NHS: Front-line and Specialised Services
Baroness Thornton Excerpts(15 years, 6 months ago)
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Baroness Thornton
My Lords, I congratulate my noble friend Lord Turnberg on this debate. Indeed, of all the speakers who have contributed today I particularly welcome the noble Baroness, Lady Jolly, to our debates and our deliberations for the future. I also need to congratulate all the speakers who have contributed today, because we have had a really excellent debate. We probably needed about two or three hours longer than we have had; maybe we need to do that.
I want to raise two matters, one strategic and one specific. Since June we have debated or had Questions on, among other things, cancer, diabetes, chronic pain, Parkinson’s disease, epilepsy, social care, COPD, neurological conditions, dementia and many others. I cannot recall a single debate or Starred Question where the issue of how services would be either safeguarded or delivered under the proposed reforms of the NHS was not raised in one way or another. The Conservative-led Government have been telling us this comforting notion that your family doctor will commission the services that you need—and who better to do so? I am on the record as saying that I support that in principle. However, Conservative MP Sarah Wollaston rather let the cat out of the bag when she wrote in the Guardian on 4 January:
“I know many GPs who are keen to tackle the redesign of care and even the issue of failing colleagues, but I know none that are interested in EU competition law. If commissioners cannot design care pathways free from the spectre of lawsuits from private providers, they will hand over to commercial commissioners prepared to take the rap”.
I think that that means that private commissioners may turn to private providers at the expense of NHS providers because of the intimidation, or their interpretation, of EU competition law. Will the Minister confirm the role that EU competition law will play in the forthcoming reforms? For example, will GP commissioners be able to choose NHS providers where they offer the best quality and comprehensive service even if they are not the cheapest, without fear of legal challenge from private enterprise cherry-picking the most lucrative contracts? The Minister will know that I have long been a supporter of choice and diversity within the NHS, but the question of how we achieve that might lead to a fundamental dividing line opening up between us.
The EU competition rules being used as a regulator for NHS services through Monitor provide us with a huge problem. The problem, if I might put it in shorthand, is that health-providing companies owned by shareholders and hedge funds are not independent providers; they are accountable to owners who want to see a profit. So patients and organisations that promote the interests of long-term conditions, for example, are correct to be asking how health services owned and run by these people will have their long-term interests at heart. These are the questions that we will need to answer when we look at the NHS Bill that is promised next week.
What role does the Minister envisage for the market, for competition and for the private sector as a result of these proposed reforms? Does he believe that collaboration or competition is the best way to run our health service? I promise noble Lords that the noble Baroness, Lady Finlay, and I have not collaborated in asking that question. These are very big issues to which, as I have said, I suspect we need to return for longer and deeper consideration.
I conclude by raising a specific issue—in many ways, a perfect example of the anxieties that are being raised in all quarters. This concerns GP commissioning and the future of cancer expertise in the new system, and I thank both Cancer Research UK and Macmillan Cancer Support for drawing this to my attention. Before I go on, I add my congratulations to the noble Lords, Lord Crisp and Lord Kakkar, who asked questions that drilled down into the detail that we are going to have to address, as indeed did my noble friend Lord Winston.
As the Minister will know, the cancer networks have been an absolutely integral and important tool in improving outcomes for cancer patients. The Government have said in the new cancer strategy, Improving Outcomes: A Strategy for Cancer, published yesterday, that cancer networks will continue to be funded during the transition period to GP commissioning. How will GP consortia make use of the expertise currently available in cancer networks to help in the effective commissioning of high-quality and seamless cancer services? How will the Government ensure that the functions currently provided by networks are not lost and standards compromised under the new commissioning regime? Will the Government ensure that cancer networks are funded throughout the transition period until 2014? Will that funding include funding that cancer networks receive from PCTs at the moment as well as directly from the Department of Health? How will GP consortia be incentivised to ensure that the critical functions of cancer networks are still carried out as they commission cancer services?
