Obesity

Diane Abbott Excerpts

Wednesday 9th November 2011 Westminster Hall

[Dr Wollaston]

I thank the Minister for that helpful response and look forward to hearing the outcome of that.

Children at primary school and in the early years before they have reached school are among the really high-risk groups. Some 85% of obese children go on to become obese adults, whereas only 12% of normal weight children become obese adults, so it makes sense to focus on that group of children, but that can happen only if we have better early identification. We should introduce annual measurements of weight and height, so that we can see when children are starting to slip towards obesity. We should target our resources much better on that group.

[Ms Diane Abbott (Hackney North and Stoke Newington) (Lab)]

Years ago, parents with chubby children would be told, “It’s puppy fat and they will grow out of it.” There is still that idea around among otherwise bright and responsible parents. We need to press the point that chubby children grow into chubby adults.

[Dr Wollaston]

I absolutely agree with the hon. Lady. We need to be much clearer with parents that their children are at risk and that being overweight is not something that they will grow out of.

We should be much more creative about how we target help to high-risk children. Why not allow all those children to have free healthy school lunches? As poverty and deprivation have such strong links with obesity, considering that high-risk group is particularly appropriate if we are to address the Marmot agenda. Unfortunately, families on tight budgets are much more likely to be pushed towards unhealthy and cheaper choices. If we want to nudge them in the right direction, we must recognise the role that price plays in the choices that they make. We should look at the role of loss leaders. We urgently need a change in what supermarkets offer so that loss leaders are redirected towards healthy rather than unhealthy products.

Why not incentivise exercise in those high-risk families with vouchers for success and free access to good-quality sports facilities? We should incentivise a whole-family approach to cooking skills because cooking is a fun activity. An effective way forward would be to make such a service free and readily available to whole families.

On liquid calories, a survey conducted by the British Dental Association and Ipsos-MORI showed that 47% of children’s fluid intake is in the form of sugary and carbonated drinks. That means that one in five children is consuming 500 calories or more a day just in the form of sugary drinks and 73%—nearly three-quarters of children—are consuming more than 200 calories a day. It is a staggering number of calories that children are consuming.

If we look at adults, we will see that there is a particular issue with alcohol. The chief medical officer has already highlighted that around 10% of an adult’s calorie intake can be through alcohol. What we should understand from that is the role that discounting plays. I have mentioned that before. It really does not matter how disciplined the rational part of our brain tries to be—the irrational and impulsive side will continue to be irrational and impulsive. It is not helpful to see heavily discounted products in super-sized multi-buy packs piled high at the check-outs in supermarkets. If we want to move “nudge” towards “shove”, we should regulate how supermarkets market their products. I do not suggest that the whole answer to obesity lies in regulating supermarkets. I realise that there is a complex interplay between over-supply, pricing, culture, marketing, poor consumer choices and human nature. There is also the interplay between genetic predisposition and a lack of exercise. However, it is unlikely that our current strategy will go far enough in this regard. If we are going to do something about the £5 billion a year that this problem is costing us—the figure is predicted to rise to £10 billion a year by 2050—I suggest and hope that the Minister takes a strong line and abandons the idea of giving the problem a little nudge, in favour of giving it an almighty shove.

--- Later in debate ---

[Ms Diane Abbott (Hackney North and Stoke Newington) (Lab)]

It is a pleasure to serve under your chairmanship, Mrs Riordan. I congratulate the hon. Member for East Londonderry (Mr Campbell) on securing this important debate, to which we have all been glad to contribute. He reminds us of how many issues we have in common in these British Isles.

I want to focus on the important subject of child obesity, and to talk about the responses so far to the Government’s obesity strategy entitled “Healthy lives, healthy people: a call to action on obesity in England”, which was presented to both Houses on 13 October. First, however, I want to say that some people might feel that Members of Parliament have a certain temerity talking about healthy lifestyles when their own lifestyle is relatively unhealthy, and I speak as someone who has been in this House for 20 years. Perhaps we should give credit to the few colleagues we sometimes see going through the Division Lobby dressed in their running gear after a bracing run. I am sure that Members will unite with me in congratulating those rare Members on that.

We are facing a crisis in childhood obesity. As I said earlier, gone are the days when we could look at a chubby child and say that they would grow out of it: chubby children grow into obese adults. I have to say, more in sorrow than in anger, that a wide range of people both inside and outside this House have expressed doubt about the effectiveness of the Government’s obesity strategy. Before moving on to what I think the Government should be doing, let me focus on the picture in London.

London has higher levels of childhood obesity than any other British region. The capital’s childhood obesity rate is 22%, compared with an average for England as a whole of just 19%. Across the capital, one in five youngsters are obese, with rates varying widely from 12% in leafy Richmond to 28% in Westminster. Childhood obesity costs the capital £7.1 million a year to treat, and the annual bill could reach £111 million if today’s young people remain obese into adulthood.

Research commissioned by the Greater London assembly found that adult obesity costs London £883.6 million a year, and in my own constituency—Members will forgive me for mentioning it—a quarter of all year 6 pupils are obese. That is one of the highest rates in the country as recorded by the national child measurement programme. In 2010 in City and Hackney, 13% of children in reception year were overweight and 14% were obese. The number of overweight children was similar to the national average, but the proportion of obese children was slightly higher. Greater efforts are needed to prevent overweight and obesity at the pre-school stage, because a high proportion of children are already obese and overweight by the time they start school. The escalation of the trend through to year 6 suggests that we also need to implement robust interventions in primary schools.

A number of Members have talked about parental responsibilities. I put it to colleagues that some of the parents who are doing what we might understand as the wrong thing are, in their own minds, trying to be good and vigilant parents. One of the problems that young children in Hackney and the rest of London have is their sedentary lifestyle, and part of what motivates parents to keep their children indoors is this idea of stranger danger. We all know that attacks on children have not gone up in 20 years, but childhood obesity has spiralled. Many parents—not bad or careless ones—think that they are doing their children a service by keeping them indoors, safely watching television or playing on the PlayStation, rather than playing outside.

I was not the most sporty of children, unlike some of the Government Members who have contributed to the debate, but in the summer holidays my mother thought nothing of us having breakfast and then going out to play all day. We might have come in for lunch, or have gone to a friend’s and come back for tea. Nowadays, no London parent would allow their child to play out all day without knowing where they were, and it is that sort of vigilance and possibly unwarranted fear of stranger danger that leads to many thoughtful parents deciding, perhaps because they have not had the education or do not have the understanding, that they will feel better if their children are indoors rather than outside playing.

Let us also remember that in a big city such as London a greater proportion than ever of our children live in flats, maisonettes and other accommodation without a back garden. As a child, if I was not out, I spent most of the day in the back garden, on the swing, climbing trees and shouting at my brother, but many children in my constituency are trapped in flats and it is not obvious to their parents where they can be allowed to play safely.

[Andrew Bingham]

That is a good point. We talked briefly about video games. Does the hon. Lady think that the advent of Wii Fit-type games is beneficial? I have seen young people playing them, and they involve a lot of jumping around and so on, which I suppose is a form of exercise, at least.

[Ms Abbott]

Far be it from me to advertise any particular product in this Chamber, but Wii Fit games are perhaps better than PlayStation games.

[Mr Simon Burns]

I have been listening carefully to the hon. Lady, who is making some valid points. The danger has to do with not simply the age of computer games but the age of television before that. For some parents—this is a generalisation—the easy option is to let their children spend hours watching television or playing games, because it involves less effort on the parents’ part. One must try to educate people that that is not only an easy option but an unfair one.

[Ms Abbott]

I am loth to agree with the Minister, but I think that he is right on that point. A particular interest of mine is the education of urban children and the challenges of getting them to achieve their educational potential. As part of working with parents, especially in urban communities, we must teach them that just putting their children in front of a television set is not necessarily the best thing for their health or their education.

I agree entirely with what has been said about exercise and sport, but we also need a particular focus on girls and exercise. Statistics show that girls give up exercise younger; after they leave school, they do not continue to exercise, as boys do. I was interested to hear about, was it ice hockey—

[Justin Tomlinson]

It was an ice-skating disco on Friday nights.

On the point about getting more girls involved, that is why I proposed merging youth and leisure services to identify opportunities. Girls, in particular, follow what is on television. If street dance, cheerleading or football is popular, let us provide those services and facilities, and they will come flocking.

[Ms Abbott]

I agree. That is the point that I was going to make. We need to be more innovative in the sorts of game that we encourage and make available to children. Girls do not want to play ping-pong, because they are quite self-conscious physically, but they will do things such as breakdancing and ice skating.

As other Members have said, we have a generation of parents, especially in inner cities, who do not know about food, have only the dimmest idea of where some foodstuffs come from and do not know how to cook. Because they are bombarded by advertising for processed food, when they whip out a ready meal from Marks and Spencer, it is not just idleness; they think that they are being good parents: “Look, I’m getting you something from Marks and Spencer which is advertised on the television.” We should work with communities and parents to educate them.

