Health

– in the House of Commons at 1:39 pm on 21st December 2010.

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Photo of Barbara Keeley Barbara Keeley Shadow Minister (Communities and Local Government) 1:39 pm, 21st December 2010

I want to talk about support for the 6 million unpaid carers who provide social care to a family member or friend. More people are having to step in to provide high levels of care to family members. The 2001 census, about which we have heard so much today, found that 10% of all carers in the UK were caring for more than 50 hours per week, but figures published more recently by the NHS information centre show that that has now more than doubled to 22%. In Salford, the proportion has been much higher for some time: 24% of Salford carers cared for more than 50 hours per week in 2001, which was more than twice the national figure.

Carers are key partners in care for the NHS, but full-time care takes a toll on the carer's own health, and their health needs should be recognised. Carers who care for more than 50 hours a week are twice as likely to suffer ill health as the general population, and those caring for a person suffering from dementia or stroke disease are also more at risk. Importantly, carers who do not receive a break from caring are much more likely to suffer mental health problems-that is, 36% of carers compared with 17% who do get a break.

The Government have announced £400 million of funding for carers' breaks over four years, to be delivered through primary care trusts initially, but there are problems with this because the funding is not ring-fenced. The Labour Government allocated £150 million over three years to primary care trusts for carers' breaks, but a survey by the Princess Royal Trust for Carers in 2009 found that less than a quarter of the first tranche of that funding had been used as intended to support carers. Given the financial pressures that are now facing primary care trusts, and their impending abolition in the NHS reorganisation, it is hard to see them doing a better job for carers now than they did last year when they did not have those pressures. There is great concern among carers and carers' organisations about the impact of the NHS reorganisation and cuts to local authority budgets. Carers UK says that carers are worried that when commissioning is handed over to GPs they will lose services on which they are relying. Many carers have negative experiences of dealing with GPs who do not have a good understanding of social care or of the specialist conditions that are giving rise to the care.

There is also much concern about cuts to social care that councils are making in response to the 27% cuts in their budgets over the next four years. The cuts are front-loaded, so together with the loss of area-based grants that were targeted at deprived areas, councils such as those in my area of Salford will have to make cuts of £40 million next year alone. The Government are putting £2 billion into councils' social care budgets over four years, but that is only half of the £4 billion that the Association of Directors of Adult Social Services has estimated is needed to meet increasing levels of need. In addition, social care is one of the biggest areas of each council's budget, yet the new money is not ring-fenced either, so councils are facing budget cuts of £5.6 billion over the same period. It is hard to imagine that social care will not be part of that.

We have already seen councils cutting funding to social care. Even before the comprehensive spending review, five councils with a "moderate" threshold were proposing to tighten their eligibility criteria to "substantial". Birmingham council and the Isle of Wight have now proposed to raise their thresholds to meet critical needs only, and other councils are considering that. North Yorkshire county council plans to reduce its number of residential care homes by two thirds, and others are taking similar action. Councils are increasing their hourly rates for care and removing maximum weekly caps, which can mean charges doubling. For very many people, that will mean that the care is not available or they cannot afford it.

In Salford, we are very fortunate to have an excellent carers centre run by the Princess Royal Trust for Carers, with Dawn O'Rooke as the manager and Julia Ellis doing a fantastic job as the primary care project worker. Staff there are concerned about what they see as a marginalisation of carers support services owing to the twin changes of GP commissioning and council budget cuts. Salford carers centre has worked with GP practices to enable GPs to identify many carers and refer them on for advice and support. That identification and referral can make a significant difference for carers in their getting benefits, using personal budgets and getting checks on their own health. However, with GPs handling commissioning, there will be significant extra pressures of time. One reads day in, day out about GPs being very concerned about that. There is a real fear that GPs in Salford will no longer prioritise the development of support for carers.

Given our record in Salford, I hope that our GP consortiums and the city council will continue to support carers' services so that the excellent work can continue. However, with GPs handling commissioning, there will be significant extra pressures, and it is hard to see councils and GP consortiums up and down the country prioritising carer support when they have so many other calls on their time and resources. Many people rely on unpaid carers, and more will have to do so over time. It is projected that that figure will reach 9 million in 25 years' time. I therefore urge Health Ministers to put their support for carers high on their agenda and to keep it there throughout 2011.

