Health Bill [Lords]

I apologise to my right hon. Friend the Secretary of State and to Opposition Front Benchers for not being here at the beginning of the debate. It has been a busy day in the House, with a range of important meetings that I have attended—and enjoyed. In response to the hon. Member for Wyre Forest (Dr. Taylor), I am not an Englishman who is too busy, but I am a Scotsman who represents an English constituency, and I want to be busy on the issue of NHS reform and NHS investment. When I was a Member of this House in 1992, my first Front-Bench job was as Labour health spokesperson. My right hon. Friend the Member for Rother Valley (Mr. Barron) is here. We are where we are today only because he campaigned on issues such as smoking and preventive strategies in primary care and because of his commitment and engagement during that period, when the then Government refused to listen to any arguments about investing in the acute sector and in preventive strategies in primary care to improve health care, particularly in working class communities. I welcome my right hon. Friend the Secretary of State to his new post. He and I share a borough, and we share a friendship; indeed, we live minutes away from each other. The fact that he has got this job is a breath of fresh air; that is not because the individual who had it before was not a breath of fresh air, but because ever since he was elected to this House and before, he has seen the importance of a preventive strategy in health care through investment in sport and sport-related issues. As Secretary of State for Culture, Media and Sport, he was the first Secretary of State to link the preventive strategy in health care with other strategies across Government, including sport. As a consequence our local authority, Wigan council, was the first to introduce free swimming not just for young people but for every single person in the community. We now have thousands upon thousands of individuals taking up healthy pursuits, and the preventive strategy has improved their health due to the intervention of my right hon. Friend. If there had to be a reshuffle, I cannot think of anybody better to take on the portfolio, and I wish him and his colleagues the very best in their efforts to build on the success of the Labour Government's record investment in health care. May I ask a favour of my right hon. Friend? I will be leaving this House after 22 years for health reasons. I am probably the reason why the NHS has had financial problems in the past few years. At least once in each of my 22 years in the House, I have been hospitalised. Because of the NHS, I am looking a very healthy ill person. But given my role as a patient in the NHS, my right hon. Friend could do me a favour if there is any work going after the next election and he is still Secretary of State, as I believe he will be. If he is looking for full-time NHS mystery shoppers, I am up for it. This Bill and previous innovations in Bills like it are about empowering patients, and it is important that health care provision should not be a passive relationship between health care authorities, doctors, clinicians and other health care professionals. It should be about engagement with the patient, to maximise their opportunity to help manage both their illness and the process of improving from ill health to sustained good health in the years ahead. The Bill will assist in that process. I have been in favour of direct payments for many years. In the case of social care, I argued the case in Government for direct payments, not to weaken public or community provision but to empower individuals to have a real say in their life as it relates to their health and social care. Yes, direct payments can be controversial, as many changes have been in the modernisation of NHS. My right hon. Friend should engage with trade unions and health care professionals, but he should do so on the basis of taking them on that journey. Direct payments, if well managed, well organised, accountable and in the context of NHS principles and the constitution, will benefit tens of thousands of individuals and their health care in the years ahead. I ask him to pursue that issue with vigour. As we evolve and develop the role of NHS foundation trusts, it is important that we find ways to make them even more accountable to the local communities in which they operate. Whether a foundation trust is acute or non-acute, it is critical that the bureaucracy of establishing it does not create barriers to the community's involvement in its management and decision making in a wider sense. That could include decisions on the professionalisation of the board memberships, or ensuring that individual communities—particularly working class communities, if Members do not mind my saying so—can engage in the decision-making process about the services that the trust provides. Trusts must reflect the priorities of the communities in which they reside. As we establish foundation trusts, for which I argued in government, it is important that communities are engaged to the fullest extent. We must bring together local government and other partners to plan and provide services, and we must ensure that community groups and organisations are an integral part of the consultation process on the development and improvement of those services. Where it is appropriate, local community organisations should be involved in the delivery of those services as well. I turn to the specific issue of children's smoking. I do that not just because of the extensive work of my right hon. Friend the Member for Rother Valley—I was a supporting act to him when I was on the Front Bench in the 1990s—but because I represent a constituency in the north-west of England that has been devastated by the twin effects of poverty and smoking-related diseases. Literally thousands upon thousands of untimely deaths in the past decade can be attributed smoking. Smoking takes a heavy toll on the lives of the people in the communities of the north-west, with 14,000 deaths a year in our region. It exacerbates health inequalities and has a negative impact on children and young people. That is the history of the north-west of England. As a consequence of decisions in previous legislation, we now have the capacity to break that horrific cycle of smoking, poverty and inequality. However, there is a loophole, and I shall talk about that in a moment. The prevalence of smoking in the north-west region is the highest in England, with 23 per cent. of the population smoking—25 per cent. of men and 22 per cent. of women. As many as 22 per cent. of 14 to 17-year-olds smoke in the north-west, despite the fact that it is now illegal to sell cigarettes to under-18s. In November 2007, leaders of local authorities, community groups, the NHS and young people's organisations came together to set out a bold vision of a tobacco-free future for our children and young people in the region. In June 2008, local authorities and health service leaders throughout the region decided, on a non-party-political basis, to build on that initiative. They made a new pledge to""make smoking history for the region's children"" and agreed that a fully funded and effective national tobacco strategy needed to be developed. There was a public consultation exercise, and 60,000 responses from people in the north-west accounted for around two thirds of the total 96,000 responses that the Department of Health received to its future of tobacco control strategy. That was a huge response from a community devastated by the effects of smoking. The response is consistent with the findings of the survey conducted last June, with north-west residents expressing overwhelming support for further measures to protect children from tobacco. Smokers and non-smokers expressed such support. It is interesting that smokers themselves recognised the dangers to young people of either commencing or being encouraged to commence smoking and continuing to do that. The survey was not simply of people who are opposed to smoking in all circumstances. It included a huge proportion of smokers, who were encouraged to start smoking in their earlier years.