Debate on the Queen's Speech: Health and Education

Speech delivered on Tue 30th Nov 2004

Mr. Paul Burstow (Sutton and Cheam) (LD): Indeed, the election cannot come soon enough. The sooner the better we can get on with it and dispose of the Queen's Speech and the legislation it contains, so much of which is about promoting fear rather than aspiring to hope and meeting the aspirations of this country.

This debate is about the inextricable links between health and education. As I listened to the Secretary of State rightly celebrate the significant improvements in survival rates in respect of cancer and coronary heart disease, I was thinking just how much that link comes into play. While undoubtedly it is right to celebrate and applaud the contribution that NHS staff have made to those successes with increased survival rates, the fact is that education messages over many decades that have resulted in more and more people giving up smoking have probably contributed even more significantly to those survival rates than anything else.

That is why we on the Liberal Democrat Benches take the view that education has a key part to play in the health of the nation—unlocking people's potential and enabling them to have opportunities to improve themselves and their lives. Education has a vital part to play in equipping people with the skills and knowledge they need to exercise an informed choice on their health, to take control of their health and, when necessary, take control of their own health care.

A number of Bills in the Queen's Speech relate to education, and I hope that my hon. Friend the Member for Newbury (Mr. Rendel) might catch your eye, Mr. Deputy Speaker, so that he can address some of them in more detail than I propose to do. However, I want to make one or two comments. The Secretary of State referred in his peroration to the dividing lines between the parties. This Queen's Speech contains a number of dividing lines, one of which is the Government's tendency to concentrate power in Whitehall, to centralise, to undermine locally elected authorities, and to set appointed and unaccountable quangos in place of democratically accountable local bodies. The education and schools Bill is just one of a succession of local government, health, education and policing Bills that have reduced local accountability and imposed national priorities.

Local authorities should have an enhanced role in co-ordinating services for school-age children. Is that not what children's trusts are meant to be all about? It makes no sense for the Government to champion integrated services with the Sure Start programme, which the Liberal Democrats support, only to abandon that principle when children reach the age of five. Local authorities should be given the opportunity to champion the co-ordination of services to ensure that no child is left behind.

On the issue of school inspections, which will also, I believe, be covered in that Bill, it is welcome that the Government are at last beginning to recognise that endless inspections are not the key to higher standards—that does not just apply to schools and education but to the health and care sectors. Instead, such inspections in schools increase the stress on teachers and pupils and take away valuable time from teaching. We hope that Ofsted will be able to move towards a more constructive role, auditing school improvement and offering advice about best practice, and that this legislation will therefore pave the way for that. But it is disappointing that the Queen's Speech does not provide similar opportunities with respect to the role of the Healthcare Commission and Commission for Social Care Inspection and, indeed, does not provide the opportunity to bring those two bodies together, so that, for the first time, we have one agency responsible for setting the framework of standards and regulation for the whole health and care sector.

The child welfare Bill, which is in its draft form for scrutiny in the House, appears to refer only to enforcement of rules after a settlement has been agreed. Our initial thoughts are that the changes are necessary but should occur before that point, to ensure that children do not get involved in long-running and emotionally damaging legal disputes. Indeed, figures from the Office for National Statistics show that 88 per cent. of non-resident parents are satisfied with informal arrangements reached outside the court, and that only 35 per cent. are satisfied with the outcome once they get to the courts. Surely that makes the case for far more pre-legal mediation and support services.

The Secretary of State for Education and Skills (Mr. Charles Clarke): Would the hon. Gentleman concede that our Green Paper on this subject sets out policies to do precisely what he suggests in terms of developing and changing the role of the Children and Family Court Advisory and Support Service? The proposal announced in the Queen's Speech relates to the court aspects of that, but what he proposes is set out clearly in the Green Paper that we published a few months ago.

Mr. Burstow: That is helpful, and we would certainly acknowledge that. We look forward to seeing the detail of the Bill and working with the Government to ensure the best outcomes for children. We share the sentiment in the Queen's Speech that the welfare of children is paramount, which is made clear in the Children Act 1989. However, an alternative view seems to be advanced in some corners, not least by the Conservatives, which perhaps the interests of parents should be paramount, and that 50:50 access should be statutory, regardless of whether that is in the best interests of the child.

