Health and Social Care Bill

I support my noble friend on these amendments. In my experience, health promotion is a tricky area for Governments. First, it is extremely boring. The messages are dull: a full and varied diet, lots of painful exercise, keep chaste, drink in moderation, do not overeat—or, as a businessman told me the other day, it is a question of infinite supply with limited demand. It is not too much of this and not too much of that—moderation in all things. Boring. Really, deeply boring. Secondly, people do not like to be told what to do by authority, particularly when the authority happens to be the Government. Thirdly, Governments are reticent; they are fearful of being dubbed the ““nanny state””. Fourthly, it is difficult to change people’s behaviours and to maintain that change. Lastly, Governments are of course short term, with a maximum of five years, while health promotion is long term, often requiring a generation. I speak with some passion about this subject because when I was Minister I was responsible for a government policy called The Health of the Nation. It was a delight. It was the one area in my portfolio other than maternity that was not about pain, suffering and death; it was full of razzmatazz and encouraging people to live a healthy life and do some things that they did not really want to do. That policy was interesting—it was cited by the WHO as a model for other countries to follow. When I went to international conferences, I was proud of it. When the new Labour Government took over their responsibilities, they decided not to adopt The Health of the Nation. A few years later they had their own promotion strategy, Our Healthier Nation. It covered much of the same ground, but not sexual health. Quite a lot of momentum was lost and we are seeing an increase in sexually transmitted diseases; indeed, between 1997 and 2005 the number of diagnosed cases of HIV increased from 2,700 to almost 7,500 and chlamydia increased by more than 300 per cent. I do not want to be negative, however. Some progress has certainly been made. It is hugely encouraging that since 1995 we have seen premature deaths from heart disease fall by over 40 per cent and premature deaths from cancer cut by nearly 20 per cent. Since 1986, life expectancy for men has increased by almost five years and for women by more than three years. So far, so good, but in other areas the nation’s health is getting worse. As we know, obesity is a real problem; it is on the increase and is a condition linked with a whole range of diseases. The proportion of men classified as obese has risen from 13 per cent to more than 22 per cent in the past 12 years. In women, the rate has gone up from 16 per cent to 24.3 per cent, or just under a quarter of the population. I fear that we are becoming the lard bucket of Europe. The number of alcohol-related deaths has almost doubled in the past 13 years and the number of alcohol-related admissions to hospital has risen by more than 80 per cent. That is a huge toll and a huge expense for our acute services. We know that binge drinking among young people has become fashionable. Young people are more likely than any other group to drink more than twice the recommended amount. This excessive drinking is more common in highly deprived areas, where the death rate is about 45 per cent higher than in other areas. People from the most deprived areas live at least five years less long than those from the most well off areas and spend a greater proportion of their lives in poor health. This inequality in length of life and good health is distressing and shameful and has to be tackled. Sir Derek Wanless, Securing Our Future Health: Taking a Long-Term View, which, incidentally, was commissioned by the King’s Fund, not the Government, and clearly pointed out that unless we embrace his third scenario, with the population becoming fully engaged in looking after its own health, the NHS is in danger of collapsing under the burden of ill health. Sir Derek states: "““Individuals are, and must remain, primarily responsible for decisions about their and their children’s personal health and lifestyle””." He goes on to say: "““But this does not remove the duties on government and many organisations in society, including businesses, to help individuals make better decisions about their health and welfare. Significant failures in how decisions are made can lead to individuals inadvertently making choices that are bad for both themselves and society. Therefore, to promote improved health outcomes and to reduce health inequalities, the government and other bodies need to act to reduce these failures and assist individuals to make better decisions””." This is where the new Care Quality Commission comes in. PCTs are one of the agencies that are tasked with promoting good health, but we know that it is not high on their agenda. In its 2007 report, State of Healthcare, the Healthcare Commission cites a mixed picture both of commissioning and delivery of services by PCTs, especially in relation to preventing illness. The commission assessed, as part of a pilot study, PCTs on a development standard for public health. It was a voluntary self-assessment scheme and of those that reported more than half described their progress only as fair. The Healthcare Commission is the only regulatory body in the world that has responsibility for the promotion of health enshrined in law and yet this responsibility is left out of the Bill. If we do not include this amendment, we will be taking a serious backward step. We need a champion for this cause and we need a regulator that has a duty to monitor the progress of PCTs in what I admit is a very difficult area.