the Epilepsy Society that, during the meeting, the Prime Minister agreed to consider the Bill and look at improving health and education services for people with the condition. In a letter to Lord Howe dated 16 May 2011, the Prime Minister acknowledged that

“there are historic weaknesses in the commissioning of services”

and that there is an urgency for change

“because these failures carry huge costs as well as having a massive impact on the lives of people with epilepsy”.

The Prime Minister concluded that there are

“potentially very significant savings from unplanned emergency admissions to be made by getting this right, which goes hand-in-hand with improvements in outcomes, including life expectancy and a reduction in the number of tragic sudden deaths in epilepsy”.

Labour Members respect the Prime Minister’s genuine concern about this condition, but I think the Minister would agree that we need to move on to action. The Epilepsy Society was very encouraged by what the Prime Minister had to say. He said that he would get back to Epilepsy Action but, to this day, he has not made any specific commitments. Does the Minister know whether the Prime Minister has had a chance to consider the points put to him by my hon. Friend the Member for Walsall South, representatives of the Joint Epilepsy Council and the hon. Member for South Thanet (Laura Sandys), who chairs the all-party group on epilepsy?

The Minister will also be aware that, during the last year of the Labour Government, the Joint Epilepsy Council won the support of the then Health Minister, Ann Keen, who so recently suffered a sad bereavement. She initiated a conference of epilepsy commissioners, which took place in January 2010. That was branded as jointly organised by the Department of Health and the Joint Epilepsy Council—a true partnership. Will the Minister tell hon. Members what discussions he and his colleagues have had with stakeholders and whether he is working with the Joint Epilepsy Council to address the shortfalls in service provision for people with epilepsy in England?

As I am sure that the Minister is aware, Epilepsy Action has carried out a study that revealed the variations in service provision, data collection, evaluation and quality of care. In the course of its study, it became apparent how many of NICE’s recommendations are still not being met, particularly in terms of access to specialist consultants and nurses, as I said earlier. Taken together, the facts from the survey do not paint a picture that is wholly encouraging. Some epilepsy sufferers and their families feel that it is a forgotten condition, which is why this debate is so important.

As the Minister will be aware, Epilepsy Action has called on the Government to take a lead in driving improvements to epilepsy service provision. Among other things, Epilepsy Action is calling for a national clinical director for epilepsy to ensure that local commissioners carry out a review of the implementation of the NICE guidelines, NHS work force planning to focus on the recruitment and training of sufficient epilepsy specialist consultants and nurses, commissioners to build a clearer picture of the epilepsy population in their area, a commitment to ensuring that all patients with suspected epilepsy see a specialist within two weeks, all acute trusts to have adequate diagnosis equipment in line with the patient population they serve and all patients to receive an annual review of their epilepsy. That would particularly help younger patients, who would be reminded, if they have forgotten, of the seriousness of their condition and of the things that they should be doing to help themselves.

Epilepsy Action is also calling for the introduction of effective transition services for children moving into adult epilepsy. Again, that is particularly important to the younger cohort. Finally, Epilepsy Action wants the Minister to consider ensuring that all patients with epilepsy who want a comprehensive care plan can get one. The Minister will be aware of those recommendations, and hon. Members want to hear how he plans to respond.

As I said at the beginning of my remarks, this condition excites a certain fear and, even today in 2011, a touch of stigma. Particularly for younger people—I consider people under the age of 35 to be young—the condition poses a risk of sudden death. That risk is higher than in other European countries, which suggests that there is something we can do. We know—the whole House knows—that the health service is going through a period of transition and change. I will not use this debate to challenge the changes that are going to happen, but because we are going through a period of change, it is very important that the measures are in place to ensure that the care people receive for such a condition is as good as it has ever been, particularly in relation to commissioning services locally. It is also important that we move forward with the improvements and pay attention to the quality of life of epilepsy sufferers that people campaigning on epilepsy have sought for many years. I await with interest the Minister’s response to the points that I have raised.

--- Later in debate ---

[Paul Burstow]

I hope to do just that, and I hope to do justice to the points that the hon. Gentleman and other hon. Members made in the debate.

At least one hon. Member—my hon. Friend the Member for Blackpool North and Cleveleys (Paul Maynard), who initiated the debate we had about a year ago—has contributed to the debate on this issue again. The message I took from last year’s debate was clear, and I take it again today. There is a real sense that we need change in the system. We need change that delivers a real focus on issues such as epilepsy to ensure that clinicians and the service respond properly to the evidence, act on the evidence, and translate it into services that are fit for purpose. At the moment, the service continues to fail hundreds of thousands of people living with epilepsy, at a huge cost to them personally and to their families. When we debated these issues a year ago, there was some uncertainty about how the Government’s plans for reform would deliver improvements. I would like to spend a little time today setting some of them out.