I am happy if the Minister wants to write to me about those questions; it is unfair to expect him to answer them in detail at this moment. But they are very important, and I look forward to his remarks.
Health: Influenza
Baroness Thornton Excerpts(15 years, 6 months ago)
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Baroness Thornton
To ask Her Majesty’s Government what is the reported increase in the incidence of influenza since the end of November; and how many adults and children suffering from influenza were admitted to hospital or died in December.
The Parliamentary Under-Secretary of State, Department of Health (Earl Howe)
My Lords, influenza-like illness, or ILI, has increased from 13 to 98 GP consultations per 100,000 people since November. The department does not currently collect data on hospital admissions. As of 6 January, there were 783 patients with ILI in critical care beds in England, and 50 flu- related fatal cases verified by the Health Protection Agency in the UK.
Baroness Thornton
I thank the Minister for that Answer. Last June, I asked him about the 50 per cent cut in the communications budget for the Department of Health. He said that,
“every programme of communication or marketing has to be justified by the evidence that it will do some good”.—[Official Report, 30/6/10; col. 1798.]
We know that pregnant women are particularly vulnerable to the H1N1 strain of influenza, and HPA’s data show that the risk of mortality for pregnant women is sevenfold greater than that for non-pregnant women. Even so, midwives received a letter from Andrew Lansley, dated 16 December, encouraging them to vaccinate pregnant women. Does the Minister think that it is possible that, had the Government acted earlier and had a public campaign, had they not cut their public health communications budget, and had Andrew Lansley sent a letter in October rather than December, the lifes of at least one pregnant woman might have been saved?
Earl Howe
My Lords, it is quite difficult to substantiate that suggestion, because the immunisation figures do not bear out the noble Baroness’s argument. The level of vaccine uptake in the over-65s is 70 per cent, which is better than in most countries of Europe. Among the at-risk under-65s, it is 45.5 per cent, which is comparable to the past two years. Therefore, it is not clear that a generalised campaign would have added value.
On the question of pregnant women, the normal procedure is for the Chief Medical Officer to write to all GPs in the summer, setting out all the at-risk groups. She did that in June. We were then alerted in December by the Health Protection Agency to a worryingly high number of pregnant women who had contracted influenza, so we wrote to both the BMA and the Royal College of Midwives to emphasise the desirability of encouraging that group of patients to get vaccinated. We did the right thing, which was to respond to emerging data.
Blood and Blood Products
Baroness Thornton Excerpts(15 years, 6 months ago)
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Baroness Thornton
My Lords, perhaps I may start by wishing the Minister and other noble Lords a very happy new year and by commending the Minister for his patience: he finally got to make the Statement. I welcome the Statement and congratulate the Minister and his colleagues on making progress in building on the work that the noble Lord knows we were trying to do on this important and tragic matter, to which I had a personal commitment. Of the haemophiliac community, almost 2,000 of the 5,000 infected people have died in the intervening period. For those with hepatitis C, it has become more urgent that the ex gratia payments should be reviewed.
This is a campaign about which we know people feel strongly. One of the saddest documents that I have read recently was a letter to the Prime Minister, written in October on behalf of the campaign for all those infected. It described how about 100 people travelled to London to listen to a debate and to lobby for the day. A number of them were very sick, including a double liver transplantee. There were widows, young people who had lost their fathers and another person whose son had died only weeks before. They felt very aggrieved by the business in the other place, which did not produce the results that they had expected. A shocked and saddened group of people struggled down the stairs from the Public Gallery to leave Parliament. The letter concluded by saying:
“It is not an Act of Parliament that is needed, but an act of political will”.
To an extent, that is what has happened today. Indeed, their disappointment was added to before Christmas when they were expecting the announcement that we now have before us. I particularly welcome the extra amounts of money available and the fact that these will not be taken into account for the purposes of taxation and means-tested residential social care support, but I have some questions for clarification.