In my view, the Government obesity policy’s reliance on responsibility deals is a little problematic. Common sense suggests that companies that make billions of pounds every year peddling fizzy drinks and foods larded with trans fats will not seriously undermine their profits by genuinely trying to change the public’s eating habits. Although we must applaud the Government for whatever progress they think they have made with responsibility deals, we must go beyond them as they are currently fashioned if we are to stop the epidemic of obesity among our young people.

To return to the Government’s obesity strategy, the message from health professionals, key health groups and experts is clear. We need tough action now and a proper long-term strategy to stem the rising tide of lifestyle-related diseases. Jamie Oliver, probably the single most famous person in public health, has said in the past few weeks that this Government’s obesity strategy is

“worthless, regurgitated, patronising rubbish”.

As usual, he was not pulling his punches. Terence Stephenson, president of the Royal College of Paediatrics and Child Health, said that the Government’s plan

“has no clear measures on how the food and drink industry will be made to be more ‘responsible’ in their aggressive marketing of unhealthy food…Suggesting that children in particular can be ‘nudged’ into making healthy choices, especially when faced with a food landscape which is persuading them to do the precise opposite, suggests this would be best described as a call to inaction.”

Which? executive director Richard Lloyd said that the Government’s approach to tackling obesity was

“woefully inadequate…The Government calls on people to cut down the calories they eat, but isn’t giving them the tools to do so.”

Charlie Powell, campaigns director of the Children’s Food Campaign, said:

“This is a deeply disappointing and utterly inadequate response which represents a squandered opportunity to address the UK’s obesity crisis.”

There is broad agreement in the House about the issues that we must address. It is a mix of issues; there is no silver bullet. Better labelling of food, including in restaurants and cafés, is part of the answer. Fashioning a sport offer for young boys and girls is crucial, as is better education and working with parents and communities.

I would like to say a word about gastric bands. We read an enormous amount about them, particularly in relation to celebrities. As a Conservative Member said, there are cases, if people have tried everything else, where a gastric band might be the answer, but I deprecate the promotion of gastric bands without some of the measures that we have discussed if that suggests to people that they can eat whatever rubbish they like because, at the end of the day, the NHS will pick up the tab for a gastric band. That is not the way forward, either for costs in the NHS or for people’s quality of life. I have read about people who, having got gastric bands, proceeded to liquidise fish and chips so they could continue to enjoy their favourite junk food. That suggests that a gastric band, in itself, is not the answer to the underlying issues.

I hope that, in his winding-up speech, the Minister will address the serious concerns raised about the Government’s obesity strategy by a wide range of stakeholders and specialists. I look forward to hearing what the Government plan to do further to address the growing epidemic of obesity among our young people.

[The Minister of State, Department of Health (Mr Simon Burns)]

It is a pleasure to serve under your chairmanship, Mrs Riordan, during this extremely interesting and thoughtful debate, to which there have been a number of erudite and imaginative contributions across the range.

I congratulate the hon. Member for East Londonderry (Mr Campbell) on securing the debate and giving us the opportunity to discuss one of the major public health issues of modern times. He has spoken repeatedly on the subject in the House and should be congratulated on doing so. He knows, of course, the scale of the problem. Most adults in England, 61%, are overweight. Sadly, one third of those are clinically obese, giving us one of the highest obesity rates in the world. As for children, almost a quarter of four to five-year-olds are overweight or obese, rising to one third in 10 to 11-year-olds. I am sure that we all agree that those figures are genuinely shocking. The hon. Gentleman will be aware that the scale of the problem in Northern Ireland, to which he alluded during the course of his remarks, is similarly daunting, with 59% of adults and 22% of children overweight or obese.

As recently as the 1980s, obesity rates among adults were a third of what they are now. Although figures for the last few years show that levels of obesity may be stabilising, that is simply not good enough, because excess weight has serious consequences for individuals, the NHS and the wider community. Not only does it cause day-to-day suffering such as back pain, breathing problems and sleep disruption, but it is a major risk factor for diseases that can kill. An obese man is five times more likely to develop type 2 diabetes, three times more likely to develop colon cancer and two and a half times more likely to develop high blood pressure than a man with a healthy weight, and women face equally serious risks. That is not to mention liver disease, heart disease, some cancers and miscarriages, all of which are linked to excess weight.

Although the real and present danger of obesity in terms of immediate health risks is seen largely in adults, obesity also has significant effects on children and young people, as many hon. Members have mentioned. Obese children are likely to suffer stigmatisation, and there are growing reports of obese children developing type 2 diabetes. We also know that if a child is obese in their early teens, there is a high chance that they will become an obese adult, with related problems later in life.

As waistlines expand, so does the amount of money that we spend on the issue. As a number of Members have said, excess weight is a burden of approximately £5 billion each year, and costs billions more through days of work and incapacity. Neither can we ignore the link between obesity and health inequalities. Data from the national child measurement programme show a marked relationship between deprivation and obesity. The Marmot review in 2010 showed the impact that income, ethnicity and social deprivation have on someone’s chances of becoming obese. As things stand, the less well-off a person is, the more likely they are to be carrying excess weight, so we are talking about an issue of social justice, as well as a narrow health issue involving exercise and healthy living.

The hon. Members for East Londonderry and for Hackney North and Stoke Newington (Ms Abbott) both asked, in effect, whether the Department of Health should work with companies that produce and sell products that contribute to the nation’s obesity and alcohol problems. Up to a point, it is the responsibility of the individual how much they consume and what they consume. How do we make sure that people know what they are eating—the calorie, salt and fat content and so on? To my mind, that means clear, easily understandable labelling, and education about what is healthy and what is the best approach.

On the narrow point of the issue mentioned by both hon. Members, improving the health of the public is clearly a priority for the Government, but we need a whole-society approach to tackle the health problems caused by poor diet, alcohol misuse and lack of exercise. To change people’s behaviours, we need to make the healthier choices the easier choices for everyone.

Commercial organisations have an influence on and can reach consumers in certain ways that Governments cannot. They have a key role in creating an environment that supports people to make informed, balanced choices that will enable them to lead healthier lives. Through their position of influence, they can address some of the wider factors that affect people’s health, such as how healthy our food is and how easy it is to access opportunities to be more physically active. Through the work on the public health responsibility deal, despite what the hon. Member for Hackney North and Stoke Newington has said, we are tapping into that unrealised potential to help improve the public’s health.

[Ms Abbott]

rose—

[Mr Burns]

I will give way in a moment. It is also important to say that, if we can get an agreement with commercial companies to change the way they behave and some of their practices, it will be far quicker to achieve that and put it in place than to wait for the heavy hand of Government legislation, which can take a minimum of a year and sometimes years. Why wait for the heavy hand of legislation that might take a long time, if we can get a voluntary agreement that will work quicker and more effectively to start dealing with the problem?

[Mr Burns]

I will give way to the hon. Member for Hackney North and Stoke Newington first, because I promised her, then my hon. Friend the Member for Central Suffolk and North Ipswich (Dr Poulter), and then I will make progress.

[Ms Abbott]

On changing commercial practices, when will the Government do something about the practice of so many supermarkets whereby they place rows of sweets next to the checkout? If a parent has fought off their children and not bought sweets on their way around the supermarket, the children then have 10 minutes to whine while the parent waits to pay for their shopping.

Oral Answers to Questions

Diane Abbott Excerpts

Tuesday 18th October 2011 Commons Chamber

[Anne Milton]

My hon. Friend is absolutely right. Local authorities have a long and proud tradition of improving the public’s health. Public Health England will bring together a fragmented system and strengthen our national response on emergencies and health protection. It will help public health delivery at a local level with proper evidence and leadership.

[Ms Diane Abbott (Hackney North and Stoke Newington) (Lab)]

Contrary to the Minister’s statement that the Health and Social Care Bill will put public health at the heart of the health service, 40 directors of public health and 400 public health academics, including Michael Marmot, wrote to The Daily Telegraph to say that the Health and Social Care Bill will

“widen health inequalities; waste much money on attempts to regulate and manage competition; and undermine the ability of the health system to respond…to communicable disease outbreaks”,

and that it will

“disrupt, fragment and weaken the country’s public health capabilities.”

How can the Minister put her judgment against that of those doctors and experts? Is not the proposal that more than 40 specialist neonatal units may lose staff in the coming year an example of the weakening of public health that is involved in the Bill and the Government’s proposals?

[Anne Milton]

I draw the hon. Lady’s attention to the fact that the Health and Social Care Bill proposes for the first time a duty on the Secretary of State to have regard to health inequalities, which, I repeat, widened under the previous Government. I also point out to her that the letter to peers signed by Professor Marmot and others welcomed the emphasis on establishing a closer working relationship between public health and local government. I suggest that the hon. Lady gets out more, because she would hear from public health doctors and local authorities on the ground who welcome these changes.