[Ms Abbott]

Will the Minister give way?

[Paul Burstow]

In a moment, if I may. We have plenty of time. I just want to say something about the voluntary sector, and then I will happily give way to the hon. Lady.

The outlook for most patients with epilepsy is good—it is important to acknowledge that—but we know that more than 1,000 people die of epilepsy-related causes each year. Many of those deaths are due to accidents or status epilepticus, but a significant number of them are attributable to SUDEP—sudden unexpected death in epilepsy. The devastating effect of any epilepsy death cannot be overestimated and cannot be understated. I pay tribute to the many voluntary sector organisations that have been referred to in this debate. They work hard to highlight the challenge, and to ensure that the failings that have been described are identified and tackled.

[Ms Abbott]

In preparing for the debate, I was struck by how much higher our rate of sudden unexpected death in epilepsy is, compared with that in the rest of Europe. Do Ministers have any analysis of why that might be?

[Paul Burstow]

I will come on to outcomes and information in a moment. Understanding the performance of our health economies, compared with that of other systems around the world, is an important part of how to ensure that we focus on what matters most to deliver change and improvement. I will talk about outcomes, data and variation in a moment, if I may.

I particularly want to acknowledge the work of Epilepsy Bereaved, which since its foundation in 1995 has led cutting-edge work to establish major risk factors and ways to reduce risks and prevent deaths. The charity provides very well-regarded bereavement support, which helps to break the isolation that people experience following SUDEP, or other seizure-related deaths. I acknowledge the organisation’s concerns that failings in care and the commissioning of services have led to many avoidable deaths from SUDEP.

In the 12 months since we last debated epilepsy services in Westminster Hall, we have made significant strides in putting in place the necessary arrangements to level the playing field in commissioning epilepsy services relative to other services.

That leads me on to the NHS outcomes framework. The hon. Member for Hackney North and Stoke Newington referred to the NICE guidelines and the role of specialists. One role that the NHS outcomes framework can play is to ensure that commissioners, providers and others are better able to identify those things that can drive up performance in the NHS. The publication of the first NHS outcomes framework marks the start of a journey for greater transparency and accountability for the outcomes that the NHS achieves for patients. It demonstrates a move from traditional input and output targets towards a focus on delivering better health outcomes for all. The framework includes a focused set of national outcome goals and supporting indicators that patients, the public and Parliament will be able to use to judge the overall progress of the NHS. A number of those goals and indicators are relevant to epilepsy. They will, of course, inform the Secretary of State’s mandate to the NHS commissioning board and, in turn, to the NHS commissioning framework.

Let me give a few examples of the relevant indicators. In domain 1 of the NHS outcomes framework—preventing people from dying prematurely—the overarching indicator is about mortality from causes considered amenable to health care. This debate demonstrates graphically that epilepsy is one of the conditions where there is plenty of room for significant progress. The hon. Member for Hackney North and Stoke Newington rehearsed the statistics, which are compelling. They point, very powerfully, to commissioners having to look at this if they are to deliver measurable improvement against that indicator.

Domain 2, enhancing quality of life for people with long-term conditions, speaks directly to the issues addressed in this debate. The overarching indicator is health-related quality of life for people with long-term conditions. It addresses such specific issues as the proportion of people feeling supported to manage their conditions. That speaks directly to issues such as care planning and case management. That indicator is not just in the NHS outcomes framework; it also sits within the adult social care outcomes framework, to try to align more joined-up thinking and commissioning on these issues. Improving functional ability in people with long-term conditions relates to ensuring that more people are able to stay in employment.

There are many other indicators. The aim of domain 3 —helping people to recover from episodes of ill health or following injury—is to capture information on patients’ journeys through the system. Domain 4—positive experiences of health care—will look at such things as patients’ experiences of primary care. My hon. Friend the Member for Blackpool North and Cleveleys described the conversations that should happen, and they should be captured.

The emerging commissioning landscape will contribute to improving not just epilepsy outcomes but outcomes across the board. In the past, commissioning has been too remote from the patients it is intended to serve. Commissioning decisions made by clinical commissioning groups will ensure that they are underpinned by clinical insight and knowledge of local health care needs, and, importantly, the perspective of the patient and family carers. Clinical commissioning at its best is a collaboration of professionals. The NHS commissioning board and clinical commissioning groups will be required to obtain clinical advice from a broad range of professionals with expertise in the

“prevention, diagnosis or treatment of illness”—

and in the—

“protection or improvement of public health”.

There is a real pull in the framework that we are putting in place to make sure that that happens. As well as promoting effective clinical leadership and multi-professional collaboration around specific conditions and pathways, we expect doctors, nurses and other professionals to come together in clinical senates to give expert advice from a variety of health and social care perspectives.