The first question concerns how the money will be distributed. The Statement says that a new trust is going to be established. Will the Minister expand on how the money is to be distributed through that trust? Will the trust be like the ones that exist at the moment or do the Government envisage something new and different? I should like some information about how the money will be made available and how it will be distributed. I would also like some clarification on prescription charges, because the Government’s decision to abandon free prescription charges for people with long-term conditions has obviously impacted on the groups that we are referring to. I know that the Minister suggested that the prescription charges will be mitigated, but can he clarify whether that will cover, for example, those in the early stage of hepatitis C, not only stage 2? Will it cover everyone encompassed by the different stages of these conditions?
The areas that I feel are less welcoming concern the issues that have been discussed in this House on many occasions to do with considerations about mortgages, life insurance and travel insurance for people affected by these conditions. I cannot see anything in the review that suggests that consideration has been given to these matters. They form part of the completion and closure that is needed. I would also like an assurance from the Minister about support for the Haemophilia Society, particularly as I understand that the Government will be working with the society to help to deliver the information programme that is going to be necessary to ensure that people in this community take advantage of the benefit that the Government are offering.
My final questions concern where the money to fund this is coming from. If the Government are successful in persuading Scotland and Wales to expand this scheme, which I hope sincerely they will be, how is that to be funded? That is the question that those Administrations will be addressing. However, I very much welcome this Statement and I congratulate the Minister and his colleagues on the progress that they have made.
Health: Parkinson’s Disease
Baroness Thornton Excerpts(15 years, 6 months ago)
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Baroness Thornton
My Lords, I congratulate my noble friend on initiating this debate, and thank her for her commitment to Parkinson’s disease and for chairing the important all-party group’s report. I doubt I shall address a question to the Minister that someone else has not already asked. None the less, as is traditional in your Lordships’ House, I shall continue to speak.
As noble Lords will know, Parkinson’s is a long-term degenerative neurological condition. Symptoms can include stiffness of movement, pain, incontinence and dementia, which fluctuate from day to day, as noble Lords have mentioned, and worsen over time. It has a profound impact on people who have it, their families and their carers. I might be the first person in this debate to mention that one of the key problems with Parkinson’s disease is the stigma that goes with it. People may not recognise that people have Parkinson’s. They might think that they are drunk or that there is something else wrong with them. That is an additional burden that people with Parkinson’s disease have to carry with them.
The background to this debate is the brilliant report Please Mind the Gap, which took evidence from 360 people with Parkinson’s, their carers, health and social care professionals and representatives of public bodies, royal colleges and the Government. It brought to light many of the geographical inequalities in availability of services across the UK.
We know that the timely intervention of a specialist nurse or a physiotherapist and proper access to services can reduce hospital admissions and greatly improve quality of life. We have discussed this. We could substitute many conditions for Parkinson’s disease. We know that is the case. We know, therefore, that getting the provision of services for people with Parkinson’s disease right is not only right but cost effective.
Take, for example, Parkinson’s nurses. As a result of the investment from Parkinson’s UK, which pump-primes nurses for two-year periods and to which I pay the highest tribute, there are more than 300 Parkinson’s nurses. I have to say that I agree with other noble Lords: there must be a question mark over their future. I ask the Minister whether there can be some monitoring of what happens to these nurses. As pressures increase on primary care trusts and reform moves forward, what happens when you lose a Parkinson’s nurse? How many more people are admitted to hospital? The Government need to look at what evidence there is.
The same applies to allied health professionals, such as physiotherapists, occupational therapists, speech and language therapists, psychologists and specialists in neurology. They are all vital in treating Parkinson’s and other neurological conditions. The Minister will not be surprised to hear me ask how such coherent and co-ordinated provision will be made available under the proposed changes to the NHS commissioning structures. Parkinson’s UK is extremely worried that it will mean a worsening of access to Parkinson’s nurses, as well as all the other allied health professionals that are needed. Indeed, Parkinson’s UK reports that it is hearing of posts remaining empty following retirement.