Ovarian Cancer

Diane Abbott Excerpts

Wednesday 12th October 2011 Westminster Hall

[Ms Diane Abbott (Hackney North and Stoke Newington) (Lab)]

Let me start by congratulating the hon. Member for Pudsey (Stuart Andrew) on securing this important and well-attended debate. Every Member who spoke made an effective and moving speech. However, the speech that stands out for me is that of my hon. Friend the Member for Slough (Fiona Mactaggart). We have already heard that ovarian cancer is a very serious condition and that it is the fifth most common cancer among UK women. Members have also set out the relatively low survival rates for ovarian cancer—they are around 40% compared with 79% for breast cancer. That is largely due to the fact that three out of four women are diagnosed late, once the cancer has spread. It is worth repeating that survival rates could be as high as 90% if the cancer were diagnosed at an early stage. In Hackney, in east London, the five-year ovarian cancer survival rate is only 35%, which is significantly below average.

Despite the evidence relating to lack of awareness, the rates of late diagnosis and the delays in diagnosis admissions by A & E, there is still no Department of Health-led activity to improve awareness of symptoms among women and GPs. That is despite the Government’s commitment to save 5,000 lives a year from cancer by 2014. I welcome the new National Institute for Health and Clinical Excellence guidance on symptoms and the increased access to diagnostics that was announced in the cancer strategy, which mean that there will be new opportunities to improve early diagnosis. But unless women know when to visit their GP, unless the symptoms of ovarian cancer become as well known among ordinary women as the symptoms of breast cancer are and unless GPs know how to consider ovarian cancer, rates of late diagnosis and delays will not improve.

We have already heard, but it is worth repeating, that there is no national outcome measure for ovarian cancer; there are only such measures for breast, lung and bowel cancer. That is already impacting on the ability of PCTs and cancer networks to undertake awareness work about ovarian cancer, as funding for awareness work is being channelled to breast, lung and bowel cancer. That will potentially lead to a worsening of the situation, because it means in practice that there will be a decline in activity.

The quality standard for ovarian cancer will be one of the first of the new suite of quality standards to be introduced by NICE to inform local commissioners, but as yet it is not clear how the standard can be used effectively. Can the Minister tell us whether the Department of Health is considering introducing a national outcome measure for ovarian cancer? Can he also say how the Department will ensure that the quality standard is used effectively?

The Minister will be aware that the first findings of the international cancer benchmarking study—a study led by the Department of Health—showed that in the UK late diagnosis is thought to be a key driver of survival rates, which are poor compared to those in other countries in the study. However, ovarian cancer is the only cancer type in the study not to have had remedial action taken to improve awareness.

The Minister will forgive me when I say that under the last Government we saw substantial investment in cancer services and consequently outcomes improved; for instance, the survival rate for breast cancer rose from 50% to more than 80%. In the case of ovarian cancer, although the figures are not necessarily much better than they were when the hon. Member for Westmorland and Lonsdale (Tim Farron) faced the issues in relation to his mother, the survival rate has in fact doubled in the past 30 years. The commitment shown by the last Labour Government meant that in excess of 1,000 more women per year in England and Wales are now surviving ovarian cancer. However, the UK survival rate for ovarian cancer is still among the lowest in Europe, at 36%. If we achieve the average European survival rate, we will save 500 lives per year.

All of us, including the Minister, know that two major trials are currently taking place: the first is for women in the general population; and the second is for women with a strong family history of ovarian cancer. The former trial will report in 2015 and the latter trial in 2012. However, it is not at all certain that the findings of those trials will result in a national screening programme. Perhaps the Minister can tell the House what the Government’s position is on that issue.

Cancer Research UK tells me that it is concerned that the Health and Social Care Bill, which is currently being debated in another place, risks fragmenting responsibility for the early diagnosis of cancer between Public Health England, local authorities and the NHS. Cancer Research UK’s proposal for guarding against fragmentation is that local authorities and clinical commissioning groups should be jointly incentivised to prioritise early diagnosis, including shared indicators in the public health and NHS outcomes frameworks. That process should be supported by shared budgets, to ensure joint responsibility for delivering improvements in awareness and early diagnosis of cancer. In other words, Cancer Research UK is concerned that policies and responsibilities around early diagnosis will fall through the cracks. How will the Minister respond to that proposal by Cancer Research UK?

The Minister will be aware that, earlier this year, at the 12th international forum of the Helene Harris Memorial Trust, which was originated and facilitated by Ovarian Cancer Action, 50 of the world’s leading researchers and clinicians in ovarian cancer came together to discuss the future for ovarian cancer research. Out of those discussions came nine key actions: improving recognition that “ovarian cancer” is a general term; better targeting of clinical trials; identifying patients at increased genetic risk; developing new approaches to identify targets for treatment; ensuring that both the tumour and the tumour micro-environment are treated; better understanding of relapses of treatment-resistant ovarian cancer; setting up international collaboration to enable tissue samples to be shared and analysed in research; developing better experimental models; and ensuring that clinical trials include measures of quality of life and symptom benefit. Ovarian Cancer Action believes that those nine actions would not only help to improve the quality of life and ovarian cancer survival rates for women in the UK, but help to position the UK as an international leader in the fight against this deadly disease. Is the Minister aware of those recommendations and what is his response to them?

My hon. Friend the Member for Cardiff West (Kevin Brennan) made the point that, in the sometimes humdrum routine of the life of a junior Minister, there is occasionally a genuine opportunity to make a difference. Having listened to the informed, personal and passionate contributions of colleagues and other hon. Members this morning, I hope that the Minister will go away from this debate determined to move ahead—on the very strong basis of what the last Labour Government did and what his Government have done up to now—and actually make a difference in relation to ovarian cancer.

[The Minister of State, Department of Health (Paul Burstow)]

Thank you very much, Mr Rosindell, for calling me to speak.

I assure the hon. Member for Hackney North and Stoke Newington (Ms Abbott) that I have not found my last 12 months “humdrum” at all and I agree entirely with the comment by the hon. Member for Cardiff West (Kevin Brennan) that being a Minister is a privilege, and a privilege that one should use fully to serve the common good and the purposes that our constituents send us here for.

I want to try to do justice to the debate, and if I do not cover any issues that have been raised, that will purely be because of time and I will write to hon. Members about those issues. However, I will try to cover as much ground as I can.

I congratulate the hon. Member for Pudsey (Stuart Andrew) on securing the debate and congratulate all those who have taken part. I particularly congratulate the all-party group on ovarian cancer, which has done an excellent job in mobilising colleagues to be here in Westminster Hall today and to be persistent and persuasive in their arguments on the issue.

As others have rightly said, the speech by the hon. Member for Slough (Fiona Mactaggart) was typically powerful and typically persuasive. I think that I have served in the House as long as the hon. Lady, and during the time that she fought her cancer I certainly admired the way that she did so, while continuing to provide the service that she gives to her constituents and the House. She made a very powerful set of points today.

I think that everyone who has spoken in the debate has been touched by ovarian cancer. I had not planned to refer to my own experience, but, given that others have talked about their experiences, I will say that my aunt died of ovarian cancer some years ago. Having fought the disease for some time, she sadly died at the Royal Marsden hospital, despite receiving excellent treatment there. Ovarian cancer touches many of us.

I thank Target Ovarian Cancer, Ovarian Cancer Action, Ovacome and the Eve Appeal, which have all done an excellent job in raising MPs’ awareness of ovarian cancer, in the ways that the hon. Member for Pudsey and others have described today. That work has done a lot, not only to initiate debates in this place, but to assist us as MPs to play our part in our communities to help to raise awareness of those issues.

I could rehearse the statistics again, but will not do so because they have already been well rehearsed and powerfully illustrated with personal stories. I certainly recognise the urgency that we need to attach to our fight against cancers and I particularly note the points that have been made today about ovarian cancer. That is why we urgently came forward with the strategy that we published in January and why we have been fast in trialling and rolling out awareness campaigns. I will say more about those awareness campaigns shortly.

As has been pointed out, late diagnosis is one of the main reasons for the relatively poor cancer survival rates in England. I must crave the forgiveness of those colleagues who have spoken today from the perspective of Northern Ireland, Scotland and Wales. They all made important points and they need to continue, as I know they will, to raise them with their colleagues in the devolved Administrations who have responsibility for health.

Research by the National Cancer Intelligence Network showed that nearly a quarter of all cancers are diagnosed through an emergency route, as my hon. Friend the Member for Westmorland and Lonsdale (Tim Farron) said. That is at a stage when the cancer is very advanced. The research also showed that one in five patients did not visit their GP before being diagnosed with cancer. Diagnosis of ovarian cancer often comes late because the symptoms in the early stages—they have been powerfully set out—are often ignored or thought to be something else.