NICE has rightly been alluded to a lot. The Government intend to build on its strong track record by re-establishing it as a statutory body. It will continue to play a key role in the NHS through the production of robust, evidence-based advice and quality standards. I will address the issue of quality standards specifically. The hon. Member for Birmingham, Selly Oak asked about surgical interventions in the context of the work being done to produce quality standards covering epilepsy services. They have already been commissioned by NICE and will cover children and adults separately. I will pass on the point that was made about the need to address issues of transition, so that that is not overlooked in producing two separate quality standards. In the children’s quality standard, there is a specific need to address access to surgical interventions, and it will be addressed.

HealthWatch has its part to play, and will better enable people to help shape health and social care services, at both a local and national level, by providing a strong forum where the views and experiences of patients, carers and the public can influence the commissioning process and improve the quality of health and social care services. There must be a clearer split of responsibility—a sense of joined-up access across the care pathway to deliver a less fragmented and more person-centred approach to planning. We accept that care and support for those with long-term conditions is a particular area where we do not get it right often enough. Not only are patients confused but their care and quality of life are compromised, and it leads to inefficiencies and duplications in the system.

The hon. Member for Birmingham, Selly Oak asked me specifically about prisoner health. One of the opportunities that arises from the establishment of the NHS Commissioning Board is that it will be the commissioner of prisoner health. With it leading on such work, we are in a much better place to assure ourselves that the NICE guidance on prisoner health and epilepsy is properly and consistently applied throughout the prison estate. I shall certainly pass on any further information that I can to the hon. Gentleman.

[Ms Abbott]

I have listened with great attention to the Minister and, naturally enough, he has started with generalities, but the nature of Westminster Hall debates lies in the opportunity for Members to get replies to specifics, so I have three questions arising from the speeches today. First, do the Government intend to appoint a national clinical director for epilepsy? The hon. Member for Blackpool North and Cleveleys (Paul Maynard) asked specifically about people being able to talk about sudden unexpected death within a couple of weeks of diagnosis, but am I to take it that the Minister has no means to direct that and will leave it to commissioning groups to decide what is appropriate? Finally, are the Government prepared to commit to the explicit inclusion of epilepsy mortality in the outcomes frameworks?

[Paul Burstow]

The hon. Lady needs to be patient, because I still have quite a lot of sheets of paper and quite a lot of answers to give. Before I took her intervention, I had answered a specific question on prisoner health from the hon. Member for Birmingham, Selly Oak. I am trying my best to cover the ground.

I will deal with the national clinical director proposition. As part of the transition—the hon. Lady alluded to this—from a command-and-control system in which the NHS is directed from the Department of Health to a model in which the service is at arm’s length and directed through goals and objectives set to a mandate, the NHS commissioning board will be where national clinical directors sit. The national commissioning board will make the decisions on the precise configuration of those appointments. Clearly, that will be modelled on the approach taken on an outcomes framework, so that there is proper coverage of all its domains. That is as much as I can say today, and perhaps we need to have a further debate, but if she wants more information, I will happily write to her with more detail. I cannot say today, however, that there will be a DH-appointed epilepsy national clinical director, because that is the old world and we are moving to a new world, whether we agree about that or not, and in that new world the responsibility for making choices about the appointment of national clinical directors will sit with the NHS commissioning board. That is as clear an answer as I can give to her question. I will answer the others as we move on.

Assessment of need was mentioned in the debate and goes to the heart of a challenge for the charities. My experience over the past 12 months of talking to many non-governmental organisations that advocate on behalf of patient groups is that some see huge opportunities in reorganising themselves to get much closer to the new commissioners and to those who will shape priorities for local services at a local level, and they are looking to organise themselves accordingly. Others are finding it more difficult to think through how to organise themselves to do that, and are therefore looking to how they can use the old levers, encouraging the Department of Health to proceed through central fiat and direction. My job is to say that that is not how it will work and, if they expect that that is how things will happen, they will be sadly disappointed. The Department and I as a Minister are only too pleased to work with organisations to ensure that they can realise and exploit the full potential of the new arrangements such as the health and wellbeing boards, the clinical commissioning groups and their duty to engage with their public, their patients and carers. Organisations, including some of the epilepsy charities, need to think that through carefully.

Health and wellbeing boards will be the local system leaders and will drive joined-up health and social care services. They have a key role, with joint strategic needs assessment and joint health and well-being strategies, in which they understand the population need and future population need, and that in turn drives commissioning for populations and outcomes. Simply said, to ensure that those joint strategic needs assessments are rich and informed, charities in the sector have a part to play in the conversation, to ensure that their input is not lost. NICE clinical guidance and quality standards play their part as well.

