Health

Nick Smith Excerpts

Tuesday 21st December 2010 Commons Chamber

[Nick Smith (Blaenau Gwent) (Lab)]

I am very pleased to take part in this debate. I applaud the new arrangements that will allow a Health Minister to respond to contributions on health.

Public health policy aims to help people live longer and healthier lives, so it is a matter of key concern to me and my constituents in Blaenau Gwent, where average life expectancy is still too low. In the July pre-recess Adjournment debate, I raised my worries about the Conservative-led Government’s reluctance to take forward Labour’s measures to curb smoking, their collapse in the face of food industry’s lobbying on food labelling and their hasty dismissal of minimum pricing for a unit of alcohol.

Sadly, the recent public health White Paper does not address my deep concerns. It sets out the scale of several significant problems. Britain has the highest rates of obesity in Europe. Smoking causes 80,000 deaths a year. A recent Alcohol Concern report showed that more than 92,000 children and young people under 18 were admitted to hospital for alcohol misuse between 2002 and 2009. Girls are more likely to need hospital treatment than boys. Diet-related disease costs the NHS £6 billion a year, alcohol abuse costs it £2.7 billion, and lack of exercise costs it £1.8 billion: a total of £10.5 billion.

Do we have a new, bold public health strategy to match that analysis? Apparently, there is a shift from nannying to nudging people to improve their health. It seems that commercial interests will dominate the partnership of those who will help us to be healthier. That is not good enough. The Independent reported recently that multinational companies dominate the Government’s public health policy. It discovered that 18 representatives of Mars, Diageo and other commercial interests attended the first public health responsibility deal meeting in September, dwarfing the representation of health and consumer groups. I do not trust commercial interests to nudge me or anyone else towards a healthier lifestyle.

I take issue with the pompous put-down that Labour opted for a nanny state. Labour recognised that the Government have a duty of care to keep the nation as healthy as possible. That duty is particularly important for our young people, and particularly for the young women who lie comatose on the streets on Friday nights, after binge-drinking sessions. Alcohol was described as the most dangerous drug in the UK in a paper published by The Lancet in November. The Government have a responsibility to take further measures to prevent alcohol abuse.

The brewer, Greene King, wrote to MPs recently:

“It is our long held view that a great deal of the UK’s antisocial behaviour stems from excessive drinking by a small minority of people, fuelled by the easy availability of alcohol from retail outlets, at very cheap prices. The solution must be proportionate to the problem and not penalise the majority of responsible drinkers.”

I concur with that statement and agree with the solution of a minimum price for alcohol. The British Medical Association supports that proposal, as does the Association of Chief Police Officers.

The Government have said that they support a ban on below-cost selling. However, if cost was defined as duty plus VAT, it would be too low to tackle irresponsible discounts in supermarkets. No measures have been put before Parliament to end below-cost selling. I believe a range of measures is necessary to tackle alcohol abuse. There may have to be restrictions on promotions. Alcohol Concern stated:

“As long as alcohol remains as heavily promoted as it currently is, young drinkers will continue to consume far more than they might otherwise, leading to inevitable health harms, wasting ambulance and police time.”

It is time we scrutinised the promotion of alcohol at cinemas, for example, where it is too easy for young people to be influenced.

I will talk briefly about measures to combat smoking. I was pleased that the all-party parliamentary group on smoking and health called on the Government to prohibit the point-of-sale display of tobacco products, and the sale of tobacco from vending machines. Those measures have widespread support. As my local director of public health at the Aneurin Bevan health board wrote to me:

“Nearly one quarter of the population in Wales are smokers and most of them started to smoke as children. The average age at which young people in Wales start smoking is between 11 and 12 years.”

She ended her letter with a plea:

“please help to protect our children and future generations from a deadly addiction by ensuring that the government implements these laws”.

Finally, I will comment on the problem of obesity. Obesity cannot be tackled by weakening the Food Standards Agency and by cutting the Change4Life anti-obesity programme. Statistics on obesity show the need for more exercise. I am therefore glad that the Government have changed their policy on school sports provision in recent days, but more needs to be done. We must ensure that all children exercise regularly at school, not just those who are gifted enough to take part in competitive sport.

