Health Bill [Lords]

Could I first say—[Interruption.] I have to tell hon. Members on the Opposition Front Bench that I have got quite broad shoulders; I have had them for 26 years in this place, and they will remain. Let me first say to my right hon. Friend the Secretary of State—I congratulate him on getting his new position on the Front Bench—that I support the Bill. It is quite wide-ranging and pulls a lot of things together, but not targets, which the hon. Member for South Cambridgeshire (Mr. Lansley) talked about. He mentioned an 18-week wait. Nowadays, everybody talks about patient choice in our national health service. In my local hospital, just five years ago, somebody wanting orthopaedic surgery was offered waits of months, if not years, for procedures on things such as knees and hips—or if they had a few thousand pounds, they could go to an independent hospital in Sheffield and have it done the following week by the same surgeon. Targets have got rid of that type of patient choice, which has been offered, wrongly, for very many years. The hon. Gentleman says that we should not have such targets and we should let health professionals get on with it. With all due respect, some of them—a minority, I have to say—were getting on with it, and getting away with it, for years by using long waits in order to be able to increase their earnings in the independent sector. This Government have stopped that, not just in South Yorkshire but up and down the land. They should be congratulated by every Member of this House, in the knowledge that many of their constituents are not covered by health insurance. Many of those people discovered that if they wanted to get a better quality of life quicker, they would be asked to go and get bank loans or dip into savings. That situation has gone, and the waiting list target alone has done more than anything else to achieve that. Of course, there has also been increased capacity because of investment. One of the aspects that I want to focus on is the national health service constitution. I know that that is, and will continue to be, a bit of a rolling programme. Nevertheless, having served on the Health Committee since the last general election, I know that many people up and down the land are frustrated when they see drugs going through the NICE process, whereby they are assessed and it is agreed that people should have them and it is accepted that they would be good clinically and cost-effective, and then those drugs are denied to them by the local purchasers—the primary care trusts. Through the constitution, people will have the right to a drug that has been through the NICE process; that is progress indeed. NICE was set up many years ago—in my view, to get rid of so-called postcode prescribing. That is an inequitable system, because whether people can have drugs that have gone through the NICE process varies from one constituency, covered by one commissioner, to the next. This will be a major step towards introducing what it was intended that NICE should do—although I know that it does many other things as well. I look forward to the Public Bill Committee's reaction to this debate, although I should say to my right hon. Friend that I am not volunteering to serve on it; I have other things to do on a Thursday morning with the Health Committee. I look forward to seeing what the constitution is going to mean—not only to patients, although it does have an effect particularly in that respect, but to staff. It also covers rights and responsibilities. Rights are very important in our health care system, but so are responsibilities. What responsibilities do we have as individuals, or do patients have in terms of their health care? What will the NHS ask of them as regards what they have to do to contribute to their own good health, besides what the health service does for their ill health? I look forward to that debate. My right hon. Friend will have heard me say on many occasions that in the 21st century the issues that will affect health care in this country, in particular, are not those that dominated public health in centuries and decades gone by. It is not about housing now, although we have to accept that there is still some poor housing around. It is certainly not about sanitation or fresh water supplies. I was one of those born into the first generation that could be immunised against many things that used to kill tens of thousands of people in previous generations. Now, at the beginning of the 21st century, we are immunising young women against cancer—just one type of cancer, I accept. That is an extraordinary step for medical science. The real threat to the health of the public in the 21st century will be about what the individual does or does not do—how much alcohol they drink, what food they eat and in what quantities, and whether they take exercise. Many things done by individuals will impact collectively on the health of the public. I look forward to the NHS constitution starting that important debate very early on in this century. It is the debate for the 21st century, come what may in terms of the health needs of the nation. It is no longer just about treating ill health, which the NHS has been doing very well for the past 60 years. I am interested in the concept of the innovation prize. The hon. Member for South Cambridgeshire said that money is given to people who have achieved something. As I understand it, the innovation prize is about doing things differently from what happened in the past when money was given to people to carry out research within the NHS. Innovation is vital. It is the reason the NHS has improved, and continues to improve, the health of this nation in many respects, and it should be encouraged. However, we need to examine the idea that if someone makes an application and gets a pot of money to do research, it goes ahead, but if they make an application and do not get the pot of money, it does not go ahead. I have here the Library research paper on the Bill, which discusses the innovation prize, saying that clause 14""enables the Secretary of State to award prizes to promote innovation (including research) in the provision of health services in England, including prizes for work done before the Bill currently before Parliament becomes law. It also enables the Secretary of State to establish a committee to advise about awarding such prizes and to pay the committee's members."" My understanding—I hope that my hon. Friend the Minister of State will clarify this when he winds up—is that this is not just about reaffirming what happened in the NHS in years gone by, when getting a grant to do research was the only thing that ever happened. The paper continues:""Debates in the House of Lords on innovation prizes were short; there was no debate at all on Report. There were no amendments in Grand Committee or on Report but on Third Reading, in response to arguments made in particular by Lord Walton and Lord Patel, the Government successfully introduced an amendment to clarify that innovation prizes would include research."" I understand that that is to make the provisions consistent with the National Health Service Acts and what happened in the past. If we are to improve the health care system and the NHS, we should recognise that one of the major quests that has been going on for the best part of 60 years is about how to spread best practice. I have always said, sometimes with my tongue in my cheek, that we tend to do that by wanting to reconfigure the NHS. We tend to say, "Well, if it's not working in that shape, let's look at another shape for it. Let's look at another way to approach it." In fact most reconfigurations, certainly in the past few years when I have been on the Health Committee