The hon. Member for Birmingham, Selly Oak asked about research. Who could disagree—I certainly do not—that the case for more research is strong? Again, however, directing more research through ministerial instruction is not how we should proceed. That might get more research but it does not guarantee quality, which is why we have for a long time had the Medical Research Council leading, with independent peer review as the process for allocating research resources. As in many other spheres, the key is to ensure the crucial infrastructure to support quality bids in the first place—the better the quality, the better the chances of an increase in the resources. We saw that with dementia; the Government had a priority to invest more but did not achieve that simply by putting up a quantum and stating that “This is what we must now spend.” Simply, it is about putting in place the steps to ensure quality research bids in the first place.

The information revolution is another important part of delivering the agenda. Today’s challenge in providing high-quality care services cannot be met without effective use of information. At present, many people who use our health and care services do not get the information that they need and expect as part of the care process, which we have heard described graphically. We sometimes fail to meet the information needs of our clinicians and care professionals, so information is critical to our ambition to put people in the driving seat of their services and their care. Through the work of the NHS Future Forum so far, we are examining how to ensure that the information strategy that will be published fully reflects the various concerns expressed.

The hon. Member for Hackney North and Stoke Newington asked a specific question about whether the information provided in Scotland and Wales is available. The answer is yes. There are comprehensive information sources available on NHS Choices, including a guide to epilepsy that contains information about SUDEP and minimising risk. The use of things such as NHS information prescriptions and, as we develop more of them, tools to help patients and clinicians make decisions are ways of further strengthening that important notion of “no decision about me without me”.

The hon. Member for Newport West (Paul Flynn) talked about his constituents Gwyn and Gill Thomas, the tragic death of their daughter from SUDEP and how they felt bewildered and, I suspect, outraged that they did not get information on which they could have acted at the time. That has spurred them on, and we can probably find echoes of that in every constituency surgery throughout the country—people motivated by personal experience to ensure that it happens to no one else. The hon. Gentleman’s example of the case of Christina and the lack of knowledge of risk underscored the as-ever exceptional contribution of my hon. Friend the Member for Blackpool North and Cleveleys to today’s debate. By talking about his own experience, he illuminates a much wider and more important picture about the frailty of human beings and their reluctance sometimes, even when professionally trained, to engage in the conversation that they are paid to have, which ultimately is a conversation about life or death. We know that NICE has set out clear guidance on care planning and case management, which provides good evidence of how they can make a difference.

The guidance also talks about the role of epilepsy nurses, and the hon. Member for Hackney North and Stoke Newington asked how the Department helps with their availability. One of the ways we help is by ensuring that good tools are available for local business cases to be put to commissioners locally. We do not mandate from the centre a certain number of such members of staff, but we make it clear through the regulatory framework and other ways that the skill and staff mix of organisations has to be appropriate to the services that they are providing. There is as well a strong economic case for epilepsy nurses to be commissioned, because of how they can have that honest conversation with the individual concerned.

Another way we can play our part at national level in raising the profile of these issues and making commissioners think through how they commission services effectively is through the development of outcome strategies. We have outcome strategies for respiratory and mental health conditions, and I recently announced the Government’s intention to develop a cross-Government outcome strategy for long-term conditions. The purpose of the strategy is to take a life-course approach. It will draw on the Government’s approach in developing our mental health strategy. Shaping it will involve a wide range of stakeholders beyond the Government.

The hon. Lady rightly rehearsed the Prime Minister’s enduring interest in these issues, which spans the whole health sphere. That is why he continues to pursue and to follow closely the key work of Health Ministers in taking forward the legislation to reform the NHS. I will inquire about the correspondence and find out what has happened about that.

Reference was made to the Joint Epilepsy Council and its activities. I applaud its work, but I must make it clear that the future of our public services is in a local rather than a national context. For the NHS, it is not about running commissioning services for specific conditions from the Department of Health; it is about local clinical commissioning groups working locally with patient groups and others better to understand local needs and to ensure that they structure services with those in mind.

--- Later in debate ---

[Paul Flynn]

rose—

[Ms Abbott]

rose—

[Paul Burstow]

I will give way to the hon. Gentleman while the hon. Lady frames her questions—she clearly has one or two—and I will then give way to her.

--- Later in debate ---

[Ms Abbott]

I have listened with great care to the Minister, who has been at pains to outline that we are moving from a world of command and control health provision to a world in which individual clinical commissioning groups will make decisions for their locality. Should the groups that are lobbying on epilepsy take from this debate a message that the days of lobbying at national level are effectively over, and that they must mobilise themselves to lobby commissioning group by commissioning group?