The hon. Member for Slough talked about volunteers, and about the volunteer who did the manicure on that day when her head was in another place. I have visited hospitals where Macmillan Cancer Support and other voluntary organisations play a part. Such volunteers bring back the key human dimension, which the hon. Lady was absolutely right to underline. We will ensure that the role of volunteers in the NHS is valued by including that point in the Department of Health’s message to the NHS in its soon-to-be-published updated volunteer strategy.

Reference has been made to the £450 million for early diagnosis work that the Government have put in as part of the spending review. The funds will support campaigns to raise public awareness of the symptoms of cancers, encouraging people to present with persistent symptoms. They will also support GPs in more effectively assessing people with possible cancer symptoms and improve access to diagnostic tests. In 2010-11, we ran local cancer awareness campaigns and a regional pilot campaign for bowel cancer, and in 2011-12 we are running a national campaign on bowel cancer, a regional campaign on lung cancer and 18 local campaigns to raise awareness of breast cancer among women over 70 and of the symptoms of some less common cancers.

A question that has been rightly put is, why, so far, have we not addressed ourselves to ovarian cancer? Understandably, Members want answers, not least because of the evidence that if we were performing at, I believe, just the average of our European neighbours—certainly if we were matching the best of them—500 additional lives would be saved every year. We are considering whether there is scope for piloting ovarian cancer awareness campaigns, drawing on the experience of our more generic campaigns on blood in urine, which can be a marker for bladder and kidney cancers, and on the evaluations of awareness campaigns on specific disease sites. That will inform us how we can most effectively roll out further campaigns. I give that undertaking, and I am more than happy to meet with members of the all-party group.

The hon. Member for Romsey and Southampton North (Caroline Nokes) spoke very persuasively about the scope for using existing screening programmes to deliver awareness-raising messages about other cancers, and ovarian cancer in particular, and we will consider how we might implement such a practical solution. Nevertheless, I hope that hon. Members appreciate that awareness raising is just one of a range of actions and that we need to look at the other aspects of the strategy that we set out earlier this year. We are working on other fronts to try to drive up earlier diagnosis and treatment.

A key focus of the cancer outcome strategy is primary care, which is why we are investing in providing GPs with practical tools for assessing patients who might have cancer. In addition, some of the cancer networks are reviewing referral pathways to help to shorten the time taken for patients to access diagnostic tests. I welcome the contribution of the cancer charities that have been working with primary care professionals to promote early diagnosis of cancer, and I specifically pay tribute to Target Ovarian Cancer, which, in partnership with BMJ Learning, has produced an online GP learning tool that covers the signs and symptoms of ovarian cancer, and diagnostic tests based on the latest evidence.

[Ms Abbott]

Will the hon. Gentleman give way?

[Paul Burstow]

I want to try to do justice to the debate and ensure that I get to answer a couple more of the questions posed, but I will give way in a moment if I can.

If a GP suspects cancer, it is vital that they can refer people urgently for further tests, using the two-week referral pathway. For women who do not meet the criteria for that pathway for suspected cancer but have symptoms that require investigation, we are providing additional funds over the next four years to support the diagnosis of ovarian cancer by giving GPs direct access to four key diagnostic tests, including non-obstetric ultrasound. Questions have been asked about what data are collected. We plan routinely to collect data on GP usage of the four tests and to publish them alongside data on GP usage of the two-week referral pathway, so that we can benchmark performance and expose areas that are not performing as well as others.

Several hon. Members asked about the CA 125 test and suggested that there are restrictions. I can assure Members that if there were restrictions we would challenge them. Just last month, Bruce Keogh, NHS medical director, wrote to strategic health authorities to raise questions about general access to diagnostics, and David Flory, deputy NHS chief executive, reiterated in the September edition of The Quarter that there must be no “arbitrary restrictions on access”. That would apply to the CA 125 test, not least because it is clearly covered in NICE guidance.

Hon. Members referred to the two ongoing trials, which are evidence of the research taking place. The UK collaborative trial of ovarian cancer screening offers real prospects for a screening tool, but on screening the Government of the day take the advice of the UK National Screening Committee, which considers the evidence from trials of the sort going on at the moment. A randomised control trial of 200,000 post-menopausal women aged between 50 and 74 is studying the use of annual CA 125 blood tests as a way to identify—along with annual trans-vaginal ultrasound—which women are most at risk of ovarian cancer. The results of the study will be available in 2015, and the Government will then respond to the recommendations that the UK National Screening Committee makes on the basis of the evidence. I hope that there will be a positive recommendation that enables us to roll out such a screening programme.

Familial ovarian cancer screening was referred to early in the debate, and a study has shown that up to 10% of ovarian cancers can be attributed to an inherited genetic predisposition. It was mentioned that the results of that research would be available in 2012, but we understand that the study will close in 2013. We would want to act on the evidence from that study.

Research, therefore, is taking place in those two fields. High-quality applications are the key to getting research funding; we do not fund solely on the basis of something being a priority. The hon. Member for Hackney North and Stoke Newington asked about Ovarian Cancer Action’s nine recommendations, and I will respond to her in writing, with copies to colleagues.

National measurement was mentioned. The NHS operating framework for England for 2011-12 requires that cancer registries record the stage of cancer, which is a key proxy for predicting outcomes, and publish one-year, as well as five-year, survival rates. We are benchmarking, providing a useful way to see who is performing well and who is not, and, as the hon. Lady mentioned, we are in the international benchmarking partnership with other nations. Would she like to make her intervention in the remaining time?

[Ms Abbott]

indicated dissent.

[Paul Burstow]

In conclusion, I hope that I have responded positively to the debate. We must make progress on a broad front in this area to improve early diagnosis and get the treatment that people need, so that we can cut the death toll in this country from all cancers. Ovarian cancer is, and will continue to be, a priority for this Government.

Coeliac Disease

Diane Abbott Excerpts

Wednesday 7th September 2011 Westminster Hall

[Ms Diane Abbott (Hackney North and Stoke Newington) (Lab)]

I apologise for being a few minutes late for the debate. I was speaking in the debate on Health and Social Care (Re-committed) Bill that is taking place in another part of the building.

I congratulate my hon. Friend the Member for Ochil and South Perthshire (Gordon Banks) on securing this important debate. It is always important when hon. Members with personal experience of an issue or condition take the opportunity to make the rest of us aware of that experience, as he has done.

As we have heard, Coeliac UK is doing excellent work, and one of the concerns that it has raised with parliamentarians is the challenge that people with coeliac disease face when eating in hospital. It says that hospital food is often restricted, and even unsafe. It receives many calls from members who have been in hospital, and have returned home malnourished and having suffered considerable weight loss. Sometimes friends and family have to provide gluten-free food. I hope that the Minister will tell us what action his Department is taking to ensure the availability of gluten-free food in hospitals throughout England and Wales.

Hon. Members will be aware that as well as securing today’s debate, my hon. Friend tabled an early-day motion in June 2010 to raise the issue of diagnosis rates. He has spoken very well on the matter this afternoon. In a parliamentary question, my hon. Friend the Member for Slough (Fiona Mactaggart) asked what information the NHS provides to people who are diagnosed with coeliac disease on managing their condition. The departmental response referred to a website with detailed information. The site also has information on how to ensure a gluten-free diet, with helpful examples of food to avoid. However, in the light of the large number of undiagnosed cases that we have heard about, I wonder whether the Minister has recently discussed the diagnosis and management of coeliac disease with representatives of the Royal colleges and other bodies representing medical professions.

My hon. Friend the Member for Aberdeen South (Dame Anne Begg) tabled an early-day motion early this year on issues relating to the hospitality industry, which we have heard more about this afternoon. What discussions, if any, has the Department held with the hospitability industry?

Outside Parliament a wide range of organisations, including Coeliac UK and the British Society of Gastroenterology, carry out excellent work on the condition. In particular, the British Society of Gastroenterology feels that an active case-finding strategy will increase the number of patients detected with coeliac disease. Does the Department have such a strategy at present?

Last year the British Society of Gastroenterology published its “Guidelines for the management of patients with coeliac disease”, in which it made a number of recommendations on what testing for coeliac disease should incorporate and how to best manage patients. Has the Department looked at those recommendations, and does it have a position on the management of patients with coeliac disease?

We have already touched on the excellent work of Coeliac UK and its ongoing campaigns such as the “Eating Out” campaign, which focuses on the food service sector, or the “Product” campaign mentioned earlier, which is about having a greater availability of gluten-free foods in supermarkets and on prescription. Of course, Coeliac UK is concerned that the medical profession has under-recognised coeliac disease so far. It is not routinely tested for, and Coeliac UK is campaigning to change that. We must build on the successes achieved, and I would be interested to hear how the Department plans to support the ongoing campaigns and the further work of Coeliac UK.

