Community Hospitals
Debate between Sarah Wollaston and Guy Opperman(12 years, 3 months ago)
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Dr Wollaston
I wish to make the case for reinvigorating community hospitals as hubs for delivering the right care at the right time and in the right place. Of course, the right place, where possible, will always involve helping people to be independent in their own homes, but community hospitals have a vital role, through both step-up and step-down care, in helping to maintain that independence.
We should look at what community hospitals are capable of, because they are not just about in-patient beds: they provide a full range of diagnostics, minor injuries units, therapies—physiotherapy and occupational —and mental health care. In my constituency, people with cancer can access chemotherapy at Kingsbridge hospital, saving them a long roundtrip to Derriford hospital. Kingsbridge hospital—South Hams, I should say—supports a triangle centre helping people and their families living with cancer, while organisations such as Rowcroft hospice are looking to expand their care-at-home system through hubs in community hospitals and, at times, by utilising their beds and support. We can get so much more from community hospitals if we reinvigorate them.
We should not think of community hospitals as backwaters; they can be centres of great innovation. The nationally recognised Torbay pilot, which provides care based in the community, started at Brixham community hospital in my constituency and is now being considered for nationwide roll-out. That is a very good model.
Guy Opperman (Hexham) (Con)
I congratulate my hon. Friend on securing this important debate. She mentions the Torbay model, which is rightly a pilot and flagship for the integration of services, but does she envisage a situation in which not only are medical services integrated in one location but other emergency services can come together? The result could be enhanced training for people, such as firemen and policemen, who could qualify as paramedics and assistants to the medical services.
Dr Wollaston
Indeed I do, and there are many community hospitals that support first responders in the way my hon. Friend describes. That is an important role, and there is perhaps even an extended role in housing, where step-down housing can enable people to make the transition back to full independence. Indeed, there are many such roles.
What are the current barriers to providing the right care at the right time and in the right place? I would like the Minister to deal with five points. First, the biggest challenge we need to address is the tariff and tariff reform. She will know that most acute hospitals are paid through a system known as payment by results, which creates some perverse incentives, whereby acute hospitals want to hoover up as much activity as possible. Often, people are treated in an acute setting when they could be more appropriately cared for in a community hospital setting or at home. Can the Minister update the House on the progress we are making on reforming the tariff, by, say, working towards a “whole year of care” model or looking at other ways to remove the incentive in the system that means that people cannot be transferred into community hospitals or provided with the right care in the right place?
Alcohol Taxation
Debate between Sarah Wollaston and Guy Opperman(13 years ago)
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Dr Wollaston
That is one of the options. I would like to outline an alternative, but I certainly thank my hon. Friend for that intervention.
Numerous studies around the world have shown public health benefits as a result of price increases and taxation policies, so is it not time for some evidence-based politics? The trouble is that there is no single, simple solution. We know that there are other factors in addition to price: availability, our drinking culture and marketing. Those are all key factors, but today’s debate is about taxation, so I will focus entirely on price, not because the others do not matter, but because they are not within the remit of the Treasury.
It is worth pointing out that most health experts feel that changing pricing is the most effective way of achieving results. I draw the attention of my hon. Friend the Minister to the letter in today’s edition of The Daily Telegraph signed by 19 organisations. I know that the Treasury is aware of the costs to our economy of dependent drinkers and binge drinking, so I will not ask my hon. Friend to respond in detail on those points. As disposable incomes have fallen, so too has the overall consumption of alcohol, but that comes on the back of decades of steady increases. Alcohol remains about 44% more affordable than it was in 1980.
In 2010, a total of 48.4 billion units of alcohol were sold in the UK. Of those, 31.8 billion units—about two thirds; the great and increasing majority—were sold by the off-trade. The widening gap between the price of on-licence and off-licence alcohol is becoming far more significant and is fuelling the rise in home drinking. Harms are not going down as we might expect as a result of the small fall in overall consumption, because of the low-price deals that are still very widely available in supermarkets, garages and convenience stores pretty much around the clock.
Guy Opperman (Hexham) (Con)
I congratulate my hon. Friend on obtaining the debate. The north-east has one of the worst rates of liver disease: we have seen an increase of 400% since 2002. I accept entirely the point that she makes about robust regulation in terms of minimum pricing, but does she accept that the local supermarkets in our individual constituencies can make a specific difference on the pricing and availability of alcohol and the way in which it is presented to our constituents?
Dr Wollaston
I absolutely agree. Most of the alcohol-related carnage is caused by young binge drinkers and by heavy or dependent drinkers, so the issue is not only about the availability of alcohol in outlets throughout the country. The harm is not going down, because those groups are the ones that are most attracted by the low-price deals.