It is clear that proposals to transfer commissioning powers from PCTs to GPs are of great concern, not only to Parkinson’s UK but to many organisations that deal with long-term and complex conditions. I agree with the noble Lord, Lord Walton of Detchant, that there must be a question mark over the ability of an NHS commissioning board to make sure that these services are delivered adequately by GP commissioning when we are not even sure how many GP commissioning boards there will be. One needs to ask: how will those consortia be able to commission the expertise to supply the support for this and the other neurological conditions mentioned by the noble Lord, Lord Walton of Detchant?
How will the Government ensure that the GP consortia involve the third sector in the delivery of these services? This question is being asked not just by Parkinson’s UK. I happened to be at a meeting attended by the Multiple Sclerosis Society and the Motor Neurone Disease Association and they expressed the same concern about the ability of the consortia to commission the right services at the right level at the right time for patients when a doctor may only ever see two patients with Parkinson’s disease as it is such an uncommon disease. We know that you effect change in the NHS through leadership. How can the Government ensure that the leadership for this condition will continue and develop? The NICE guidelines are to be reviewed this year. If the Government do not go ahead with that review and do not come forward with robust guidelines, how will they ensure that the leadership for this condition will be maintained?
The Minister cannot have failed to notice that the same questions have been asked with regard to stroke, diabetes, MS and epilepsy. With all those conditions the same level of anxiety is evident about what the future holds under the proposed changes to the NHS. I am merely amplifying what has already been said but we are getting to the point where we need answers about how these conditions will be managed.
NHS: Targets
Baroness Thornton Excerpts(15 years, 7 months ago)
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Earl Howe
I am sorry that the noble Lord is a sceptic on these matters. In the field of mental health care, for example, where there is a long-standing position of private sector contestability, we have seen that standards have been driven up. There is no doubt that the foundation trust model has also paved the way for higher quality in healthcare.
Baroness Thornton
My Lords, turning to waiting lists for accident and emergency services, which we obviously want to provide the highest possible care, I want to ask how the newly proposed scheme will improve the quality of care. For example, how will the abolition of the 19-minute response time to a 999 call that is not life threatening affect the health outcome for an elderly lady who has slipped and broken her wrist on the ice? Such a slip may not be life threatening, but the elderly lady may wait for quite some time for an ambulance and then wait considerably longer than four hours in accident and emergency. Is the waiting time not an outcome here? If the Government do not intend to introduce a new outcomes framework for two years, would the Government not be better to leave the current guarantees in place because we know that they ensure patient safety?
Earl Howe
My Lords, on ambulance response times, the existing eight-minute target will remain in place for category A calls. For category B calls, which are serious but not immediately life threatening, Peter Bradley, who is the national ambulance director, has been working with Professor Cooke to develop a set of 11 clinical quality indicators for the ambulance service. We are clear that those indicators will provide a much better and more rounded set of objectives than a mere 19-minute response time. Of course response times are important, but there are other things that should be focused on as well. We hope to improve standards in this way as from April next year.
NHS: Global Health
Baroness Thornton Excerpts(15 years, 7 months ago)
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Baroness Thornton
My Lords, the noble Lord, Lord Crisp, has a passion for this important issue, and I congratulate the noble Lord on initiating this debate tonight, the quality of which has proved his passion to be correct.
Good health in one country cannot be maintained if there is widespread ill health and disease in so many others. I have always felt privileged to be able to participate in debates in your Lordships’ House when such expertise and personal commitment is shown and, as so many noble Lords have said tonight, in a globalised and interdependent world, one in which disease certainly knows no boundaries, health is a global issue. The rich world has a responsibility to the developing world to support the growth of their health infrastructures and the growth of their medical education.
