Health Bill [Lords]

Before moving on to the main points I wish to make, I would like to talk about two issues that have taken up a lot of time in our debate. The first is the ban on in-store display material for cigarettes. Before I became a Member of Parliament, I worked in marketing and advertising for 17 years—indeed, at one point I worked with a cigarette brand—and I urge the Government to consider very carefully whether the proposals they are making today will have the outcomes they desire. I wholeheartedly agree that we need to manage very carefully the way that cigarettes are marketed and sold to anybody, and particularly young people, but the Government are confusing the two issues of access to cigarettes and the attractiveness of cigarettes. Simply stopping access to cigarettes, as the measure seeks to do, by hiding them under the counter in shops does not tackle the key issue, which is that youngsters find the idea of smoking cigarettes attractive; it is seen as part of their social life and as making them cool members of their community. Supermarkets have not been successful in marketing own-label cigarettes because they do not have the required brand cachet. Simply hiding cigarettes under the counter does not solve the problem that the Minister is trying to address, which is to stop so many young people in our community smoking. I wholeheartedly support him in that objective, but I am not sure he is using the right tools to achieve it, and I think he needs to do far more work with cigarette manufacturers to understand properly the key motivations and drivers that make people smoke. I do not think that can be achieved simply by getting rid of display material. The second issue is to do with a point the Secretary of State made about the National Institute for Health and Clinical Excellence and the availability of recommended treatments. I am sure I do not need to remind the Minister that the Government have already intervened to change what NICE has said should be the desired amount of access to in vitro fertilisation treatment. NICE has firmly said women between the ages of 23 and 39 should have access to three cycles of IVF treatment. That is certainly not available in my constituency, my primary care trust area or my strategic health authority area. It is unavailable not because of any lack of desire to make this very important service accessible to my constituents, but because of a lack of money and funding. We need to prioritise funding. The Government have said today that it will be mandatory for all PCTs to make all NICE guidelines available to all our constituents, but the Government also need to address how that will be paid for, because it is unclear to me how they will square that circle in my area, and other Members may have the same problem. The three main points I wish to make today are to do with three omissions from the Bill. One of them has already been touched on and noble Members in the other place have tried to rectify the problem, but the other two have not yet been covered. The Bill is wide-ranging, so it is surprising that it does not address any of them. The Secretary of State brushed aside the deliberations of noble Members in the other place when he said he was not minded to allow the new clause 34 that they had inserted into the Bill to remain. The measure allows for exemptions to private patient caps for NHS foundation trusts to be made in regulations. That is particularly important in my constituency. Basingstoke and North Hampshire NHS Foundation Trust, which serves my constituents but is located in the constituency of my right hon. Friend the Member for North-West Hampshire (Sir George Young), provides excellent care, particularly in cancer treatment. It has an international reputation, which is extraordinary for what is a district hospital. It has that reputation because of the quality and calibre of its surgeons and cancer specialists and the ground-breaking work they do in rare abdominal cancer, liver cancer and colon cancer. The hospital has the capacity to treat far more patients than it does at present, but because of the restrictions currently in place it is prohibited from doing so. It is therefore prohibited from expanding its work in a way that would benefit the people suffering from these chronic diseases—I am sure many Members' will have constituents and family members who have suffered from some of them. Also, such development could boost the income of what is a very successful hospital. That income would be used to improve its ability to serve our local community and to improve the local NHS services that are already in place. I felt that the amendment in the other place gave the Government the opportunity to introduce regulations that would help my hospital and my community to get a better service. I was therefore disappointed that the Secretary of State was so quick to dismiss as merely a quick fix a measure that had been well thought-through and well debated in the other place. Basingstoke residents already know the importance of having an internationally renowned hospital in our community, and the benefits of that. We have the Pelican cancer research centre and the ARK, a state-of-the-art teaching facility, and all because of the expertise in the community. We should be nurturing that expertise, not limiting it as the Government and some of the Secretary of State's party colleagues, such as the hon. Member for Wolverhampton, South-West (Rob Marris), seem to suggest. I urge the Government to think again. I do no think they should consult too widely as that may well lead to the idea being kicked into the long grass, as currently happens to so many ideas in this place. Consultation is not necessarily the right way forward. The