and examined in detail what is happening in the health service, have been intended to spread best practice and get things working better in various parts of the NHS. Instead of thinking of the prizes as structural changes, we should realise that they are about incentivising people to do things themselves. In the past, somebody would get a grant for research and then do it. I hope that my hon. Friend the Minister will tell me that the prizes are about using the high levels of skills that we have at all grades—not just among hospital nurses and doctors but in other, related professions—to ensure that innovation is encouraged in a more constructive and flexible way. Various organisations have produced briefings for this debate and for the debates in the House of Lords, and I should like to read out some of their concerns. All of them represent the health professions at some level, and they ask questions about the innovation prizes. In a briefing for Second Reading in the other place, the British Medical Association stated:""Doctors are at the forefront of innovation in the NHS and the Government's continued commitment to encourage innovation is welcome. We would seek further clarity from the Government on its intention on possible membership of the committee that the Secretary of State may establish to advise on the form and allocation of innovation prizes."" The NHS Confederation, in its briefing for Second Reading in the other place, stated:""There is little detail in the bill about how the prizes would operate."" That is absolutely true. It continued:""We would welcome further clarification to the following questions: What will be the size of innovation prizes? Will prizes be awarded to individuals or organisations? Who will make up the committee and how will they be appointed?"" Those are typical questions in the NHS—"There is another committee. Who is going to be on it? Is this a chance for me? Can we get a representative on it?" It is typical of the structure and culture of the NHS. The Royal College of Nursing, in a Second Reading briefing for this place, stated:""Nurses are often at the forefront of innovation to improve the quality of patient care. The RCN welcomes the commitment to establish innovation prizes if these are transparent, fair and genuinely raise the morale of NHS staff. However, the way in ""which the schemes are implemented locally will be key in terms of assessing the practical impact the prizes will have on the NHS and those that work in it."" I leave those thoughts with my hon. Friend the Minister, because it seems to me that we have an opportunity to bring innovation into the NHS by encouraging health professionals to do things that will get them the prize or whatever it is, including by spreading best practice in their workplace. I hope that the prizes are used sensibly and flexibly, so that we can further improve the NHS. From what both Front Benchers said earlier, it seems that the part of the Bill that is likely to create debate during its passage is the provisions in part 3 on point-of-sale tobacco advertising and vending machines. I wish to say a few words about smoking and health inequalities. Members may know that in March, the Health Committee published a report on health inequalities. It addressed smoking, which is a major issue in health inequalities in this country and in other parts of the world. The report showed clearly that the more deprived a person is, the more likely they are to smoke. Smoking is linked to almost every indicator of deprivation, including in income, education and housing tenure. There can be no question about that. Perhaps I ought to be saving part of my speech for another debate, because we have not yet had the opportunity to debate the Government's response to the report. Other countries, particularly in northern Europe, classify deprivation and so on not by social class, as we do, but by education. There is no doubt that in countries not dissimilar to ours, there is more smoking among people whose education level is not high. In turn, smoking drives health inequalities here in the UK. It accounts for half the gap in life expectancy between the richest and poorest in our society. There is clear evidence that quitting, or even better not starting, greatly reduces that gap. According to recent research by Dr. Laurence Gruer, the least affluent never-smokers have a much better survival rate than the most affluent smokers. Not smoking is a way of partly bridging the gap of health inequalities in this country. In recent decades there have been great reductions in smoking rates, but they have been greatest among the most affluent. There is a danger that the poorest families could be left behind. I see that two members of the Select Committee are present for the debate, and one thing that we found was that although the health of the population is getting better, with life expectancy getting longer in every social class, the gap between the lower and higher social classes is widening. That is disturbing. Just as smoking usually starts in childhood, so do the health inequalities that it brings. By protecting young people from tobacco marketing and reducing youth smoking rates, the Bill promises to reduce the health gap in future generations. That should not be considered lightly, because we are not talking about what is going to happen this year, next year or the year after. It is about what will happen in ill health and smoking maybe a generation down the line. The measures in the Bill are proposed not in isolation but as part of a comprehensive strategy, most of which has gone through the House in recent years. It is especially important to have a proper plan for tobacco control, particularly if we believe that it is important to reduce health inequalities. When New York went smoke-free, it was not in isolation but as part of a five-point plan including taxation, cessation support, public education and evaluation. Smoking among New Yorkers fell by almost 20 per cent. in four years, and the greatest improvements were among disadvantaged and high-prevalence groups. I wish to progress the health case against point-of-sale display. In its report on health inequalities, the Health Committee supported that aspect of the Bill. The hon. Member for South Cambridgeshire rightly mentioned tobacco smuggling, but the relevant recommendation in the report stated:""Smoking remains one of the biggest causes of health inequalities; we welcome both the Government's ban on smoking in public places, and its intention to ban point of sale tobacco advertising, as evidence indicates that both of these measures may have a positive impact on health inequalities."" That is very important, and the last time the House legislated on smoking, when we had the big debate about smoking in public places in 2006, it was the recommendation of the Health Committee that carried the legislation through. I congratulate hon. Members of all parties, including the hon. Member for South Cambridgeshire, the hon. Member for Romsey (Sandra Gidley) and the hon. Member for Wyre Forest (Dr. Taylor), who supported that recommendation at the time. Considering the matter in detail and having the Select Committee take evidence and make recommendations made a major contribution to turning the proposal into the popular legislation that it is now. Up and down the land, people say that the smoking ban is the best thing that happened—I hear that all the time. It happened because the House examined the evidence, considered the problems in our society and reached the right conclusions. I may be in a different Lobby from the hon. Member for South Cambridgeshire on Report, but the evidence shows that the Select Committee also got it right on this occasion.