[Paul Burstow]

They must certainly be prepared to engage a lot more at local level. That is an important part of commissioning to fit the needs of postcodes rather than by prescribing from the centre and having postcode lotteries. It is not possible from so far away to be clear about the specific needs of a population. That is why the change is so important. However, the Department of Health expects and Ministers want to have a relationship with those organisations, because they can inform the shape of the mandate that the Secretary of State will set for the NHS. They can inform the way in which NHS outcomes framework, the adult social care outcomes framework and the public health outcomes framework operate, and their priorities. There will still be a rich conversation at national level about action, but there will be an even richer conversation about outcomes, performance and commissioning, which need to be local.

In conclusion, I am grateful to the hon. Member for Birmingham, Selly Oak for calling this debate and his perseverance in applying for it. He has rightly rehearsed a matter that has been neglected for too long. I believe that the Government’s changes, particularly our focus on outcomes and greater respect for clinical judgment at local level, will deliver improvements in services and quality of life, and indeed will save lives through improved commissioning at local level.

Oral Answers to Questions

Diane Abbott Excerpts

Tuesday 22nd November 2011 Commons Chamber

[Anne Milton]

My right hon. Friend the Secretary of State for Health has already agreed to meet some people. The hon. Gentleman is right to say that health inequalities are not just something faced by the urban poor and deprived; they are also an issue in rural areas. We must make sure that people have adequate access.

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

The Minister will be aware of the emphasis that Professor Michael Marmot places in his review of health inequalities—which I have read, so I can quote it—on

“giving every child the best start in life”,

on creating

“fair employment and good work for all”

and on reducing “inequalities in income”. Yet, under this Government, 90% of local councils will be forced to make cuts to Sure Start, unemployment continues to spiral—it is at a 17-year high—and, far from reducing income inequality, the House of Commons Library has calculated that an area such as mine in Hackney, which is one of the poorest in the country, will lose at least £9.6 million in cuts to housing benefit alone and a further £2.84 million through cuts to child tax credit. However desirable some of the organisational changes in public health are in principle, how can the Government possibly make progress on tackling health inequality in that context?

[Anne Milton]

How can the hon. Lady give Government Members lectures on health inequalities, given that those got worse under the previous Government? Life expectancy in Kensington and Chelsea is 85 whereas it is 74 in Blackpool, and that is after 13 years of a Labour Government. Family nurse partnerships have doubled and we are well on track to get the additional 4,200 health visitors. Through the public health Cabinet Sub-Committee we are determined to raise the standard of living for all, by providing new strategies on child poverty, social mobility, tax, pension retirement ages and so on. We are doing something, whereas the previous Government did nothing.

Obesity

Diane Abbott Excerpts

Wednesday 9th November 2011 Westminster Hall

[Dr Wollaston]

I thank the Minister for that helpful response and look forward to hearing the outcome of that.

Children at primary school and in the early years before they have reached school are among the really high-risk groups. Some 85% of obese children go on to become obese adults, whereas only 12% of normal weight children become obese adults, so it makes sense to focus on that group of children, but that can happen only if we have better early identification. We should introduce annual measurements of weight and height, so that we can see when children are starting to slip towards obesity. We should target our resources much better on that group.

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

Years ago, parents with chubby children would be told, “It’s puppy fat and they will grow out of it.” There is still that idea around among otherwise bright and responsible parents. We need to press the point that chubby children grow into chubby adults.

[Dr Wollaston]

I absolutely agree with the hon. Lady. We need to be much clearer with parents that their children are at risk and that being overweight is not something that they will grow out of.

We should be much more creative about how we target help to high-risk children. Why not allow all those children to have free healthy school lunches? As poverty and deprivation have such strong links with obesity, considering that high-risk group is particularly appropriate if we are to address the Marmot agenda. Unfortunately, families on tight budgets are much more likely to be pushed towards unhealthy and cheaper choices. If we want to nudge them in the right direction, we must recognise the role that price plays in the choices that they make. We should look at the role of loss leaders. We urgently need a change in what supermarkets offer so that loss leaders are redirected towards healthy rather than unhealthy products.

Why not incentivise exercise in those high-risk families with vouchers for success and free access to good-quality sports facilities? We should incentivise a whole-family approach to cooking skills because cooking is a fun activity. An effective way forward would be to make such a service free and readily available to whole families.

On liquid calories, a survey conducted by the British Dental Association and Ipsos-MORI showed that 47% of children’s fluid intake is in the form of sugary and carbonated drinks. That means that one in five children is consuming 500 calories or more a day just in the form of sugary drinks and 73%—nearly three-quarters of children—are consuming more than 200 calories a day. It is a staggering number of calories that children are consuming.