We have already heard about diagnosis, and the Minister will know that Coeliac UK has petitioned the Government to improve the rate of diagnosis of coeliac disease by including a target for GPs in the quality and outcomes framework. If a target on coeliac disease were to be included into that framework, GPs would have to deliver a better rate of diagnosis of the condition. That campaign has attracted nearly 9,000 signatures, and Coeliac UK is continuing with that and has made a new submission to the National Institute for Health and Clinical Excellence for such a target to be included. It would be helpful if the Minister updated us on the Government’s position on the issues raised in that petition.

Apart from early diagnosis and the management of coeliac disease, my hon. Friend the Member for Ochil and South Perthshire called this debate to discuss community-led pharmacy prescriptions. He has spoken effectively on that matter.

Moving on to the socio-economic impact of coeliac disease, we know that it is difficult to assess the overall burden of the disease owing to the absence of recorded information on diagnosis rates. There is a need for a central register of patients with coeliac disease, and I wonder whether the Minister will comment on that. We know that coeliac disease has an impact on both the individual and the community because of its high prevalence and the long-term complications arising from late diagnosis. The development of osteoporosis or bowel cancer has an impact not only on the individual affected but on the community and the health service. Even in the short term, the absence of diagnosis has a socio-economic impact. My hon. Friend said how shocked he was when his GP said, almost lightly, that he had missed two other cases of the disease that month. According to an independent study commissioned by Coeliac UK in 2006, just under half of people with coeliac disease who had been wrongly diagnosed believed that their job or career had suffered due to the condition prior to diagnosis.

As we have heard, Coeliac UK wants to see greater understanding and familiarity with the disease among GPs, and higher levels of referral to dieticians. A survey of registered dieticians conducted by Coeliac UK showed a wide variation nationally in the provision of dietetic expertise for patients with coeliac disease. Current provision is around one third of what it would be were we to provide diagnosed coeliacs in the UK with basic support and an annual review.

I will conclude my remarks by saying to the Minister that there is a continued cost to the health service due to repeat visits to GPs by people with undiagnosed coeliac disease—my hon. Friend referred to that in his personal case. Furthermore, left untreated or undiagnosed, coeliac disease can lead to more serious complications such as bowel cancer, which puts an even bigger drain on health service resources. Coeliac UK recognises the competing demands on health service resources and budgets, but coeliac disease is easily controllable once diagnosed—we can see that by looking at my two hon. Friends the Members for Ochil and South Perthshire and for North Durham (Mr Jones), who are able to be excellent and inspirational Members of Parliament because their coeliac disease is so well managed. It is a disease that can be self-managed if diagnosed early enough in life.

Government policy needs to acknowledge the scale of the impact of coeliac disease across a large segment of the population. Policy must also take into account the potentially serious nature of the disease, the cost in financial terms, and the suffering of the undiagnosed. In particular, measures should be taken to address the lack of awareness about the disease and provide a framework to ensure that GPs receive appropriate training and resources. Ongoing training should be provided to enable GPs to give better care in the community.

Once again, I congratulate my hon. Friend the Member for Ochil and South Perthshire on securing this debate, and my hon. Friend the Member for North Durham on chairing the all-party group on coeliac disease and dermatitis herpetiformis. A number of colleagues from all sides of the House take a keen interest in this issue and wish to commend the work of the all-party group in promoting awareness about the disease. I look forward to the Minister’s response.

Health and Social Care (Re-committed) Bill

Diane Abbott Excerpts

Wednesday 7th September 2011 Commons Chamber

[Ms Diane Abbott (Hackney North and Stoke Newington) (Lab)]

The decision to seek an abortion may be the most serious and difficult that many women face in their lives, and I think it deserves some seriousness and calm in this debate.

For nearly five decades, this House has been in agreement that abortion and matters related to it should be above mere party and partisan politics. For nearly five decades, there has been a settled pro-choice majority in this House and in the country, and for nearly five decades the House has believed that when Members of all parties have religious or ethical objections to abortion, their right to vote against it should be absolutely respected. However, this amendment is not about that. It is a shoddy, ill-conceived attempt to promote non-facts to make a non-case.

[Several hon. Members]

rose—

[Ms Abbott]

I am afraid that we are an hour into an hour-and-a-half debate, and I am anxious to allow time for other Members to speak.

The case that the amendment is intended to make is that tens of thousands of women every year are either not getting counselling that they request, or are getting counselling that is so poor that only new legislation can remedy the situation. I might say, after many years in the House, that in matters of this kind, if legislation is the answer we have almost certainly asked the wrong question.

The amendment is the opposite of evidence-based policy making. We know that the British Medical Association advises its members:

“A decision to terminate a pregnancy is never an easy one. In making these decisions, patients and doctors should ensure that the decision is supported by appropriate information and counselling about the options and implications.”

We know that the Royal College of Obstetricians and Gynaecologists guidance on abortion states:

“Women should be given counselling according to their need—including post-abortion if she needs it. All women should be offered standalone counselling. The counselling should include: implications counselling (aims to enable the person concerned to understand the…course of action…); support counselling (aims to give emotional support in times of particular stress) and therapeutic counselling (aims to help people with the consequences of their decision and to help them resolve problems which may arise as a result)”.

We know that Department of Health regulations state:

“Counselling must be offered to women who request or appear to need help in deciding on the management of the pregnancy or who are having difficulty in coping emotionally”.

We also know that all the clinics that have been discussed in the debate are inspected and regulated.

Yet the proposers of the amendment are asking us to believe, on the basis of purely anecdotal evidence, that tens of thousands of doctors, nurses and charity workers involved in the 190,000 abortions a year are wilfully ignoring both the law and the guidance of the British Medical Association and the Royal Colleges. They go further than that, arguing that tens of thousands of doctors, nurses and charity workers are merely in it for the money. They imply that those men and women are involved in some sort of grotesque piecework. It is almost as though they were paid per abortion. The proposers of the amendment, I might add, also seem to be arguing that thousands of women do not actually know what they are doing. It tells us something about the validity of their claims that they are obliged to smear tens of thousands of doctors and nurses to make any kind of case. No wonder that a journalist for The Sunday Times—no friend of the liberal left, but one who happens to have served as a lay member of the Royal College of Obstetricians and Gynaecologists—last weekend described the amendments as a “senseless and sinister bid” to cut abortions.

[Mr Kevin Barron (Rother Valley) (Lab)]

I agree with my hon. Friend. Any evidence that we have heard has been anecdotal—we have heard of a 16-year-old’s journey and of e-mails that hon. Members have seen but that I have not. However, my hon. Friend makes a real point. The conclusion of the consultation might be that a termination takes place, but this is the only procedure in this country that requires the informed consent of two doctors. Government Members besmirch doctors by saying that such things happen daily, but that is not true. From my nine years on the General Medical Council, I recognise that we have good ethical guidelines for doctors. Nothing is done without the informed consent of two medical practitioners.

[Ms Abbott]

My right hon. Friend makes an excellent point.

[Several hon. Members]

rose—

[Ms Abbott]

I would be more willing to give way were we not so far advanced in a debate that will last for only an hour and a half. I was not aware that so many Back Benchers wanted to contribute, because they have not hitherto tried to intervene.

Some colleagues have expressed their surprise that yet again we are discussing women’s reproductive rights in this House, but they should not be surprised. Abortion has never stood on its own as a technical issue; it is part of a century-long debate about women’s sexuality, womens’s rights and women’s freedoms. Sadly, for some people that is apparently still contested ground in 2011. Some even argue that the proposals are best seen as part of a wider push on the socially conservative agenda that has been so successful for right-wing politicians in America. Thankfully, in this country, that agenda has come up against a determination to keep such issues above party politics, the absence of a Fox News pumping out socially conservative propaganda 24 hours a day and British common sense.

I could say many things on the lack of an evidence base behind the amendments, but let me say this: women—both individual women and women in general—have been called in aid in this debate, and indeed they face very real problems in this society, here in 2011. They face spiralling unemployment as a direct consequence of the coalition’s policies and the sexualisation of our culture, which affects younger and younger female children—[Interruption.] I hope that hon. Members listen to this, because it is a point that many mothers and fathers will understand. Too many young women in communities up and down the country think that the only road to fame and fortune is to pump their bottom and their breasts full of silicone and tout themselves as some sort of media celebrity. Another issue is the number of very young women who have been badly parented, who have children too young and who, with all their good intentions, parent their own children badly in turn. Even in an era of financial constraint, those are the issues that this House should be addressing.

Nobody is saying that arrangements in relation to counselling cannot be improved. I believe that the hon. Member for Cambridge (Dr Huppert) has tabled a good amendment to that effect, which some of us hope finds favour in another place. However, the Bill and the amendment are not appropriate for a full and careful debate on abortion. The amendments deal with matters that are amply covered by existing law and regulations.