Government should talk to the hospitals that are being restricted and hampered. I know the management of my local hospital would be more than happy to talk to the Government on this matter. I shall now move on to the other two measures that I am surprised were not included in the Bill. I echo the sentiments of my hon. Friend the Member for South Cambridgeshire (Mr. Lansley) that the Secretary of State should perhaps take on the role of public health Minister himself. The Government's policy needs to put more emphasis on public health. It is disappointing that the amendment to include more detail in the constitution was not passed in the other place. Among other things, it gave more clarity as to the central role public health should take in the NHS. Public health remains a Cinderella service in the NHS. The Minister needs to think very carefully about that, and particularly the role of health visitors. It is interesting that the Government have not taken the opportunity presented by the Bill to start to deliver on their pledge to implement Lord Laming's recommendations after the recent and tragic death of baby P. The recommendations included highlighting the key role health visitors play in child protection and their function as a universal service, seeing all children in their home environment and with the potential to develop strong relationships with families. The Government missed the opportunity to put these recommendations in place and to put them into action. The Government must live up to their promise to implement Lord Laming's report in full. Many of the ideas contained in the report do not require legislation, but the Government know that taking health visitors off the statute book in 2001 has had a significantly deleterious effect on the number of health visitors coming into the profession. There has been a 13 per cent. drop in the number of health visitors in this country since the dedicated health visitor register was closed in 2004 and the Bill could have provided an opportunity for the Government to demonstrate the valuable role that health visitors can play. They could even have considered placing the role of health visitor back on a statutory footing. I know the profession is interested in talking to the Government about that. Unless the Committee picks this issue up in more detail, it will be another missed opportunity in the Bill. I say that because the move towards using a mix of lower-skilled staff to replace qualified health visitors is not consistent with the Government's undertaking to implement Lord Laming's report in full; it is precisely the highly qualified and highly skilled nature of health visiting that he focused on in his report. The service is stretched to breaking point in too many parts of the country, leaving more than two out of three health visitors saying that they no longer have the resources to respond to the needs of even the most vulnerable children. I urge the Minister to consider in his response how he could weave this idea and, in particular, the implementation in full of recommendation 32 of Lord Laming's report into the Bill, even at this late stage. The third and final issue that I wish to raise relates to children's trusts. Clause 2 contains a detailed analysis of the duty to have regard to the NHS constitution, yet the group of organisations that are to have such a duty does not include any mention of children's trusts or Sure Start centres. To someone like me, who looks at these issues in some detail, it feels as though the Department of Health has put its head in the sand. The Apprenticeships, Skills, Children and Learning Bill establishes children's trusts as statutory bodies that have an important, if not vital, role to play in the commissioning of services, including NHS services, for children in local communities. I find it interesting that the Department of Health does not appear to be talking to its colleagues in the Department for Children, Schools and Families in order to understand how this Bill and the NHS constitution will interact and link in with children's trusts, which its DCSF colleagues feel have such a pivotal role to play. Perhaps this is an oversight or something that the new ministerial group has not yet thought about, but I urge it to do so. If it does not, when the Bill is read by the people running our health services in our communities, such as the group of people I met in my constituency on Friday, who are doing all they can to weave together children's services and make a better and more sustainable offer in Basingstoke, those people will be forgiven for thinking that the Department of Health still does not understand the importance of integrated working in the way it structures legislation. As I said, I noticed that Sure Start children's centres are also not an integral part of the Bill, despite their being a flagship policy of this Government—again the Department of Health does not seem to be getting a grip on that. Ministers are doubtless aware that the national evaluation of Sure Start undertook a study in 2007 on the effectiveness of Sure Start local programmes and demonstrated clearly that health-led Sure Start children's centres are the most effective way of using the significant amount of public money involved. I realise that there are many new faces on the Treasury Bench and perhaps they need a little more time to get to grips with this part of their brief, but I urge them to look carefully at how they can work more effectively with their colleagues in the DCSF, because such working simply is not happening and that is not right for taxpayers' money, for our constituents or for the people who work in the NHS and our children's centres, and those who work in our children's trust boards in the future.