It is an unusual experience for me to speak in this pre-recess Adjournment debate rather than answer it, which is what I used to do. I think that the Deputy Leader of the House has opted out a little bit by cutting his work load. However, I would like to wish everybody a very happy Christmas.

Photo of Jason McCartney Jason McCartney Conservative, Colne Valley 1:46 pm, 21st December 2010

It is an absolute pleasure to be speaking in this pre-Christmas Adjournment debate-my first. I offer season's greetings to everybody.

When I was elected to this House, I promised that I would continue to fight to bring full maternity care back to Huddersfield Royal infirmary. I have already raised the issue in this House several times, and I welcome the opportunity to do so once again. The issue of maternity services in Huddersfield has been a very emotional and controversial topic in my constituency. Huddersfield Royal infirmary's consultant-led maternity services closed in August 2008, and mums now have to be transferred to Calderdale Royal hospital if there are complications during birth. Many mums, though, are not taking any risks at all and opting to go to Halifax for all the birthing process. There is a new midwife-led unit at Huddersfield Royal infirmary, but mums want specialist and emergency care to be available there too. Many have got in touch with me through a Facebook group that I have set up. I have more than 7,000 members, and cases are being messaged through to me all the time from mums who have had bad experiences.

In an emergency, the time it takes to travel to Halifax from Huddersfield and my constituency can be the difference between life and death for mother and baby. I joined two of my constituents to set up a campaign group in memory of their little girl who died at just two days old. Following the closure of Huddersfield's specialist maternity services, the mum had to be transferred to Calderdale for an emergency delivery. During that time, the baby suffered a lack of oxygen to her brain which resulted in severe brain damage. The young parents then had to make the heart-breaking decision to turn off her life support system after just two days. We do not know for definite that things would have been different if Huddersfield had had specialist care available, but the little girl would surely have had a better chance if that emergency care had been available closer to where the parents live. I pay tribute to the parents, Alanna and Glynn, who set up the campaign group, MOMS-Move Our Maternity Services back to Huddersfield-with me.

I welcome the opportunity to raise once again the issue of getting specialist maternity care back at Huddersfield Royal infirmary, and I look forward to hearing from the Minister.

Photo of Nick Smith Nick Smith Labour, Blaenau Gwent 1:48 pm, 21st December 2010

I am very pleased to take part in this debate. I applaud the new arrangements that will allow a Health Minister to respond to contributions on health.

Public health policy aims to help people live longer and healthier lives, so it is a matter of key concern to me and my constituents in Blaenau Gwent, where average life expectancy is still too low. In the July pre-recess Adjournment debate, I raised my worries about the Conservative-led Government's reluctance to take forward Labour's measures to curb smoking, their collapse in the face of food industry's lobbying on food labelling and their hasty dismissal of minimum pricing for a unit of alcohol.

Sadly, the recent public health White Paper does not address my deep concerns. It sets out the scale of several significant problems. Britain has the highest rates of obesity in Europe. Smoking causes 80,000 deaths a year. A recent Alcohol Concern report showed that more than 92,000 children and young people under 18 were admitted to hospital for alcohol misuse between 2002 and 2009. Girls are more likely to need hospital treatment than boys. Diet-related disease costs the NHS £6 billion a year, alcohol abuse costs it £2.7 billion, and lack of exercise costs it £1.8 billion: a total of £10.5 billion.

Do we have a new, bold public health strategy to match that analysis? Apparently, there is a shift from nannying to nudging people to improve their health. It seems that commercial interests will dominate the partnership of those who will help us to be healthier. That is not good enough. The Independent reported recently that multinational companies dominate the Government's public health policy. It discovered that 18 representatives of Mars, Diageo and other commercial interests attended the first public health responsibility deal meeting in September, dwarfing the representation of health and consumer groups. I do not trust commercial interests to nudge me or anyone else towards a healthier lifestyle.

I take issue with the pompous put-down that Labour opted for a nanny state. Labour recognised that the Government have a duty of care to keep the nation as healthy as possible. That duty is particularly important for our young people, and particularly for the young women who lie comatose on the streets on Friday nights, after binge-drinking sessions. Alcohol was described as the most dangerous drug in the UK in a paper published by The Lancet in November. The Government have a responsibility to take further measures to prevent alcohol abuse.