The Conservatives also propose the abolition of CAFCASS. The Liberal Democrats hope that the Government—from what we have just heard, we are reassured—will take a more measured view and not simply play to the gallery, particularly a gallery that is often filled with people wearing Batman costumes. We need to ensure that the needs and interests of the child really are placed first, and if that means that both parents have 50:50 access, that is right, but if it means that the interests of the child are not central, it is not right.

I said that education and health are inextricably linked. One area in which there is a need for rapid progress is school meals, and I note that the public health White Paper says that the Government plan a three-year review of school meal standards in England. That is a devolved matter, and one might think that school meals standards would not vary much between Scotland and England. On the face of it, one would expect them to do the same thing. On closer examination, however, there is a clear difference between Scotland and England in terms of the emphasis given in relation to nutrient guidelines, for example. In Scotland, the guidance on school meal standards talks about achieving nutrient requirements as "essential", and the overall tone is set by words like "should" and "required". Compliance in relation to nutrition is clearly expected. By contrast, England's guidance specifically says that only the regulations are compulsory and that the guidance on good practice, which includes nutrient levels, is "not required by law". The net effect of putting the nutrient recommendations at the end, pointing out that the guidance is not compulsory, and using words such as "aim" and "try" is that the specific nutrient content of school meals is marginalised.

The Health Committee was therefore absolutely right to recommend that England should shift as soon as possible from the current food-based standards to the Scottish nutrient-based standards. The White Paper is disappointing, as it simply states that the Government will consider such a change—and, in a leisurely fashion, over the next three years. Yet good-quality, nutritious food has a key part to play both in terms of the academic attainment and performance of children and in terms of shaping healthy diet habits that will last a lifetime.

Mr. Barry Sheerman (Huddersfield) (Lab): I hate to score points against the Health Committee, as its Chairman is a good friend, but three years ago, the Education Committee, in its inquiry into school meals, also strongly recommended that. We are still waiting for the Secretary of State to act on it.

Mr. Burstow: The hon. Gentleman has not so much scored a point off his hon. Friend the Chairman of the Health Committee, but has made a useful point about the fact that this issue has been hanging around for a long time. The evidence is compelling that, in England, the school meals service is suffering from poor standards and underinvestment, and that it is doing a disservice in many parts of the country, despite the noble efforts of the many catering staff who try to provide meals.

The same delay, hesitation and further consultation in relation to the public health White Paper's proposals also applies to alcohol, smoking and food labelling. The Queen's Speech included a drugs and alcohol abuse Bill. Although that is a Home Office Bill, drug and alcohol abuse have far-reaching public health consequences, which turn up in our accident and emergency departments on Thursday, Friday and Saturday night, almost every weekend, in every city centre up and down the country. While the Liberal Democrats welcome the Government's commitment to increase the number of addicts going into treatment, we will be examining closely the details of the Government's proposals. The Government rightly talk about the need to expand treatment, yet their own figures on the numbers in treatment are misleading. They claim that 154,000 problem drug users underwent treatment in 2003-04, with an expansion in treatment places of 55 per cent. in the past five years. But if we examine the figures in more detail, we see that that was an estimate. What the National Treatment Agency for Substance Misuse goes on to say is that 125,900 individuals were "in contact with treatment". Precisely what that means is perhaps the subject for an Adjournment debate, but it suggests that the Government have claimed too much.

In relation to tackling the alarming rise in alcohol abuse, this Bill, in line with the Government's alcohol strategy, appears to be focused on containment and punishment rather than on treatment and prevention. While we welcome a clampdown on alcohol-fuelled rowdiness, which makes such a mess of our streets, blights the lives of many in our town centres and certainly does not make those in our communities feel safer, that is only half the equation. The Government are failing to address the health consequences of Britain's binge drinking culture, which is a ticking health time bomb.

There has been a 75 per cent. increase in hospital treatment for alcoholic liver disease since 1996. Alcohol-related deaths have hit a new record, and have more than doubled over the past 20 years. The Government must focus on more than just containment of the problem; they need to deal with the causes.

Alcohol abuse among teenagers is storing up huge long-term health consequences. Every day, nine children are admitted to hospital because of alcohol- related problems—a shocking statistic. The public health White Paper was hopelessly weak on this issue. Last year, a MORI poll revealed that only 7 per cent. of men and 22 per cent. of women knew what the Government's recommended alcohol consumption was for them. Clear labelling with the numbers of units should be mandatory, and linked to a major public information initiative to publicise the recommended intake limits.

