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Health and Social Care Bill

moved Amendment No. 74: 74: Clause 42, page 20, line 27, after second ““of”” insert ““health promotion and”” The noble Baroness said: I make no apology for returning to health promotion. I took care to read some of last week’s debate on the Bill, particularly the speech of the noble Baroness, Lady Cumberlege, in which she said that she always found health promotion rather boring. I beg to differ—I do not find it boring in the least. In my early years as a general practitioner, I used to think that if you could make a patient happy, they were usually healthy or they thought that they were. It was an important thing to do. One of the reasons I went into politics was that I decided that patients were usually unhappy because of circumstances such as terrible housing, poor education or too many or too few children. They were not matters which concerned the health service. The downside—if I dare utter it in this Building—of having a national health service free at the point of delivery is that a high proportion of patients somehow devolve their own healthcare to the National Health Service. That was certainly the case with an awful of patients whom I saw. Their healthcare was no longer any of their concern. What they did to their bodies, how they abused them or how they lived did not matter, because the health service would put it right. We have to recognise that some people do not give a fig, because they know, think or say, ““It’s my right to have it put right if I abuse myself in this way””. Another factor that prevents good health promotion is confusion of messages. It is quite extraordinary how much the press and the media will grab any little thing. A medical researcher may come up with something in some obscure journal—for example, if we all drink lots of red wine, we will all be extremely healthy, because that is what happens in France. That is a crude example, but there are numerous other such examples of silly, small research projects being publicised in this way. Having been a junior doctor, I know of people who are desperate to get into the press, to get their name in print and get a paper written. The newspapers will take it up and, as a consequence, the general public become incredibly confused. I was a community services manager in Ealing a long time ago. One of my clinics was in Southall, an area with a large Asian community and, consequently, high levels of diabetes and cardiovascular disease. At one end of the clinic, dentists would tell mothers and children that they must end their meals with a nice, bland piece of cheese because the acid from fruit would rot the enamel of their teeth. At the other end of the clinic, the health visitors were waging a huge campaign to try to stop the population of Southall eating animal fats, cheese, ghee and so on because that was terribly bad for their health and would give them heart attacks. I promise the Committee that that sort of thing goes on in one clinic. I suspect that it still goes on in some GP surgeries. Sadly, over the past 10 years, community services and community clinics have tended to disappear because the targets for the primary care trusts have been all about hospital care and GP care. That has shown some benefits because the promotion of those targets has seen, as the noble Baroness, Lady Cumberlege, said last week, a reduction in deaths from heart disease; a reduction in deaths from many cancers; and much better investigation and treatment of many cancers. A lot of good work is going on because of those targets and because of the work being carried out in general practices and in hospitals. The work that used to be done primarily by community workers, health visitors, district nurses and school nurses was crucial in young people's lives: they were told what they should be doing, what they should be eating, when they should start having sex and so on. Over recent years, services such as family planning and sexual health clinics have been reduced. We have not seen much movement in teenage pregnancy rates, but we have seen a rise in HIV rates, a rise in sexually transmitted diseases up and down the country and, of course, a rise in obesity because no one is receiving the sort of advice which health visitors and school nurses used to give routinely to mothers, babies and small children. Alcoholism is rampant. I do not know where one lays the blame for that, but I suspect that advertising and manufacturers’ profits have much to do with the rise in alcoholism. There is a huge job to do and the need to promote a particular lifestyle may be different in each community. I know Southall well and I know that we had to work on particular problems there. That is why this should be done at PCT level. We feel that, in future, the Care Quality Commission should ensure that the primary care trusts do not neglect all those services for health promotion and health prevention which are so essential. I beg to move.