Nudging and soft partnerships, although helpful, are not sufficient. Self-regulation by supermarkets and tobacco companies will not deliver the better health and extra years that we hope for. Bluntly, if we do not act, the financial consequences for the NHS alone—the £10.5 billion that I referred to earlier—will be immense. Ministers must accept that meaningful regulation and taxation have a role—to rule them out is irresponsible and doctrinaire. The Government’s recent White Paper on health is not good enough for my constituents in Blaenau Gwent, nor for people across our country. We must do better than this.

--- Later in debate ---

[Anne Milton]

I thank the hon. Lady for that intervention. She is right to suggest that there can be an intention at Westminster, but the point is ensuring that it is effected on the ground. I will say a little more about that shortly.

We do not believe that a legislative approach is always the way to proceed when requiring health bodies and GPs to identify patients who are carers or have a carer and refer them to sources of help and support. Indeed, often it is not. We feel more comfortable with that as a weapon, but it does not necessarily produce the result that the hon. Lady wants.

It will be for PCTs and subsequently the GP consortiums to decide their priorities in the light of their local circumstances. However, we believe that GPs and their staff will play a vital role in identifying carers; many carers have not yet been identified. That is why we are investing £6 million from April 2011 in GP training, which will mean that more GPs and their practice teams gain a better understanding of carers and the support that they may need. That is important.

I believe that GPs are much better placed truly to understand the value and needs of carers. I do not need to tell the hon. Lady that the considerable social, human and, indeed, financial value that carers offer cannot be overestimated—she is aware of that. However, centrally driven methods are not always the best way forward. I welcome her continued feedback to ensure that we get the money spent where it is needed most.

Let me deal now with the speech made by my hon. Friend the Member for Colne Valley (Jason McCartney). I take the opportunity to pay tribute not only to midwives but to all the staff who will be working to deliver babies safely into the world, while we are enjoying our turkey or whatever we choose to eat on Christmas day.

The Government are committed to devolving power to local communities—to people, patients, GPs and councils—which are best placed to determine the nature of their local NHS services. I pay tribute to my hon. Friend for raising the matter previously and for continuing to raise his constituents’ concerns.

The Government have said that, in future, clinicians and patients must lead all service changes, which should not be driven from the top down. To that end, the Secretary of State has outlined new, strengthened criteria that he expects decisions on NHS changes to meet. They must focus on improving patient outcomes, consider patient choice, have support from GP commissioners and be based on sound clinical evidence. I think that that was what my hon. Friend was getting at.

The Department has asked local health services to consider how continuing schemes meet the new criteria. Some will be subject to further review. That does not necessarily extend to reopening previously concluded processes, as in Huddersfield—I would not like to lead my hon. Friend down an alley—or halting those that have passed the point of no return, with contracts signed and building work started. However, NHS Yorkshire and the Humber has advised that the decision to implement the looking to the future programme and change in maternity services in Huddersfield was clinically driven, with strong emphasis on patient safety and quality of care. It was also made after considerable scrutiny and consideration, including a formal period of public consultation and advice to the then Secretary of State for Health from the independent reconfiguration panel, whose recommendations were endorsed in full.However, I know that my hon. Friend will continue to gather local evidence and experience and feed it back, which I welcome.

Let us look at the problem described by the hon. Member for Blaenau Gwent (Nick Smith). I disagree with much of what he said. We have a bold public health strategy for the first time, and it has been widely welcomed. He should not believe everything he reads in the newspaper—it could lead him into all sorts of misapprehensions. The Government alone cannot improve public health; we need to use all the tools in the box.

The hon. Gentleman should note that health inequalities grew, rather than decreased, under the previous Government. There are massive opportunities to improve public physical, mental, emotional and spiritual health and well-being in England. As he rightly pointed out, we have some of the highest obesity rates of any country in the world. People living in the poorest areas die on average seven years earlier than people living in richer areas, and they have higher rates of mental illness, disability, harm from alcohol, drugs and smoking, and childhood emotional and behavioural problems. Changing people’s lifestyles and removing health inequalities could make double the improvement to life expectancy that we could make through health care, so we must address public health.

The Government published our strategy in our White Paper “Healthy lives, healthy people”. We will establish Public Health England, a national public health service, return public health leadership to local government, and strengthen professional leadership nationally by giving a more defined role to the chief medical officer, and locally through strong and inspirational leadership roles for directors of public health.

Historically, all the big public health improvements came via local authorities, and I am convinced that returning public health responsibilities to local authorities will achieve what we need, which is social and economic change as well as health change.

[Nick Smith]

rose—

[Anne Milton]

I am happy to give way.