If we look at adults, we will see that there is a particular issue with alcohol. The chief medical officer has already highlighted that around 10% of an adult’s calorie intake can be through alcohol. What we should understand from that is the role that discounting plays. I have mentioned that before. It really does not matter how disciplined the rational part of our brain tries to be—the irrational and impulsive side will continue to be irrational and impulsive. It is not helpful to see heavily discounted products in super-sized multi-buy packs piled high at the check-outs in supermarkets. If we want to move “nudge” towards “shove”, we should regulate how supermarkets market their products. I do not suggest that the whole answer to obesity lies in regulating supermarkets. I realise that there is a complex interplay between over-supply, pricing, culture, marketing, poor consumer choices and human nature. There is also the interplay between genetic predisposition and a lack of exercise. However, it is unlikely that our current strategy will go far enough in this regard. If we are going to do something about the £5 billion a year that this problem is costing us—the figure is predicted to rise to £10 billion a year by 2050—I suggest and hope that the Minister takes a strong line and abandons the idea of giving the problem a little nudge, in favour of giving it an almighty shove.

--- Later in debate ---

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

It is a pleasure to serve under your chairmanship, Mrs Riordan. I congratulate the hon. Member for East Londonderry (Mr Campbell) on securing this important debate, to which we have all been glad to contribute. He reminds us of how many issues we have in common in these British Isles.

I want to focus on the important subject of child obesity, and to talk about the responses so far to the Government’s obesity strategy entitled “Healthy lives, healthy people: a call to action on obesity in England”, which was presented to both Houses on 13 October. First, however, I want to say that some people might feel that Members of Parliament have a certain temerity talking about healthy lifestyles when their own lifestyle is relatively unhealthy, and I speak as someone who has been in this House for 20 years. Perhaps we should give credit to the few colleagues we sometimes see going through the Division Lobby dressed in their running gear after a bracing run. I am sure that Members will unite with me in congratulating those rare Members on that.

We are facing a crisis in childhood obesity. As I said earlier, gone are the days when we could look at a chubby child and say that they would grow out of it: chubby children grow into obese adults. I have to say, more in sorrow than in anger, that a wide range of people both inside and outside this House have expressed doubt about the effectiveness of the Government’s obesity strategy. Before moving on to what I think the Government should be doing, let me focus on the picture in London.

London has higher levels of childhood obesity than any other British region. The capital’s childhood obesity rate is 22%, compared with an average for England as a whole of just 19%. Across the capital, one in five youngsters are obese, with rates varying widely from 12% in leafy Richmond to 28% in Westminster. Childhood obesity costs the capital £7.1 million a year to treat, and the annual bill could reach £111 million if today’s young people remain obese into adulthood.

Research commissioned by the Greater London assembly found that adult obesity costs London £883.6 million a year, and in my own constituency—Members will forgive me for mentioning it—a quarter of all year 6 pupils are obese. That is one of the highest rates in the country as recorded by the national child measurement programme. In 2010 in City and Hackney, 13% of children in reception year were overweight and 14% were obese. The number of overweight children was similar to the national average, but the proportion of obese children was slightly higher. Greater efforts are needed to prevent overweight and obesity at the pre-school stage, because a high proportion of children are already obese and overweight by the time they start school. The escalation of the trend through to year 6 suggests that we also need to implement robust interventions in primary schools.

A number of Members have talked about parental responsibilities. I put it to colleagues that some of the parents who are doing what we might understand as the wrong thing are, in their own minds, trying to be good and vigilant parents. One of the problems that young children in Hackney and the rest of London have is their sedentary lifestyle, and part of what motivates parents to keep their children indoors is this idea of stranger danger. We all know that attacks on children have not gone up in 20 years, but childhood obesity has spiralled. Many parents—not bad or careless ones—think that they are doing their children a service by keeping them indoors, safely watching television or playing on the PlayStation, rather than playing outside.

I was not the most sporty of children, unlike some of the Government Members who have contributed to the debate, but in the summer holidays my mother thought nothing of us having breakfast and then going out to play all day. We might have come in for lunch, or have gone to a friend’s and come back for tea. Nowadays, no London parent would allow their child to play out all day without knowing where they were, and it is that sort of vigilance and possibly unwarranted fear of stranger danger that leads to many thoughtful parents deciding, perhaps because they have not had the education or do not have the understanding, that they will feel better if their children are indoors rather than outside playing.

Let us also remember that in a big city such as London a greater proportion than ever of our children live in flats, maisonettes and other accommodation without a back garden. As a child, if I was not out, I spent most of the day in the back garden, on the swing, climbing trees and shouting at my brother, but many children in my constituency are trapped in flats and it is not obvious to their parents where they can be allowed to play safely.