Dr Wollaston
May I make a little progress? The case against a minimum price of between 45p and 50p a unit may hang on the loss of income to the Treasury. Alcohol duty raised £9.5 billion in 2010-11, which is equivalent to 1.7% of total Government revenue. There is a certain illogicality in the bands set by the European Union, so to a certain extent, as my hon. Friend the Member for Burton (Andrew Griffiths) said, there is great encouragement towards higher strength products.
The amount received by the Treasury is the same whether a product is sold in a pub or a supermarket. VAT is levied on top, but there are no specific data on where and on what products it is levied. Will the Minister set out estimates of the loss of income that would arise from the introduction of a minimum unit price of between 45p and 50p? Will she also set that against the benefits in estimated savings to the Home Office, the Department of Health and the Ministry of Justice that would result from a reduction in alcohol-related harms?
The Department of Health leads on alcohol policy. It has stated repeatedly that it does not wish to disadvantage moderate drinkers on a low income. However, it has failed to point out that harmful drinking disproportionately affects the poorest and most vulnerable in our society, and is a significant contributor to health inequality. A report on the Department’s behalf from September 2011, titled “Narrowing the health inequalities gap”, makes it quite clear that if it were not for alcohol-related deaths, and if we had had an effective policy, the objective to narrow the overall life expectancy gaps for the spearhead local authority areas—the most deprived areas in our country—
“would…certainly have been achieved for males; and would be well on the way to being achieved for females.”
The evidence is not just that low-income groups suffer the most health harms, but that they suffer the most harms as a result of violence in their communities.
If we look at the evidence from some shopping basket data published in a university of Sheffield study, we can see that for
“a 50p minimum price, a harmful drinker will spend on average an extra £163 per year whilst the equivalent spending increase for a moderate drinker is £12.”
In other words, the published data state that such a policy will not penalise low-income moderate drinkers.
The deprived spearhead communities have the most to gain from an effective alcohol policy. A minimum or floor price can be set that is not regressive and is affordable for anyone who is not drinking at hazardous levels. As one of my correspondents pointed out:
“If you can’t afford 50p per unit it is a good sign that you are drinking too much.”
The charge is often made that without an increase in duty the profits will go to the drinks industry and retailers, not the Treasury. I can understand that, but if we can introduce windfall taxes on energy companies, why not have windfall taxes on supermarkets that profit from windfall gains? With more than 31 billion units sold in the off-trade, why not even consider a health levy on unopened bottles, perhaps of between 5p and 10p a unit, targeting just the off-trade? That would be more than enough to allow for decent treatment programmes. Evidence shows that for every pound we invest in such programmes, we save £5 in wider benefits to the economy because of reduced harms.
Guy Opperman
Does my hon. Friend think that it would be a good idea to introduce an alcohol Act similar to that which exists in Scotland?
Dr Wollaston
I could not agree more.
Finally—I know that other Members would like to come in—there are those who argue that a minimum price is illegal under EU law. If so, why are the Scottish Government so confident that it is not? I draw the Minister’s attention to a reply given by Mr Dalli on behalf of the European Commission to a question put by an MEP on that point. The bones of the reply are that
“the Commission fully shares with the Honourable Member the conviction that there are strong public health reasons for the EU to tackle alcohol-related harm including minimum pricing measures.”
Will the Minister set out today whether there have been discussions with the Scottish Executive on the matter? Will she also comment on what steps the Treasury will take to tackle supermarkets’ plans to undermine Scotland’s decisive action to tackle the carnage caused by alcohol? Tesco recently e-mailed Scottish customers to reassure them that they will still be able to access cut-price deals after the Act is in force, as the products will be delivered from across the border. Will the Minister join me in condemning that e-mail from Tesco?
Yesterday, the Select Committee on Health returned from a visit to Carlisle, and it is clear that the city is expecting an increase in cross-border sales. It would prefer to see us use an evidence-based policy to protect the north-west, which has suffered from the devastating impact of alcohol. There have been many calls for effective minimum pricing and numerous models show the amount of lives and money saved, so I do not want to go over them in detail, other than to point out again that a 50p minimum price could save nearly 10,000 lives a year.
We have shown that Britain is prepared to stand our ground in the EU when it comes to the City of London. Now is the time to put the lives of our young people ahead of the theoretical risk of a legal challenge. A precedent exists in the loi Evin, which the French introduced to protect children from the effects of alcohol marketing in France. It has been challenged repeatedly by the industry in the EU’s courts, but it was upheld on the grounds of the health benefits. I fully agree with that.