The brewer, Greene King, wrote to MPs recently:

"It is our long held view that a great deal of the UK's antisocial behaviour stems from excessive drinking by a small minority of people, fuelled by the easy availability of alcohol from retail outlets, at very cheap prices. The solution must be proportionate to the problem and not penalise the majority of responsible drinkers."

I concur with that statement and agree with the solution of a minimum price for alcohol. The British Medical Association supports that proposal, as does the Association of Chief Police Officers.

The Government have said that they support a ban on below-cost selling. However, if cost was defined as duty plus VAT, it would be too low to tackle irresponsible discounts in supermarkets. No measures have been put before Parliament to end below-cost selling. I believe a range of measures is necessary to tackle alcohol abuse. There may have to be restrictions on promotions. Alcohol Concern stated:

"As long as alcohol remains as heavily promoted as it currently is, young drinkers will continue to consume far more than they might otherwise, leading to inevitable health harms, wasting ambulance and police time."

It is time we scrutinised the promotion of alcohol at cinemas, for example, where it is too easy for young people to be influenced.

I will talk briefly about measures to combat smoking. I was pleased that the all-party parliamentary group on smoking and health called on the Government to prohibit the point-of-sale display of tobacco products, and the sale of tobacco from vending machines. Those measures have widespread support. As my local director of public health at the Aneurin Bevan health board wrote to me:

"Nearly one quarter of the population in Wales are smokers and most of them started to smoke as children. The average age at which young people in Wales start smoking is between 11 and 12 years."

She ended her letter with a plea:

"please help to protect our children and future generations from a deadly addiction by ensuring that the government implements these laws".

Finally, I will comment on the problem of obesity. Obesity cannot be tackled by weakening the Food Standards Agency and by cutting the Change4Life anti-obesity programme. Statistics on obesity show the need for more exercise. I am therefore glad that the Government have changed their policy on school sports provision in recent days, but more needs to be done. We must ensure that all children exercise regularly at school, not just those who are gifted enough to take part in competitive sport.

Nudging and soft partnerships, although helpful, are not sufficient. Self-regulation by supermarkets and tobacco companies will not deliver the better health and extra years that we hope for. Bluntly, if we do not act, the financial consequences for the NHS alone-the £10.5 billion that I referred to earlier-will be immense. Ministers must accept that meaningful regulation and taxation have a role-to rule them out is irresponsible and doctrinaire. The Government's recent White Paper on health is not good enough for my constituents in Blaenau Gwent, nor for people across our country. We must do better than this.

Photo of Therese Coffey Therese Coffey Conservative, Suffolk Coastal 1:54 pm, 21st December 2010

It is a great privilege to speak in this pre-Christmas debate. I have already exchanged seasonal greetings with your good self, Mr Speaker, and other colleagues.

I rise to speak about the integrated drug treatment system, which is the drug treatment system for people in prison. The issue came to my attention when I visited my local prison, Hollesley Bay. I do not want to get into the rights and wrongs of drugs today; that issue has been debated in Westminster Hall. I am more concerned about value for money and the diversion of funds from primary care trusts to the continuation of prisoners taking heroin substitutes, at the taxpayers' expense.

In a recent Question Time, the Lord Chancellor and Secretary of State for Justice spoke of how important it is to get prisoners off drugs and to remove drugs from our prison estate. I fully endorse that view. Everybody was depressed in the mid-'90s when a judge ruled that it was against somebody's human rights not to be allowed drugs when in prison. A number of hon. Members, including you, Mr Speaker, have raised questions on this topic. This is yet another example, dare I say it, of a conflict between the judiciary and the common sense of the general public.

The cost of the IDTS to the taxpayer for the last three years has been £23.8 million, £39.7 million and £44.4 million. I am sure that my local residents would love an increase in health spending of such an amount. Such funding for the three prisons in the Suffolk district area and the one in the Great Yarmouth borough and Waveney district area has risen from £400,000 to £555,000. In Hollesley Bay prison in my constituency, £190,000 is allocated to just one prisoner. It is astonishing that under this system, one prisoner can continue to have a heroin substitute every day, at the expense to other people of just less than £200,000. The figures show no sign of decreasing.