[Andrew Bingham]

That is a good point. We talked briefly about video games. Does the hon. Lady think that the advent of Wii Fit-type games is beneficial? I have seen young people playing them, and they involve a lot of jumping around and so on, which I suppose is a form of exercise, at least.

[Ms Abbott]

Far be it from me to advertise any particular product in this Chamber, but Wii Fit games are perhaps better than PlayStation games.

[Mr Simon Burns]

I have been listening carefully to the hon. Lady, who is making some valid points. The danger has to do with not simply the age of computer games but the age of television before that. For some parents—this is a generalisation—the easy option is to let their children spend hours watching television or playing games, because it involves less effort on the parents’ part. One must try to educate people that that is not only an easy option but an unfair one.

[Ms Abbott]

I am loth to agree with the Minister, but I think that he is right on that point. A particular interest of mine is the education of urban children and the challenges of getting them to achieve their educational potential. As part of working with parents, especially in urban communities, we must teach them that just putting their children in front of a television set is not necessarily the best thing for their health or their education.

I agree entirely with what has been said about exercise and sport, but we also need a particular focus on girls and exercise. Statistics show that girls give up exercise younger; after they leave school, they do not continue to exercise, as boys do. I was interested to hear about, was it ice hockey—

[Justin Tomlinson]

It was an ice-skating disco on Friday nights.

On the point about getting more girls involved, that is why I proposed merging youth and leisure services to identify opportunities. Girls, in particular, follow what is on television. If street dance, cheerleading or football is popular, let us provide those services and facilities, and they will come flocking.

[Ms Abbott]

I agree. That is the point that I was going to make. We need to be more innovative in the sorts of game that we encourage and make available to children. Girls do not want to play ping-pong, because they are quite self-conscious physically, but they will do things such as breakdancing and ice skating.

As other Members have said, we have a generation of parents, especially in inner cities, who do not know about food, have only the dimmest idea of where some foodstuffs come from and do not know how to cook. Because they are bombarded by advertising for processed food, when they whip out a ready meal from Marks and Spencer, it is not just idleness; they think that they are being good parents: “Look, I’m getting you something from Marks and Spencer which is advertised on the television.” We should work with communities and parents to educate them.

In my view, the Government obesity policy’s reliance on responsibility deals is a little problematic. Common sense suggests that companies that make billions of pounds every year peddling fizzy drinks and foods larded with trans fats will not seriously undermine their profits by genuinely trying to change the public’s eating habits. Although we must applaud the Government for whatever progress they think they have made with responsibility deals, we must go beyond them as they are currently fashioned if we are to stop the epidemic of obesity among our young people.

To return to the Government’s obesity strategy, the message from health professionals, key health groups and experts is clear. We need tough action now and a proper long-term strategy to stem the rising tide of lifestyle-related diseases. Jamie Oliver, probably the single most famous person in public health, has said in the past few weeks that this Government’s obesity strategy is

“worthless, regurgitated, patronising rubbish”.

As usual, he was not pulling his punches. Terence Stephenson, president of the Royal College of Paediatrics and Child Health, said that the Government’s plan

“has no clear measures on how the food and drink industry will be made to be more ‘responsible’ in their aggressive marketing of unhealthy food…Suggesting that children in particular can be ‘nudged’ into making healthy choices, especially when faced with a food landscape which is persuading them to do the precise opposite, suggests this would be best described as a call to inaction.”

Which? executive director Richard Lloyd said that the Government’s approach to tackling obesity was

“woefully inadequate…The Government calls on people to cut down the calories they eat, but isn’t giving them the tools to do so.”

Charlie Powell, campaigns director of the Children’s Food Campaign, said:

“This is a deeply disappointing and utterly inadequate response which represents a squandered opportunity to address the UK’s obesity crisis.”

There is broad agreement in the House about the issues that we must address. It is a mix of issues; there is no silver bullet. Better labelling of food, including in restaurants and cafés, is part of the answer. Fashioning a sport offer for young boys and girls is crucial, as is better education and working with parents and communities.

I would like to say a word about gastric bands. We read an enormous amount about them, particularly in relation to celebrities. As a Conservative Member said, there are cases, if people have tried everything else, where a gastric band might be the answer, but I deprecate the promotion of gastric bands without some of the measures that we have discussed if that suggests to people that they can eat whatever rubbish they like because, at the end of the day, the NHS will pick up the tab for a gastric band. That is not the way forward, either for costs in the NHS or for people’s quality of life. I have read about people who, having got gastric bands, proceeded to liquidise fish and chips so they could continue to enjoy their favourite junk food. That suggests that a gastric band, in itself, is not the answer to the underlying issues.

I hope that, in his winding-up speech, the Minister will address the serious concerns raised about the Government’s obesity strategy by a wide range of stakeholders and specialists. I look forward to hearing what the Government plan to do further to address the growing epidemic of obesity among our young people.