The nature of our responsibilities includes without doubt the need for overseas doctors to train in the UK without unacceptable barriers being placed in their way, or expense, and indeed the need for UK doctors to spend time abroad. We recognise that is a legitimate part of their qualifications, as mentioned by the noble Lord, Lord Patel, and others. It also includes the need to prepare our own UK-based doctors for the implications and effect of globalisation in our own health service and the UK population. The noble Lord is quite right—our medical training must encompass this challenge and its complexity.
The previous Government, with no small help, I suspect, from the noble Lord, Lord Crisp, produced Health is global: a UK Government strategy 2008-13 in September 2008. In it there was recognition of the fact that a healthy population is fundamental to prosperity, security and stability. It also linked the Government’s domestic and international objectives to the issue of improving global health. Could the Minister tell the House, therefore, what the Government are doing to continue this work? Has the department embraced the recommendations contained in that strategy?
We can look at the threat that global disease can pose. SARS and swine flu are two of the most dramatic examples where the world had to work together to protect itself. There is no doubt that a weakness in the healthcare in one country can put millions at risk. Nearer to home, however, in the UK, and particularly in London, we only have to think about TB and the communities most at risk. I am reminded of this by the noble Baroness, Lady Masham, who questioned me many times when I was a Minister about this.
Seventy-two per cent of UK cases of TB are among people born abroad, and about 40 per cent of cases in England are in London. It is vital, therefore, that the health service in London understands the nature of this problem, the communities at risk, and what needs to happen. The increase in migration into the UK means that UK doctors treat patients from all over the world, and medical students must be prepared for this change and understand its implications.
The report, Tomorrow’s Doctors, referred to by several noble Lords, has very wise words on these matters. It says that this is,
“leading to demands for greater cultural competency in the doctor-patient interaction”.
That is quite right. It continues:
“Medical students have to be prepared carefully for this change, with curricula exposing them to an understanding of why migration happens and specific migrant health issues as well as how to treat a broad range of diseases not routinely seen in the UK”.
Can the Minister say, therefore, whether TB and other conditions and their management are adequately included in the training of doctors in the UK? Indeed, would the forthcoming change of the Health Education Board mentioned in the document referred to by the noble Lord, Lord Jay, which will be an issue for the House in months to come, encompass the proposal made by the noble Lord, Lord Crisp, and other noble Lords today?
Hospices and Palliative Care Services
Baroness Thornton Excerpts(15 years, 7 months ago)
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Baroness Thornton
My Lords, I congratulate the noble Viscount, Lord Bridgeman, on securing this short but important debate, which has had many very pertinent contributions. The goal of palliative care is to prevent and relieve suffering and improve quality of life for people with serious and complex illnesses. End-of-life care affects all of us; it is everybody’s business and, as such, must be a central focus of any health, social care and housing reform agenda.
Much of the recent progress in end-of-life care was enabled by its inclusion as one of only eight high-level priorities in the NHS Next Stage Review, which the previous Government brought forward. Indeed, we made end-of-life care a priority; we made a commitment to it and, significantly, we increased funding to hospices. The key challenge facing the Government now is to ensure that end-of-life care continues to be one of the top few high-level organisational priorities at each stage of the forthcoming reforms. The proposals in the White Paper published this summer did not reflect the importance of end-of-life care sufficiently to guard against it being subsumed by other higher profile priorities. That is not just my opinion; it is also the opinion of the Palliative Care Association.
I have glanced at the results of the consultation published today and have yet to find the words “end-of-life strategy”. It may be in the operation strategy document, which is my weekend reading. I echo my noble friend Lord Faulkner in his concern about how the new GP commissioning will deliver palliative care. I suspect that many organisations that have campaigned for end-of-life care so successfully in recent years will be concerned about what comes next. Diluting recognition of end-of-life care as a discrete, high-level priority risks undermining the progress made, and I suggest devalues end-of-life care as a government priority. I should be grateful for the Minister’s comments on this and his reassurance. Surely, if the Government intend to drive cultural change in the NHS, as they say they do, it is essential that they reflect the whole journey of a person’s care throughout their life to their death and into bereavement care for their family and friends. The Minister needs to address some serious worries and concerns raised during this debate.