Photo of Guy Opperman Guy Opperman Conservative, Hexham

Does my hon. Friend agree that it cannot be right that we have inherited a system under which approximately 300 of the 1,000 prisoners in my major local prison of Durham are on methadone? The reality is that either we give them drugs on a prescribed basis, or they will obtain drugs illegally. What does she think we should do about that?

Photo of Therese Coffey Therese Coffey Conservative, Suffolk Coastal

That is an extraordinary situation, and I am sure that the people of Hexham and Northumberland would be astonished to hear that the taxpayer is continuing to fund it.

I understand that Subutex, one methadone substitute, is highly valued and is traded in our prisons. Although I do not condone the policy of continuing to give methadone to prisoners, perhaps we should switch to liquid-only substitutes and remove the element of drug trading.

I cannot pretend that Suffolk is the most expensive part of the country for treatment costs. In Suffolk, the average cost per treatment is about £800. I am sure that the people of Cambridgeshire will be delighted to know that Whitemoor prison has been given a budget of about £312,000 from the PCT to pay for nine expected treatments, at a cost of £34,708 per treatment. That is scandalous in this day and age, and something has to be done. I hate it when politicians say that, but I genuinely believe that this issue is within our control and that we can do something about it.

When people come into prison, we should be trying not to continue their habits, but to get them off their habits. I understand that the primary reason we have switched increasingly to methadone prescription in drug treatment is that if people leave prison having been off drugs, they are more likely to have a bad reaction when they get their first fix. Perhaps I am a bit traditional, but my response to that is, "Tough!" I would rather that our precious NHS money was used on health care. I know that we are increasing the funds, but health care costs are also increasing. I dare say that the constituents of Suffolk Coastal would rather the money was spent on improving health care at Ipswich hospital. Despite the review by Professor Boyle, constituents in places on the coast such as Aldeburgh and Orford are still being put at risk, because if they have a heart attack the expected treatment time from when an ambulance is called to when it arrives is beyond the national guidelines. That is because there is not enough money to serve everybody.

I am not saying that we should not treat people to try to help them with their drug problem when they go into prison. In fact, I think it was the father of a famous pop star, whom I will not publicise, who said that one reason people commit offences is so that they can go into prison and get off drugs. I endorse that, and we should provide such help. Drugs are a scourge on the country because of the misery and crime that they generate.

I will conclude, because plenty of other Members want to speak about health. I could have addressed my points to the Ministry of Justice, but I believe that the Department of Health can move us forward and ask whether the situation that I have described is the best way to use our precious resources in the NHS.

Photo of Chi Onwurah Chi Onwurah Shadow Minister (Business, Innovation and Skills) 2:00 pm, 21st December 2010

A merry Christmas to you, Mr Speaker, and to the House.

I was born in Wallsend in the 1960s, and my mother was born in Newcastle in the '20s. What we had in common, which we share with any child of the north, was the impact of geography on our life chances. A child born in Newcastle today is expected to die five years before one born in South Cambridgeshire, the constituency of the Secretary of State for Health.

Of my mother's six brothers and sisters, only one survived into adulthood. We have certainly made great strides since those dark days, but health is still a critical political, social and personal issue. Newcastle has world-beating hospitals-the Royal Victoria infirmary, the Freeman and the General hospital. We also have the Campus for Ageing and Vitality, the Centre for Life, the Great North children's hospital and the Northern Institute for Cancer Research, but what we do not have is health equality.

The people of Newcastle are more likely to die early from cancer, heart disease or stroke. We tend to die younger, are more obese as children, and are more likely to die from the cold as pensioners. We suffer more from the diseases of our industrial legacy, such as asbestosis, and we are more likely to be born into poverty, experience mental illness and commit suicide. One in 25 adults in Newcastle claims incapacity benefit for mental illness, four times the rate in the constituency of the Secretary of State for Education.

I will be frank and say that I do not believe the last Government did enough to tackle the issue of mental health. It is the responsibility not only of health care providers but of social services, educators, the police and prison officers. The lack of co-ordination and support was tragically highlighted by the case of Raoul Moat earlier this year.