Improving training of health care workers is also vital, particularly in primary care, as identifying and tackling alcohol dependence problems at an early stage is key. According to research by Alcohol Concern, of an average 360 hazardous and harmful drinkers who visit a GP every year, seven or fewer will have their drinking addressed by their doctor. Alcohol problems are treated more easily and more cheaply if caught early, yet only 7 per cent. of all NHS spending on alcohol misuse is spent by GPs. The Government must ensure that this Bill begins to deal with alcohol problems, and does not just deal with drug problems, and that treatment for dependency is extended to people with alcohol problems as well as those with drug problems.

The Government's White Paper on public health also falls short in terms of protecting people from harm caused by passive smoking, and the Queen's Speech contains no Bill to do something about it. If the Secretary of State for Health admits, as he does, that passive smoking harms, that passive smoking kills and that there is no safe level of smoke, how can there be any exceptions from a ban on smoking in enclosed public places? The idea of exempting pubs that do not serve food is strange: the distinction seems to me to be born of administrative convenience rather than any real logic. Why should the health of someone eating a ploughman's lunch with a pint in a pub be more important than that of someone drinking a pint on its own?

Guidance on the health and safety responsibilities of employers to their employees makes it very clear that current evidence of second-hand smoke doing harm and killing people is so compelling that failure to protect staff from that risk puts employers at risk of legal action. Research makes plain that ventilation systems cannot guarantee a safe working environment. I am told that as many as 10,000 air changes an hour, equivalent to a mini-tornado, blowing through a pub would be necessary to achieve anything like the necessary risk reduction. The Government's proposal to ban smoking in bar areas is unworkable and cannot ensure the safety of bar workers, let alone anyone else.

Just where is the sense of urgency? No legislation has been announced in the Queen's Speech, and we have a timetable that is content with a three-year delay before even a partial ban on smoking in enclosed public places comes into effect. Why are the Government putting off giving a lead for two years? Despite the chief medical officer's recommendation in his 2003 report "Going Smoke Free" that NHS premises should be smoke-free by 2004, we must wait until 2006 for even that fairly modest step to be taken. Just where is the leadership?

Then there is the question of labelling. Delaying action until 2006 and leaving everything to voluntary labelling codes fails to give consumers the information that they need to make health choices now. I hope that the Government will think again about introducing such measures earlier, not least given the clear public support that the Food Standards Agency has found.

The Queen's Speech also states that the Government want to continue their reform of the NHS, offering more information, power and choice to patients, with equal access for all and a service that is free at the point of delivery. It is a wonderful motherhood and apple pie moment but how real is choice when so many people struggle to get on to the list of a local GP or NHS dentist in the first place? People in many areas are struggling to gain access to local GPs. According to the Audit Commission, as many as 250,000 people each year cannot find a GP because of list closures and other problems, and find themselves being assigned to a GP as a consequence.

In its rather understated way, the Audit Commission described that as

"a significant issue for patients."

It certainly is a significant issue for many of our constituents. People should be able to choose their GPs and obtain care closer to their homes; they should not be allocated GPs on a basis that might entail longer journeys from where they live. Where is the choice for those 250,000 people each year? Where, indeed, is the choice for my constituents? Recently one of them, Miss Jean Duncanson, wrote to me about the difficulty that she and two of her neighbours in Elizabeth house—local authority sheltered housing—had experienced in registering with the local GP in Cheam village. Neither she nor her neighbours were able to do so; instead, they were told that they must travel by bus to practices in Sutton. My constituent felt discriminated against and let down. There was a surgery just around the corner, close to her home, to which she could not gain access.

It is not just a question of access to GPs, however. Only last week the National Audit Office expressed concern that the new dentists' contract might result in dentists' reducing their NHS commitments further owing to lack of detail about the changes. Clearly the move away from a piecemeal, piece-rate approach makes sense, but the NAO has tapped an anxiety that needs to be addressed. The situation is indeed very worrying, given that only half the population are currently registered with NHS dentists. We need to make significant progress. The Government's dental work force review, which it took the Government over two years to publish, found that there is currently a shortfall of nearly 2,000 dentists—whole time equivalent—and that the number is set to rise to up to 5,000 by 2011. The Government say that there will be 1,000 extra dentists, but that is less than the forecast shortfall. Again, there does not seem to be enough urgency in the face of what is a massive problem of dental failure. It was inherited from the Conservatives, but it has not been addressed adequately in seven years of Labour government. Ministers are for ever talking about patient choice, but when it comes to finding a dentist millions of people throughout the country have no choice at all.