[Mark Pritchard]

rose—

[Dr Daniel Poulter (Central Suffolk and North Ipswich) (Con)]

rose—

[Ms Abbott]

I shall give way to the hon. Member for Central Suffolk and North Ipswich (Dr Poulter).

[Dr Poulter]

The hon. Lady is making an excellent speech and has outlined the fact that there is adequate provision for counselling in the status quo. Doctors, nurses and other medical professionals who must deal with such situations every day have adequate measures in place, as the Royal College of Obstetricians and Gynaecologists has outlined. They do not look only at the medical consultation, but at the whole patient, as we have heard. If that means that counselling is required, they will ensure that their patient gets it. Does she agree that this is not the place for the amendment, which serves no purpose, and that we need to get on and debate the Bill?

[Ms Abbott]

I am grateful to the hon. Gentleman, who is, of course, a practising doctor who knows a great deal more about these matters than many of us in the House.

As hon. Members have heard, the amendments deal with matters that are amply covered by existing law and regulations that are well known to doctors and nurses. They deal with matters that must, at the end of the day, be between a woman and a doctor. I deprecate the extent to which amendment 1 is an attempt to import American sensationalism, confrontation and politicisation into these issues in a way that will be of no benefit to ordinary women.

There is no evidence base for the amendments, and on the basis of all the recent polls there is no substantive support for amendments of this nature. Legislation addressing the issues raised by Government Members is already in place. This House should have more respect for the medical profession and for the vulnerable women who put themselves forward for abortion in one of the most difficult periods in their lives, rather than support an amendment of this nature, which is spurious and baseless. I urge the House emphatically to reject the amendment.

[The Parliamentary Under-Secretary of State for Health (Anne Milton)]

I feel that I need to start by saying that this debate is about women; it is not about hon. Members. It is about ensuring that women get the very best possible services that they not only need but deserve.

There was much comment and speculation ahead of the debate, not all of it accurate or helpful. It might therefore be useful if I explain the Government’s approach to meeting the spirit of the amendments without primary legislation. I associate myself with my hon. Friend the Member for Bracknell (Dr Lee), who urged calm and balance. Today’s debate has not necessarily reflected either of those things.

How do the Government intend to meet the spirit of the amendments?

Oral Answers to Questions

Diane Abbott Excerpts

Tuesday 12th July 2011 Commons Chamber

[Mr Burns]

My hon. Friend makes an extremely important point, because not only are his figures correct, but thereafter until the end of the decade there will be savings of £1.7 billion a year, on current projections. Every single penny of that will be reinvested in front-line services for patients.

[Ms Diane Abbott (Hackney North and Stoke Newington) (Lab)]

The Minister continues to insist that his reorganisation will result in savings that will be reinvested in patient care. Yet even before we have the impact assessment for the changes in the legislation, we know, as will Members across this House, that on a daily basis people are leaving primary care trusts with their redundancy money. That totals £800 million and upwards, and it has not been costed. We also know that the Royal College of General Practitioners has said that we will have gone from having 163 statutory organisations to having 521. Are not the costs of this misconceived car crash of a reorganisation spiralling out of control?

[Mr Burns]

The reality is that the hon. Lady does not understand, or will not accept, the figures published in the impact assessment. What she does not like is the fact that by the end of this Parliament there will be savings of about £5 billion, and thereafter of £1.7 billion until the end of the decade. That will all be reinvested in front-line services. The hon. Lady will not accept, and wishes to misrepresent to members of the public, the resulting benefits in improved and enhanced patient care.

Oral Answers to Questions

Diane Abbott Excerpts

Tuesday 7th June 2011 Commons Chamber

[Paul Burstow]

What we are doing at the moment with the pause is making sure that we revise the proposals in ways that ensure that we deliver the outcomes set out in the White Paper last year. One of the things we said in the White Paper, and which the Bill currently provides for, is that GP commissioning consortia can collaborate where they need to commission for larger populations.

[Ms Diane Abbott (Hackney North and Stoke Newington) (Lab)]

On GP commissioning consortia, one of the concerns that the Minister will have heard during his pause is the public’s concern about the possible role of the private sector in GP commissioning. Although we all agree that the private sector has always had, and will always have, a role in the NHS, does the Southern Cross Healthcare disaster not show the dangers of leaving health and social care to the short-term decisions of private equity bosses?

[Paul Burstow]

rose—

Public Health Observatories

Diane Abbott Excerpts

Tuesday 17th May 2011 Commons Chamber

[Grahame M. Morris]

Absolutely. That is a critical issue. In some respects, the Government have taken their eye off the ball. I will develop that point a little later and would like the Minister to respond to it.

As my hon. Friend pointed out, there is a clear and present danger of a reversal of health inequalities, which would be exacerbated by decisions taken elsewhere across Government. It is such an important issue, and one that I have long campaigned on. As someone who has worked in the health service and served on a local authority, I feel very passionately about it.

Remarkably, we are now considering proposals that risk losing our greatest weapon in tackling public health inequalities: evidence-based health intelligence. More recently, as my hon. Friends have noted, the Marmot review has restated the link between socio-economic factors and health, which are known as the wider determinants of health. One of the more serious threats to the future of public health intelligence is its future funding under the new arrangements proposed by the Government. In my view, the Secretary of State has shown little interest in the functioning of public health intelligence under these proposed structures.

Public health policies must take account of local circumstances as health inequalities remain stark, particularly in areas such as my constituency. For example, smoking-related deaths vary greatly across different parts of the country. Public health intelligence must drive public health practice. I appreciate that public health observatories self-generate revenue, alongside their Department of Health grant and moneys from primary care trusts and strategic health authorities. They also have opportunities to gain commissions from universities and charitable organisations, but it would be extremely risky to proceed down the Government’s proposed route without the certainty of their core Department of Health funding, which I understand is to be reduced by 30% this year.

Staff and people associated with the service have reported to me that valued employees are already being laid off at the north-west public health observatory, which is based at Liverpool John Moores university, and there is a similar situation at the north-east public health observatory. Local authorities commission the majority of public health services from a ring-fenced budget. What assurances can the Minister give me on safeguarding through this hiatus—this period of transition—and for the long term under the new arrangements?

I also thank David Kidney, the former Member for Stafford, who is now head of policy at the Chartered Institute of Environmental Health, for his assistance in preparing for this debate. The institute has stated its view that Public Health England must be established with a degree of independence, a point I made earlier, and with the ability to oversee arrangements for collecting, analysing and disseminating valuable data for public health services.

In short, it is now time for Ministers to provide concrete assurances that the role of public health intelligence, the collection of the evidence base and, in particular, public health observatories will be safeguarded for the future.

[Ms Diane Abbott (Hackney North and Stoke Newington) (Lab)]

rose—

[Madam Deputy Speaker (Dawn Primarolo)]

Order. There are just over 10 minutes left, so is it by agreement that I call the hon. Member?

--- Later in debate ---

[Ms Diane Abbott (Hackney North and Stoke Newington) (Lab)]

I congratulate my hon. Friend the Member for Easington (Grahame M. Morris) on raising this very important issue on the Adjournment. I, like everyone else in the Chamber, want to hear what the Minister has to say in response to the important points that he has made.

One reason why my hon. Friend’s debate is so important is that, amid all the public anger about the health service reforms, the effects on public health have not received the attention that they should have. Speaking as an east end MP, I must say that the information that the public health observatories produce is important in ensuring that whoever commissions services commissions for the population, not just for GPs’ lists. I live in an area where many communities are either not registered with a GP or in other ways socially excluded.

My hon. Friend has raised the important issue of health inequality, and it is easy to talk about that in the abstract, but we should reflect on the fact that this is 2011, because the life expectancy of someone in the richest part of Glasgow is 10 years more than that of someone in the poorest part, and if we take the Jubilee line tonight we will find that the people living at every stop from Westminster going east until Canning Town lose a few years in life expectancy. This is a very real issue and an indictment of our society. I congratulate my hon. Friend again on raising it, and I will listen with interest to what the Minister has to say.

[The Parliamentary Under-Secretary of State for Health (Anne Milton)]

I am grateful to the hon. Member for Easington (Grahame M. Morris) for raising the subject of public health observatories, and I should probably declare an interest, because my husband is a public health physician. Anybody who has an interest in public health knows how important the observatories are, but time is very short, and I will not get to all the points that the hon. Gentleman made.

The public health observatories have been around for more than a decade, and they produce a whole series of high-quality data. Annual health profiles, for instance, of local areas allow for those comparisons that are so important, and there is no doubt about the importance of reducing inequalities. The reports of Sir Douglas Black, Peter Townsend and more recently Sir Michael Marmot are all key documents.