As a Newcastle MP, I consider my primary duty to be to work for the health and well-being of my constituents, so the existing inequalities concern me and I am worried that they will widen under the current Government. I hope that the Minister can offer me some reassurance. The previous Government doubled health funding in real terms, reduced waiting times and improved health outcomes. Deaths from heart disease and stroke went down by 40%. They also worked hard to tackle poverty and its associated evils, such as poor housing, low aspiration and unemployment, which all have an impact on health.

Improvements in those areas benefited the mental and physical health and well-being of all our constituents, but in Newcastle, inequalities have been maintained or even increased. In 1998, early death rates from heart disease and stroke were 19% higher in Newcastle than the national average. In 2007, they were 26% above a much reduced national average.

The last Government prioritised tackling health inequalities in 2006-too late, certainly, but as a result the North East strategic health authority, primary care trusts and hospitals are all working to address the problem. However, that is all set to change. The Government's reforms to the NHS are estimated to cost £3 billion, without counting the cost of disruption and the loss of skills. Our strategic health authority and primary care trust are being abolished and funding will be in the hands of GP consortiums, of which Newcastle will host one of the first. The Government do not like targets, but will the Minister confirm that she expects the key measures of health inequality to reduce as a consequence of those changes? Will she also confirm that Newcastle will not have to pay anything for those reforms from its health allocation?

The Secretary of State recently wrote to me to say that the 2011-12 allocation for Newcastle represented a growth of 2.8%, including a change to the funding formula. Despite written questions, however, I have been unable to clarify how the changes will address health inequalities. The Government's changes to formulas have tended to work against us in the north-east, so will the Minister confirm that more will be invested in health services for every man, woman and child in Newcastle in every year of the comprehensive spending review period?

Photo of Guy Opperman Guy Opperman Conservative, Hexham

Does the hon. Lady agree that the health service in Newcastle now covers not just her constituents in Newcastle but mine in Hexham, both because they are run by the same trusts and because the services are now so interdependent?

Photo of Chi Onwurah Chi Onwurah Shadow Minister (Business, Innovation and Skills)

The hon. Gentleman is absolutely right. Health services in Newcastle are accessed by a wide range of people from across the north-east.

Finally, the Minister will know that health depends on many factors. The Government's wide-ranging cuts will have a negative impact on people's health, especially the health of the most deprived. Cuts to fuel poverty reduction programmes such as Warm Front will leave pensioners in Newcastle cold, and therefore more vulnerable to illness. Cuts to area-based grants such as Supporting People mean that there will be less investment in support services for those with mental health problems, and cuts to the working neighbourhood fund mean that my constituents will have less help to get back into work, with all the health advantages that work brings.

I shall give the Minister a specific example. In Newcastle, about £10 million a year goes to charities to help deliver services for the vulnerable. The Government's cuts mean that that figure will go down by 75%, which will have many consequences. One charity to which I have spoken estimates that it will have to close hostels, leading to the number of rough sleepers in the city rising by up to 500%. Rough sleeping obviously has terrible consequences for the health of the individual concerned, but Newcastle as a whole will also pay the cost. The police, health services, social services and the third sector will all have to focus more resources on those sleeping in the streets, reducing the help available to others-help that supports the health of the city.

There are many similar examples. Will the Minister assure me that she has assessed the impact of the cuts on Newcastle in the broadest sense, and that she is confident that the health inequalities between Newcastle and the rest of the country will be reduced over the term of this Government?

Photo of Robert Buckland Robert Buckland Conservative, South Swindon 2:07 pm, 21st December 2010

May I convey my compliments of the season to all Members, and indeed to the staff of the House, who work so hard for all of us?

The reason for my contribution today is my long-standing commitment to the cause of raising the profile and interests of all children and adults who suffer from the lifelong conditions of autism, autism spectrum disorders and Asperger's syndrome. I speak as a parent of a child on the spectrum, and as treasurer of the all-party group on autism.

I wish to urge the Government to refer autism to the National Institute for Health and Clinical Excellence as a key topic for a NICE quality standard, which would cover diagnosis, post-diagnostic support and support for those with co-occurring mental health problems. It is vital that at the stage when commissioning is handed over to GP consortiums, a national quality standard applies to help local commissioners act appropriately.