The Secretary of State spoke of the need to move from the current waiting-time targets to an 18-week end-to-end journey time for the patient. That may be a welcome goal of which we all approve, but just when will the Government make available information on diagnostic waiting times? In June, when the Secretary of State made a statement on the NHS improvement plan, he accepted that diagnostic waiting lists were the NHS's hidden waiting lists. Many of my constituents feel that they are stuck and lost in limbo, waiting for diagnostic appointments and the right scans so that they have the diagnosis that will enable them to secure the treatment that they need. It cannot be right for the information not to be collected and published, when that would allow everyone to see just how well their own NHS trust is performing and would help us to see how waiting times can be cut.

People are waiting for months in hospitals across the country for vital computerised tomography, magnetic resonance imaging and other diagnostic scans. As I have said, the Government have announced that they will cut the waiting times, but they themselves do not know how many patients are waiting for diagnostic tests or how long they are waiting; and they have failed to introduce a system for the routine collection of data from hospitals which would provide a clear picture. Without reliable and accurate data, how on earth do the Government expect anyone to plan properly to reduce diagnostic waiting times in the first place?

The hon. Member for South Cambridgeshire (Mr. Lansley) raised the question of my party's commitment to hypothecation of national insurance to fund the NHS. While not wishing to talk about his own policy on many matters, he was quite happy to talk about ours. I too am happy to say a little more about our policy. I certainly want to make it clear that we are committed to matching the Government's spending plans in full, and to achieving the staffing improvements that have been proposed for the next four or five years.

The aim, first and foremost, of our proposal for an NHS contribution is to make clearer to people just how much they are spending on the NHS from their taxes, as an aid to accountability and transparency. We are committed to hypothecating national insurance for that purpose. The figures given by the hon. Gentleman are the sort that one should look at closely before foolishly stepping into the big hole that he was trying to dig for me. If he writes to me setting out the basis of his calculations and assumptions, I shall be more than happy to write back explaining where he is confused and wrong about our policy. Perhaps when he writes to me he will also explain how the Conservatives justify spending £1.2 billion to fund a policy that used to be called the patient passport policy, but is now a policy without a name—but with a deadweight cost of £1.2 billion for the NHS, without a single extra operation being performed as a result. If the hon. Gentleman is prepared to write to me about that, I shall be more than prepared to respond to him further on other matters.

The Queen's Speech also referred to the Government's intention to continue pre-legislative scrutiny of the draft Mental Health Bill. I have had an opportunity, as I am sure others have, to dip into some of the evidence sessions—to hear some of what has been said, and to read many of the transcripts. It appears from the evidence taken to date by a Joint Committee that has examined the draft Bill in detail that it has a long way to go before being anywhere near acceptable to those with an interest in mental health services and problems. It strikes one as a Bill that was drafted in the Home Office rather than one that was conceived to meet the needs of people with mental health problems. That concern is shared by the Law Society, by nearly all—if not all—mental health charities, and by professional groups.

The Government have performed a unique act. They have managed to construct a coalition of interested parties across the board, all of whom say one thing: that the Bill is the wrong Bill. Compulsion is not the right way in which to deal with mental health problems. Indeed, Cliff Prior, chief executive and chairman of the mental health charity Rethink, said the following in giving evidence to the Committee:

"When this long drawn out process began in 1999, the government's stated aim was to reduce compulsion. It was told that its plans would do just the opposite. Despite a few concessions, nothing has been done to address this fundamental flaw."

Indeed, I understand that when, during some of the visits carried out so far, people were asked whether they preferred prison or a mental health institution, many opted for prison because there is a guaranteed release date and the guarantee of spending a certain amount of time each day in the fresh air. Those two guarantees do not seem to apply to people who languish under restraint in mental health institutions.

Finally, the Queen's Speech talks about health care free at the point of delivery. We Liberal Democrats are entirely signed up to that principle, but if it is indeed to be free and available at the point of delivery, why, for example, does a person with advanced dementia who requires catheterisation, help with feeding—even peg feeding—and intimate personal care have to pay for such care? How can that be fair? The Queen's Speech should have included a Bill to end the arbitrary divide between health care, nursing care and personal care—a divide that is defined more by who provides the care than by the nature of the care itself.

This is a Home Office Queen's Speech and a programme with one date in mind: polling day. Health and education are the poor relations in the legislative programme that this Queen's Speech sets out. That programme places fear ahead of hope, and we Liberal Democrats will continue to provide an effective opposition to it.