It is important to remember that over the past decade or so health inequalities have become worse, but I point no fingers, because it is testament to the fact that it is extremely difficult to reduce inequalities. The hon. Gentleman mentioned several issues that contribute to that. There are a range of factors, not least changing people’s behaviour, which is not easy. The Government’s contribution of £12 million to the observatories is testament to how important it is that we get good intelligence. He will have read the public health White Paper, in which he will see our commitment to this. For the first time, we will ring-fence funds for public health.

The movement of public health into local authorities has been fairly widely welcomed. There are transitional arrangements that we need to get right, but it will be based on a direct line of sight from the Department of Health, as we need to bring some things together. We need clear responsibilities and a clear outcomes framework to ensure that local authorities give us what we need, with all that based on good and sound intelligence. Although the public health observatories have done a very good job, there are some areas—for instance, changing behaviour—where the intelligence is not good and we have not collected it together.

We want the data and evidence from the observatories to be used to improve the health of everybody, regardless of age, ethnicity, gender, income or sexuality. The public health White Paper sets out a clear life-course approach to that. It is impossible to make these changes without good intelligence and information. Despite the wealth of data, the evidence of what works is not necessarily being used as effectively as it could be, nor is it as widely available as it could be, and it remains only part of the information that we need. In any system where there are numerous stand-alone organisations, there are always dangers of overlap and duplication, and we want to eliminate that as much as possible. In short, we want to move from a system where we have a complex web of information functions performed by multiple organisations towards a system where that information is fully integrated into the public health system.

As the hon. Gentleman said, this is not about one Department—the Department of Health—doing it alone, but about public health being absolutely everybody’s business. The difference can be made from the top to the bottom in Government and right across the different Departments; it is an issue for us all. If we are truly to make inroads into these very persistent, difficult to move inequalities in health, we have to approach it in that way. There is no question of losing the main functions of the observatories; on the contrary, in fact. By transferring those functions to Public Health England, we will improve how they are used.

The hon. Gentleman will be aware that we have consulted for several months on the new public health system, and we are continuing to listen. It is very interesting to see what we are getting back, with a warm welcome for many of the changes. There are always anxieties about difficult periods of transition. We have convened a working group on information and intelligence for public health, which is chaired by the regional director of public health for South Central Strategic Health Authority, Professor John Newton. It has representatives from the Department, the Health Protection Agency, the public health observatories and the cancer registries, and it is meeting fortnightly to develop our approach to public health information and intelligence. This is an opportunity to get it absolutely right.

The future of the observatories is being very closely managed, and that includes their locations. Department of Health funding for the observatories has been agreed for 2011-12. Although there has been a reduction in the core contribution for each observatory, the Department of Health funding set aside as the core public health information and intelligence budget remains similar to previous years, and that will be supplemented by additional Department of Health grants, so overall funding will be about the same.

I should like to thank the north-east public health observatory for its contributions, including in relation to the national library for public health and the learning disability specialist observatory. Its strong strategic relationship with the academic sector through its host, the university of Durham, has been particularly beneficial. Officials in the Department are in regular contact with both institutions so that financial and other pressures are addressed as they arise. Like most of its counterparts, the north-east observatory receives income from the Department of Health, the NHS and others. I understand that it currently has a working capital of about £1 million, which is not insignificant.

The university’s human resources policies require it to alert staff at least six months before any changes in employment, which is important for staff at this uncertain time. We are making sure that the university is aware of the ongoing need for the observatory’s work, and hence its expert staff. It is important that we do not see any loss in that.

We are lucky in this country to have such a rich source of expertise. We must ensure that we maximise the benefit of that expertise, knowledge and intelligence. I hope that I have reassured the hon. Gentleman. I thank him for raising this issue and giving me an opportunity to say how much we value the work of observatories. Their functions remain indispensable, but they must adapt to the new system. We want to streamline the system and do what we set out to do, which is to reduce inequalities in health. We will base any action we take on sound evidence.

[Ms Abbott]

Will the Minister explain how, under the proposed system, we can make the free-standing GP commissioning consortia, some of which may be managed by private-sector organisations, pay attention in their commissioning decisions to the issues raised by public health observatories and others? It seems to me that without PCTs and other regional structures, it will be perfectly possible for the commissioning structures to ignore what public health observatories say.

[Anne Milton]

I thank the hon. Lady for raising that point. In fact, we inherited that system. Time and time again, budgets for public health have been raided to meet short-term commitments. One point of ring-fencing public health funding is to ensure that public health is central to the work that the local authority does and that it informs the commissioning arrangements in a local area. It is not good having just one area looking at public health. We are ring-fencing that money and will have a clear outcomes framework that sets out what the Government expect.

We will ensure that the consortia have regard to the public’s health. When we say “public health” it can sound a bit jargonistic. We are talking about the public’s health and about reducing the inequalities that have dogged society up to now and which successive Governments have failed to reduce. We have to do something different. We are moving from a system in which public health got sidelined and in which the work of public health observatories, although valuable, was not mainstream, to a system where that work is brought into the mainstream and into the direct line of sight. All those who make commissioning decisions and all local authorities should hear the clear message from Government that public health is everybody’s business.

Question put and agreed to.

Childhood Obesity

Diane Abbott Excerpts

Tuesday 3rd May 2011 Westminster Hall

[David Tredinnick (Bosworth) (Con)]

I congratulate my hon. Friend the Member for Brentford and Isleworth (Mary Macleod) on securing this crucial debate, and my other hon. Friends who have spoken.

I was in the Mall on Friday for what everybody agreed was a most wonderful royal wedding. However, my heart sank when I saw a very large, hugely overweight man hanging on to a railing for dear life and panting. He may have had a problem caused by steroids or something else, but it is most likely that he was obese. I thought how unhappy he must be with his life—my hon. Friend the Member for North Swindon (Justin Tomlinson) touched on the issue of happiness. One point we must get across to people who are obese is that they can be much happier if they overcome obesity.

My hon. Friends have made many points, but I want to touch on three issues. First, I want to look at the Change4Life programme and the changes that the Minister proposes to make. Secondly, I would like to say something about the impact of high-energy drinks that contain a lot of sugar and caffeine. Thirdly, I will speak about sizes of portions and clothes.

I will start by referring to the October 2007 Government report, “Tackling Obesities: Future Choices”, on what the human body is designed to do. It points out, with classic understatement, that our biological system is,

“not well adapted to a changing world, where the pace of technological progress and lifestyle change has outstripped that of human evolution.”

Many years ago in this Chamber—the old Grand Committee Room—I listened to a debate one evening, instigated by the food and health forum, that I have never forgotten. The speaker was a professor of nutrition and he said, “Look, in a nutshell, if you want to stay healthy, remember that we have not really evolved since the stone age; we are essentially stone-age people in the 20th century.” He said that if we want to be healthy, we should live like stone-age people. We should walk most of the time and run occasionally, eat berries and vegetables in season, catch fish when possible, and eat meat rarely. I was struck by that speech. Generally, our health problems arrive when we deviate from that simple model.

Last week, The Daily Telegraph looked at the problem of obesity as it affects parents. It pointed out that British men are among the fattest in Europe and that according to the World Health Organisation, we do less exercise as a nation than almost every other country in the world. In another article, I read that the World Health Organisation believes that in the regions of Europe, the east Mediterranean and the Americas, over 50% of women are overweight.

We have an enormous problem. All my hon. Friends have drawn on statistics. We tend to follow what happens in America, so we should be aware of what is happening in that country, where the problem is greater—obesity rates are 36% among women and 32% among men. The number of obese men in England has doubled since 1993, and the number of obese women has risen by half.

My hon. Friend the Member for Harlow (Robert Halfon) referred eloquently to issues in his constituency, but in my constituency we do not have the problems that affect many others. For example, the prevalence of obesity among reception-age children in the east midlands is just under 10%, and for year six children by region it is 18%. In Hinckley and Bosworth, the figures are smaller at just over 7% and under 16% respectively. Those are still enormous figures, however, and we must put that in the context of my original point about happiness. How many of those children are very unhappy with their lives?

The Minister inherited the Change4Life programme from the previous Government and I hope she will say a few things about the changes that she proposes to make. As I understand it, the funding for that programme is to change and she will be looking for contributions from the food industry. That may be a good thing, but I would like reassurances that the food industry will not be driving the agenda. I know that she has already said that we will not legislate further to bring in a range of new standards, but I think the quid pro quo is that we must know that the food industry will be very supportive of measures that do exactly what has been suggested and ensure that we see a reduction in sugar. There is far too much sugar in cereal, for example. I suggest to my hon. Friends that if they really want a cereal that is sugar-free, they should make it themselves; it is not difficult. I look to the Minister for support on that issue.