The National Autistic Society's recent "You need to know" campaign revealed some startling statistics about children with autism and about child and adolescent mental health services, which are known as CAMHS. Some 71% of children with autism have a co-occurring mental health problem, and last year one in 10 children who used CAMHS had autism-that is more than 10,000 children. However, only one in three parents of children with autism who were surveyed thought that CAMHS had helped them. The problem is that professionals, no matter how dedicated they may be, often do not have enough information and understanding when it comes to meeting the needs of children and young people with autism. It places those people at a disadvantage for treatment in the health service.

There was some excellent news last week in the publication of statutory guidance for adults with autism as a result of the Autism Act 2009, and I welcome the carefully set out guidelines, which have been the subject of proper consultation. They have been strengthened and improved through lobbying by hon. Members and other organisations with a key interest. For example, particular emphasis is placed on the need for local child and adolescent mental health services to develop agreements with adult mental health services about the transition of children with autism who use those services into adult mental health care. We hear a lot about the problems of transition, and I am glad that concrete action is being taken. That will be welcome news for many children and young adults in Swindon and elsewhere.

A further enhancement of those guidelines in the form of a quality standard, together with commissioning guidelines, will increase and improve that provision even more. It has worked elsewhere. For example, for services for children with a learning disability, the introduction of a national indicator, a vital signs indicator and an annual health check all required self-reporting on training needs by the staff in child and adolescent mental health services. By last year, that resulted in almost all CAMHS services-98%; a remarkably good statistic-reporting that they provided specialist learning disability support. However, in sad contrast, only 10% of child and adolescent mental health services reported that they provided targeted autism support.

I accept that NICE is autonomous, but the National Quality Board's prioritisation committee selects the topics for discussion and adoption as NICE quality standards, with referral by Ministers. The Government therefore have a role in being able to refer a topic for the adoption of a quality standard, which is more than a guideline because it builds on the guidelines to provide a framework for professionals. It will also help patients find their way around the system. Further, it will help NHS bodies to assess the quality of the service that they provide. That information, with evidence of best practice, will help commissioners to plan better services for the future.

I am extremely keen for those measures to be adopted at the earliest opportunity. I will revert to them as often as I have to in the new year if the message has not yet got through. I urge the Government to refer the proposals to NICE to help chart a brighter future for the treatment of children and young adults with autism in the health service.

Photo of Anne Milton Anne Milton The Parliamentary Under-Secretary of State for Health 2:12 pm, 21st December 2010

I welcome all the contributions. We have had an excellent run-around of some hon. Members' interests and specific issues relating to their constituencies.

I start with Barbara Keeley. As she rightly pointed out, the Government have recently announced that they will provide additional funding of £400 million to the NHS in the next four years to enable more carers to take breaks from their caring responsibilities. I commend her for her continued interest in the subject. I trained as a nurse and worked in the NHS for 25 years, and the question is now, as it always has been: who cares for the carers? The hon. Lady is right to highlight the problems that carers suffer-the impact on their physical and mental health and well-being, as well as the immense emotional burden that many bear.

The spending review has made available additional funding in primary care trust baselines to support the provision of breaks for carers. The new moneys will go into PCT budgets from April 2011 and into GP consortium budgets from 2013. The 2011 NHS operating framework, which was published on 15 December, makes it clear that PCTs should pool budgets with local authorities to provide carers with breaks as far as possible via direct payments or personal health budgets, which will doubtless ensure some progress.

The new funding is part of a package of measures that we announced in the recently published update to the carers strategy. The next steps set out the priorities for action in the next four years, focusing on what will make the biggest impact on carers' lives. It is important to recognise that the subject is of interest to hon. Members of all parties. I do not think there is division along party lines. The hon. Lady's insight into and knowledge of what is happening on the ground will be important to ensure that future policy and direction is well informed.

Photo of Barbara Keeley Barbara Keeley Shadow Minister (Communities and Local Government)

Can the Under-Secretary say more about what will happen if PCTs do not spend the money on carers' breaks? The Minister of State, Department of Health, Paul Burstow, who is responsible for social care, campaigned in the House when the Labour Government had a similar problem. As I said earlier, the problem is that, according to a survey, only a quarter of the money had been spent on carers' breaks. It is fine to allocate it, but the trouble is getting the PCTs to spend it.