Autism
Baroness Thornton Excerpts(15 years, 7 months ago)
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Earl Howe
My Lords, the statutory guidance that already exists—it has been revised in light of the response to the consultation—makes it explicitly clear that in addition to general autism awareness-raising training for staff, local areas should develop or provide specialist training for those in key roles who have a direct impact on access to services for adults with autism, such as GPs, community care assessors and commissioners and service planners.
Baroness Thornton
My Lords, I congratulate the Minister on continuing to make progress in this matter. As he will know, commissioning for autism services requires expert knowledge and, as my noble friend said, a recent National Audit Office survey found that 80 per cent of GPs said that they needed more training in autism awareness. Can the Minister outline whether any progress is being made to change that situation because, if it applies to GPs, it probably applies to other health workers? Is the Minister also supportive of the call from the National Autistic Society for NICE guidelines and for the inclusion of autism as one of the future quality standards currently under consideration by the National Quality Board?
Earl Howe
My Lords, we cannot mandate to NICE what quality standards are produced. However, the case for developing a quality standard for autism will be considered as part of work to commission a comprehensive library of such standards from NICE in line with our plans in the White Paper. NICE is already developing clinical guidelines on diagnostic pathways for autism, including one for children and young people with autism. That is scheduled to be published in September next year. On training, I cannot really add much to what I have already said to the noble Lord, Lord Low, but it is very high on the agenda.
Health: Passive Smoking
Baroness Thornton Excerpts(15 years, 8 months ago)
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Earl Howe
My Lords, we have no plans to legislate further for banning smoking in cars. As she will know, when a car is used as a workplace smoking is illegal, but when a car is being used privately that is a different matter. We do not intend to legislate.
On messages in schools, we know that youngsters are concerned about parental smoking. In fact, the younger the child, the more concerned the child tends to be. Schools are encouraged to include advice on smoking in the PSHE curriculum.
Baroness Thornton
My Lords, following the successful implementation of the smoking ban in all workplaces and public places in July 2007, which was opposed by many in the party opposite, will the Minister undertake—
Baroness Thornton
I except the noble Baroness, Lady O’Cathain, from that.
Will the Minister undertake to ensure that, under the proposals for GP commissioning, NHS smoking cessation services will continue to be effectively commissioned and funded and that nicotine products will continue to be prescribed?
Earl Howe
My Lords, the noble Baroness, Lady Thornton, is wrong. The Conservative Party did not oppose the second-hand smoke provisions. We did not oppose them in principle; we supported the Government. We opposed some of the detail, but that is a different thing.
On smoking cessation, there is no doubt that local stop-smoking services are effective and are available free of charge in communities across the country. Evidence shows that the most effective way of stopping smoking is with local stop-smoking services because smokers get behavioural support as well as effective medicines and treatments on the NHS.
Public Health
Baroness Thornton Excerpts(15 years, 8 months ago)
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Baroness Thornton
My Lords, I thank the Minister for repeating the Statement, which as we know was well trailed on the “Andrew Marr Show” on Sunday and on the “Today” programme this morning. There are some things that we would like to welcome and support in the Statement, and there are some that we think are a cause for concern. My overall impression is slight disappointment at the insubstantial nature of this Statement. Much of it is common sense and much of it picks up where the previous Government left off, but the Government have had quite some time to think about and to decide on the direction for public health. I believe that this White Paper is short on strategy. Therefore, I look forward to more substance as we move forward.
I think that we would agree that local authorities have an important role to play in the delivery of the public health agenda. Presumably, the new public health service will take on some of the responsibilities of the Health Protection Agency. I have to say to the noble Earl that I wonder why it was necessary to announce the abolition of the HPA, except to make a political point, which is disappointing, when a new agency is being created. The appointment of the new directors of public health will be very important in this programme of delivering a public health agenda. For them to be effective, they will need to be independent. How do the Government intend to ensure that directors of public health in local authorities have the necessary independence and power to deliver an agenda, which sometimes a local authority may not want to hear and may find expensive to deliver?