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

It is a pleasure to serve under your chairmanship, Mrs Riordan, during this extremely interesting and thoughtful debate, to which there have been a number of erudite and imaginative contributions across the range.

I congratulate the hon. Member for East Londonderry (Mr Campbell) on securing the debate and giving us the opportunity to discuss one of the major public health issues of modern times. He has spoken repeatedly on the subject in the House and should be congratulated on doing so. He knows, of course, the scale of the problem. Most adults in England, 61%, are overweight. Sadly, one third of those are clinically obese, giving us one of the highest obesity rates in the world. As for children, almost a quarter of four to five-year-olds are overweight or obese, rising to one third in 10 to 11-year-olds. I am sure that we all agree that those figures are genuinely shocking. The hon. Gentleman will be aware that the scale of the problem in Northern Ireland, to which he alluded during the course of his remarks, is similarly daunting, with 59% of adults and 22% of children overweight or obese.

As recently as the 1980s, obesity rates among adults were a third of what they are now. Although figures for the last few years show that levels of obesity may be stabilising, that is simply not good enough, because excess weight has serious consequences for individuals, the NHS and the wider community. Not only does it cause day-to-day suffering such as back pain, breathing problems and sleep disruption, but it is a major risk factor for diseases that can kill. An obese man is five times more likely to develop type 2 diabetes, three times more likely to develop colon cancer and two and a half times more likely to develop high blood pressure than a man with a healthy weight, and women face equally serious risks. That is not to mention liver disease, heart disease, some cancers and miscarriages, all of which are linked to excess weight.

Although the real and present danger of obesity in terms of immediate health risks is seen largely in adults, obesity also has significant effects on children and young people, as many hon. Members have mentioned. Obese children are likely to suffer stigmatisation, and there are growing reports of obese children developing type 2 diabetes. We also know that if a child is obese in their early teens, there is a high chance that they will become an obese adult, with related problems later in life.

As waistlines expand, so does the amount of money that we spend on the issue. As a number of Members have said, excess weight is a burden of approximately £5 billion each year, and costs billions more through days of work and incapacity. Neither can we ignore the link between obesity and health inequalities. Data from the national child measurement programme show a marked relationship between deprivation and obesity. The Marmot review in 2010 showed the impact that income, ethnicity and social deprivation have on someone’s chances of becoming obese. As things stand, the less well-off a person is, the more likely they are to be carrying excess weight, so we are talking about an issue of social justice, as well as a narrow health issue involving exercise and healthy living.

The hon. Members for East Londonderry and for Hackney North and Stoke Newington (Ms Abbott) both asked, in effect, whether the Department of Health should work with companies that produce and sell products that contribute to the nation’s obesity and alcohol problems. Up to a point, it is the responsibility of the individual how much they consume and what they consume. How do we make sure that people know what they are eating—the calorie, salt and fat content and so on? To my mind, that means clear, easily understandable labelling, and education about what is healthy and what is the best approach.

On the narrow point of the issue mentioned by both hon. Members, improving the health of the public is clearly a priority for the Government, but we need a whole-society approach to tackle the health problems caused by poor diet, alcohol misuse and lack of exercise. To change people’s behaviours, we need to make the healthier choices the easier choices for everyone.

Commercial organisations have an influence on and can reach consumers in certain ways that Governments cannot. They have a key role in creating an environment that supports people to make informed, balanced choices that will enable them to lead healthier lives. Through their position of influence, they can address some of the wider factors that affect people’s health, such as how healthy our food is and how easy it is to access opportunities to be more physically active. Through the work on the public health responsibility deal, despite what the hon. Member for Hackney North and Stoke Newington has said, we are tapping into that unrealised potential to help improve the public’s health.

[Ms Abbott]

rose—

[Mr Burns]

I will give way in a moment. It is also important to say that, if we can get an agreement with commercial companies to change the way they behave and some of their practices, it will be far quicker to achieve that and put it in place than to wait for the heavy hand of Government legislation, which can take a minimum of a year and sometimes years. Why wait for the heavy hand of legislation that might take a long time, if we can get a voluntary agreement that will work quicker and more effectively to start dealing with the problem?

[Mr Burns]

I will give way to the hon. Member for Hackney North and Stoke Newington first, because I promised her, then my hon. Friend the Member for Central Suffolk and North Ipswich (Dr Poulter), and then I will make progress.

[Ms Abbott]

On changing commercial practices, when will the Government do something about the practice of so many supermarkets whereby they place rows of sweets next to the checkout? If a parent has fought off their children and not bought sweets on their way around the supermarket, the children then have 10 minutes to whine while the parent waits to pay for their shopping.