Submitted by

Photo of Anne Milton Anne Milton The Parliamentary Under-Secretary of State for Health

I thank the hon. Lady for that intervention. She is right to suggest that there can be an intention at Westminster, but the point is ensuring that it is effected on the ground. I will say a little more about that shortly.

We do not believe that a legislative approach is always the way to proceed when requiring health bodies and GPs to identify patients who are carers or have a carer and refer them to sources of help and support. Indeed, often it is not. We feel more comfortable with that as a weapon, but it does not necessarily produce the result that the hon. Lady wants.

It will be for PCTs and subsequently the GP consortiums to decide their priorities in the light of their local circumstances. However, we believe that GPs and their staff will play a vital role in identifying carers; many carers have not yet been identified. That is why we are investing £6 million from April 2011 in GP training, which will mean that more GPs and their practice teams gain a better understanding of carers and the support that they may need. That is important.

I believe that GPs are much better placed truly to understand the value and needs of carers. I do not need to tell the hon. Lady that the considerable social, human and, indeed, financial value that carers offer cannot be overestimated-she is aware of that. However, centrally driven methods are not always the best way forward. I welcome her continued feedback to ensure that we get the money spent where it is needed most.

Let me deal now with the speech made by my hon. Friend Jason McCartney. I take the opportunity to pay tribute not only to midwives but to all the staff who will be working to deliver babies safely into the world, while we are enjoying our turkey or whatever we choose to eat on Christmas day.

The Government are committed to devolving power to local communities-to people, patients, GPs and councils-which are best placed to determine the nature of their local NHS services. I pay tribute to my hon. Friend for raising the matter previously and for continuing to raise his constituents' concerns.

The Government have said that, in future, clinicians and patients must lead all service changes, which should not be driven from the top down. To that end, the Secretary of State has outlined new, strengthened criteria that he expects decisions on NHS changes to meet. They must focus on improving patient outcomes, consider patient choice, have support from GP commissioners and be based on sound clinical evidence. I think that that was what my hon. Friend was getting at.

The Department has asked local health services to consider how continuing schemes meet the new criteria. Some will be subject to further review. That does not necessarily extend to reopening previously concluded processes, as in Huddersfield-I would not like to lead my hon. Friend down an alley-or halting those that have passed the point of no return, with contracts signed and building work started. However, NHS Yorkshire and the Humber has advised that the decision to implement the looking to the future programme and change in maternity services in Huddersfield was clinically driven, with strong emphasis on patient safety and quality of care. It was also made after considerable scrutiny and consideration, including a formal period of public consultation and advice to the then Secretary of State for Health from the independent reconfiguration panel, whose recommendations were endorsed in full.However, I know that my hon. Friend will continue to gather local evidence and experience and feed it back, which I welcome.

Let us look at the problem described by Nick Smith. I disagree with much of what he said. We have a bold public health strategy for the first time, and it has been widely welcomed. He should not believe everything he reads in the newspaper-it could lead him into all sorts of misapprehensions. The Government alone cannot improve public health; we need to use all the tools in the box.

The hon. Gentleman should note that health inequalities grew, rather than decreased, under the previous Government. There are massive opportunities to improve public physical, mental, emotional and spiritual health and well-being in England. As he rightly pointed out, we have some of the highest obesity rates of any country in the world. People living in the poorest areas die on average seven years earlier than people living in richer areas, and they have higher rates of mental illness, disability, harm from alcohol, drugs and smoking, and childhood emotional and behavioural problems. Changing people's lifestyles and removing health inequalities could make double the improvement to life expectancy that we could make through health care, so we must address public health.

The Government published our strategy in our White Paper "Healthy lives, healthy people". We will establish Public Health England, a national public health service, return public health leadership to local government, and strengthen professional leadership nationally by giving a more defined role to the chief medical officer, and locally through strong and inspirational leadership roles for directors of public health.

Historically, all the big public health improvements came via local authorities, and I am convinced that returning public health responsibilities to local authorities will achieve what we need, which is social and economic change as well as health change.