I am disappointed at the cheap gibes in the Statement, which I can only assume were the idea of the Minister’s bosses—that the nanny state ruled during the Labour years and that Mr Lansley’s “nudge-nudge” public health strategy will be more effective. We need to get past that sort of name calling. The evidence shows that by taking a lead, as Labour did, in the diagnosis of public health issues based on evidence and in taking some of the big decisions on, for example, smoking, exercise and diet—the noble Earl has not ruled out that this Government might need to do that too—we provided a good framework for people to take responsibility for their health and to start to change their habits. I hope that this Government will continue to support families where it is needed.
I do not think that nudging would have got us the ban on smoking in the workplace. “Nudge” will not replace the brilliantly successful schools sports programme. I am not sure that nudge will deliver the national screening programme mentioned in the Statement. I am certainly sure that nudge will not deliver healthy meals in schools or fruit for schoolchildren. So I am sceptical about the nudge part of this Statement.
However, we can all agree that factors such as unemployment, education, environment and equality are important determinants of health. The Statement is correct in saying:
“Unhealthy behaviours, like drinking too much, smoking … are … rooted in poor aspiration, adverse peer pressure and low self-esteem”.
As Marmot puts it, and as the noble Earl has said, they are the “causes of the causes”. That is absolutely correct.
I disagree with this Statement where it puts forward a cross-government initiative; that is, joined-up government. The noble Earl needs to explain how throwing somewhere between 400,000 and 500,000 people on the dole will help their self-esteem and their family’s prospects. He would need to explain the joined-up bit of the Government that led his right honourable friend the Secretary of State for Education to get rid of the successful school sports scheme that got our nation’s children playing sport. Ditto housing benefit cuts, which may put some families’ homes at risk or move them away from where they can earn a living. That is not going to provide the right environment. Finally, we have the abolition of the education maintenance allowance, which has allowed thousands of children from low-income families to stay on at school after 16. If, as Marmot says, life chances and opportunities are an important part of people’s well-being and health, how can the Minister explain the contribution of this initiative to public health?
I want to turn to the regulation of tobacco. This House has debated this issue at length and over quite some time, and by several large majorities it supported the introduction of point-of-sale tobacco regulation and the banning of tobacco products in vending machines. Just this morning, on the “Today” programme, the Secretary of State confirmed that he accepted the evidence that the visibility of cigarettes is a factor that leads to the initiation of smoking. He also mentioned the issue of plain packaging and the Government’s intention to consult on this. We all know that such a consultation will take years and that any action to put tobacco into plain packaging, following on from such a consultation, will take years to come into force. This cannot and should not be seen as an alternative to the legislation to ban tobacco displays. The display legislation is on the statute book. It will protect this generation of children from brightly coloured displays in shops. I should like to ask the Minister this: will cigarettes no longer be on display in supermarkets from October next year? Further, if the Government intend to consult on plain packaging, how long will the consultation take, who will run it and how much will it cost?
I have two or three more questions for the Minister. I warmly welcome the Government’s intention to invest in Sure Start children’s centres and in more health visitors. I also support the development of health protection plans and screening programmes, but I have to ask the Minister: is this nudge or is this target? How are the Government going to decide whether enough people are being screened, because that aim needs a target rather than a nudge? The ring-fencing of public health budgets is going to be a challenge. How will the Government decide what is going to be included in those budgets and what will be excluded? Moreover, how are they going to stop hard-pressed local authorities from raiding them? That will indeed be a challenge. We support the Government in doing this, but we will need to address how it will be possible to deliver that ring-fencing.
Finally, I certainly welcome the greater use of voluntary and community organisations. We worked with many organisations in different health fields, and that is exactly right. However, the funding and support for these organisations needs to be maintained.