[Mr Speaker]

Order. The Minister is of course welcome to take the hon. Gentleman’s intervention, but she still has a few contributions to respond to, and we need to make some progress.

[Nick Smith]

I welcome the proposal to ask local authorities to take responsibility for public health—in the round, that is a good thing—but will they get the resources to do that job?

[Anne Milton]

Thank you, Mr Speaker. I am afraid that I got rather carried away with this new-style debate, but I am mindful of the time.

For the first time, public health spending is ring-fenced. Public health interventions have been cut because of spending by PCTs, so it is really important to ring-fence such funding. The Government will focus on outcomes that are meaningful to people and communities. We published proposals for a public health outcomes framework yesterday for consultation, to which I am sure the hon. Gentleman would like to respond. I hope I have reassured him that the Government are taking the action necessary to improve the public’s health. I would be happy to discuss that with him in more detail another time, and perhaps to correct some of the myths that he believes. Nothing is ruled out. We will do everything we need to do to improve the public’s health, but we must use all the tools in the box. We cannot improve public health by Government intervention alone.

My hon. Friend the Member for Suffolk Coastal (Dr Coffey) raised the issue of integrated drug treatment systems for prisons that aim to increase the volume and quality of treatment available to prisoners. I welcome her involvement in her local prison. Such systems also aim to improve integration between clinical counselling, assessment, referral and through-care services, and to reinforce continuity of care when prisoners are released into the community.

The Government must reshape drug treatment to focus on recovery and to improve the continuity of treatment in the community following release. Abstinence is where we need to go. As outlined in the Ministry of Justice Green Paper on sentencing reform and rehabilitation, and in accordance with the much more outcome-focused approach announced in the new drug strategy, a payment-by-results approach to commissioning drug treatment for prisoners on release will be trialled in two areas. Recovery wings will be trialled in four prisons, with an emphasis on offenders receiving short custodial sentences, who therefore require a co-ordinated approach from prison and community. The combining of prison drug budgets with the combined drug interventions programme and a community-pooled treatment budget will allow for great flexibility, which is what we need in configuring services. To my mind, we have failed adequately to address drug abuse and prisoner addiction, and in turn failed our communities. We have not spent much-needed resources well.

I probably answered many of the points made by the hon. Member for Newcastle upon Tyne Central (Chi Onwurah) in my answer to the hon. Member for Blaenau Gwent on public health more generally. My husband’s family are all from Hartlepool. The hon. Lady was right to raise the issue of health inequalities. “Healthy lives, healthy people” underlines the priority that we are giving to tackling inequalities and supporting the principles of the Marmot review. We are focusing on the health and social needs of disadvantaged groups and areas, including on how money is allocated to local communities for public health interventions.

Despite the fact that the previous Government doubled health funding, as the hon. Lady rightly said, health inequalities got worse. I do not think that that was because of a lack of commitment on Labour’s part. It is extremely difficult to tackle health inequalities head-on, which is why our White Paper is so widely welcomed. The action outlined in that paper will reduce those truly shocking health inequalities.

It is important to recognise that this is not just about the money that is spent, but about how it is spent. I welcome the hon. Lady’s non-partisan comments about the previous Government’s record. For the first time, we are consulting on public health and ring-fencing money, and I believe that we can make a real difference.

The last Back-Bench contribution was from my hon. Friend the Member for South Swindon (Mr Buckland) on autism. I should like to take this opportunity to pay tribute to the parents and carers—young and old—who care for children and adults with autism. For some, that is a considerable burden that we should not underestimate. The National Institute for Health and Clinical Excellence is currently developing three autism clinical guidelines. The recognition, referral and diagnosis of autism guidelines are scheduled to be published in September next year; the diagnosis and management of autism in adults guidelines are scheduled to be published in July 2012—that might feel a long way off, but it is coming—and the management of autism in children and young people was referred to NICE by Ministers in November this year.

I pay tribute to my hon. Friend for his interest in autism, which has been discussed on many occasions in the House since I became a Member. There is no doubt that the expertise and input of people like him—people who have personal experience—is crucial in ensuring that we get the right policies that can have an effect on the ground, including in his constituency. His expertise and that of other hon. Members is critical.

Mr Speaker, I apologise for going beyond my allotted 10 minutes, but I wish you and all the staff of the House a very happy Christmas. I thank them for all their support this year and wish them well for the next.