My next point relates to high-energy drinks. I have not heard a word about high-energy drinks this morning; I think that that is a forgotten area. Children and adults are consuming drinks that have two or three times the recommended caffeine level and a very high sugar content. If people have far too much caffeine, they get behavioural disorders. It is very bad for them. It increases their heart rate, and there have been instances of children going to hospital in such circumstances. It is extremely dangerous.

I recommend that the Minister look at the research conducted by Johns Hopkins university, which concluded that energy drinks should be labelled with highly visible health warnings aimed at young people. I will not quote from the study extensively, but it based its recommendations on research that discovered that certain drinks contained as much as 14 times more caffeine than the average can of cola. That is the same as drinking seven cups of coffee.

While we are on the subject of coffee, is it not extraordinary that we are now being invited by coffee shops to drink half-pint mugs of coffee? Have we taken leave of our senses? Have we all gone mad? If I stop for a cup of coffee with a friend, I often order the smallest cup of coffee and split it into two mugs because it is too much. In the 19th century, coffee cups were tiny. That is another issue that we must address.

[Ms Diane Abbott (Hackney North and Stoke Newington) (Lab)]

Drinking half a pint of coffee would be one thing. Is not the problem with coffee shops that often people are also drinking coffee with cream, sugar and additives? Sometimes with these half-pint cups of coffee, people would get fewer calories in an ordinary meal.

--- Later in debate ---

[Ms Diane Abbott (Hackney North and Stoke Newington) (Lab)]

I congratulate the hon. Member for Brentford and Isleworth (Mary Macleod) on calling this very important debate. I also congratulate you, Ms Dorries. I am sure that you have chaired many debates, but this is the first time that I have spoken under your distinguished chairmanship.

When we discuss childhood obesity, we should be clear that we are talking not about how children look but about how they feel, because one of the problems with debates about body size is that they can have an element of judgmentalism, which makes the issue more difficult and emotional for people. I think that we can all agree, as a Chamber, that everyone’s child is loveable and everyone’s child is beautiful. We do not want to get into being judgmental about body size, because the other side of the coin from childhood obesity is childhood eating disorders—particularly among girls, but also, increasingly, among boys.

I want to touch on the introductory remarks made by the hon. Member for Brentford and Isleworth about the origins of childhood obesity. She talked about parenting. I do not disagree with anything that she said, but let us stand back and realise that we live in a world that has changed since the days when Nye Bevan set up the national health service. At that time, fewer than one in 10 households had a television and fewer than a third owned a car. Nowadays, 98% of households have at least one television, if not two or three, and 19.5 million households own a car.

When the NHS was set up, the only form of processed food available was spam. Now, there is an infinite variety of processed food; it is possible to eat it three times a day, with all the problems of trans fats, added sugar and so on that that involves. It is also the case that when the NHS was set up, many more people did manual labour. We are looking at a world that has changed. It is not just that people are making different personal choices; they live in a much less mobile, much less active, much more sedentary world.

When I was a child, I was not as sporty as some of the Government Members present, but in the summer holidays I would have my breakfast and then go out and play all day. Children played out all day. Their parents did not worry about where they were; they just knew that they were playing out. Children played down back alleys and in other people’s gardens. We might or might not come home for lunch, but we came home for tea. I am a parent myself—my son is now 19—and I would not have dreamt of letting him play out on the streets of London. Whereas parents 30 or 40 years ago thought nothing of letting their children play out unsupervised, nowadays parents feel much happier if their children are at home watching television or playing a computer game. They think that they are being good parents and they are certainly less fearful parents.

When I was a child, children routinely walked to school. Now, I see children driven to school over much shorter distances than I used to cover when I walked to school. Again, those parents think that they are being good parents. Perhaps my family was not as grand as those of some hon. Members, but when I was a child, we always sat down for a family meal together. We waited for my father to come home from work and we all sat down and ate as a family. There was not the snacking that my son routinely did when he was at home. Our world is very different from Nye Bevan’s.

Even over the past 20 or 30 years, however, the world has changed. People’s notions of what it means to be a good parent have been attenuated, certainly in big cities, although things may be different in Shropshire and more rural areas. In big cities, people think being a good parent means having their child safely at home. They think it means that their child is never hungry and that there is always food in the fridge to feed them. They think it means that they must feed their child the most heavily advertised and expensive products. The issue is not, therefore, just one of individual choices; we live in a changing society with changing ideas about parenthood.

Altogether, this is a more sedentary and materialistic society. As Members have said, even if children are active at school, that activity will stop when they leave. That is particularly true of girls. There are also the attractions of television. When I was a child, there was no daytime television, so children could not sit at home in the daytime watching television. We were out in the garden, on the swing or up the park; we were chasing people up and down, shouting at our brother and doing all the things that helped us work off the calories bit by bit.

We live in a changed world, which is part of the reason why we have seen a gradual increase in children leading more sedentary lifestyles, eating more processed food and snacking on processed food between meals. When I was a child, the only form of fast food was fish and chips or food from a Wimpy bar. I remember begging my father to take me to a Wimpy bar, which I thought was the height of sophistication and glamour. There was no question of children routinely stopping off at some fast-food shop on the way home from school or having fast food between meals; we lived in a very different world.

What can the Government do in a world that has changed and become commodified—one in which the average British child recognises nearly 400 brand names? We have touched on a number of issues that I am interested to hear the Minister talk about. In particular, there is the issue of what happens in school. As we have heard, one important thing is that children can learn to cook in school and can be taught about good nutrition. There is also the issue of the sort of school meals that are made available. There was some resistance to Jamie Oliver-type school meals, particularly when they were introduced at secondary school level, but introducing children to healthy food at primary school will set up habits that see them through life.

There is also the issue of food labelling. I would be interested to hear what the Minister has to say about traffic-light labelling, which is the easiest for mothers in places such as Hackney to understand. Mothers there are not going to read a label or to try to do the sums to work out how many calories there are in a packet of food if there are 60 calories per 100 grams. However, a traffic-light label in red, yellow and green is easy for them to understand.

I will be interested to hear the Minister explain how the commissioning model of health care in public health will engage with these issues. I am particularly interested to hear what she says about the extent to which Change4Life is working with the food industry. As one Member said, we might as well have the Silk Cut marathon, but I have an open mind and I am waiting to hear what the Minister has to say.

Childhood obesity is about how our children feel, not how they look. If somebody was a little chubby when I was a child, people used to say, “Oh, she’ll grow out of it,” but 70% of obese children stay obese well into adult life, with all the outcomes we are so familiar with in terms of heart disease, diabetes, stroke and blood pressure.

The striking thing about child obesity in 2011 is the extent to which it is a problem of poverty in the United Kingdom and the United States. Historically, it and the gout that went with it were problems that rich people had. Increasingly, however, heroes in popular culture in America and elsewhere are strikingly obese, which never used to be the case. Obesity is a problem of poverty; it is about a lack of information and a lack of access to a healthy diet.

We have heard about the increase in the numbers and about the real danger that significant numbers of today’s children will live shorter lives than their parents and spend their lives in poor health. We as a political class, and the Government, cannot simply leave childhood obesity as a matter of parental or children’s choice. Of course, choice is a big issue, but we have to set out a policy framework, whether it relates to schools, labelling or schemes such as Change4Life.

We have to set out a policy framework that makes things easier for parents, who are under more pressure than ever from commodification and materialism, and who are more frightened than ever about simply letting their children out to play. We have to set out a policy framework that makes it easier for parents, including Members of the House, to make the right decisions and to determine not only how their children look now, but how their health will be in years to come.

Oral Answers to Questions

Diane Abbott Excerpts

Tuesday 26th April 2011 Commons Chamber

[Mr Lansley]

Yes. My right hon. Friend will know that we have done that in the past, and we continue to do so. Just as early implementers of health and wellbeing boards have an important voice in how local authorities will strengthen public accountability and democratic accountability, we also now have an opportunity that we did not have in the consultation last year for the new pathfinder consortia, as they come together—88% of the country is already represented by them—to have their voices heard. I hope that the public generally will exercise this opportunity too. I know that groups representative of patients are doing so and very much want to get involved in these discussions.

[Ms Diane Abbott (Hackney North and Stoke Newington) (Lab)]

The Secretary of State will be aware that if Lib Dem MPs were seriously opposed to this reorganisation, they could have voted against it on Second Reading—so how can he expect the public to take these discussions and the listening exercise seriously? Are they not just a device to get the coalition through the May elections, and is he not determined to get away with as little substantive change as he can manage?

[Mr Lansley]

On the contrary—the hon. Lady should know, because I made it clear on 4 April, that my objective, and that of the Prime Minister, the Deputy Prime Minister and all of the Government, is further to strengthen the NHS, and we will use this opportunity to ensure that the Bill is right for that purpose. The reason Government Members supported the Bill on Second Reading, and Labour Members should have done so, is that, as the right hon. Member for Wentworth and Dearne (John Healey) said, the general aims of reform are sound.