Health Services (Gloucestershire)

I am glad that the hon. Gentleman makes that point. Historically, part of the problem is that public health has often lost out when pressure has been brought to bear on PCTs from the acute sector. As we move to a different place in which projects, programmes and interventions have an impact—in some areas, public health promotion could be better in terms of outcomes—we must have a discussion about how many of our services should be provided in hospitals, and how many of the services that are provided in hospitals should have a better link to community services, particularly for people with long-term conditions. This lunchtime, I was at a conference with the Local Government Association. We are continuing to work, more than ever before, on looking at the role of public health in relation to the way in which local government runs its business. Factors such as the development of housing, safer communities and the general environment all have a role to play in public health. As for smoking cessation, next year we will put in place legislation that will make most public places smoke-free. That will be a major contribution to changing the culture around smoking. To achieve a more mature, wide-ranging and long-term view of public health, we need to tackle the traditional situation in the health service whereby funding has overwhelmingly been directed towards those in the acute sector at the expense of those in the community. Painful choices are being made because of the need to deal with the deficits in a minority of organisations. That is causing problems even for PCTs that are in balance. My own PCTs in Doncaster—an area with huge health challenges—are in balance. In 1997 they were having to bail out other sectors of the NHS, but that was based on previous ways in which funding was organised and so was not done transparently—it was a fix designed to make everything look all right. It was not all right then, it was not all right in 1987, it was not all right in 1977, and it is not all right in 2006—but now we have an opportunity to try to get it right once and for all. I will deal as best I can with the points that hon. Members raised about financial balance. However, the important point is what will happen if we continue to stick our heads in the sand and do not deal with the problems that we face. As health services change, people’s needs change as well. In relation to the consultation launched today on the different services in the Gloucestershire area, I will not deny for one minute that there is clearly a financial imperative. I have read the document and had discussions with hon. Members and health professionals in other regions that I cover, and it is clear that in trying to find a way forward we have to take into account people’s understandable commitment to the health provision that they perceive that they are getting at the moment, as against what they might want in future. Those may be two different things. Someone who is 80 might want something very different from someone who is 60, and very different from what I, as someone in my 40s, might want when I am 70, 80 or even older. Part of this process—I am aware that it is a difficult one—is the honest discussion that people need to have about the services currently provided, and the shortfalls and problems involved, as against what else would be on offer.