Photo of Nick Smith Nick Smith Labour, Blaenau Gwent

I welcome the proposal to ask local authorities to take responsibility for public health-in the round, that is a good thing-but will they get the resources to do that job?

Photo of Anne Milton Anne Milton The Parliamentary Under-Secretary of State for Health

Thank you, Mr Speaker. I am afraid that I got rather carried away with this new-style debate, but I am mindful of the time.

For the first time, public health spending is ring-fenced. Public health interventions have been cut because of spending by PCTs, so it is really important to ring-fence such funding. The Government will focus on outcomes that are meaningful to people and communities. We published proposals for a public health outcomes framework yesterday for consultation, to which I am sure the hon. Gentleman would like to respond. I hope I have reassured him that the Government are taking the action necessary to improve the public's health. I would be happy to discuss that with him in more detail another time, and perhaps to correct some of the myths that he believes. Nothing is ruled out. We will do everything we need to do to improve the public's health, but we must use all the tools in the box. We cannot improve public health by Government intervention alone.

My hon. Friend Dr Coffey raised the issue of integrated drug treatment systems for prisons that aim to increase the volume and quality of treatment available to prisoners. I welcome her involvement in her local prison. Such systems also aim to improve integration between clinical counselling, assessment, referral and through-care services, and to reinforce continuity of care when prisoners are released into the community.

The Government must reshape drug treatment to focus on recovery and to improve the continuity of treatment in the community following release. Abstinence is where we need to go. As outlined in the Ministry of Justice Green Paper on sentencing reform and rehabilitation, and in accordance with the much more outcome-focused approach announced in the new drug strategy, a payment-by-results approach to commissioning drug treatment for prisoners on release will be trialled in two areas. Recovery wings will be trialled in four prisons, with an emphasis on offenders receiving short custodial sentences, who therefore require a co-ordinated approach from prison and community. The combining of prison drug budgets with the combined drug interventions programme and a community-pooled treatment budget will allow for great flexibility, which is what we need in configuring services. To my mind, we have failed adequately to address drug abuse and prisoner addiction, and in turn failed our communities. We have not spent much-needed resources well.

I probably answered many of the points made by Chi Onwurah in my answer to the hon. Member for Blaenau Gwent on public health more generally. My husband's family are all from Hartlepool. The hon. Lady was right to raise the issue of health inequalities. "Healthy lives, healthy people" underlines the priority that we are giving to tackling inequalities and supporting the principles of the Marmot review. We are focusing on the health and social needs of disadvantaged groups and areas, including on how money is allocated to local communities for public health interventions.

Despite the fact that the previous Government doubled health funding, as the hon. Lady rightly said, health inequalities got worse. I do not think that that was because of a lack of commitment on Labour's part. It is extremely difficult to tackle health inequalities head-on, which is why our White Paper is so widely welcomed. The action outlined in that paper will reduce those truly shocking health inequalities.

It is important to recognise that this is not just about the money that is spent, but about how it is spent. I welcome the hon. Lady's non-partisan comments about the previous Government's record. For the first time, we are consulting on public health and ring-fencing money, and I believe that we can make a real difference.

The last Back-Bench contribution was from my hon. Friend Mr Buckland on autism. I should like to take this opportunity to pay tribute to the parents and carers-young and old-who care for children and adults with autism. For some, that is a considerable burden that we should not underestimate. The National Institute for Health and Clinical Excellence is currently developing three autism clinical guidelines. The recognition, referral and diagnosis of autism guidelines are scheduled to be published in September next year; the diagnosis and management of autism in adults guidelines are scheduled to be published in July 2012-that might feel a long way off, but it is coming-and the management of autism in children and young people was referred to NICE by Ministers in November this year.

I pay tribute to my hon. Friend for his interest in autism, which has been discussed on many occasions in the House since I became a Member. There is no doubt that the expertise and input of people like him-people who have personal experience-is crucial in ensuring that we get the right policies that can have an effect on the ground, including in his constituency. His expertise and that of other hon. Members is critical.

Mr Speaker, I apologise for going beyond my allotted 10 minutes, but I wish you and all the staff of the House a very happy Christmas. I thank them for all their support this year and wish them well for the next.